Quitting cold turkey works better; may help explain why e-cigs depress quitting cigs

Nicola Lindson-Hawley and colleagues just published a well-done study, “Gradual versus abrupt smoking cessation,” that compared gradual vs. abrupt smoking cessation and found that abrupt cessation worked better.  People who tried to quit by tapering down rather than just stopping were 20-30% less likely to succeed in quitting smoking.
 
While the paper did not consider e-cigarette use, it may help explain why e-cigarettes are associated with less quitting, since they are generally used as part of a “taper down” strategy, which is less effective than cold turkey (although the people in the Lindson-Hawley study were getting NRT).
 
Here is the 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.
 
Design: Randomized, controlled noninferiority trial. (International Standardized Randomized Controlled Trial Number Register: ISRCTN 22526020)
 
Setting: Primary care clinics in England.
 
Participants: 697 adult smokers with tobacco addiction.
 
Intervention: 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.
 
Measurements: The primary outcome measure was prolonged validated smoking abstinence 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).
 
Limitations: Blinding was impossible. Most participants were white.
 
Conclusion: 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.
 
Primary Funding Source: British Heart Foundation.
 
The full paper is available here: http://annals.org/article.aspx?articleid=2501853
 
The accompanying editorial is here: http://annals.org/article.aspx?articleid=2503390