Smokers In General Population Research Articles

Use of varenicline for smoking cessation in UK primary care: an association rule mining analysis

BackgroundAssociation rule mining (ARM) is a structured data mining method used to discover numerically important and often unexpected associations between variables in a dataset without being hypothesis driven. Although widely applied in business, ARM has been little used in public health. Smoking is the largest avoidable cause of death and health inequalities in the UK, and varenicline is one of the most effective treatments to help smokers quit. We used ARM methods to identify the comorbidity characteristics of patients who typically do not receive varenicline for smoking cessation in UK primary care to identify numerically important groups in which varenicline is not being used. MethodsFrom the Health Improvement Network primary care database we obtained data on demographic and lifestyle characteristics, medical diagnoses based on Quality and Outcomes Framework disease indicators, and prescription of varenicline in all current smokers aged at least 16 years in 2011. ARM identifies rules of the form A→B, where A and B are disjoined sets of items such that B is likely to occur when A occurs. We therefore identified rules for sets of characteristics (A) of patients who did and did not receive a prescription for varenicline during 2011 (B). All (A) sets were required to contain a minimum of 500 patients, and we ordered rules according to their confidence, which is the probability of B given A. Findings were compared with traditional risk factor analysis of predictors of receiving a varenicline prescription by logistic regression. Ethics approval was granted from the EPIC Scientific Review Committee. Findings477 620 smokers were included in the analysis, of whom 19 316 (4%) were prescribed varenicline. Patients in the top ten rules for receiving varenicline were all heavy smokers, without obesity, excessive alcohol intake, hypertension, anxiety, depression, or psychotic disorders. Rates of receiving varenicline in these groups were at least 13·3%, which is much higher than in the general smoking population (4%). Patients in the initial top ten rules for not receiving varenicline were lighter smokers without comorbidity; however, of smokers with at least one comorbidity, those not prescribed varenicline were typically older (aged >60 years), non-heavy smokers without chronic obstructive pulmonary disease, but with a psychotic disorder or dementia; in these groups, fewer than 0·7% of patients were prescribed varenicline. Logistic regression also identified these characteristics, but did not provide the context of numerical importance. InterpretationARM analysis shows that varenicline is systematically underused in people with severe mental health problems, a group in whom smoking prevalence is extremely high and has changed very little over recent years. Although use of varenicline is subject to caution in these groups, the risk of continued smoking is likely to far exceed any risk arising from varenicline use. ARM has thus identified an important area of under-access of one of the most effective smoking cessation treatments. FundingThe authors are members of the UK Centre for Tobacco and Alcohol Studies, and the study is funded by the centre.

Escalating Doses of Transdermal Nicotine in Heavy Smokers

Fixed-dose nicotine replacement therapy (NRT) is efficacious for smoking cessation in the general population of smokers. However, it is less effective in populations with psychiatric comorbidities and/or severe tobacco dependence where the percent nicotine replacement is suboptimal. The objective of this pilot study was to determine the effectiveness of nicotine patch dose titration in response to continued smoking in heavily dependent smokers with psychiatric comorbidity. In a single-arm, open-label study adult smokers (mean cigarettes per day, 25.4 ± 13.4; range, 14-43; n = 12) willing to quit were treated with escalating doses of transdermal nicotine and brief counseling intervention if they continued to smoke over a 9-week treatment period. Plasma nicotine and cotinine, along with expired carbon monoxide levels, and the subjective effects of smoking, urge to smoke, demand elasticity, and mood symptoms were also assessed. The mean NRT dose was 32.7 (SD, 16.4) mg/d (range, 7-56 mg/d). Smokers reported significant reductions in both cigarettes per day (mean decrease, 18.4 ± 11.5) confirmed by expired carbon monoxide (mean decrease, 13.5 ± 13.0) with no significant changes in plasma nicotine concentrations during the course of NRT dose titration. There were significant effects on the subjective effects of smoking and measures of smoking behavior. Most commonly reported adverse events were respiratory infections, skin irritation at patch site, nausea, and sleep disturbances, which were generally mild and transient. Titrating doses of NRT to effect with brief intervention hold promise as an effective clinical strategy to assist heavily dependent psychiatrically ill smokers to change their smoking behavior.

