Internet-based Smoking Cessation Intervention Research Articles

Prevalence and Characteristics of Smokers Interested in Internet-Based Smoking Cessation Interventions: Cross-sectional Findings From a National Household Survey

BackgroundAn accurate and up-to-date estimate of the potential reach of Internet-based smoking cessation interventions (ISCIs) would improve calculations of impact while an understanding of the characteristics of potential users would facilitate the design of interventions.ObjectiveThis study reports the prevalence and the sociodemographic, smoking, and Internet-use characteristics of smokers interested in using ISCIs in a nationally representative sample.MethodsData were collected using cross-sectional household surveys of representative samples of adults in England. Interest in trying an Internet site or “app” that was proven to help with stopping smoking was assessed in 1128 adult smokers in addition to sociodemographic characteristics, dependence, motivation to quit, previous attempts to quit smoking, Internet and handheld computer access, and recent types of information searched online.ResultsOf a representative sample of current smokers, 46.6% (95% CI 43.5%-49.6%) were interested in using an Internet-based smoking cessation intervention. In contrast, only 0.3% (95% CI 0%-0.7%) of smokers reported having used such an intervention to support their most recent quit attempt within the past year. After adjusting for all other background characteristics, interested smokers were younger (OR=0.98, 95% CI 0.97-0.99), reported stronger urges (OR=1.29, 95% CI 1.10-1.51), were more motivated to quit within 3 months (OR=2.16, 95% CI 1.54-3.02), and were more likely to have made a quit attempt in the past year (OR=1.76, 95% CI 1.30-2.37), access the Internet at least weekly (OR=2.17, 95% CI 1.40-3.36), have handheld computer access (OR=1.65, 95% CI 1.22-2.24), and have used the Internet to search for online smoking cessation information or support in past 3 months (OR=2.82, 95% CI 1.20-6.62). There was no association with social grade.ConclusionsAlmost half of all smokers in England are interested in using online smoking cessation interventions, yet fewer than 1% have used them to support a quit attempt in the past year. Interest is not associated with social grade but is associated with being younger, more highly motivated, more cigarette dependent, having attempted to quit recently, having regular Internet and handheld computer access, and having recently searched for online smoking cessation information and support.

Selection of intervention components in an internet stop smoking participant preference trial: Beyond randomized controlled trials

To address health problems that have a major impact on global health requires research designs that go beyond randomized controlled trials. One such design, the participant preference trial, provides additional information in an ecologically valid manner, once intervention efficacy has been demonstrated. The current study presents illustrative data from a participant preference trial of an internet-based smoking cessation intervention. Participants (N=7763) from 124 countries accessed the intervention and were allowed to choose from nine different site components to aid their quit attempt. Of consenting participants, 36.7% completed at least one follow-up assessment. Individuals with depression were more likely to choose a mood management module and participants who smoked a higher number of cigarettes were more likely to choose a cigarette counter and a nicotine replacement therapy guide. Furthermore, depressed participants selecting the mood management component were more likely to report at least one successful 7 day quit (37.2% vs. 22.2%) in the 12 months following the intervention. Thus, participants with depressive symptoms appear to make choices on the basis of their needs and to benefit from these decisions. This suggests that providing the ability to customize previously validated resources may be a successful way to widely disseminate interventions.

A pilot study of StopAdvisor: A theory-based interactive internet-based smoking cessation intervention aimed across the social spectrum

BackgroundThis article reports a pilot study of a new smoking cessation website (‘StopAdvisor’), which has been developed on the basis of PRIME theory, evidence, web-design expertise and user-testing. The aims were to i) evaluate whether cessation, website usage and satisfaction were sufficiently high to warrant a randomised controlled trial (RCT) and ii) assess whether outcomes were affected by socio-economic status. MethodsThis was an uncontrolled pilot study. Two hundred and four adult daily smokers willing to make a serious quit attempt were included. All participants received support from ‘StopAdvisor’, which recommends a structured quit plan and a variety of evidence-based behaviour change techniques for smoking cessation. A series of tunnelled sessions and a variety of interactive menus provide tailored support for up to a month before quitting through until one-month post-quit (http://www.lifeguideonline.org/player/play/stopadvisordemonstration). The primary outcome was self-report of at least 1month of continuous abstinence collected at 2months post-enrolment and verified by saliva cotinine or anabasine. Usage was indexed by log-ins and page views. Satisfaction was assessed by dichotomous ratings of helpfulness, personal relevance, likelihood of recommendation and future use, which were collected using an online questionnaire at 2months post-enrolment. Outcomes according to socio-economic status were assessed. ResultsAt 8weeks post-enrolment, 19.6% (40/204) of participants were abstinent according to the primary outcome criteria (95% C.I.=14.1% to 25.1%). Participants viewed a mean of 133.5 pages (median=71.5) during 6.4 log-ins (median=3). A majority of respondents rated the website positively on each of the four satisfaction `ratings (range=66.7% to 75.3%). There was no evidence of an effect of socio-economic status on abstinence (OR=1.01, C.I.=0.50–2.07), usage (page-views, t(202)=0.11, p=.91; log-ins, t(202)=0.21, p=.83), or satisfaction (helpfulness, OR=1.09, C.I.=0.41–2.88; personal relevance, OR=0.55, C.I.=0.20–1.56; recommendation, OR=0.98, C.I.=0.34–2.81; use in future, OR=1.45, C.I.=0.49–4.27). ConclusionsThe systematic application of theory, evidence, web-design expertise, and user-testing has resulted in a website that shows sufficiently promising efficacy and usability to warrant evaluation in a RCT. The website appears to be similarly effective and acceptable to users across the social spectrum.

