Exploratory analyses of the popularity and efficacy of four behavioral methods of gradual smoking cessation.

INTRODUCTION: Around half of smokers attempt to stop by cutting-down first. Evidence suggests this results in similar quit rates to abrupt quitting. Evidence for the effectiveness and popularity of different gradual cessation methods is sparse. METHOD: Secondary, exploratory, analyses of a randomized trial of gradual versus abrupt smoking cessation. Gradual participants (N=342) chose between four methods of cutting-down over two weeks: cutting-out the easiest cigarettes first (HR-E); cutting-out the most difficult cigarettes first (HR-D); smoking on an increasing time schedule (SR); and not smoking during particular periods (SFP). Nicotine replacement therapy and behavioral support were provided before and after quit day. We used logistic and linear regression modelling to test whether method chosen was associated with smoking reduction, quit attempts, and abstinence, whilst adjusting for potential confounders. RESULTS: Participants were on average 49 years old, smoked 20 cigarettes per day, and had an FTCD of 6. 14.9% (51/342) chose HR-E, 2.1% (7/342) HR-D, 46.2% (158/342) SFP, and 36.8% (126/342) SR. We found no evidence of adjusted or unadjusted associations between method and successful 75% reduction in cigarette consumption, reduction in percentage cigarettes per day or exhaled carbon monoxide, quit attempts, or abstinence at four-week or six-month follow-up. CONCLUSIONS: Future research and practice could focus more heavily on the SR and SFP methods as these appeared notably more popular than HR. There was substantial imprecision in the efficacy data, which should be treated with caution; however none of the gradual cessation methods showed clear evidence of being more efficacious than others.