Objectives: This study describes the use of gradual smoking cessation compared to abrupt cessation among smokers seen at smoking cessation clinics in France. Methods: Follow-up data from 28,156 adult smokers seen at smoking cessation clinics between 2007 and 2010 were analyzed. Factors associated with the different cessation methods were determined using multivariate regression models. Results: Only 4.4% of smokers quit gradually, while 48.7% quit smoking without prior reduction. These cessation methods were associated with one-month abstinence rates of 31.9% and 34.1%, respectively (p=0.108). Gradual cessation was more common among patients with the following characteristics: age ≥45 years, high initial smoking intensity, no prior cessation attempts, low confidence in their ability to quit, and indicators of anxiety and depression. Prescriptions for oral nicotine replacement therapy were twice as common for patients using a gradual cessation approach as for those quitting without prior reduction. A higher number of follow-up visits was required for gradual cessation than for quitting without prior reduction. Conclusion: For smokers with a severe baseline profile, gradual cessation may achieve abstinence rates similar to those who quit without tapering. However, intensive follow-up combined with appropriate treatment appears essential for the success of a gradual cessation approach.