UK researchers have reported the results of their study on quitting smoking and they seem to show that people will be more successful if they just stop smoking rather than try to stop gradually. The study was carried out by scientists from the University College London. the University of Oxford and the University of Birmingham. The British Heart Foundation provided funding. The study was published in Annals of Internal Medicine, a peer-reviewed journal.
Almost 700 people were recruited for the the study and randomly assigned to either a group that would be quitting smoking immediately or a group that would be expected to give up after a certain amount of time. After 4 weeks, there was a 10% increase in those who had continued with giving up smoking in the group which had stopped suddenly compared to those who were giving up gradually. The participants of both groups were allowed nicotine replacement therapy (NRT) in the form of patches or gum after the quit day. After six months, the number of people who were still not smoking had reduced to 15.5% in the group that were giving up gradually compared to 22% in the group that had given up straight away. The researchers were pleased with the results, but cautioned that not everyone is able to abruptly stop smoking.
The study was a randomised controlled trial which balances for potential confounders and the participants were adult smokers who were willing to quit. For the purposes of the study, addiction to smoking was defined as either smoking a minimum of 15 cigarettes day, smoking a minimum of 12.5g loose leaf tobacco or being tested as having an end expiratory carbon monoxide concentration of at least 15 parts per million (the amount of carbon monoxide exhaled when breathing). Potential participants could not take part if they could not take NRT, were participating in other medical trials or could not meet the requirements of the trial or if they were already taking part in smoking cessation treatment.
The participants in the trial were asked to set a day when they would quit smoking about two weeks after starting the trial. The gradual group were asked to reduce their smoking by 75% - by 50% in the first week and by another 25% during the second week. The other group were asked to follow their normal smoking habits as usual until the quit day.
Both groups were given access to NRT: the gradual-cessation group were given gum or spray and nicotine patches. The abrupt-cessation group were only given nicotine patches before the day they had to quit. Access was also given to NRT products, both long and short term, and behaviour counselling after the day they had to quit.
Data was collected on the participants at the start of the study which included their preference for abrupt or gradual cessation, their smoking history and the extent of their nicotine dependence. The researchers measured the amount of cigarettes smoked, carbon monoxide inhalation and cotinine in the saliva (helps to measure exposure to tobacco smoke). Their withdrawal symptoms were also measured by asking participants to rate their physical symptoms and mood on a standardised scale. The number of participants quitting smoking was measured after four weeks and six months. If participants were not able to follow up, the analysis assumed that they had resumed smoking.
The study was well-designed for the purpose which was to assess which was the best method for quitting smoking: either by abruptly stopping the habit or by gradual means. More people in the abrupt-cessation group continued to abstain from smoking in both the four week and six month follow-ups. The large sample means that the results can be accepted, and the researchers made every effort to ensure that they were not purely down to chance. There were some limitations in that there were only 6% of non-white groups included in the study.
Quitting smoking is a public health issue and the more information that can be gathered on the process, the better. The NHS offers a number of free services to help people quit, whether they decide to quit gradually or all at once. People who are considering stopping smoking are recommended to see their GP who will be able to discuss the options available to give them the best chance of quitting.
Lindson-Hawley, N., et al., Gradual Versus Abrupt Smoking Cessation: A Randomised Controlled Noninferiority Trial, March 2016, Annals of Internal Medicine (published online)
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