Does how you quit affect success? A comparison between abrupt and gradual methods using data from the International Tobacco Control Policy Evaluation Study

Abstract

Two recommended quit methods in standard cessation programs involve either gradual reduction of smoking prior to complete abstinence ("cut down") or abrupt abstinence from cigarettes ("cold turkey"). This study examined the reported use, characteristics of users, and the impact of self-selected strategy choice on quitting success and relapse of adult smokers who reported quitting on their own. Data came from the first three waves of the International Tobacco Control Policy Evaluation 4-Country Survey (ITC-4). The ITC-4 is a random-digit-dialed telephone survey of a cohort of more than 8,000 adult smokers from the United Kingdom, the United States, Canada, and Australia, with a 75% follow-up rate. The results indicated that 68.5% of the smokers who had made a quit attempt between waves reported using the cold-turkey method. Of those who used the cold turkey method, 22% and 27% succeeded at Waves 2 and 3, respectively, compared with the 12% and 16%, respectively, who used the cut-down method. Multivariate analyses revealed that cold-turkey users were more likely to be aged 25-39 years, male, from the United Kingdom, and smoking heavily, and had lower perceived dependence. Controlling for sociodemographic and known predictors of quitting including use of medications, we found that smokers who used the cold-turkey method to quit were almost twice as likely to abstain for a month or more in their attempt. Overall, we cautiously conclude that cold turkey should be the recommended strategy for smokers who want to quit on their own.

To what extent do smokers make spontaneous quit attempts and what are the implications for smoking cessation maintenance? Findings from the International Tobacco Control Four country survey

“…Our finding that abrupt cessation is associated with better outcomes than cutting down replicates similar findings from earlier waves of the ITC study (Cheong, Yong, & Borland, 2007), and this appears to occur largely independent of the delay between the decision to quit and implementation, something that is surprising. We thought it possible that the period of cutting down might have explained some differential success rate by delay in actually quitting.…”

A Pilot Study Testing SMS Text Delivered Scheduled Gradual Reduction to Pregnant Smokers

“…Thus, for pregnant smokers, an SMS intervention might need to be supplemented. Adding scheduled gradual reduction (SGR) might help pregnant women, most of whom have already reduced their smoking (England et al, 2001) but cannot quit (Pickett, Rathouz, Kasza, Wakschlag, & Wright, 2005) because "self-weaning" often undermines cessation (Cheong, Yong, & Borland, 2007).…”

Comparing abrupt and gradual smoking cessation: A randomized trial

“…Some studies found that most smokers used the abrupt method in their most recent quit attempt (Cheong et al, 2007;Hughes, 2007;Hyland et al, 2004;Shahab et al, 2009), but others found that half or more of the smokers who planned to quit were interested in gradual rather than abrupt cessation Peters et al, 2007;Shiffman et al, 2007), and that at any time point, most smokers were attempting smoking reduction (Beard et al, 2011). Smokers' preferences may also fluctuate over time (Peters and Hughes, 2009) or geographically.…”

“…Several observational studies found that smoking abstinence rates were higher in smokers who quit abruptly than in those who quit gradually (Cheong et al, 2007;Fiore et al, 1990;Glasgow et al, 1985;Peters et al, 2007;West et al, 2001). However, in observational studies, associations may be explained by confounding variables such as motivation to quit, self-efficacy, dependence level, or the amount of support received, as those who used the gradual method may have been less likely to receive professional support, since gradual cessation is not recommended by most treatment guidelines (Fiore, 2008;West et al, 2000).…”

“…From the literature, it is however not clear whether using abrupt versus gradual quitting is associated with motivational variables. Some studies found that gradual quitters were less motivated to quit than abrupt quitters or felt more peer pressure to quit (Bolliger, 2000), but other studies found that motivation to quit, self-efficacy and tobacco dependence were not associated with use of abrupt versus gradual methods (Cheong et al, 2007;Hughes, 2007).…”