THE IMPACT OF TOBACCO CONTROL EXPENDITURES ON SMOKING INITIATION AND CESSATION

Between 1997 and 2007, smoking prevalence declined from 33% to 28% in Switzerland. Over the same period, funding for tobacco control activities significantly increased, resulting in the implementation of a large variety of national and regional interventions. In this paper, I exploit variation over time and across cantons of tobacco control expenditures to examine the impact of these policies on smoking decisions. I use retrospective smoking information from the Swiss Health Survey (2007) and find that tobacco control expenditures decreased the probability of smoking initiation among adolescents and young adults and increased cessation rates in the general population of smokers. I estimate that if funding had been kept at the 1997 level, there would have been 107,000 additional smokers in 2007.

Smokers who seek help in specialized cessation clinics: How special are they compared to smokers in general population?

Introduction:Patients of specialized nicotine dependence clinics are hypothesized to form a distinct subpopulation of smokers due to the features associated with treatment seeking. Theaimof the study was to describe this subpopulation of smokers and compare it to smokers in general population.Material and methods:A chart review of 796 outpatients attending a specialized nicotine dependence clinic, located in Toronto, Ontario, Canada was performed. Client smoking patterns and sociodemographic characteristics were compared to smokers in the general population using two Ontario surveys – the Ontario Tobacco Survey (n = 898) and the Centre for Addiction and Mental Health Monitor (n = 457).Results:Smokers who seek treatment tend to smoke more and be more heavily addicted. They were older, had longer history of smoking and greater number of unsuccessful quit attempts, both assisted and unassisted. They reported lower education and income, had less social support and were likely to live with other smokers.Conclusions:Smokers who seek treatment in specialized centers differ from the smokers in general population on several important characteristics. These same characteristics are associated with lower chances for successful smoking cessation and sustained abstinence and should be taken into consideration during clinical assessment and treatment planning.

Effectiveness of varenicline versus nicotine replacement therapy for smoking cessation with minimal professional support: evidence from an English population study

Limited evidence from randomised controlled trials suggests that varenicline might be more effective than nicotine replacement therapy (NRT) in achieving abstinence from smoking. The comparative effectiveness of varenicline when prescribed under routine circumstances and in the general population has not been tested. To compare the abstinence rates of smokers trying to stop having used varenicline vs. NRT on prescription (Rx) when provided with minimal professional support in the general population while adjusting for key potential confounders. A large survey of a representative sample of the English population. Participants were 1,579 adults who smoked within the previous 12months and made at least one quit attempt with varenicline or NRT Rx in their most recent quit attempt. The main outcome measure was self-reported abstinence up to the time of the survey, adjusted for key potential confounders including urges to smoke. A sensitivity analysis was conducted in subsamples in which the quit attempt started up to 6months or more than 6months ago. The adjusted odds of abstinence in users of varenicline were 1.76 (95% CI = 1.22-2.53) times higher compared with users of NRT Rx. However, there was no detectable difference in the subsample of smokers who started their quit attempt more than 6months ago (adjusted OR = 1.03, 95%CI = 0.54-1.96). Varenicline use with minimal professional support in the general population of smokers appears more effective than NRT Rx in achieving short-term abstinence. However, this effect may disappear in the long-term. Research is needed to confirm this and establish what may underlie it.

Subphenotypes of Mild-to-Moderate COPD by Factor and Cluster Analysis of Pulmonary Function, CT Imaging and Breathomics in a Population-Based Survey

Introduction: Classification of COPD is currently based on the presence and severity of airways obstruction. However, this may not fully reflect the phenotypic heterogeneity of COPD in the (ex-) smoking community. We hypothesized that factor analysis followed by cluster analysis of functional, clinical, radiological and exhaled breath metabolomic features identifies subphenotypes of COPD in a community-based population of heavy (ex-) smokers. Methods: Adults between 50–75 years with a smoking history of at least 15 pack-years derived from a random population-based survey as part of the NELSON study underwent detailed assessment of pulmonary function, chest CT scanning, questionnaires and exhaled breath molecular profiling using an electronic nose. Factor and cluster analyses were performed on the subgroup of subjects fulfilling the GOLD criteria for COPD (post-BD FEV1/FVC < 0.70). Results: Three hundred subjects were recruited, of which 157 fulfilled the criteria for COPD and were included in the factor and cluster analysis. Four clusters were identified: cluster 1 (n = 35; 22%): mild COPD, limited symptoms and good quality of life. Cluster 2 (n = 48; 31%): low lung function, combined emphysema and chronic bronchitis and a distinct breath molecular profile. Cluster 3 (n = 60; 38%): emphysema predominant COPD with preserved lung function. Cluster 4 (n = 14; 9%): highly symptomatic COPD with mildly impaired lung function. In a leave-one-out validation analysis an accuracy of 97.4% was reached. Conclusions: This unbiased taxonomy for mild to moderate COPD reinforces clusters found in previous studies and thereby allows better phenotyping of COPD in the general (ex-) smoking population.

