Could smoking reduction improve your health?

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Although around 70% of smokers say they would like to quit smoking, many are not planning to try to quit within the next six months. A sizeable minority are more attracted to the idea of reducing smoking rather than quitting altogether. It is also true that with increases in the cost of cigarettes and restrictions on smoking in public places, many smokers are having to reduce their smoking, whether they like it or not.

However, is there a health benefit from reducing the number of cigarettes smoked? Now this may sound like a silly question. Most of us are aware that there is a clear “dose-response” relationship between the number of cigarettes smoked and the risk of suffering from a disease such as lung cancer. But we must remember that most of the people in these studies were smokers smoking at their natural rate. A person who has always smoked 10 cigarettes per day may not be like someone who smoked 20 per day and then reduced to 10 per day. One of the effects we know about is that people who cut down their daily consumption tend to increase the amount they inhale from each cigarette. In fact it is not difficult to suck two or three times as much smoke out of a cigarette by simply inhaling more deeply and taking more puffs per cigarette. Clearly if someone inhaled twice as much smoke out of each cigarette we would not expect any health benefit from cutting the number of cigarettes per day in half.

Last month, Professors Charlotta Pisinger and Nina Godtfredsen from Denmark published a comprehensive review of the medical literature on the health effects of reduced smoking (in the journal, “Nicotine & Tobacco Research”). They defined smoking reduction as reducing the number of cigarettes per day by at least 50%. Overall, they found that such a reduction may improve some respiratory symptoms, and may reduce lung cancer risks. However, on some of the “harder” outcome measures, such as performance on lung function tests, there was no improvement from reduced smoking. Perhaps most importantly, in the largest study that looked at effects on mortality, people who cut down by 50% and maintained it over 15 years were just as likely to die early as those who didn’t cut down, and of course both groups had much higher death rates than those who quit smoking.

So overall, the data suggests that the health benefits of reduced smoking are much smaller than one might expect or hope for. It is also important to recognize that most smokers find it very difficult to reduce by much more than 50% and then maintain the lower level for a long period. When stressful life events occur, there’s a strong tendency to return to the old level of smoking. It suggests to me that it makes much more sense to make a firm plan to quit smoking altogether. If something is causing you to hesitate about quitting completely on one day, then by all means make a plan to reduce prior to quitting. But its important that your reduction has a plan (i.e. a date) by which you will reach zero cigarettes per day and keep it at that. The evidence is absolutely clear that quitting smoking results in substantial health benefits, as summarized in previous posts.
http://www.healthline.com/blogs/smoking_cessation/2007/02/how-bad-is-smoking-for-health.html
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About the Author


MA, MAppSci, PhD

Dr. Jonathan Foulds is an expert in the field of tobacco addiction.

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