Starting nicotine gum, while reducing the number of cigarettes smoked by half at 4 weeks before a target date for quitting smoking is no more effective than beginning nicotine replacement on the quit date without tapering off beforehand, according to a study published in the Archives of Internal Medicine.

Dr. Jean-Francois Etter, of the University of Geneva, Switzerland and colleagues studied 314 adults who smoked at least 15 cigarettes per day (an average of 23.7 cigarettes per day).

About half of the subjects were assigned to use nicotine polacrilex gum (Nicorette) 4 weeks before and 8 weeks after their target quit date and to reduce the number of cigarettes they smoked by half before the quit date. The other subjects were assigned to use the same nicotine gum for 8 weeks beginning on their quit date and instructed to quit smoking abruptly.

Both groups were told to chew up to 10 pieces of gum per day. No face-to-face counseling was provided.

According to Etter and colleagues, "Smoking cessation rates were high in both groups, and they were similar in both groups on all follow-up surveys."

Eight weeks following the target quit date, self-reported 4-week abstinence rates were 41.6 percent in the smokers who started nicotine gum ahead of their target quit date and 44.4 percent in those who started nicotine gum on their quit date. One year following the target quit date, smoking abstinence rates were 20.8 percent and 19.4 percent, respectively.

Contrary to the expectation that a gradual reduction in smoking would improve quit rates by the end of treatment, the investigators found that those who quit abruptly had higher quit rates than those who cut back gradually.

"This undermines the cut-down-quit strategy and may imply that abrupt quitting is more effective than gradual quitting, as suggested by other investigators," Etter and colleagues conclude.

These results, they note, are similar to those of previous studies indicating that pre-quitting nicotine gum does not significantly improve smoking cessation rates. The results contrast, however, with previous studies where pre-quitting treatment with the nicotine patch for 2 to 4 weeks was more effective than standard nicotine treatment.