A meta-analysis of the effectiveness of gradual versus abrupt smoking cessation
Jixiang Tan 1
Lin Zhao 1
Hong Chen 2  
More details
Hide details
Department of Emergency & Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Hong Chen   

Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Youyi Road, Yuanjiagang Yuzhong District 400016 Chongqing, China
Publish date: 2019-02-13
Tob. Induc. Dis. 2019;17(February):9
The aim of this review is to test whether a gradual reduction in smoking results in a superior quit rate compared to abrupt cessation.

This review was based on Cochrane methodology for conducting metaanalysis. Only randomized controlled trials were eligible for this review. The participants were adult smokers who were addicted to tobacco, defined as those who smoked at least 15 cigarettes or 12.5 grams of loose-leaf tobacco daily or who had an end-expiratory carbon monoxide concentration of at least 15 ppm. Both groups used an equal amount of nicotine replacement therapy (NRT) before and after quitting smoking. The Review Manager Database (RevMan version 5.3) was used to analyze selected studies.

Three randomized controlled trials involving 1607 patients were included. The prolonged abstinence rate of the gradual cessation group was significantly lower than that of the abrupt group (relative risk, RR=0.77). The result of 7-day smoking cessation rate was also lower in the gradual group (RR=0.76).

Comparing the combination of NRT and abrupt cessation, the smoking cessation rate of the combination of NRT and gradual cessation is significantly lower. No significant adverse events were found in either group.

Authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
1. Ezzati M, Lopez AD. Estimates of global mortality attributable to smoking in 2000. Lancet. 2003;362(9387):847-852. doi:10.1016/s0140-6736(03)14338-3.
2. Cheong Y, Yong HH, Borland R. Does how you quit affect success? A comparison between abrupt and gradual methods using data from the International Tobacco Control Policy Evaluation Study. Nicotine Tob Res. 2007;9(8):801-810. doi:10.1080/14622200701484961.
3. Hughes JR. Smokers who choose to quit gradually versus abruptly. Addiction. 2007;102(8):1326-1327. doi:10.1111/j.1360-0443.2007.01948.x.
4. Tobacco Use and Dependence Guideline Panel. Treating Tobacco Use and Dependence: 2008 Update. Rockville, MD: US Department of Health and Human Services; 2008.
5. New Zealand Ministry of Health. New Zealand Smoking Cessation Guidelines. Wellington, New Zealand: Ministry of Health; 2007. https://www. treatobacco. net/ en/ uploads/ documents/ Treatment% 20 Guidelines/ New%20Zealand%20treatment%20guidelines%20in% 20 English% 202007. Pdf. Accessed November 1, 2018.
6. Society for Research on Nicotine and Tobacco. National treatment guidelines. Madison, Wisconsin: Society for Research on Nicotine and Tobacco; 2012. https://www.test.bwa-communica.... Accessed February 18, 2016.
7. West R. Behaviour change in theory and in real life. London, UK: University College London; 2008. Accessed September 19, 2013.
8. Fiore MC, Novotny TE, Pierce JP, et al. Methods used to quit smoking in the United States. Do cessation programs help? JAMA. 1990;263(20):2760-2765. doi:10.1001/jama.1990.03440200064024.
9. Peters EN, Hughes JR, Callas PW, Solomon LJ. Goals indicate motivation to quit smoking. Addiction. 2007;102(7):1158-1163. doi:10.1111/j.1360-0443.2007.01870.x.
10. Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons, and Staff. A clinical practice guideline for treating tobacco use and dependence: 2008 update. A U.S. Public Health Service report. Am J Prev Med. 2008;35(2):158-176. doi:10.1016/j.amepre.2008.04.009
11. West R, McNeill A, Raw M. Smoking cessation guidelines for health professionals: an update. Health Education Authority. Thorax. 2000;55(12):987-999. doi:10.1136/thorax.55.12.987
12. Higgins JPT, Green S, eds. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. The Cochrane Collaboration; 2011.
13. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1-12. doi:10.1016/0197-2456(95)00134-4.
14. Lindson-Hawley N, Banting M, West R, Michie S, Shinkins B, Aveyard P. Gradual Versus Abrupt Smoking Cessation: A Randomized, Controlled Noninferiority Trial. Ann Intern Med. 2016;164(9):585-592. doi:10.7326/m14-2805.
15. Hughes JR, Solomon LJ, Livingston AE, Callas P, Peters EN. A randomized, controlled trial of NRT-aided gradual vs. abrupt cessation in smokers activelytrying to quit. Drug Alcohol Depend. 2010;111(1-2):105-113. doi:10.1016/j.drugalcdep.2010.04.007.
16. Etter JF, Huguelet P, Perneger TV, Cornuz J. Nicotine gum treatment before smoking cessation: a randomized trial. Arch Intern Med. 2009;169(11):1028-1034. doi:10.1001/archinternmed.2009.12.
17. West R, Shiffman S. Effect of oral nicotine dosing forms on cigarette withdrawal symptoms and craving: a systematic review. Psychopharmacology. 2001;155(2):115-122. doi:10.1007/s002130100712.
18. Zwar N, Borland R, Peters M, et al. Supporting Smoking Cessation: A Guide for Health Professionals. Melbourne: The Royal Australian College of General Practitioners; 2011.
19. McRobbie H, Bullen C, Glover M, et al. New Zealand Smoking Cessation Guidelines. N Z Med J. 2008;121(1276):57-70.
20. Woolacott NF, Jones L, Forbes CA, et al. The clinical effectiveness and costeffectiveness of bupropion and nicotine replacement therapy for smoking cessation: a systematic review and economic evaluation. Health Technol Assess. 2002;6(16):1-245. doi:10.3310/hta6160.
21. Lindson-Hawley N, Aveyard P, Hughes JR. Reduction versus abrupt cessation in smokers who want to quit. Cochrane Database Syst Rev. 2012;11:CD008033. doi:10.1002/14651858.CD008033.pub3.
22. West R, Brown J. Smoking and smoking cessation in England 2011. London, UK: Smoking in England; 2012. https://www.smokinginengland.i.... Accessed September 19, 2013.
23. Larabie LC. To what extent do smokers plan quit attempts? Tob Control. 2005;14(6):425-428. doi:10.1136/tc.2005.013615
24. West R, Sohal T. Catastrophic pathways to smoking cessation: Findings from a national survey. BMJ. 2006;332(7539):458-460. doi:10.1136/
25. Ferguson SG, Shiffman S, Gitchell J, Sembower MA, West R. Unplanned quit attempts - Results from a U.S. sample of smokers and ex-smokers. Nicotine Tob Res. 2009;11(7):827-832. doi:10.1093/ntr/ntp072
26. Wee LH, Shahab L, Bulgiba A, West R. Conflict about quitting predicts the decision to stop smoking gradually or abruptly: evidence from stop smoking clinics in Malaysia. J Smok Cessat. 2011;6(1):37-44. doi:10.1375/jsc.6.1.37