Reduziertes Rauchen: Was können Interventionen erreichen und wie sollten sie gestaltet sein?

Zusammenfassung

Dieses Review befasst sich mit neueren Ergebnissen zur Reduktion des Rauchkonsums von Rauchern, die aktuell nicht an einem Rauchstopp interessiert sind. Es wurde eine systematische Literaturrecherche durchgeführt. Eine Minderung des gesundheitlichen Risikos allein durch Reduktion des Konsums von Zigaretten kann auf Basis der aktuellen Studienlage nicht zweifelsfrei belegt werden. Es zeigt sich jedoch eine Erhöhung der Wahrscheinlichkeit für einen späteren Rauchstopp von Rauchern, die ihren Zigarettenkonsum reduzieren. Der Großteil der aktuell publizierten Studien belegt eine Eignung der Nikotinersatztherapie (NET) zur Unterstützung einer Reduktion. Die NET hat vor allem in Verbindung mit verhaltensbezogenen Interventionen sowohl einen positiven Effekt auf die Reduktion der Anzahl täglich gerauchter Zigaretten als auch auf eine längerfristige Abstinenz. In Bezug auf schizophrene Patienten finden sich erste positive Effekte von verhaltensbezogenen Interventionen ohne NET. Insgesamt ist die Anzahl der aktuellen Studien für reduziertes Rauchen angesichts der hohen gesundheitlichen Folgen der Tabakabhängigkeit zu gering und inkonsistent. Weitere klinische Studien zu diesem Thema sind dringend erforderlich.

Abstract

This review considers more recent findings on reduction of cigarette consumption among smokers who are not currently interested in smoking cessation. We performed a systematic literature search. The currently available studies do not provide clear evidence that just reducing cigarette consumption decreases the health risk. However, smoking reduction does appear to increase the probability that smokers will later quit smoking. The majority of the currently published studies provide evidence that nicotine replacement therapy (NRT) is suitable for supporting reduction. NRT, particularly in combination with behaviour-related interventions, has a positive effect both on reducing the number of cigarettes smoked daily and on longer-term abstinence. Initial positive effects of behaviour-related interventions without NRT were found in schizophrenia patients. Overall, in view of the significant health-related consequences of nicotine dependence too few studies have examined smoking reduction and the findings are inconsistent. Further clinical studies on this topic are urgently required.

Schlüsselwörter

Zigaretten Reduktion - Harm Reduction - Zigaretten reduzieren - Rauchen reduzieren - Reduktion von Zigaretten

Keywords

cigarette reduction - harm reduction - reducing cigarettes - reducing smoking - reduction of cigarettes

