***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND New ways of improving the efficacy of nicotine therapy need to be explored . We tested whether starting nicotine polacrilex gum treatment 4 weeks before the quit date improved smoking abstinence rates compared with starting treatment on the quit date . METHODS An open r and omized trial of 314 daily smokers ( mean , 23.7 cigarettes/d ) enrolled through the Internet and by physicians in Switzerl and from November 2005 to January 2007 . In the precessation treatment group , participants received nicotine polacrilex gum ( 4 mg , unflavored ) by mail for 4 weeks before and 8 weeks after their target quit date , and they were instructed to decrease their cigarette consumption by half before quitting . In the usual care group , participants received the same nicotine gum for 8 weeks after their quit date and were instructed to quit abruptly . Instructions were limited to a booklet sent by mail and access to a smoking cessation Web site . Results are expressed as self-reported abstinence rates at the end of treatment and as biochemically verified smoking abstinence ( cotinine plus carbon monoxide ) after 12 months . RESULTS Eight weeks after the target quit date , self-reported 4-week abstinence rates were 41.6 % in the precessation treatment group and 44.4 % in the usual care group ( P = .61 ) . One year after the target quit date , biochemically verified 4-week smoking abstinence rates were 20.8 % in the precessation treatment group and 19.4 % in the usual care group ( P = .76 ) . CONCLUSION Starting nicotine gum treatment 4 weeks before the target quit date was no more effective than starting treatment on the quit date One hundred ten patients addicted to nicotine were subjected to either sudden or gradual withdrawal in the course of a smoking cessation programme . Eighty-two patients emerged from the treatment as non-smokers . In a follow-up after 1 year 70 % of these successful clients replied to an anonymous question naire . Concerning the relapse rate , no significant difference could be found between the two treatment groups , but patients who underwent slow withdrawal smoked significantly less when comparing their current consumption with that before the start of the therapy . Patients who underwent sudden stopping reached their original level of nicotine use again Two recommended quit methods in st and ard cessation programs involve either gradual reduction of smoking prior to complete abstinence ( " cut down " ) or abrupt abstinence from cigarettes ( " cold turkey " ) . This study examined the reported use , characteristics of users , and the impact of self-selected strategy choice on quitting success and relapse of adult smokers who reported quitting on their own . Data came from the first three waves of the International Tobacco Control Policy Evaluation 4-Country Survey ( ITC-4 ) . The ITC-4 is a r and om-digit-dialed telephone survey of a cohort of more than 8,000 adult smokers from the United Kingdom , the United States , Canada , and Australia , with a 75 % follow-up rate . The results indicated that 68.5 % of the smokers who had made a quit attempt between waves reported using the  cold-turkey method . Of those who used the cold turkey method , 22 % and 27 % succeeded at Waves 2 and 3 , respectively , compared with the 12 % and 16 % , respectively , who used the cut-down method . Multivariate analyses revealed that  cold-turkey users were more likely to be aged 25 - 39 years , male , from the United Kingdom , and smoking heavily , and had lower perceived dependence . Controlling for sociodemographic and known predictors of quitting including use of medications , we found that smokers who used the cold-turkey method to quit were almost twice as likely to abstain for a month or more in their attempt . Overall , we cautiously conclude that cold turkey should be the recommended strategy for smokers who want to quit on their own OBJECTIVE To evaluate the smoking cessation efficacy of nicotine patch therapy as an adjunct to low-intensity , primary care intervention . DESIGN R and omized , placebo-controlled , double-blind , multisite trial . SETTING S Twenty-one primary care sites in Nebraska . PATIENTS A total of 369 smokers of 20 or more cigarettes per day . INTERVENTION Two brief primary care visits for smoking intervention with 10 weeks of active or placebo-patch therapy . MAIN OUTCOME MEASURES Confirmed self-reported abstinence 3 , 6 , and 12 months after the quit day . RESULTS Compared with placebo control subjects , participants assigned nicotine patches had higher 3-month ( 23.4 % vs 11.4 % ; P < .01 ) and 6-month ( 18.5 % vs 10.3 % ; P < .05 ) abstinence rates . The 1-year abstinence rates