Abrupt smoking cessation yields better quit rates than gradual approach, study finds
Although abrupt cessation should be encouraged, gradual cessation programs could still be worthwhile if they increase the number of persons who try to quit or take up support and medication while trying.
Smokers who quit abruptly are more likely to abstain from tobacco than those who use a more gradual cessation method, according to a recent study.
At primary care clinics in England, researchers randomized 355 smokers to abrupt cessation and 342 smokers to gradual cessation before measuring abstinence rates at 4 weeks, 8 weeks, and 6 months. Results were published March 15 by Annals of Internal Medicine.
The abrupt-cessation group quit smoking altogether on a prespecified quit date, whereas the gradual quitters slowly reduced their smoking by 75% in the 2 weeks prior to quitting. Both groups received nicotine replacement patches and short-acting nicotine replacement therapy in addition to behavioral support from nurses, although only gradual quitters received short-acting nicotine replacement therapy prior to their quit date.
The primary outcome was 4-week validated abstinence as determined by the Russell Standard, in which abstinence is validated by an exhaled CO concentration of less than 10 parts per million. (The Russell Standard allows a 2-week grace period from the quit day for slips and uses an intention-to-treat approach assuming that patients lost to follow-up are smokers.) Among the abrupt-cessation and gradual-cessation group, 49.0% (95% CI, 43.8% to 54.2%) and 39.2% (95% CI, 34.0% to 44.4%), respectively, achieved the primary outcome, a relative risk (RR) of 0.80 (95% CI, 0.66 to 0.93). These results did not demonstrate noninferiority (unadjusted RR, 0.80; 90% CI, 0.68 to 0.96).
The secondary outcomes of abstinence at 8 weeks and 6 months also did not show noninferiority. At 8 weeks, 36.6% of those in the abrupt-cessation group maintained abstinence, compared to 29.2% of the gradual-cessation group (RR, 0.80, 95% CI, 0.63 to 0.95). At 6 months, 22.0% in the abrupt-cessation group versus 15.5% in the gradual-cessation group maintained abstinence (RR, 0.71; 95% CI, 0.46 to 0.91).
Researchers also looked into whether outcomes differed according to participants' preferred method of quitting. They found that smokers who preferred to quit gradually were less likely to achieve abstinence, irrespective of the quit method they were assigned.
“These results imply that, in clinical practice, we should encourage persons to stop smoking abruptly and not gradually,” the study authors concluded. “However, gradual cessation programs could still be worthwhile if they increase the number of persons who try to quit or take up support and medication while trying.”
They noted limitations to the study, such as how blinding was impossible and how nonwhite participants comprised only 6% of the trial population. “[T]he results may not apply to groups other than white British persons, although we can think of no mechanism that might explain effect modification by ethnic group,” they wrote.