• Literatur

• 1 Lim SS, Vos T, Flaxman AD et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2224-2260
• 2 Doll R, Peto R, Boreham J et al. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ (Clinical research ed) 2004; 328: 1519
• 3 Klesges RC, Sherrill-Mittleman D, Ebbert JO et al. Tobacco use harm reduction, elimination, and escalation in a large military cohort. Am J Public Health 2010; 100: 2487-2492
• 4 Glasgow RE, Gaglio B, France EK et al. Do behavioral smoking reduction approaches reach more or different smokers? Two studies; similar answers. Addict Behav 2006; 31: 509-518
• 5 Pisinger C, Godtfredsen NS. Is there a health benefit of reduced tobacco consumption? A systematic review. Nicotine Tob Res 2007; 9: 631-646
• 6 Hughes JR, Carpenter MJ. Does smoking reduction increase future cessation and decrease disease risk? A qualitative review. Nicotine Tob Res 2006; 8: 739-749
• 7 Shiffman S, Hughes JR, Ferguson SG et al. Smokers’ interest in using nicotine replacement to aid smoking reduction. Nicotine Tob Res 2007; 9: 1177-1182
• 8 Bolliger CT, Zellweger JP, Danielsson T et al. Influence of long-term smoking reduction on health risk markers and quality of life. Nicotine Tob Res 2002; 4: 433-439
• 9 Stellman SD, Garfinkel L. Lung cancer risk is proportional to cigarette tar yield: evidence from a prospective study. Prev Medicine 1989; 18: 518-525
• 10 Keil U, Liese AD, Hense HW et al. Classical risk factors and their impact on incident non-fatal and fatal myocardial infarction and all-cause mortality in southern Germany. Results from the MONICA Augsburg cohort study 1984-1992. Monitoring Trends and Determinants in Cardiovascular Diseases. Eur Heart J 1998; 19: 1197-1207
• 11 Meisinger C, Doring A, Thorand B et al. Association of cigarette smoking and tar and nicotine intake with development of type 2 diabetes mellitus in men and women from the general population: the MONICA/KORA Augsburg Cohort Study. Diabetologia 2006; 49: 1770-1776
• 12 Teo KK, Ounpuu S, Hawken S et al. Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case-control study. Lancet 2006; 368: 647-658
• 13 Bjartveit K, Tverdal A. Health consequences of smoking 1-4 cigarettes per day. Tob Control 2005; 14: 315-320
• 14 Tverdal A, Bjartveit K. Health consequences of reduced daily cigarette consumption. Tob Control 2006; 15: 472-480
• 15 Flanders WD, Lally CA, Zhu BP et al. Lung cancer mortality in relation to age, duration of smoking, and daily cigarette consumption: results from Cancer Prevention Study II. Cancer Res 2003; 63: 6556-6562
• 16 Hughes JR, Carpenter MJ. The feasibility of smoking reduction: an update. Addiction (Abingdon, England) 2005; 100: 1074-1089
• 17 Godtfredsen NS, Prescott E, Vestbo J et al. Smoking reduction and biomarkers in two longitudinal studies. Addiction (Abingdon, England) 2006; 101: 1516-1522
• 18 Gerber Y, Myers V, Goldbourt U. Smoking reduction at midlife and lifetime mortality risk in men: a prospective cohort study. Am J Epidemiol 2012; 175: 1006-1012
• 19 Hart C, Gruer L, Bauld L. Does smoking reduction in midlife reduce mortality risk? Results of 2 long-term prospective cohort studies of men and women in Scotland. Am J Epidemiol 2013; 178: 770-779
• 20 Lee PN. The effect of reducing the number of cigarettes smoked on risk of lung cancer, COPD, cardiovascular disease and FEV(1) – a review. Regul Toxicol Pharmacol 2013; 67: 372-381
• 21 Gelkopf M, Noam S, Rudinski D et al. Nonmedication smoking reduction program for inpatients with chronic schizophrenia: a randomized control design study. J Nerv Ment Dis 2012; 200: 142-146
• 22 Bernard PP, Esseul EC, Raymond L et al. Counseling and exercise intervention for smoking reduction in patients with schizophrenia: a feasibility study. Arch Psychiatr Nurs 2013; 27: 23-31
• 23 Wu BJ, Chen HK, Lee SM. Do atypical antipsychotics really enhance smoking reduction more than typical ones?: the effects of antipsychotics on smoking reduction in patients with schizophrenia. J Clin Psychopharmacology 2013; 33: 319-328
• 24 Rohde P, Lewinsohn PM, Brown RA et al. Psychiatric disorders, familial factors and cigarette smoking: I. Associations with smoking initiation. Nicotine Tob Res 2003; 5: 85-98
• 25 Olincy A, Young DA, Freedman R. Increased levels of the nicotine metabolite cotinine in schizophrenic smokers compared to other smokers. Biol Psychiatry 1997; 42: 1-5