for the active and placebo patch groups were 14.7 % and 8.7 % , respectively ( P = .07 ) . Of smokers aged 45 years and older , 9 ( 18.8 % ) of 48 using active patches compared with 0 of 31 using placebo patches achieved 12-month abstinence ( chi 2 = 6.56 ; P < .05 ) . Among those with high nicotine dependency scores ( Fagerstrom score > or = 7 ) , 1-year abstinence rates were significantly higher in the nicotine patch group ( 19.1 % ) compared with the placebo group ( 5.0 % ) ( chi 2 = 10.7 ; P = .001 ) . However , there was no significant difference in 1-year quit rates for participants with low Fagerstrom scores ( < 7 ) . CONCLUSIONS Nicotine patch therapy enhanced 6 month quit rates as an adjunct to brief primary care intervention . The highest quit rates were achieved by participants who specifically contacted the site to enroll in the study or to obtain a prescription for nicotine patches . Differences in participant selection factors may account , in part , for the lower smoking cessation rates associated with primary care intervention . Duration of counseling , patient age , and Fagerstrom scores may be important factors related to the long-term smoking cessation success of nicotine patch therapy Background The st and ard way to stop smoking is to stop abruptly on a quit day with no prior reduction in consumption of cigarettes . Many smokers feel that reduction is natural and if reduction programmes were offered , many more might take up treatment . Few trials of reduction versus abrupt cessation have been completed . Most are small , do not use pharmacotherapy , and do not meet the st and ards necessary to obtain a marketing authorisation for a pharmacotherapy . Design / Methods We will conduct a non-inferiority r and omised trial of rapid reduction versus st and ard abrupt cessation among smokers who want to stop smoking . In the reduction arm , participants will be advised to reduce smoking consumption by half in the first week and to 25 % of baseline in the second , leading up to a quit day at which participants will stop smoking completely . This will be assisted by nicotine patches and an acute form of nicotine replacement therapy . In the abrupt arm participants will use nicotine patches only , whilst smoking as normal , for two weeks prior to a quit day , at which they will also stop smoking completely . Smokers in either arm will have st and ard withdrawal orientated behavioural support programme with a combination of nicotine patches and acute nicotine replacement therapy post-cessation . Outcomes /Follow-upThe primary outcome of interest will be prolonged abstinence from smoking , with secondary trial outcomes of point prevalence , urges to smoke and withdrawal symptoms . Follow up will take place at 4 weeks , 8 weeks and 6 months post-quit day . Trial Registration Current Controlled Trials IS RCT The nicotinic antagonist mecamylamine was evaluated in a r and omized smoking cessation trial . Four groups of participants ( n = 20 per group ) received nicotine plus mecamylamine , nicotine alone , mecamylamine alone , or no drug for 4 weeks before cessation . After the quit-smoking date , all subjects received nicotine plus mecamylamine treatment for 6 weeks . Nicotine skin patches ( 21 mg/24 hr ) and mecamylamine capsules ( 2.5 - 5.0 mg twice per day ) were used . Precessation mecamylamine significantly prolonged the duration of continuous smoking abstinence ; abstinence rates at the end of treatment were 47.5 % with mecamylamine and 27.5 % without mecamylamine . Nicotine + mecamylamine reduced ad lib smoking , smoking satisfaction , and craving more than either drug alone . Moreover , the orthostatic decrease in blood pressure caused by mecamylamine was offset by nicotine . Mecamylamine before smoking cessation may be an effective adjunct to nicotine patch therapy The present study investigated whether treatment with the combination of denicotinized cigarettes and 21-mg nicotine patch for 2 weeks before a design ated quit date could lessen cravings for smoking , thereby helping smokers abstain from smoking . The study was a r and omized controlled clinical trial conducted at Roswell Park Cancer Institute , Buffalo , New York , in 2004 and 2005 . Patients included 98 adult heavy smokers ( using 20 or more cigarettes/day ) . Half of the subjects received 2 weeks of combination of denicotinized cigarettes ( Quest 3 ) and 21-mg nicotine patch for 2 weeks before the quit date . The remaining smokers were switched to light cigarettes ( Quest 1 ) during the 2 weeks before the quit date . After the quit date , all subjects received counseling for smoking cessation and were provided nicotine patches for up to 8 weeks after the quit date . Self-reported