Gradual reduction in smoking as successful as abrupt quitting

Although many smokers try to quit by selecting a "quit day" and going cold turkey, a new Cochrane review finds that quitting gradually might work just as well.

The authors evaluated 10 studies with 3,760 participants and studies had a minimum six-month follow-up period.

"All participants were asked to choose or were given a quit day to work toward, whether they quit gradually or abruptly," said lead reviewer Nicola Lindson. "In these structured circumstances reduction was as successful as abrupt quitting."

Lindson is a researcher at the U.K. Centre for Tobacco Control Studies at the University of Birmingham, in England.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

The studies all differed on the instructions given to participants on how they should reduce the amount of cigarettes smoked. For example, one study asked them to reduce their smoking by 50 percent over four weeks and then quit completely. Another study asked participants to reduce their smoking by five to 10 cigarettes per week over five weeks until they were not smoking at all.

Four studies gave participants either self-help information booklets or a handheld computer program to educate them on either of the assigned smoking cessation methods. Five studies gave participants either behavioral support through face-to-face counseling or via telephone calls, which taught strategies to help them avoid smoking when tempted. One study gave participants both self-help booklets and behavioral counseling.

Three studies gave participants nicotine replacement therapy, such as nicotine gum and lozenges, to help with either the smoking reduction or abrupt quitting.

Lindson said smokers might benefit from choosing more than one method to find success, such as combining a reduction or abrupt quit attempt with behavioral support or nicotine replacement therapy.

"At present, reduction is not recommended by national guidelines in the U.K. and U.S., so many sources of support do not offer a gradual quitting option," she said.

"The American Lung Association advocates that those who wish to quit smoking do so with multiple intervention techniques," said Jessica Kelly, manager of Advocacy and Respiratory Health Programs at the American Lung Association of Indiana. "Most smokers need more than one attempt to quit smoking and some may find that different combinations of therapies will work better for their needs and lifestyle."

The review discloses that one of its co-authors received consulting fees from pharmaceutical companies that make smoking cessation products and another received consulting fees from companies that market products and services to aid in smoking cessation.