Abstract
BackgroundWithin a web-assisted tobacco intervention, we provided a function for smokers to asynchronously communicate with a trained tobacco treatment specialist (TTS). Previous studies have not attempted to isolate the effect of asynchronous counseling on smoking cessation.ObjectiveThis study aimed to conduct a semiquantitative analysis of TTS-smoker communication and evaluate its association with smoking cessation.MethodsWe conducted a secondary analysis of data on secure asynchronous communication between trained TTSs and a cohort of smokers during a 6-month period. Smokers were able to select their preferred TTS and message them using a secure web-based form. To evaluate whether the TTS used evidence-based practices, we coded messages using the Motivational Interviewing Self-Evaluation Checklist and Smoking Cessation Counseling (SCC) Scale. We assessed the content of messages initiated by the smokers by creating topical content codes. At 6 months, we assessed the association between smoking cessation and the amount of TTS use and created a multivariable model adjusting for demographic characteristics and smoking characteristics at baseline.ResultsOf the 725 smokers offered asynchronous counseling support, 33.8% (245/725) messaged the TTS at least once. A total of 1082 messages (TTSs: 565; smokers 517) were exchanged between the smokers and TTSs. The majority of motivational interviewing codes were those that supported client strengths (280/517, 54.1%) and promoted engagement (280/517, 54.1%). SCC code analysis showed that the TTS provided assistance to smokers if they were willing to quit (247/517, 47.8%) and helped smokers prepare to quit (206/517, 39.8%) and anticipate barriers (197/517, 38.1%). The majority of smokers’ messages discussed motivations to quit (234/565, 41.4%) and current and past treatments (talking about their previous use of nicotine replacement therapy and medications; 201/565, 35.6%). The majority of TTS messages used behavioral strategies (233/517, 45.1%), offered advice on treatments (189/517, 36.5%), and highlighted motivations to quit (171/517, 33.1%). There was no association between the amount of TTS use and cessation. In the multivariable model, after adjusting for gender, age, race, education, readiness at baseline, number of cigarettes smoked per day at baseline, and the selected TTS, smokers messaging the TTS one or two times had a smoking cessation odds ratio (OR) of 0.8 (95% CI 0.4-1.4), and those that messaged the TTS more than two times had a smoking cessation OR of 1.0 (95% CI 0.4-2.3).ConclusionsOur study demonstrated the feasibility of using asynchronous counseling to deliver evidence-based counseling. Low participant engagement or a lack of power could be potential explanations for the nonassociation with smoking cessation. Future trials should explore approaches to increase participant engagement and test asynchronous counseling in combination with other approaches for improving the rates of smoking cessation.
Highlights
BackgroundSmoking is the number one preventable cause of death [1]
After adjusting for gender, age, race, education, readiness at baseline, and number of cigarettes smoked per day at baseline, compared with treatment specialist (TTS) 1, the odds of quitting were lower for TTS 2 and TTS 3, but not significant
In the multivariable model after adjusting for gender, age, race, education, readiness at baseline, number of cigarettes smoked per day at baseline, and the selected TTS, compared with smokers who did not message the TTS, smokers messaging the TTS one or two times had a smoking cessation odds ratio (OR) of 0.8, and those that messaged the TTS more than two times had a smoking cessation OR of 1.0
Summary
1 in 5 adults in the United States, or 42.1 million people, currently smoke cigarettes [2]. Quitting reduces the risk of smoking-related diseases, including cardiovascular diseases [3]. Current guidelines recommend that smokers use behavioral counseling to aid their quitting efforts [4]. Most smokers do not use counseling in their quit attempts. Despite the wide availability of Quitlines, a telephone-based tobacco counseling that has been established in all 50 states, it has been reported that only 1% to 2% of smokers use Quitline services [5,6]. More innovations are needed to increase access to counseling resources [1]. Previous studies have not attempted to isolate the effect of asynchronous counseling on smoking cessation
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