Readiness to Quit Smoking and Quit Attempts Among Australian Mental Health Inpatients

Introduction:Mental health inpatients smoke at higher rates than general population smokers. However, provision of nicotine-dependence treatment in inpatient settings is low, with barriers to the provision of such care including staff views that patients do not want to quit. This paper reports the findings of a survey of mental health inpatients at a psychiatric hospital in New South Wales, Australia, assessing smoking and quitting motivations and behaviors.Methods:Smokers (n = 97) were surveyed within the inpatient setting using a structured survey tool, incorporating the Fagerström Test for Nicotine Dependence, Reasons for Quitting Scale, Readiness and Motivation to Quit Smoking Questionnaire, and other measures of smoking and quitting behavior.Results:Approximately 47% of smokers reported having made at least one quit attempt within the past 12 months, despite nearly three quarters (71.2%) being classified as in a “precontemplative” stage of change. Multinomial logistic regressions revealed that self-reporting “not enjoying being a smoker” and having made a quit attempt in the last 12 months predicted having advanced beyond a precontemplative stage of change. A high self-reported desire to quit predicted a quit attempt having been made in the last 12 months. Conclusions:The majority of smokers had made several quit attempts, with a large percentage occurring recently, suggesting that the actual quitting behavior should be considered as an important indication of the “desire to quit.” This paper provides further data supporting the assertion that multimodal smoking cessation interventions combining psychosocial and pharmacological support should be provided to psychiatric inpatients who smoke.

The Use of Nicotine Replacement Therapy for Smoking Reduction and Temporary Abstinence: An Interview Study

Nicotine replacement therapy (NRT) is commonly used to aid smoking reduction (SR) or in situations of enforced temporary abstinence (TA). National Surveys have suggested that in the general population of smokers, the use of NRT in these ways has little effect on cigarette consumption and that use of the nicotine patch is common. This study aimed to gain a better understanding of what might underlie this. Semistructured telephone interviews were conducted with 36 smokers who reported that they were using NRT for SR and/or TA. Open-ended questions explored smokers' knowledge, beliefs, and experience of using NRT for SR and/or TA. Interviews were analyzed using a variant of framework analysis. Smokers reported using a variety of methods to reduce their cigarette consumption, including increasing the interval between cigarettes and attempting nondaily or social smoking. Smokers also modified how they smoked their cigarettes by trying to inhale less, not inhaling at all, or only smoking part of the cigarette. Nicotine patches appeared to be popular because they were discreet, easy to use, provided a prolonged effect, and had an established history. Smokers had little knowledge of the regulatory restrictions on the use of NRT. Smokers used a wide variety of means of reducing smoke exposure without stopping completely, including ones that did not involve reducing consumption. Nicotine patches were considered convenient to help with this, and there appeared to be little awareness of regulatory restrictions on their use.

Smoking and Cancer: A Review of Public Health and Clinical Implications

The cultivation of tobacco dates backwards to 6000 BC. Use of tobacco for spiritual, euphoric, and medicinal purposes, and its ultimate spread to the 4 corners of the globe, lay at the heart of the current pandemic of tobacco-related disease, including lung, head and neck, and many other forms of cancer. While evidence for the carcinogenic properties of tobacco was documented as early as the 1800s, it was not until the 20th century that the role of tobacco use and smoke exposure in the growing pandemic of lung and other cancers was fully appreciated. The evidence is now indisputable, and current research and intervention activities center on mechanisms by which tobacco use and smoke cause cancer, ways of stemming the worldwide pandemic of tobacco-related disease, and how to help people with cancer quit smoking. With respect to the latter, approaches to smoking cessation that are effective for the general population of smokers are equally applicable to cancer patients, thrusting physicians and other health professionals to the forefront of the antismoking arena. However, the scale of the tobacco pandemic has grown so large that it literally will take a village, complete with heads of nations, world-governing bodies, local leaders, physicians, and many others, to pass and enforce legislation and policies necessary to stem the worldwide tobacco pandemic and to implement cessation programs for smokers and users of other forms of tobacco across the globe.

