Background:
Smoking remains the leading cause of preventable death in the United States. While smoking prevalence in the general population has declined in the U.S., smoking remains highly prevalent in prison populations with approximately 70% reporting current smoking. Individuals within the criminal justice system represent a vulnerable group of smokers with limited access to traditional healthcare or smoking cessation treatments. This study examined differences in smoking characteristics based on smokers' self-initiated pre-quit reductions in cigarettes per day (CPD).

Methods:
This study utilized data from a randomized clinical trial comparing four sessions of smoking cessation counseling to brief physician advice only to quit. All participants received 12 weeks of bupropion. Participants (N=500) were recruited from community corrections supervision (M age = 37.4, 67% male, 68% non-white). Questionnaires assessed smoking history and participants were seen at baseline and one week later to begin treatment. The present study compared two groups of smokers based on whether they self-selected to reduce smoking by at least 25% between baseline and first treatment session (n = 121) or whether they increased smoking or did not reduce (n =365).

Results:
Chi-square and one-way analysis of variance revealed that individuals who reduced smoking pre-quit were more likely to be Black and lower educated with at least one prior quit attempt. Additionally, individuals who reduced smoking were older when first become a daily smoker, reported higher expectations for self-help materials and group therapy, as well as reported lower withdrawal and withdrawal expectations. No reduction in smoking related to lower likelihood of achieving at least one quit attempt during the one-year study period as compared to either increased or reduced smoking.

Conclusions:
Action pre-cessation resulted in successes post-quit. Overall, individuals who self-initiate pre-cessation smoking reduction exhibit higher expectations for some smoking cessation treatments and lower expectations for withdrawal improving likelihood of smoking cessation.