• 26 Ruther T, Bobes J, De Hert M et al. EPA guidance on tobacco dependence and strategies for smoking cessation in people with mental illness. Eur Psychiatry 2014; 29: 65-82
• 27 Lindson-Hawley N, Aveyard P, Hughes JR. Reduction versus abrupt cessation in smokers who want to quit. Cochrane Database Syst Rev 2012; 11 CD008033
• 28 Okuyemi KS, Thomas JL, Warren J et al. Relationship between smoking reduction and cessation among light smokers. Nicotine Tob Res 2010; 12: 1005-1010
• 29 Cropsey KL, Jackson DO, Hale GJ et al. Impact of self-initiated pre-quit smoking reduction on cessation rates: results of a clinical trial of smoking cessation among female prisoners. Addict Behav 2011; 36: 73-78
• 30 Shiffman S, Ferguson SG, Strahs KR. Quitting by gradual smoking reduction using nicotine gum: a randomized controlled trial. Am J Prev Med 2009; 36: 96-104 e101
• 31 Stead LF, Lancaster T. Interventions to reduce harm from continued tobacco use. Cochrane Database Syst Rev 2007; CD005231
• 32 Asfar T, Ebbert JO, Klesges RC et al. Do smoking reduction interventions promote cessation in smokers not ready to quit?. Addict Behav 2011; 36: 764-768
• 33 Beard E, McNeill A, Aveyard P et al. Association between use of nicotine replacement therapy for harm reduction and smoking cessation: a prospective study of English smokers. Tobacco Control 2013; 22: 118-122
• 34 Piper ME, McCarthy DE, Baker TB. Assessing tobacco dependence: a guide to measure evaluation and selection. Nicotine Tob Res 2006; 8: 339-351
• 35 Mooney ME, Johnson EO, Breslau N et al. Cigarette smoking reduction and changes in nicotine dependence. Nicotine Tob Res 2011; 13: 426-430
• 36 Beard E, Aveyard P, Brown J et al. Assessing the association between the use of NRT for smoking reduction and attempts to quit smoking using propensity score matching. Drug Alcohol Depend 2012; 126: 354-361
• 37 Beard E, Aveyard P, McNeill A et al. Mediation analysis of the association between use of NRT for smoking reduction and attempts to stop smoking. Psychol Health 2012; 27: 1118-1133
• 38 Peters EN, Hughes JR. The day-to-day process of stopping or reducing smoking: a prospective study of self-changers. Nicotine Tob Res 2009; 11: 1083-1092
• 39 Beard E, Vangeli E, Michie S et al. The use of nicotine replacement therapy for smoking reduction and temporary abstinence: an interview study. Nicotine Tob Res 2012; 14: 849-856
• 40 Estabrooks PA, Gaglio B, Morse EF et al. Defining and understanding success at smoking reduction: a mixed-methods study. Addic Beh 2010; 35: 1113-1119
• 41 Glasgow RE, Gaglio B, Estabrooks PA et al. Long-term results of a smoking reduction program. Med Care 2009; 47: 115-120
• 42 Chan SS, Leung DY, Abdullah AS et al. A randomized controlled trial of a smoking reduction plus nicotine replacement therapy intervention for smokers not willing to quit smoking. Addiction (Abingdon, England) 2011; 106: 1155-1163
• 43 Lam TH, Chan SS, Abdullah AS et al. Smoking reduction intervention for smokers not willing to quit smoking: a randomised controlled trial. Hong Kong Med J 2012; 18 (Suppl. 03) 4-8
• 44 Tang YY, Tang R, Posner MI. Brief meditation training induces smoking reduction. Proc Natl Acad Sci USA 2013; 110: 13971-13975
• 45 Moore D, Aveyard P, Connock M et al. Effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking: systematic review and meta-analysis. BMJ (Clinical research ed) 2009; 338: b1024
• 46 Beard E, McNeill A, Aveyard P et al. Use of nicotine replacement therapy for smoking reduction and during enforced temporary abstinence: a national survey of English smokers. Addiction (Abingdon, England) 2011; 106: 197-204
• 47 Beard E, Bruguera C, Brown J et al. Was the expansion of the marketing license for nicotine replacement therapy in the United kingdom to include smoking reduction associated with changes in use and incidence of quit attempts?. Nicotine Tob Res 2013; 15: 1777-1781
• 48 Hughes JR, Rennard SI, Fingar JR et al. Efficacy of varenicline to prompt quit attempts in smokers not currently trying to quit: a randomized placebo-controlled trial. Nicotine Tob Res 2011; 13: 955-964
• 49 Hatsukami DK, Rennard S, Patel MK et al. Effects of sustained-release bupropion among persons interested in reducing but not quitting smoking. Am J Med 2004; 116: 151-157
• 50 Franklin TR, Harper D, Kampman K et al. The GABA B agonist baclofen reduces cigarette consumption in a preliminary double-blind placebo-controlled smoking reduction study. Drug Alcohol Depend 2009; 103: 30-36