Cold Turkey

iStock_000062038310_MediumIf you're attempting to quit smoking, turns out the best way is simply to do so "cold turkey" rather than attempt a gradual cessation approach. That's according to a study Rick and I discuss on PodMed this week, as published in Annals of Internal Medicine. Both short- and long-term success rates were better in those who chose a date to quit and then did so compared to those who tried to cut down over time, with both groups receiving pychosocial support and nicotine replacement.

Almost 700 adult smokers were enrolled in this trial from primary care clinics in England. Subjects either quit abruptly or gradually reduced their smoking behavior over two weeks before a stop date. Here's the data:

The primary outcome measure was prolonged validated abstinence from smoking 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).

Rick and I agree that this study adds to our burgeoning knowledge on how best to support people who desire to quit smoking. Of course I opine that this is all very well until we outlaw the things but that's another story. Other topics this week include a failure of genetic assessment to change behavior in the BMJ, vaccination and subsequent disease in JAMA, and safer prescribing in NEJM.  Until next week, y'all live well.

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