Abstract
Background:
Most smoking cessation guidelines advise quitting abruptly. However, many quit attempts involve gradual cessation. If gradual cessation is as successful, smokers can be advised to quit either way.
Objective:
To examine the success of quitting smoking by gradual compared with abrupt quitting.
Design:
Randomized, controlled noninferiority trial. (International Standardized Randomized Controlled Trial Number Register: ISRCTN22526020)
Setting:
Primary care clinics in England.
Participants:
697 adult smokers with tobacco addiction.
Intervention:
Participants quit smoking abruptly or reduced smoking gradually by 75% in the 2 weeks before quitting. Both groups received behavioral support from nurses and used nicotine replacement before and after quit day.
Measurements:
The primary outcome measure was prolonged validated abstinence from smoking 4 weeks after quit day. The secondary outcome was prolonged, validated, 6-month abstinence.
Results:
At 4 weeks, 39.2% (95% CI, 34.0% to 44.4%) of the participants in the gradual-cessation group were abstinent compared with 49.0% (CI, 43.8% to 54.2%) in the abrupt-cessation group (relative risk, 0.80 [CI, 0.66 to 0.93]). At 6 months, 15.5% (CI, 12.0% to 19.7%) of the participants in the gradual-cessation group were abstinent compared with 22.0% (CI, 18.0% to 26.6%) in the abrupt-cessation group (relative risk, 0.71 [CI, 0.46 to 0.91]). Participants who preferred gradual cessation were significantly less likely to be abstinent at 4 weeks than those who preferred abrupt cessation (38.3% vs 52.2%; P = 0.007).
Limitations:
Blinding was impossible. Most participants were white.
Conclusion:
Quitting smoking abruptly is more likely to lead to lasting abstinence than cutting down first, even for smokers who initially prefer to quit by gradual reduction.
Primary Funding Source:
British Heart Foundation.
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Author, Article, and Disclosure Information
Nicola Lindson-Hawley,
From the University of Oxford, Oxford; University of Birmingham, Birmingham; and University College London, London, United Kingdom.
Note: Drs. Lindson-Hawley, Aveyard, Michie, and West are members of the United Kingdom Centre for Tobacco and Alcohol Studies (UKCTAS). UKCTAS receive funds from Cancer Research UK; Economic and Social Research Council; Medical Research Council; and National Institute for Health Research, under the auspices of the UK Clinical Research Collaboration.
Grant Support: From the British Heart Foundation.
Disclosures: Dr. Lindson-Hawley reports a grant from the British Heart Foundation to conduct the reported study and grants from the National Institute for Health Research outside the submitted work. Dr. West reports grants, personal fees, and nonfinancial support from Pfizer and and personal fees from GlaxoSmithKline outside the submitted work. Dr. Aveyard reports grants from United Kingdom Centre for Tobacco and Alcohol Studies and the National Institute for Health Research School for Primary Care Research during the conduct of the study; and personal fees from Pfizer and McNeil outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2805.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Reproducible Research Statement:Study protocol: Published online (open access) at www.trialUpsjournal.com/content/10/1/69. Statistical code and data set: Available to approved persons through written agreements with the author team.
Corresponding Author: Nicola Lindson-Hawley, PhD, Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom; e-mail, nicola.
Current Author Addresses: Drs. Lindson-Hawley, Shinkins, and Aveyard: Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom.
Ms. Banting: Primary Care Clinical Sciences, The Learning Centre, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom.
Dr. West: Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom.
Dr. Michie: Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom.
Author Contributions:Conception and design: P.N. Aveyard, N. Lindson-Hawley, S. Michie, R. West.
Analysis and interpretation of the data: P.N. Aveyard, M. Banting, N. Lindson-Hawley, B. Shinkins, R. West.
Drafting of the article: P.N. Aveyard, N. Lindson-Hawley, B. Shinkins.
Critical revision for important intellectual content: P.N. Aveyard, N. Lindson-Hawley, S. Michie, B. Shinkins, R. West.
Final approval of the article: P.N. Aveyard, M. Banting, N. Lindson-Hawley, S. Michie, B. Shinkins, R. West.
Provision of study materials or patients: P.N. Aveyard, M. Banting, N. Lindson-Hawley.
Statistical expertise: B. Shinkins.
Obtaining of funding: P.N. Aveyard.
Administrative, technical, or logistic support: P.N. Aveyard, M. Banting, N. Lindson-Hawley.
Collection and assembly of data: P.N. Aveyard, M. Banting, N. Lindson-Hawley.
This article was published at www.annals.org on 15 March 2016.
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