A UK study validates the superiority of quitting smoking abruptly, which nearly doubles the success rate compared to gradual cessation.
North Americans have been flooded with smoking cessation campaigns for decades as a public health precursor to betterment of health. Typically clinical guidelines have suggested abrupt cessation; a recent UK study published by Annals of Internal Medicine validated the superiority of quitting smoking abruptly compared to gradual cessation, as better abstinence rates were yielded in both long and short time intervals. The study further examined the structures required by gradual cessation that may be unavailable to many, therefore further deterring cessation.
The study utilized a randomized controlled non-inferiority trial inclusive of 697 adult smokers with tobacco addiction. The methodology of the study regarded randomly assigning participants to gradually reduce tobacco intake over two weeks prior to an assigned quit date or to abruptly quit smoking on an assigned quit date.
The gradual cessation group was provided short acting nicotine replacement therapy (NRT) (gums, lozenges, etc) and nicotine patches days before the quit date. This group aimed to reduce smoking prior to the quit date by reducing smoking to  half of the baseline by the end of the first week, and a quarter of the baseline amount by the second week; the two week reduction before quit day is current practice in England. Participants in this group were also mandated to choose one of three structured reduction programs: scheduled, hierarchical or smoke-free periods.
The abrupt cessation group only received nicotine patches the day before the quit day. Both groups were subjected to behavioural support, nicotine patches and short acting NRT after the quit date. This group was instructed to continue smoking at their regular consumption, with no reduction between baseline and the quit date. Behavioural support initiated a program that would aid participants during the hardest parts of the day in which planned strategies were developed to support success rates. Prior to abrupt cessation, participants were instructed to utilize nicotine patches but not NRT. Evidence from prior studies has suggested pre-cessation nicotine therapies can influence quit rates.
Aside from the minor differences outlined above, the treatment program in both groups was the same. Participants visited their research nurse for two weeks prior to their quit date and the day before their quit date, weekly for four weeks after the quit date and eight weeks after the quit date. The primary outcome measurement was prolonged validated abstinence from smoking rates four and eight weeks post quit date. The secondary outcome measurement was prolonged validated abstinence six months post quit date.
The primary outcome four weeks post quit date achieved by the gradual-cessation group was 39.2% compared to the success rate of 49.0% by the abrupt cessation group. By the four week mark, evidence suggested achieving abstinence was significantly less in the gradual cessation group than in the abrupt cessation group. For the secondary outcome measure of six months, risk estimates indicated abrupt cessation superiority over gradual cessation.
Clear evidence was formulated from the study that supports current clinical guidelines of abrupt smoking cessation opposed to gradual cessation. Even with adherence to behavioural support and pre-quit NRT, gradual cessation participants still demonstrated lower abstinence rates. Reasoning for this is attributed to participants possibly making a quit attempt while still smoking or not having appropriate gradual cessation structures in place (quit date, reduction goals) in order to maximize success. The only limitation that affected the study was not being able to study a diversified cohort, as most participants were Caucasian.
The study hopes to influence the current practice of quitting smoking in encouraging abrupt cessation, as according to the evidence, it does yield longer abstinence periods. The study also hopes to inspire fellow researchers to put forth additional gradual cessation studies to evaluate a wider range of quitting options.
Written By: Tina Dias