cravings for smoking , withdrawal symptoms , and smoking abstinence were measured at predetermined intervals using phone-based surveys and in clinical visits . The group that used denicotinized cigarettes and nicotine patch before quitting reported less frequent and less intense cravings for cigarettes in the 2 weeks before and after the design ated quit date . Self-reported withdrawal symptoms and quit rates did not differ significantly between the groups . The use of a denicotinized cigarette combined with the nicotine patch appears to lessen cravings to smoke in the immediate postcessation period . A larger , better-powered study is needed to test if this treatment combination has merit for increasing quit rates The study examined the occurrence of acute  tobacco withdrawal symptoms  among three methods of smoking cessation . Smokers were asked to smoke ad lib for 3 days and then r and omly assigned to one of three groups for the next 5 days : ( 1 ) total cigarette cessation ; ( 2 ) 50 % reduction of number of cigarettes ; or ( 3 ) reduction of nicotine yield of cigarettes . Of the 13 measures of tobacco withdrawal , six of the measures showed significant differences in severity of withdrawal symptoms between the total cessation group and partial reduction groups . There were no significant differences in severity of withdrawal between the two partial reduction groups This study compared the efficacy of 2 traditional methods of smoking cessation , gradual reduction and " cold turkey , " with a new approach involving variation in the intercigarette interval . One hundred twenty-eight participants quit smoking on a target date , after a 3-week period of ( a ) scheduled reduced smoking ( progressive increase in the intercigarette interval ) , ( b ) nonscheduled reduced smoking ( gradual reduction , no specific change in the intercigarette interval ) , ( c ) scheduled nonreduced smoking ( fixed intercigarette interval , no reductions in frequency ) , or ( c ) nonscheduled nonreduced smoking ( no change in intercigarette interval or smoking frequency ) . Participants also received cognitive-behavioral relapse prevention training .  Abstinence at 1 year averaged 44 % , 18 % , 32 % , and 22 % for the 4 groups , respectively . Overall , the scheduled reduced group performed the best and the nonscheduled reduced group performed the worst . Both scheduled groups performed better than nonscheduled ones . Scheduled reduced smoking was associated with reduced tension , fatigue , urges to smoke , withdrawal symptoms , increased coping effort ( ratio of coping behavior to urges ) , and self-efficacy , suggesting an improved adaptation to nonsmoking and reduced vulnerability to relapse Two theoretical approaches to smoking cessation were compared . Participants were r and omly assigned either to ( a ) a traditional treatment program that used contingency contracting and that emphasized the necessity for absolute abstinence ( AA ) or to ( b ) a relapse-prevention ( RP ) treatment that focused on gradual acquisition of nonsmoking skills . It was hypothesized that participants in the RP treatment would be less successful initially but would have better maintenance skills and thus would relapse less during a 1-year follow-up period . Each program was evaluated in two formats : group-based treatment and self-help material s. Results indicated comparable 1-year abstinence rates for all treatments , although more participants dropped out of the self-help formats . Participants in the RP intervention were more likely to lapse sooner after quitting and were more likely to quit again during the 1-year maintenance period . Exploratory analyses of successful participants suggested that women were more successful in the RP program and that men had greater success with the AA approach Tobacco use is a major cause of cardiovascular , respiratory and oncological disease . Quitting smoking significantly benefits health , but for highly dependent smokers , unable to overcome their nicotine dependence , the concept of smoking reduction as a method of harm reduction is gaining ground . The University Hospital of Basle , Switzerl and , has run double-blind , placebo-controlled smoking cessation and smoking reduction studies : the CEASE trial 
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We were unable to draw conclusions about the difference in adverse events between interventions , however recent studies suggest that pre-quit NRT does not increase adverse events .
AUTHORS ' CONCLUSIONS Reducing cigarettes smoked before quit day and quitting abruptly , with no prior reduction , produced comparable quit rates , therefore patients can be given the choice to quit in either of these ways .