![]() In particular, well‐conducted, adequately‐powered studies should focus on investigating the most effective features of reduction‐to‐quit interventions to maximise cessation rates.Ĭan people stop smoking by cutting down the amount they smoke first? 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. ![]() We downgraded the evidence across comparisons due to risk of bias, inconsistency and imprecision. 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. 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 comparing the efficacy of reduction‐to‐quit interventions with no treatment was inconclusive and of low certainty. ![]() 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. There was no clear evidence that the number of people reporting SAEs, or changes in withdrawal symptoms, differed between trial arms. There was some evidence that AEs occurred more frequently in studies that compared reduction using pharmacotherapy versus no pharmacotherapy however, the AEs reported were mild and usual symptoms associated with NRT use. Pre‐quit AEs, SAEs and nicotine withdrawal symptoms were measured variably and infrequently across studies. More evidence is likely to change the interpretation of the latter effects.Īlthough there was some evidence from within‐study comparisons that behavioural support for reduction to quit resulted in higher quit rates than self‐help resources alone, the relative efficacy of various other characteristics of reduction‐to‐quit interventions investigated through within‐ and between‐study comparisons did not provide any evidence that they enhanced the success of reduction‐to‐quit interventions. However, a significant subgroup analysis (P < 0.001, I 2 = 80% for subgroup differences) suggests that this may only be true when fast‐acting NRT or varenicline are used (both moderate‐certainty evidence) and not when nicotine patch, combination NRT or bupropion are used as an aid (all low‐ or very low‐quality evidence). Our analysis comparing reduction using pharmacotherapy with reduction alone found low‐certainty evidence, limited by inconsistency and imprecision, that reduction aided by pharmacotherapy resulted in higher quit rates (RR 1. Subgroup analysis provided some evidence (P = 0.01, I 2 = 77%) that reduction‐to‐quit interventions may result in more favourable quit rates than abrupt quitting if varenicline is used as a reduction aid. We judged this estimate to be of moderate certainty, due to imprecision. However, when comparing reduction‐to‐quit interventions with abrupt quitting (standard care) we found evidence that neither approach resulted in superior quit rates (RR 1. We identified very low‐certainty evidence, limited by risk of bias, inconsistency and imprecision, comparing the effect of reduction‐to‐quit interventions with no treatment on cessation rates (RR 1.74, 95% CI 0.90 to 3.38 I 2 = 45% 6 studies, 1599 participants). ![]() We judged 18 of the studies to be at high risk of bias, but restricting the analysis only to the five studies at low or to the 28 studies at unclear risk of bias did not significantly alter results. People enrolled in the studies typically smoked an average of 23 cigarettes a day. Most recruited adults from the community using media or local advertising. We identified 51 trials with 22,509 participants.
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