Smoking prevalence, behaviours, and cessation among individuals with COPD or asthma

Smoking prevalence, behaviours, physician counselling regarding smoking cessation, and smoking cessation medications were evaluated among male and female smokers with COPD and asthma compared to the general smoking population. Data from the large, nationally representative Canadian Community Health Survey (CCHS) was used (for 2003 CCHS, n = 134,072). All data were based on self-report, including the presence of COPD and asthma which were defined by health-professional diagnosis. Nicotine addiction was assessed by the Fagerstrom Test for Nicotine Dependence. In 2003, 32.8% of individuals with COPD, 21.0% with asthma, and 22.1% without COPD or asthma were current smokers. After adjusting for sociodemographic and smoking behaviour confounders, among current smokers, greater odds of high or very high nicotine addiction were observed among women with versus without COPD (OR = 2.49, 95% CI = 1.41-4.39), and among women with versus without asthma (OR = 1.74, 95% CI = 1.01-2.99), but no associations were seen among men. Smokers with COPD and asthma were no more likely to have received physician counselling regarding smoking cessation, nor smoking cessation pharmacotherapy compared to the general smoking population. Gender differences were observed in the association between COPD and asthma and higher nicotine addition levels in current smokers. These findings could in part explain population trends showing that COPD and asthma are increasing more rapidly in women. Physician counselling and pharmacotherapy for smoking cessation do not appear to be received more frequently among individuals with COPD or asthma compared to the general smoking population, despite the greater vulnerability of such patients to smoking effects.

Smoking cessation: Next steps for special populations research and innovative treatments.

The current introductory article provides the rationale for the special section on understudied smokers and innovative treatments. This article proposes a definition of "special populations" of smokers, outlines a priori criteria by which to judge whether an intervention should be adapted for these smokers, and delineates a process by which cultural adaptation of an intervention can be achieved. Next steps for innovative, theory-based treatments with special populations and with general populations of smokers are discussed. Special populations of smokers are defined as having (a) >10% higher smoking prevalence than the general population of smokers, (b) disproportionate tobacco-related health disparities, (c) less access to treatments, and (d) a lack of prospective, longitudinal treatment trials. Cultural adaptation of evidenced-based treatments (EBTs) for underserved smokers should be applied more widely, outside the bounds of race and ethnicity, but also judiciously, following several a priori criteria. Cultural adaptation may be justified if the target population differs from the general population in (a) rates and patterns of smoking, (b) burden of tobacco-related health diseases, (c) predictors of smoking behavior, (d) risk factors for treatment failure, (e) protective factors that facilitate quitting, (f) treatment engagement, (g) treatment response, and (h) perceived social validity of the EBT. Once these criteria are met, four phases of cultural adaptation of an EBT for the target population are proposed. Innovative treatments need to be developed that use novel channels and linkages between channels; test novel theories or build on mechanisms research to more accurately pinpoint targets of change; and increase consumer demand for EBTs. The process of cultural adaptation should be thoughtfully conducted with a priori definitions and criteria as well as standardized processes. Coupled with innovative, theory-based treatments, these considerations could help to jump-start stalled smoking cessation rates.

Obesity and Smoking: Comparing Cessation Treatment Seekers With the General Smoking Population

Obesity and smoking represent the leading preventable causes of morbidity and mortality in the United States. This study compared the prevalence of obesity among smokers seeking cessation treatment (n=1,428) vs. a general population (n=4,081) of never smokers, former smoker, and current smokers. Data from treatment-seeking smokers in the Wisconsin Smokers' Health Study (WSHS) and individuals who completed the National Health and Nutrition Examination Survey (NHANES) 2005-2006 were pooled and obesity rates and other health characteristics were compared. The prevalence of obesity was significantly higher among WSHS treatment-seeking smokers (36.8%) vs. NHANES current smokers (29.6%), but the obesity rates of WSHS treatment-seeking smokers did not differ from NHANES former smokers (36.5%) or never smokers (36.5%). Treatment-seeking smokers were more likely to be female and to have higher educational attainment compared to NHANES participants. Analysis of health characteristics revealed that treatment-seeking smokers had higher levels of dietary fiber and vitamin C and lower blood levels of total cholesterol, triglycerides, and fasting glucose compared to NHANES current smokers. Results suggest that treatment-seeking smokers may have a different health profile than current smokers in the general population. Health care providers should be aware of underlying heath issues, particularly obesity, in patients seeking smoking cessation treatment.

