Reduction versus abrupt cessation in smokers who want quit

Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, West Midlands, UK, B15 2TT.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 03/2010; 3(3):CD008033. DOI: 10.1002/14651858.CD008033.pub2
Source: PubMed


The standard way to quit smoking is to smoke as normal until a quit day at which point the smoker stops using all cigarettes. Most smokers who try to quit end up relapsing, therefore there are a number of people who have tried to quit abruptly in the past without success, and are disillusioned with this approach. An alternative way to give up could be to reduce the amount of cigarettes smoked before going on to quit completely. There is evidence to suggest that reducing smoking before quitting would be popular with smokers. This means that offering this approach to quitting could encourage more smokers to give up, however before offering this approach it is important to ensure it is at least as successful as abrupt quitting. This is because given a choice smokers who would otherwise have quit abruptly may choose to reduce first instead. If reduction isn't as effective, smokers who choose that method will be at a disadvantage. The aim of this review was to compare quit rates in reduction to quit and abrupt quitting interventions to see if reducing to quit is at least as successful as abrupt quitting. Ten studies were found which compared reducing smoking before quitting with abrupt quitting. Pooled results found that neither reducing or abrupt quitting produced superior quit rates. This was true whether nicotine replacement therapy was used as part of the intervention or not, and whether participants were offered self-help materials or behavioural support. These results suggest that smokers should be given a choice of quitting methods, either reducing smoking before quitting or abrupt quitting, however, to inform the development of new interventions more research is needed into which method of reducing smoking is the most effective.

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    • "Future work may want to examine not only cessation rates in exercise-aided smoking cessation programs, but also cigarette consumption. If exercise leads to reductions in cigarettes smoked, this in turn may ultimately lead to successful cessa- tion[60]. Exercise may have positive effects on delaying or reducing tobacco-related morbidity and mortality in both abstinent and non-abstinent smokers[26]. "
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    ABSTRACT: Background Exercise has been proposed as a useful smoking cessation aid. Purpose The purpose of the present study is to determine the effect of an exercise-aided smoking cessation intervention program, with built-in maintenance components, on post-intervention 14-, 26- and 56-week cessation rates. Method Female cigarette smokers (n = 413) participating in a supervised exercise and nicotine replacement therapy (NRT) smoking cessation program were randomized to one of four conditions: exercise + smoking cessation maintenance, exercise maintenance + contact control, smoking cessation maintenance + contact control or contact control. The primary outcome was continuous smoking abstinence. Results Abstinence differences were found between the exercise and equal contact non-exercise maintenance groups at weeks 14 (57 vs 43 %), 26 (27 vs 21 %) and 56 (26 vs 23.5 %), respectively. Only the week 14 difference approached significance, p = 0.08. Conclusions An exercise-aided NRT smoking cessation program with built-in maintenance components enhances post-intervention cessation rates at week 14 but not at weeks 26 and 56.
    Full-text · Article · Jan 2016 · Annals of Behavioral Medicine
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    • "A last question addressed in this paper is concerned with the extent to which 'conflict about quitting' might account for the way that smokers approach their quit attempts, particularly whether they try to stop abruptly or by gradually reducing the amount they smoke. Evidence from randomised controlled trials appears to indicate that there is no difference in the likelihood of success as a function of whether one stops gradually or abruptly and this was independent of whether pharmacotherapy, self help therapy or behavioural support were included (Lindson et al., 2010). This suggests that more smokers could be led to try to quit with the help of behavioural support by permitting them to quit gradually if they wanted to. "
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    ABSTRACT: Background: Little is known about the extent to which smokers attending stop-smoking clinics experience conflicting motivations about their quit attempt, whether such conflict can be understood in terms of a single dimension and if this ‘conflict about quitting’ differs from motivation to stop smoking and is associated with a smoker's choice of method to stop smoking (stopping gradually or abruptly). Method: Sociodemographic, smoking and quit attempt characteristics as well as measures relating to conflict about stopping smoking were recorded in a cross-sectional survey of 198 smokers attending five quit smoking clinics in Malaysia. Results: Five measures (having seriously thought about quitting before, being happy about becoming a non-smoker, being strongly motivated to stop, intending to stop smoking completely and believing in stopping for good this time) were loaded onto a single factor that could be labelled ‘conflict about quitting’. The resultant scale had moderate internal reliability (Cronbach's α= .625). Most smokers exhibited conflicting motivations about stopping smoking, with over half (52.0%, 95% CI 45.1–59.1) scoring 2 or higher on the 5-point conflict scale. ‘Conflict about quitting’ was significantly associated with the decision to stop smoking gradually rather than abruptly controlling for other variables (OR 1.36, 95% CI 1.05–1.76) and was more strongly associated with the choice of smoking cessation method than motivation to stop smoking. Conclusions: ‘Conflict about quitting’ can be conceptualised as a single dimension and is prevalent among smokers voluntarily attending stop-smoking clinics. The finding that smokers who display greater conflict about quitting are more likely to choose gradual cessation may explain contradictory findings in the literature regarding the effectiveness of different methods of smoking cessation.
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    • "However, a review by Hughes [8] outlined the evidence collected to-date on these issues and concluded that attention to reduction as a smoking goal has value because there is evidence that reductions in smoking are positively associated with quit attempts in the future. Further, a recent Cochrane Systematic Review [10] concluded that there was support for the use of reduction goals as part of tobacco cessation interventions. "
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    ABSTRACT: Pre-cessation reduction is associated with quitting smoking. However, many smokers reduce the amount consumed but may not quit altogether. Using a representative sample of adult current daily smokers, this project explored future intentions of smokers regarding cigarette consumption. This information is important because it can provide a framework within which to plan tobacco cessation initiatives. A random digit dialing telephone survey was conducted of 889 Canadian current daily smokers, 18 years and older. The response rate was 65% (of households with a smoker in residence, 65% agreed to participate). Analyses focused on the 825 respondents who smoked at least 10 cigarettes per day at some point in their lives. As part of this survey, respondents were asked their future plans about their smoking (maintain, increase, reduce, quit). Of these 825 respondents, the majority of respondents had plans to change their cigarette use, with 55% planning to quit, 18.8% to reduce and 22.5% to maintain the amount they smoked (3.4% did not know and 2 respondents planned to increase). Most smokers who planned to reduce their smoking saw it as a step towards quitting smoking completely. These results present a picture of smokers, the majority of whom appear to be in some form of transition. Many smokers planned to reduce, of which the overwhelming majority saw their reduction as a step towards quitting. Opportunities exist to capitalize on these intentions to change in efforts to promote tobacco cessation.
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