How far should we promote smoking reduction in order to promote smoking cessation?

Smoking is the greatest preventable cause of death worldwide. In recent years considerable efforts have been devoted to reducing exposure to tobacco and related products. The ultimate aim has been to persuade people to stop smoking. It is generally recognized that smoking cessation is effective in reducing the burden of disease associated with smoking. However, smoking is an addiction to nicotine and relatively few people can quit successfully without professional help. Many do not want even to try. There is evidence that a reduction in cigarette consumption could result in improved health and provide an intermediate step before complete cessation, especially for those smokers who are not ready or willing to quit. Smoking reduction intervention with counselling and/or nicotine replacement therapy (NRT) have been shown by randomised controlled trials to be effective in reducing cigarette consumption for the general smoking population. We here present the argument that there may be a case for promoting smoking reduction both as a desirable goal in itself and as a first step towards smoking cessation.