A randomized controlled trial of a smoking reduction plus nicotine replacement therapy intervention for smokers not willing to quit smoking

Aims To examine the effectiveness of smoking reduction counselling plus free nicotine replacement therapy (NRT) for smokers not willing to quit. Design, setting and participants A total of 1154 Chinese adult smokers not willing to quit but who were interested in reducing smoking were allocated randomly to three arms. Intervention group A1 (n=479) received face-to-face counselling on smoking reduction and adherence to NRT at baseline, 1 week and 4 weeks with 4 weeks of free NRT. Group A2 (n=449) received the same intervention, but without the adherence intervention. Control group B (n=226) received simple cessation advice at baseline. Measurements Self-reported 7-day point prevalence of tobacco abstinence and reduction of cigarette consumption (≥50%) at 6 months and continuous use of NRT for 4 weeks at 3 months. Findings Using intention-to-treat analysis, compared to control group B, the intervention groups (A1+A2) had achieved higher 6-month tobacco abstinence (17.0% versus 10.2%, P=0.01) and reduction rates (50.9% versus 25.7%, P<0.001). There was no significant difference in the 4-week NRT adherence rate at 3 months, but group A1 achieved a higher abstinence rate than group A2 at 6 months (20.9% versus 12.9%; P=0.001). Conclusions In smokers with no immediate plans to quit, smoking reduction programmes with behavioural support and nicotine replacement therapy are more effective than brief advice to quit. Current guidelines recommend advice to quit on medical grounds as the best clinical intervention in this group of smokers, but smoking reduction programmes offer an alternative and effective option.