Controlled smoking (part I): a last resort?

Traditional intervention strategies with smokers have focused on primary prevention programmes (to ‘stop people starting’ and on quit/cessation programmes (to ‘start people stopping’). Although essential elements of a public health policy, prevention and cessation programmes often do not impact on people with chronic highly treatment-resistant smoking behaviours. As one component of a whole health policy, controlled/attenuated smoking progrmmes offer an essential service for smokers who refuse to quit, despite major health problems. ‘Controlled smoking’ is considered to be the reduction of volume intake of cigarettes, achieved via stimulus control of time, place, people or events. Controlled smoking goals typically focus on reductions of 50–80% of original baseline smoking levels, maintained at follow-up.