rather than a cessation study. The results indicated that 9% became abstinent and 9–36% showed some improvement on various reduced smoking behavior parameters from posttest to follow-up. These results would suggest that further tobacco exposure reduction can occur in about a third or more of the population. In addition, the smoking cessation rate is no lower than that observed among a general population of smokers or general practice intervention with smokers. In a later study, Glasgow et al. (1989) explored how an abstinence-based program, in which smoking was not condoned after the quit date, compared to a program in which participants had the option of complete smoking cessation or controlled smoking. No significant differences in smoking cessation rates were observed between the two conditions at either posttest or six months. This result would indicate that allowing controlled smoking among those who want to quit does not necessarily lead to either less interest in abstinence or a promotion of abstinence. In a review article (Hughes, 2000) also concluded that smokers can sustain reductions in smoking, and reductions in smoking do not undermine cessation.

More recent exploration of reduced smoking has used computerized devices to gradually wean smokers from cigarettes as a means to achieve cessation. One computerized program, Lifesign Computer Assisted Smoking Program, involves a scheduled reduction by increasing the interval between cigarettes and informing individuals when to smoke. The scheduled time-interval approach seems the most promising of the behavioral treatment methods based on studies by Cinciripini and colleagues (Cinciripini et al., 1995 and 1997) compared to abrupt cessation or non-scheduled reduction of cigarettes. This behavioral method systematically reduces the level of nicotine exposure, disrupts habitual smoking patterns, and gives smokers the opportunity to develop new behaviors or skills in response to cues associated with smoking.

Summary and Recommendations

In summary, the results from these studies show that smokers can reduce their smoking rate using behavioral methods, that this rate can be sustained over time, and that reduced smoking does not necessarily compromise cessation efforts. However, more systematic studies focused directly on these issues should be conducted. Furthermore, tobacco addiction involves more than a physical addiction to nicotine, but also behavioral and psychological aspects that also need to be targeted in exposure reduction as well as cessation. Rigorous studies combining behavioral and pharmacological methods for reduced smoking have yet to be conducted. For example, the use of pharmacological agents may have

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