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NICE Underpinning Review
Aims of the review: To review the effectiveness of harm reduction approaches with the intention of quitting (ie ‘cutting down to quit’ or ‘reduction to stop smoking’), with and without assistance.
Research questions:
How effective are pharmacotherapies in helping people cut down smoking before quitting?
How effective are different combinations of nicotine replacement therapy (NRT) products in helping people cut down smoking before quitting?
How effective are ‘nicotine-containing products’ in helping people cut down smoking before quitting?
How effective are behavioural support, counselling, advice or self-help (with or without pharmacotherapy) in helping people cut down smoking before quitting?
Is there an optimal period for helping people cut down smoking with the aim of quitting?
Is it more or less effective to draw up a schedule to help someone cut down smoking with the aim of quitting?
Do some tobacco harm-reduction approaches have a differential impact on different groups (for example, people of different ages, gender, socioeconomic status or ethnicity)?
Are there any unintended consequences from adopting a tobacco harm-reduction approach, for example, does it deter people from trying to stop smoking?
Despite the differing approaches to analysis by statisticians and the differences in included studies, the narrative findings of this review and that by Lindson 2010, which looked specifically at gradual versus abrupt quitting, both indicate there is no evidence of difference between gradual reduction and abrupt cessation methods.
Overall, the data suggest it is reasonable to give those who are looking to give up smoking the choice of whether they cut down gradually or quit abruptly. Also to provide choice over the method of reduction (scheduled, over a short or long time period). However, these conclusions need to be set against the findings from Hughes 2010 ++. This study suggests a reduction approach may allow smokers to delay their quit attempts and increase the likelihood of relapse. There are indications that NRT support may enhance the ability of smokers to quit abruptly over purely behavioural approaches.
Although some study samples were from disadvantaged groups there was very little evidence on differential impact between groups.
Although there is useful contextual information from the studies which is likely to be enhanced in due course by the findings from the long term reduction review (Review 3) and barriers and facilitators review (Review 4), further research is clearly needed: more high quality studies that are adequately powered with consistent outcome measures to help answer the questions of what techniques work best and for whom (both in terms of participant motivation and particular population groups).