• Rachna Begh, Nicola Lindson-Hawley, and Paul Aveyard.
• UK Centre for Tobacco and Alcohol Studies, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. rachna.begh@phc.ox.ac.uk.
• Bmc Med. 2015 Oct 12; 13: 257.

BackgroundPromoting and supporting smoking reduction in smokers with no immediate intention of stopping smoking is controversial given existing fears that this will deter cessation and that reduction itself may not improve health outcomes.DiscussionEvidence shows that smokers who reduce the number of daily cigarettes smoked are more likely to attempt and actually achieve smoking cessation. Further, clinical trials have shown that nicotine replacement therapy benefits both reduction and cessation. Worldwide data suggests that 'non-medical' nicotine is more attractive to people who smoke, with electronic cigarettes now being widely used. Nevertheless, only one small trial has examined the use of electronic cigarettes to promote reduction, with direct evidence remaining inconclusive. It has been suggested that long-term reduced smoking may directly benefit health, although the benefits are small compared with cessation.SummaryThe combined data imply that smoking reduction is a promising intervention, particularly when supported by clean nicotine; however, the benefits are only observed when it leads to permanent cessation.

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