Lindson, Nicola (2012)
Ph.D. thesis, University of Birmingham.
The Department of Health aim to reduce smoking prevalence to 10% by 2020; however estimates suggest this shall not be achieved. One way to increase the decline may be to introduce new cessation interventions into NHS Stop Smoking Services. Literature reviews and meta-analyses were used to test the efficacy of smoking reduction and nicotine preloading in comparison to current NHS treatments (abrupt quitting and nicotine replacement therapy post-quit, respectively), in smokers who wanted to quit. Results of the two reviews suggest that both approaches produce similar quit rates to their comparators. We suggest that pre-quit reduction should be offered alongside abrupt quitting, to encourage more smokers to use cessation services. However the use of nicotine preloading would be premature, as evidence of benefit is inconclusive. The protocol for a randomised controlled non-inferiority trial using both approaches is presented. Trial participant interviews suggest that reduction methods are feasible and may have more enduring popularity than abrupt quitting, providing further support for this approach. Accounts also suggest potential mechanisms of preloading, although a literature review provided little evidence of these. Further research should establish the effect of preloading, its mechanisms of action, and the best way to advise smokers to reduce.
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