Reduction versus abrupt cessation in smokers who want to quit

Abstract

Background The standard way to stop smoking is to quit abruptly on a designated quit day. A number of smokers have tried unsuccessfully to quit this way. Reducing smoking before quitting could be an alternative approach to cessation. Before this method is adopted it is important to determine whether it is at least as successful as abrupt quitting. Objectives 1. To compare the success of reducing smoking to quit and abrupt quitting interventions. 2. To compare adverse events between arms in studies that used pharmacotherapy to aid reduction. Search strategy We searched the Cochrane Tobacco Addiction Review Group specialised register, MEDLINE, EMBASE and PsycInfo for topic specific terms combined with terms used to identify trials of tobacco addiction interventions. We also searched reference lists of relevant papers and contacted authors of ongoing trials. Date of most recent search: November 2009. Selection criteria We included randomized controlled trials (RCTs) that recruited adults who wanted to quit smoking. Studies included at least one condition which instructed participants to reduce their smoking and then quit and one condition which instructed participants to quit abruptly. Data collection and analysis The outcome measure was abstinence from smoking after at least six months follow-up. We pooled the included trials using a Mantel-Haenszel fixed-effect model. Trials were split for two subgroup analyses: pharmacotherapy vs no pharmacotherapy, self help therapy vs behavioural support. Adverse events were summarised as a narrative. It was not possible to compare them quantitatively as there was variation in the nature and depth of reporting across studies.

A meta-analysis of the effectiveness of gradual versus abrupt smoking cessation

“…This meta-analysis showed that the prolonged and 7-day abstinence rates of the combination of NRT and gradual method to quit were significantly lower than the combination of NRT and abrupt method. This is not consistent with results of previous meta-analyses by Lindson-Hawley et al 21 who found that the overall rate ratio for abstinence for reduction versus abrupt cessation was 0.94 (95% CI: 0.79–1.13; p=0.51). Although they conducted a subgroup analysis of the data, there was still no significant difference in abstinence rate between the two groups.…”

A meta-analysis of the effectiveness of gradual versus abrupt smoking cessation

“…This meta-analysis showed that the prolonged and 7-day abstinence rates of the combination of NRT and gradual method to quit were significantly lower than the combination of NRT and abrupt method. This is not consistent with results of previous meta-analyses by Lindson-Hawley et al 21 who found that the overall rate ratio for abstinence for reduction versus abrupt cessation was 0.94 (95% CI: 0.79–1.13; p=0.51). Although they conducted a subgroup analysis of the data, there was still no significant difference in abstinence rate between the two groups.…”

Nicotine replacement therapy to aid gradual cessation in smokers with no intention to quit: Association between reduction quantity and later abstinence

“…The present study provided preliminary evidence that smokers who increased their percentage reduction progressively were more likely to quit eventually than those who did not reduce or did not increase their reduction. It is consistent with the psychopathological view that progressive increase in the reduction quantity may increase self-efficacy and thereby their motivation to quit eventually ( Lindson-Hawley et al, 2012 ). Only the smokers who could maintain and increase reduction at all follow-ups showed more abstinence significantly because they showed a higher persistency in reducing smoking towards the cessation goal.…”

Commentary on Wu et al . (2017): Do very brief reduction interventions increase quitting among smokers not ready to quit?

“…maintains behavior) could be useful to overcome barriers to staying quit, such as high dependence, among those already motivated. Knowing which of these was the active ingredient in successful reduction studies is important for knowing who would benefit most from reduction interventions.Importantly, this trial is consistent with the finding that reducing CPD increases abstinence among smokers not ready to quit [2] but does not appear to be effective among those who intend to quit now [12]. One explanation for this difference is that reducing CPD could be effective by increasing motivation to quit [11] and thus less impactful for those already motivated to quit.…”

“…Importantly, this trial is consistent with the finding that reducing CPD increases abstinence among smokers not ready to quit [2] but does not appear to be effective among those who intend to quit now [12]. One explanation for this difference is that reducing CPD could be effective by increasing motivation to quit [11] and thus less impactful for those already motivated to quit.…”

