A randomized controlled trial of a smoking reduction plus nicotine replacement therapy intervention for smokers not willing to quit smoking Sophia S. C. Chan 1 , Doris Y. P. Leung 1 , Abu S. M. Abdullah 2 , Vivian T. Wong 3 , Anthony J. Hedley 4 & Tai-Hing Lam 4 School of Nursing,The University of Hong Kong, Pokfulam, Hong Kong, 1 Boston University School of Public Health, Boston, MA, USA, 2 Hong Kong Buddhist Hospital, Kowloon, Hong Kong 3 and School of Public Health,The University of Hong Kong, Pokfulam, Hong Kong 4 ABSTRACT Aims To examine the effectiveness of smoking reduction counselling plus free nicotine replacement therapy (NRT) for smokers not willing to quit. Design, setting and participants A total of 1154 Chinese adult smokers not willing to quit but who were interested in reducing smoking were allocated randomly to three arms. Intervention group A1 (n = 479) received face-to-face counselling on smoking reduction and adherence to NRT at baseline, 1 week and 4 weeks with 4 weeks of free NRT. Group A2 (n = 449) received the same intervention, but without the adherence intervention. Control group B (n = 226) received simple cessation advice at baseline. Measurements Self-reported 7-day point prevalence of tobacco abstinence and reduction of cigarette consumption (50%) at 6 months and continuous use of NRT for 4 weeks at 3 months. Findings Using intention-to-treat analysis, compared to control group B, the interven- tion groups (A1 + A2) had achieved higher 6-month tobacco abstinence (17.0% versus 10.2%, P = 0.01) and reduc- tion rates (50.9% versus 25.7%, P < 0.001). There was no significant difference in the 4-week NRT adherence rate at 3 months, but group A1 achieved a higher abstinence rate than group A2 at 6 months (20.9% versus 12.9%; P = 0.001). Conclusions In smokers with no immediate plans to quit, smoking reduction programmes with behav- ioural support and nicotine replacement therapy are more effective than brief advice to quit. Current guidelines recommend advice to quit on medical grounds as the best clinical intervention in this group of smokers, but smoking reduction programmes offer an alternative and effective option. Keywords Adherence counselling, behavioural counselling, nicotine replacement therapy, smoking reduction, tobacco abstinence, unmotivated smokers. Correspondence to: Tai-Hing Lam, Department of Community Medicine, School of Public Health, Li Ka Shing Faculty of Medicine,The University of Hong Kong, 5/F, William MW Mong Block, LKS Faculty of Medicine, 21 Sassoon Road, Pokfulam, Hong Kong. E-mail: hrmrlth@hkucc.hku.hk. Submitted 18 May 2010; initial review completed 9 August 2010; final version accepted 28 January 2011 INTRODUCTION Quitting smoking can reduce the risks of many tobacco- related diseases, with gains in health and life extension. China has the largest smoking population in the world. Quitting appears to be very difficult for many Chinese smokers. In China, the city of Hong Kong has the lowest smoking prevalence, but two-thirds of smokers have never tried to give up smoking [1]. Even with the help of health-care professionals and medication, many smokers fail to quit because of nicotine dependence [2,3]. Smoking reduction (SR) is a therapeutic option for smokers who are unable or unwilling to quit [4–6], although its long-term benefit on health is uncertain [7]. Some fear that SR may undermine cessation by reducing motivation to quit because they perceive SR as an alter- native to complete cessation [8–10]. Others have argued that SR may be an intermediate step towards complete cessation [11], as smokers can feel more control over their smoking habits if they can reduce their cigarette consumption successfully, which motivates them to quit smoking [12]. Also, quitting is easier for light smokers due to lower nicotine dependence [13–15]. Nicotine replacement therapy (NRT) is effective in helping unmotivated smokers to reduce their daily ciga- rette consumption [16–19]. Two randomized controlled RESEARCH REPORT doi:10.1111/j.1360-0443.2011.03363.x © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction Addiction, 106, 1155–1163