Discontinuation of Nicotine Replacement Therapy Among Smoking-Cessation Attempters

Nicotine replacement therapy (NRT) doubles successful quitting, but more than half of NRT users do not comply with optimal treatment regimens. From the 2005 Colorado state tobacco survey, quit attempters who utilized NRT (N=366) were analyzed in spring 2007. Descriptive and regression analyses were used to examine reasons for discontinuing NRT, length of time on NRT, and quit intentions. The reasons for discontinuing NRT were resuming smoking (34%), side effects (17%), NRT not helping with quitting (14%), quitting smoking (10%), and cost (5%). Poverty, age, and non-Latino minority status were associated with reasons for discontinuation other than quitting smoking. Having side effects was associated with a short duration of NRT use and 95% lower odds of intending to quit in the next month. In the first population-level study examining reasons for discontinuing NRT, general-population smokers who initiate NRT use when attempting to quit are highly likely to discontinue NRT prematurely. Age and culturally-appropriate medication management interventions may increase NRT compliance and improve cessation outcomes.

Perfil dos fumantes que não buscam tratamento para deixar de fumar, município do Rio de Janeiro

It is essential to understand that not all smokers are equal, and that certain smokers need to be "won" as "potential clients" of an intervention program aimed at addressing their specific needs. Thus, the objective of the article was to compare the profile of smokers recruited for a smoking cessation clinical trial with that of the general smoking population in the city of Rio de Janeiro, in the years 2002-2003. Heterogeneities observed may indicate the need for adopting different recruitment strategies, associated with the existing interventions, to encourage as many and as diverse eligible individuals as possible.

Exposure of Prague's homeless population to lead and cadmium, compared to Prague's general population

Homelessness is a growing problem in the Czech Republic where homeless people represent a specific minority group beset by many problems linked to their divergent lifestyle. It was therefore expected that the homeless population would be at greater risk of exposure to environmental pollutants than the general population. The aim of our study was to compare blood lead (B-Pb) and blood cadmium (B-Cd) levels in the homeless population (HP) with those obtained from the Human Biomonitoring Project (CZ-HBM), which used blood donors considered representative of the general population (GP). We present data obtained between 2004 and 2006 for B-Pb and B-Cd in 257 Prague homeless adults and compare them to B-Pb and B-Cd levels in 104 Prague adult blood donors from the CZ-HBM project in 2005. The mean (geometric) B-Pb levels in men were 36.5 (HP) and 35.4microg/l (GP), which is not significantly different. However, statistically significant differences were observed between men and women in the GP (P<0.001), but not in HP; B-Pb levels in women (34.8microg/l) did not differ from those of HP men (36.5microg/l), but were significantly (P<0.001) higher than those of GP women (25.8microg/l). B-Pb levels were not influenced by smoking. B-Cd levels in the homeless nonsmokers (geometric means 1.06 and 1.18microg/l in men and women, respectively) were more than 2.5 times higher than in the nonsmoking GP (0.36 and 0.38microg/l for men and women, respectively). B-Cd levels were significantly (P<0.001) influenced by smoking in both groups, but, surprisingly, the values in GP smokers (men=0.96microg/l, women=0.93microg/l) were lower than those in HP nonsmokers (men=1.06microg/l, women=1.18microg/l). A positive correlation was found between cadmium and lead in both men (P<0.05) and women (P<0.01). Our results indicate that the homeless population under study might be exposed to lead and cadmium more extensively than the general population of Prague and that homeless women represent a particularly vulnerable population group.

Is cigarette smoking related to alcohol use during the 8 years following treatment for adolescent alcohol and other drug abuse?

The present study examined the relationship between cigarette smoking and alcohol use outcomes over an 8-year period following treatment for adolescent alcohol and other drug (AOD) use disorders. The present study was based on a sample of 166 adolescents recruited during inpatient AOD abuse treatment. Included in this study were 123 (74% of the full sample) participants, of whom 41% were female, 81% identified themselves as White and who averaged 15.9 years of age (SD = 1.3) when entering treatment. Data for the present study were drawn from interviews conducted at the time of treatment and 2-, 4-, 6- and 8-years post-treatment. Twenty six percent of participants had quit smoking for > 1 year at the 8-year assessment, while 44% reported persistent smoking over time. Overall smoking rates decreased significantly over time. Subjects associated with the highest alcohol involvement trajectory reported significantly greater likelihood of persistent smoking as well as higher current smoking and cigarette consumption across time points. The significant declines observed in smoking from adolescence into young adulthood were contrary to expectations, indicating that this behaviour may be less stable than previously thought among adolescent AOD abusers. Smoking involvement over time was greater within the highest alcohol use trajectory, consistent with previous evidence for a positive relationship between these behaviours. However, when compared with the general population smoking rates remained very high regardless of alcohol involvement. Thus, individuals treated for AOD abuse as adolescents remained at elevated risk for tobacco related disease regardless of post-treatment AOD use outcomes.