A meta-analysis of the effectiveness of gradual versus abrupt smoking cessation

“…This meta-analysis showed that the prolonged and 7-day abstinence rates of the combination of NRT and gradual method to quit were significantly lower than the combination of NRT and abrupt method. This is not consistent with results of previous meta-analyses by Lindson-Hawley et al 21 who found that the overall rate ratio for abstinence for reduction versus abrupt cessation was 0.94 (95% CI: 0.79–1.13; p=0.51). Although they conducted a subgroup analysis of the data, there was still no significant difference in abstinence rate between the two groups.…”

Nicotine replacement therapy to aid gradual cessation in smokers with no intention to quit: Association between reduction quantity and later abstinence

“…The present study provided preliminary evidence that smokers who increased their percentage reduction progressively were more likely to quit eventually than those who did not reduce or did not increase their reduction. It is consistent with the psychopathological view that progressive increase in the reduction quantity may increase self-efficacy and thereby their motivation to quit eventually ( Lindson-Hawley et al, 2012 ). Only the smokers who could maintain and increase reduction at all follow-ups showed more abstinence significantly because they showed a higher persistency in reducing smoking towards the cessation goal.…”

Commentary on Wu et al . (2017): Do very brief reduction interventions increase quitting among smokers not ready to quit?

“…maintains behavior) could be useful to overcome barriers to staying quit, such as high dependence, among those already motivated. Knowing which of these was the active ingredient in successful reduction studies is important for knowing who would benefit most from reduction interventions.Importantly, this trial is consistent with the finding that reducing CPD increases abstinence among smokers not ready to quit [2] but does not appear to be effective among those who intend to quit now [12]. One explanation for this difference is that reducing CPD could be effective by increasing motivation to quit [11] and thus less impactful for those already motivated to quit.…”

“…Importantly, this trial is consistent with the finding that reducing CPD increases abstinence among smokers not ready to quit [2] but does not appear to be effective among those who intend to quit now [12]. One explanation for this difference is that reducing CPD could be effective by increasing motivation to quit [11] and thus less impactful for those already motivated to quit.…”

A meta-analysis of the effectiveness of gradual versus abrupt smoking cessation

“…This meta-analysis showed that the prolonged and 7-day abstinence rates of the combination of NRT and gradual method to quit were significantly lower than the combination of NRT and abrupt method. This is not consistent with results of previous meta-analyses by Lindson-Hawley et al 21 who found that the overall rate ratio for abstinence for reduction versus abrupt cessation was 0.94 (95% CI: 0.79–1.13; p=0.51). Although they conducted a subgroup analysis of the data, there was still no significant difference in abstinence rate between the two groups.…”

Nicotine replacement therapy to aid gradual cessation in smokers with no intention to quit: Association between reduction quantity and later abstinence

“…The present study provided preliminary evidence that smokers who increased their percentage reduction progressively were more likely to quit eventually than those who did not reduce or did not increase their reduction. It is consistent with the psychopathological view that progressive increase in the reduction quantity may increase self-efficacy and thereby their motivation to quit eventually ( Lindson-Hawley et al, 2012 ). Only the smokers who could maintain and increase reduction at all follow-ups showed more abstinence significantly because they showed a higher persistency in reducing smoking towards the cessation goal.…”

Commentary on Wu et al . (2017): Do very brief reduction interventions increase quitting among smokers not ready to quit?

“…maintains behavior) could be useful to overcome barriers to staying quit, such as high dependence, among those already motivated. Knowing which of these was the active ingredient in successful reduction studies is important for knowing who would benefit most from reduction interventions.Importantly, this trial is consistent with the finding that reducing CPD increases abstinence among smokers not ready to quit [2] but does not appear to be effective among those who intend to quit now [12]. One explanation for this difference is that reducing CPD could be effective by increasing motivation to quit [11] and thus less impactful for those already motivated to quit.…”

“…Importantly, this trial is consistent with the finding that reducing CPD increases abstinence among smokers not ready to quit [2] but does not appear to be effective among those who intend to quit now [12]. One explanation for this difference is that reducing CPD could be effective by increasing motivation to quit [11] and thus less impactful for those already motivated to quit.…”