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Updated: Jul 13, 2026

Methods to Evaluate Cytotoxicity and Immunosuppression of Combustible Tobacco Product Preparations
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Published on: January 10, 2015

Interventions to reduce harm from continued tobacco use.

L F Stead1, T Lancaster

  • 1Oxford University, Department of Primary Health Care, Old Road Campus, Headington, Oxford, UK, OX3 7LF. lindsay.stead@dphpc.ox.ac.uk

The Cochrane Database of Systematic Reviews
|July 20, 2007
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Nicotine replacement therapy (NRT) helps some smokers reduce cigarette consumption and carbon monoxide levels. However, long-term health benefits of reduced smoking remain unclear, suggesting NRT is best used before quitting.

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Area of Science:

  • Public Health
  • Addiction Medicine
  • Tobacco Control

Background:

  • Smokers unable or unwilling to quit may benefit from harm reduction strategies.
  • Reducing tobacco exposure can involve smoking fewer cigarettes or using less toxic products.
  • Interventions primarily focus on reducing the number of cigarettes smoked.

Purpose of the Study:

  • To evaluate smoking reduction interventions' effects on biomarkers of damage and exposure.
  • To assess impacts on cigarette consumption, quitting rates, and long-term health.
  • To synthesize evidence from controlled trials on harm reduction strategies.

Main Methods:

  • Systematic review of randomized and quasi-randomized controlled trials.
  • Searched Cochrane Tobacco Addiction Group register for harm reduction, smoking reduction, and cigarette reduction.
  • Pooled data using a fixed-effect model for similar interventions; others summarized narratively.

Main Results:

  • Thirteen trials evaluated interventions to reduce smoking; most used nicotine replacement therapy (NRT).
  • NRT (gum, inhaler) significantly increased odds of reducing cigarettes per day (CPD) by 50% (OR 2.02) and quitting (OR 1.90).
  • Carbon monoxide and cotinine reductions were less pronounced than CPD reduction; sustained reduction was achieved by few.

Conclusions:

  • Insufficient evidence exists for long-term benefits of smoking reduction interventions without cessation.
  • NRT (gum, inhaler) can help some smokers reduce CPD and carbon monoxide levels.
  • NRT for reduction is best considered a precursor to quitting due to unclear long-term health benefits.