Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Centre for Behaviour Change, University College London, London, UK.
Nicotine Tob Res. 2020 Dec 12;22(12):2257-2261. doi: 10.1093/ntr/ntaa123.
Around half of smokers attempt to stop by cutting-down first. Evidence suggests that this results in similar quit rates to abrupt quitting. Evidence for the effectiveness and popularity of different gradual cessation methods is sparse.
Secondary, exploratory, analyses of a randomized trial of gradual versus abrupt smoking cessation. Gradual participants (N = 342) chose between four methods of cutting-down over 2 weeks: cutting-out the easiest cigarettes first (HR-E); cutting-out the most difficult cigarettes first (HR-D); smoking on an increasing time schedule (SR); and not smoking during particular periods (SFP). Nicotine replacement therapy and behavioral support were provided before and after quit day. We used logistic and linear regression modeling to test whether the method chosen was associated with smoking reduction, quit attempts, and abstinence, while adjusting for potential confounders.
Participants were on average 49 years old, smoked 20 cigarettes per day, and had a Fagerstrom Test for Cigarette Dependence score of 6. 14.9% (51/342) chose HR-E, 2.1% (7/342) HR-D, 46.2% (158/342) SFP, and 36.8% (126/342) SR. We found no evidence of adjusted or unadjusted associations between method and successful 75% reduction in cigarette consumption, reduction in percentage cigarettes per day or exhaled carbon monoxide, quit attempts, or abstinence at 4-week or 6-month follow-up.
Future research and practice could focus more heavily on the SR and SFP methods as these appeared notably more popular than HR. There was substantial imprecision in the efficacy data, which should be treated with caution; however, none of the gradual cessation methods showed clear evidence of being more efficacious than others.
There is evidence that people who would like to quit smoking gradually should be supported to do so. However, as this is relatively new thinking and there is large potential for variation in methods, guidance on the best way to offer support is sparse. This article is an exploratory analysis of the popularity and efficacy of various methods in an attempt to move the topic forward and inform the implementation of gradual smoking cessation methods in practice. The identified popularity of some methods over others signposts directions for future research.
大约有一半的吸烟者首先试图减少吸烟量来戒烟。有证据表明，这种方法可以达到与突然戒烟相似的戒烟率。不同逐渐戒烟方法的有效性和普及性的证据很少。
对一项逐渐戒烟与突然戒烟的随机试验的二次、探索性分析。逐渐戒烟组（N=342）在 2 周内选择以下 4 种减少吸烟量的方法：先减少最容易的香烟（HR-E）；先减少最困难的香烟（HR-D）；按递增时间表吸烟（SR）；和在特定时间段不吸烟（SFP）。在戒烟日前后提供尼古丁替代疗法和行为支持。我们使用逻辑和线性回归模型来测试所选方法是否与吸烟量减少、戒烟尝试和戒烟有关，同时调整潜在的混杂因素。
参与者平均年龄为 49 岁，每天吸烟 20 支，尼古丁依赖测试量表（Fagerstrom Test for Cigarette Dependence）得分为 6. 14.9%（51/342）选择 HR-E，2.1%（7/342）选择 HR-D，46.2%（158/342）选择 SFP，36.8%（126/342）选择 SR。我们没有发现方法与成功减少 75%吸烟量、每天吸烟量百分比或呼出的一氧化碳减少、戒烟尝试或 4 周或 6 个月随访时的戒烟之间存在调整或未调整的关联的证据。
未来的研究和实践可以更加关注 SR 和 SFP 方法，因为这些方法似乎比 HR 方法更受欢迎。功效数据的精确度相当低，应该谨慎对待；然而，没有一种逐渐戒烟的方法显示出明显比其他方法更有效。
有证据表明，那些希望逐渐戒烟的人应该得到支持。然而，由于这是一种相对较新的思维方式，而且方法上存在很大的差异，因此关于提供支持的最佳方式的指导很少。本文是对各种方法的普及性和有效性的探索性分析，旨在推动这一话题的发展，并为实践中逐渐戒烟方法的实施提供信息。一些方法比其他方法更受欢迎的事实为未来的研究指明了方向。
