Background

The standard way most people are advised to stop smoking is by quitting abruptly on a designated quit day. However, many people who smoke have tried to quit many times and may like to try an alternative method. Reducing smoking behaviour before quitting could be an alternative approach to cessation. However, before this method can be recommended it is important to ensure that abrupt quitting is not more effective than reducing to quit, and to determine whether there are ways to optimise reduction methods to increase the chances of cessation.

Authors' conclusions

There is moderate‐certainty evidence that neither reduction‐to‐quit nor abrupt quitting interventions result in superior long‐term quit rates when compared with one another. Evidence comparing the efficacy of reduction‐to‐quit interventions with no treatment was inconclusive and of low certainty. There is also low‐certainty evidence to suggest that reduction‐to‐quit interventions may be more effective when pharmacotherapy is used as an aid, particularly fast‐acting NRT or varenicline (moderate‐certainty evidence). Evidence for any adverse effects of reduction‐to‐quit interventions was sparse, but available data suggested no excess of pre‐quit SAEs or withdrawal symptoms. We downgraded the evidence across comparisons due to risk of bias, inconsistency and imprecision. Future research should aim to match any additional components of multicomponent reduction‐to‐quit interventions across study arms, so that the effect of reduction can be isolated. In particular, well‐conducted, adequately‐powered studies should focus on investigating the most effective features of reduction‐to‐quit interventions to maximise cessation rates.