title: Quitting by gradual smoking reduction using nicotine gum: a randomized controlled trial.
abstract: BACKGROUND
  Many smokers express a desire to quit smoking by gradually reducing the number of cigarettes they smoke until they stop completely. This study tested the efficacy of nicotine gum in facilitating cessation through gradual reduction.
  
  
  METHODS
  This was a multi-center, placebo-controlled, double-blind RCT of 2- and 4-mg nicotine gum versus placebo.
  
  
  METHODS
  3297 smokers who were interested in quitting gradually.
  
  
  METHODS
  Subjects were instructed to gradually reduce their smoking while increasing their gum use over the course of up to 8 weeks. Once they had achieved initial abstinence (no smoking for 24 hours), gum was to be used in accordance with the current FDA-approved directions for cessation. The study was conducted under over-the-counter conditions, with no counseling provided. Continuous abstinence was assessed after 28 days and 6 months. Secondary measures of smoking reduction were also assessed. Analyses were conducted in 1999-2000 and 2007-2008.
  
  
  METHODS
  Smokers on active gum were significantly more likely to achieve initial cessation (2 mg: OR=1.42; 4 mg: OR=1.90); 28-day continuous abstinence (2 mg: OR=2.01; 4 mg: OR=4.66); and continuous abstinence at 6 months (2 mg: OR=1.80; 4 mg: OR=5.96). During the reduction phase, active gum aided smoking reduction, and participants who reduced their smoking were more likely to achieve abstinence.
  
  
  CONCLUSIONS
  These findings demonstrate that smokers who wish to quit smoking by gradual reduction can increase their success by using nicotine gum to facilitate reduction and cessation.
authors.affiliation: Pinney Associates, Inc., and the University of Pittsburgh, Pittsburgh, Pennsylvania, USA. shiffman@pinneyassociates.com
authors.forename: Saul
authors.initials: S
authors.lastname: Shiffman
authors.forename: Stuart G
authors.initials: SG
authors.lastname: Ferguson
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Strahs
mesh_terms: D000328:Adult; D002638:Chewing Gum; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018722:Nicotinic Agonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016540:Smoking Cessation / Q000379:methods*; D012959:Socioeconomic Factors; D014029:Tobacco Use Disorder / Q000188:drug therapy*
chemical_list: D002638:Chewing Gum; D018722:Nicotinic Agonists; D009538:Nicotine