title: Gradual Versus Abrupt Smoking Cessation: A Randomized, Controlled Noninferiority Trial.
abstract: BACKGROUND
  Most smoking cessation guidelines advise quitting abruptly. However, many quit attempts involve gradual cessation. If gradual cessation is as successful, smokers can be advised to quit either way.
  
  
  OBJECTIVE
  To examine the success of quitting smoking by gradual compared with abrupt quitting.
  
  
  METHODS
  Randomized, controlled noninferiority trial. (International Standardized Randomized Controlled Trial Number Register: ISRCTN22526020).
  
  
  METHODS
  Primary care clinics in England.
  
  
  METHODS
  697 adult smokers with tobacco addiction.
  
  
  METHODS
  Participants quit smoking abruptly or reduced smoking gradually by 75% in the 2 weeks before quitting. Both groups received behavioral support from nurses and used nicotine replacement before and after quit day.
  
  
  METHODS
  The primary outcome measure was prolonged validated abstinence from smoking 4 weeks after quit day. The secondary outcome was prolonged, validated, 6-month abstinence.
  
  
  RESULTS
  At 4 weeks, 39.2% (95% CI, 34.0% to 44.4%) of the participants in the gradual-cessation group were abstinent compared with 49.0% (CI, 43.8% to 54.2%) in the abrupt-cessation group (relative risk, 0.80 [CI, 0.66 to 0.93]). At 6 months, 15.5% (CI, 12.0% to 19.7%) of the participants in the gradual-cessation group were abstinent compared with 22.0% (CI, 18.0% to 26.6%) in the abrupt-cessation group (relative risk, 0.71 [CI, 0.46 to 0.91]). Participants who preferred gradual cessation were significantly less likely to be abstinent at 4 weeks than those who preferred abrupt cessation (38.3% vs 52.2%; P = 0.007).
  
  
  CONCLUSIONS
  Blinding was impossible. Most participants were white.
  
  
  CONCLUSIONS
  Quitting smoking abruptly is more likely to lead to lasting abstinence than cutting down first, even for smokers who initially prefer to quit by gradual reduction.
  
  
  BACKGROUND
  British Heart Foundation.
authors.forename: Nicola
authors.initials: N
authors.lastname: Lindson-Hawley
authors.forename: Miriam
authors.initials: M
authors.lastname: Banting
authors.forename: Robert
authors.initials: R
authors.lastname: West
authors.forename: Susan
authors.initials: S
authors.lastname: Michie
authors.forename: Bethany
authors.initials: B
authors.lastname: Shinkins
authors.forename: Paul
authors.initials: P
authors.lastname: Aveyard
mesh_terms: D000328:Adult; D001521:Behavior Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016540:Smoking Cessation / Q000379:methods*; D013375:Substance Withdrawal Syndrome / Q000209:etiology; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000150:complications / Q000517:prevention & control*