Cigarette Promotional Offers: Who Takes Advantage?

Promotional offers on cigarettes (e.g., dollar-off, multipack discounts) composed the largest share of tobacco industry marketing expenditures, totaling $8.9 billion, or 72% of the total budget in 2002. Internal industry documents indicate that young adults, potential quitters, and other price-sensitive groups are the targets of these marketing tactics. How effective they are in actually reaching these groups in the general population of smokers has not yet been investigated.Data were from 4618 current smokers responding to the large, random-digit-dialed population-based 2002 California Tobacco Survey. The characteristics were identified of smokers who reported that they used these offers "every time I see one."Thirty-five percent of smokers used promotional offers every time they saw one. Multivariate analyses identified young adults, women, African Americans, those with higher daily cigarette consumption, and those worried about cigarette costs as more likely to use promotional offers at every opportunity. Smokers most committed to quitting were no more likely to use promotional offers than those with no intention to quit. Cigarette brand was highly correlated with age and race/ethnicity, and therefore was not included in the multivariate analysis. Those who smoked menthol cigarettes and Camels, more often young adults and African Americans, were much more likely than those of other brands to use promotional offers.With the exception of smokers intending to quit, cigarette promotional offers are effectively reaching most industry-targeted groups. Importantly, young adults, who have the greatest long-term customer potential, are responding.

Disparity in the Use of Smoking Cessation Pharmacotherapy Among Medicaid and General Population Smokers

The prevalence of smoking remains higher among the Medicaid population compared with the general population. To reduce this disparity, the majority of state Medicaid programs now provide coverage for smoking cessation pharmacotherapy. The objectives of this study were to (1) assess awareness of this benefit among Medicaid smokers and (2) compare the use of pharmacotherapy among a sample of Medicaid smokers with smokers in the general population of western New York. This report summarizes findings from two cross-sectional studies conducted in western New York State during 2002 to 2003: (1) Medicaid smokers (n = 1,174) completed an interviewer-administered questionnaire in the Office of Medicaid Management and (2) smokers from the general population (n = 852) completed a telephone survey. The majority of Medicaid smokers (54%) remain unaware of the program benefit providing coverage for smoking cessation pharmacotherapies. Medicaid smokers were much less likely (odds ratio = 0.33, 95% confidence interval = 0.25-0.44) than the general population to report having ever used pharmacotherapies. Highlighting the availability of the smoking cessation pharmacotherapy benefit to Medicaid program participants may be one strategy to enhance quit attempts among this population. Future research should identify other potential barriers to the use of effective pharmacotherapies among poorer smokers.

Preoperative Smoking Cessation

Preoperative Smoking Cessation

Subtyping general population smokers not intending to quit by stages to reduce smoking

The present study proposes target groups for preventive measures in smokers not intending to quit based on the intention to reduce smoking using the stages of change concept. Smokers were identified within a representative general population sample (T1; N=4,075) and assessed after 30 months (T2; N=913) and 36 months (T3; N=786). The cross-sectional analyses of the present study included at T2 677 smokers not intending to quit within the next 6 months (cessation-precontemplation stage). The prospective analyses were based on 584 of these smokers who were followed up at T3. At T2, 9.1% intended to reduce substantially within the next 6 months (reduction-contemplation stage), 1.2% intended to reduce substantially within the next 4 weeks (reduction-preparation stage), 3.7% had already reduced for up to 6 months (reduction-action stage), and 8.2% had maintained reduction for more than 6 months (reduction-maintenance stage). Subjects in the different reduction stages differed with respect to previous quit or reduction attempts, degree of nicotine dependence, and amount of cigarette consumption. Advanced reduction stages were significantly associated with increased chance of future reduction attempts. Future progress in the cessation stages (OR=4.7, 95% CI=1.5-13.1) and future quit attempts (OR=4.8, 95% CI=1.3-15.2) were significantly more likely for those in the reduction-action stage compared with the reduction-precontemplation stage. Analyses separating the components of the stage measure revealed further need for the validation of the common operational definition. In conclusion, a substantial subgroup of smokers not intending to quit could be subtyped by the reduction stages and might be accessible by smoking-reduction interventions. Our data did not support an undermining effect associated with later reduction stages with respect to future quit attempts and progress within the cessation stages.