Abstract

BackgroundReducing smoking prevalence is a public health priority that can save more lives and money than almost any other known preventive intervention. Internet interventions have the potential for enormous public health impact given their broad reach and effectiveness. However, most users engage only minimally with even the best designed websites, diminishing their impact due to an insufficient ‘dose’. Two approaches to improve adherence to Internet cessation programs are integrating smokers into an online social network and providing free nicotine replacement therapy (NRT). Active participation in online communities is associated with higher rates of cessation. Integrating smokers into an online social network can increase support and may also increase utilization of cessation tools and NRT. Removing barriers to NRT may increase uptake and adherence, and may also increase use of online cessation tools as smokers look for information and support while quitting. The combination of both strategies may exert the most powerful effects on adherence compared to either strategy alone.Methods/DesignThis study compares the efficacy of a smoking cessation website (WEB) alone and in conjunction with free NRT and a social network (SN) protocol designed to integrate participants into the online community. Using a 2 (SN, no SN) x 2 (NRT, no NRT) randomized, controlled factorial design with repeated measures at baseline, 3 months, and 9 months, this study will recruit N = 4,000 new members of an internet cessation program and randomize them to: 1) WEB, 2) WEB + SN, 3) WEB + NRT, or 4) WEB + SN + NRT. Hypotheses are that all interventions will outperform WEB and that WEB + SN + NRT will outperform WEB + NRT and WEB + SN on 30-day point prevalence abstinence at 9 months. Exploratory analyses will examine theory-driven hypotheses about the mediators and moderators of outcome.DiscussionAddressing adherence in internet cessation programs is critical and timely to leverage their potential public health impact. This study is innovative in its use of a social network approach to improve behavioral and pharmacological treatment utilization to improve cessation. This approach is significant for reducing tobacco’s devastating disease burden and for optimizing behavior change in other arenas where adherence is just as critical.Trial registrationISRCTN:ISRCTN45127327

Highlights

  • Introduction to Statistical Mediation AnalysisNew York, NY: Lawrence Erlbaum Associates; 2008.99

  • The majority of U.S adults are internet users [8], and internet use continues to expand through all segments of the U.S population [9], especially among rural populations, racial/ethnic minorities, and lower income groups that are at disproportionate risk for smoking

  • Internet interventions are a promising delivery channel for tobacco cessation treatment that have the potential for enormous public health impact

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Summary

Discussion

Improving adherence in internet cessation programs is critical to leverage the potential public health impact of this ‘broad reach’ treatment modality. Full time professionals typically manage a diffuse group of paraprofessionals recruited from the network itself and trained by the hosting organization [101] This model dates back to the earliest days of online networks, such as support forums on Compuserve, and continues today where companies such as Kaiser Permanente recruit, incentivize, and train specific keyplayers in their online support communities to enhance discussions, recruit new members, and enforce discipline. These individuals (often called ‘peer moderators’ or ‘MVPs’) are usually managed virtually online, critically enabling the workforce to be spread across time zones.

Background
Methods/Design
Limitations
National Tobacco Cessation Collaborative
Rainie L
27. World Health Organization: Adherence to Long-term Therapies
32. Etter JF
41. Eysenbach G
57. Centola D
71. SRNT Subcommittee on Biochemical Verification
Findings
98. MacKinnon DP
Full Text
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