Smoking reduction strategies show success

December 04, 2002

People who use nicotine replacement products like skin patches, gum and inhalers while continuing to smoke can cut their daily cigarette consumption almost in half, according to a new study.

Using data from 11 previous studies of nicotine replacement products, Swedish researcher Karl Olov Fagerström and colleagues calculated an approximate 50 percent drop in daily cigarette consumption among smokers across all the studies.

The individuals also reduced their exposure to harmful carbon monoxide, a toxic smoking byproduct, by 30 percent. Blood nicotine concentrations were the same with gum or inhaler and increased by 54 percent with the patch, when high doses were used. Blood nicotine concentrations increased by 54 percent with the patch but did not cause any significant adverse reactions, say the authors.

Several reduction strategies, ranging from behavioral interventions to the use of nicotine replacement devices, show promising signs of decreasing smoking over time, according to these and other reports in a supplement to the December issue of the journal Nicotine and Tobacco Research.

But they haven't received as much attention as "cold turkey" methods. Previous studies have shown that even some cutback in smoking reduces risk for heart disease, emphysema and cancer.

"Few if any alternatives to complete and abrupt quitting have been developed," says Fagerström, of Fagerström Consulting AB and Smokers Information Center in Helsingborg, Sweden, who notes that that there are few other risky behaviors, including drug dependence, that rely exclusively on abstinence as a treatment.

Despite the attention given to replacement devices, most smokers trying to quit or cut back use behavioral strategies, such as only smoking on certain days or only smoking half a cigarette, according to Dr. Kolawole S. Okuyemi, M.D., MPH, of the University of Kansas Medical Center and colleagues.

Okuyemi and co-authors questioned 484 African-American smokers about eight different smoking reduction behavioral strategies. They found that smokers who used four or more of these strategies smoked an average of 11 cigarettes per day, compared to 14 cigarettes and 18 cigarettes for smokers that used only one to three strategies and no strategies, respectively.

This suggests that "smokers not interested in quitting but willing to reduce their smoking should be encouraged to utilize a variety of smoking reduction strategies," say the researchers.

Fagerström and co-authors also compared the long-term effects on smokers using either the Nicorette oral inhaler or the Eclipse, a cigarette-like device that heats but doesn't burn tobacco. Smokers using both products sharply cut back on daily cigarette consumption, but the Eclipse device increased carbon monoxide exposure by 45 percent, while the inhaler reduced carbon monoxide by 47 percent.

"The most important implication of this finding is that products that could be used for smoking reduction or substitution are not equally beneficial," says the research team.

In other studies:

-- Smokers trying to reduce health risks by switching to lower tar cigarettes may be misled by the "light" and "ultra light" labels on some tobacco products, according to a study by Elizabeth A. Gilpin, M.S., of the University of California, San Diego, and colleagues.

Data from a 1996 survey of 8,582 California smokers showed that 60 percent of those surveyed thought that "light" and "ultra-light" referred to low tar or nicotine content or otherwise implied a health claim.

"However, as early as 1983, evidence indicated that smokers of low tar/nicotine brands actually received about the same amount of tar and nicotine as smokers of regular brands," Gilpin noted.

Smokers of regular brands who considered themselves to be more addicted, who were trying unsuccessfully to quit or cut consumption and who had health concerns were more likely to consider switching to a low tar or nicotine brand, the analysis showed.

Gilpin and colleagues suggest that these individuals view switching as a short-term strategy to lessen their health risks from smoking, even though they still may want to quit in the long term. They are apt to believe they are pursing better health by choosing "light" labeled tobacco products. The researchers say such labels should be regulated in the same way that "light" and "low calorie" food labels have been regulated in the United States.

-- Smokers may find themselves smoking less due to the success of campaigns to educate people about secondhand smoke and smoking restrictions that protect the health of nonsmokers, say Gilpin and John P. Pierce, Ph.D., of the University of California, San Diego, in another study in the special issue.

California adult smokers, surveyed multiple times from 1990-1999, steadily decreased their daily cigarette consumption over that period. According to the results of the 1999 survey, smokers who believed secondhand smoke was harmful to nonsmokers and who worked and lived in smoke-free environments consumed fewer cigarettes a day than individuals for whom second-hand smoke and environmental smoking restrictions were not an issue.

The authors conclude that the decline in cigarette consumption among continuing smokers (from the successful campaign to protect nonsmokers) may result in a reduction in harm to the population from smoking in the future.
The two Fagerström papers were supported by funds from Pharmacia Corporation. The Okuyemi study was supported by grants from the National Cancer Institute, Cancer Research Foundation of America and the Robert Wood Johnson Foundation. The Gilpin and Gilpin and Pierce studies were supported by funds from the National Cancer Institute, the California Department of Health Services and the University of California.


Health Behavior News Service: 202-387-2829 or Interviews: Contact Karl Fagerström at; Kolawole Okuyemi at 913-588-1938; or Elizabeth A. Gilpin at 858-822-2385. Nicotine & Tobacco Research: Contact Gary E. Swan, Ph.D., at 650-859-5322.

Center for Advancing Health

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