Reduction versus abrupt cessation in smokers who want to quit
Editorial Group: Cochrane Tobacco Addiction Group
Published Online: 14 NOV 2012
Assessed as up-to-date: 19 AUG 2012
Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Lindson-Hawley N, Aveyard P, Hughes JR. Reduction versus abrupt cessation in smokers who want to quit. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD008033. DOI: 10.1002/14651858.CD008033.pub3.
- Publication Status: New search for studies and content updated (no change to conclusions)
- Published Online: 14 NOV 2012
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.
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.
We searched the Cochrane Tobacco Addiction Review Group specialised register using topic specific terms. The register contains reports of trials of tobacco addiction interventions identified from searches of MEDLINE, EMBASE and PsycInfo. We also searched reference lists of relevant papers and contacted authors of ongoing trials. Date of most recent search: July 2012.
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 sub-group 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.
Ten studies were relevant for inclusion, with a total of 3760 participants included in the meta-analysis. Three of these studies used pharmacotherapy as part of the interventions. Five studies included behavioural support in the intervention, four included self-help therapy, and the remaining study had arms which included behavioural support and arms which included self-help therapy. Neither reduction or abrupt quitting had superior abstinence rates when all the studies were combined in the main analysis (RR= 0.94, 95% CI= 0.79 to 1.13), whether pharmacotherapy was used (RR= 0.87, 95% CI= 0.65 to 1.22), or not (RR= 0.97, 95% CI= 0.78 to 1.21), whether studies included behavioural support (RR= 0.87, 95% CI= 0.64 to 1.17) or self-help therapy (RR= 0.98, 95% CI= 0.78 to1.23). We were unable to draw conclusions about the difference in adverse events between interventions, however recent studies suggest that pre-quit NRT does not increase adverse events.
Reducing cigarettes smoked before quit day and quitting abruptly, with no prior reduction, produced comparable quit rates, therefore patients can be given the choice to quit in either of these ways. Reduction interventions can be carried out using self-help materials or aided by behavioural support, and can be carried out with the aid of pre-quit NRT. Further research needs to investigate which method of reduction before quitting is the most effective, and which categories of smokers benefit the most from each method, to inform future policy and intervention development.
Plain language summary
Comparing reducing smoking to quit with abrupt quitting.
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.