Development of StopAdvisor: A theory-based interactive internet-based smoking cessation intervention.

Reviews of internet-based behaviour-change interventions have shown that they can be effective but there is considerable heterogeneity and effect sizes are generally small. In order to advance science and technology in this area, it is essential to be able to build on principles and evidence of behaviour change in an incremental manner. We report the development of an interactive smoking cessation website, StopAdvisor, designed to be attractive and effective across the social spectrum. It was informed by a broad motivational theory (PRIME), empirical evidence, web-design expertise, and user-testing. The intervention was developed using an open-source web-development platform, 'LifeGuide', designed to facilitate optimisation and collaboration. We identified 19 theoretical propositions, 33 evidence- or theory-based behaviour change techniques, 26 web-design principles and nine principles from user-testing. These were synthesised to create the website, 'StopAdvisor' (see http://www.lifeguideonline.org/player/play/stopadvisordemonstration). The systematic and transparent application of theory, evidence, web-design expertise and user-testing within an open-source development platform can provide a basis for multi-phase optimisation contributing to an 'incremental technology' of behaviour change.

Interpreting the Outcomes of Automated Internet-Based Randomized Trials: Example of an International Smoking Cessation Study

BackgroundSmoking is one of the largest contributors to the global burden of disease. Internet interventions have been shown to reduce smoking rates successfully. However, improved methods of evaluating effectiveness need to be developed for large-scale Internet intervention trials.ObjectiveTo illustrate a method to interpret outcomes of large-scale, fully automated, worldwide Internet intervention trials.MethodsA fully automated, international, Internet-based smoking cessation randomized controlled trial was conducted in Spanish and English, with 16,430 smokers from 165 countries. The randomized controlled trial replicated a published efficacy trial in which, to reduce follow-up attrition, 1000 smokers were followed up by phone if they did not provide online follow-up data.ResultsThe 7-day self-reported abstinence rates ranged from 36.18% (2239/6189) at 1 month to 41.34% (1361/3292) at 12 months based on observed data. Given high rates of attrition in this fully automated trial, when participants unreachable at follow-up were presumed to be smoking, the abstinence rates ranged from 13.63% (2239/16.430) at 1 month to 8.28% (1361/16,430) at 12 months. We address the problem of interpreting results with high follow-up attrition rates and propose a solution based on a smaller study with intensive phone follow-up.ConclusionsInternet-based smoking cessation interventions can help large numbers of smokers quit. Large-scale international outcome studies can be successfully implemented using automated Internet sites. Interpretation of the studies’ results can be aided by extrapolating from results obtained from subsamples that are followed up by phone or similar cohort maintenance methods.Trial RegistrationClinicalTrials.gov NCT00721786; http://clinicaltrials.gov/ct2/show/NCT00721786 (Archived by WebCite at http://www.webcitation.org/63mhoXYPw)

Effect of Tailoring in an Internet-Based Intervention for Smoking Cessation: Randomized Controlled Trial

BackgroundStudies suggest that tailored materials are superior to nontailored materials in supporting health behavioral change. Several trials on tailored Internet-based interventions for smoking cessation have shown good effects. There have, however, been few attempts to isolate the effect of the tailoring component of an Internet-based intervention for smoking cessation and to compare it with the effectiveness of the other components.ObjectiveThe study aim was to isolate the effect of tailored emails in an Internet-based intervention for smoking cessation by comparing two versions of the intervention, with and without tailored content.MethodsWe conducted a two-arm, randomized controlled trial of the open and free Norwegian 12-month follow-up, fully automated Internet-based intervention for smoking cessation, slutta.no. We collected information online on demographics, smoking, self-efficacy, use of the website, and participant evaluation at enrollment and subsequently at 1, 3, and 12 months. Altogether, 2298 self-selected participants aged 16 years or older registered at the website between August 15, 2006 and December 7, 2007 and were randomly assigned to either a multicomponent, nontailored Internet-based intervention for smoking cessation (control) or a version of the same Internet-based intervention with tailored content delivered on the website and via email.ResultsOf the randomly assigned participants, 116 (of 419, response rate = 27.7%) in the intervention group and 128 (of 428, response rate = 29.9%) in the control group had participated over the 12 months and responded at the end of follow-up. The 7-day intention-to-treat abstinence rate at 1 month was 15.2% (149/982) among those receiving the tailored intervention, compared with 9.4% (94/999) among those who received the nontailored intervention (P < .001). The corresponding figures at 3 months were 13.5% (122/902) and 9.4% (84/896, P =.006) and at 12 months were 11.2% (47/419) and 11.7% (50/428, P = .91). Likewise, the intervention group had higher self-efficacy and perceived tailoring at 1 and 3 months. Self-efficacy was found to partially mediate the effect of the intervention.ConclusionTailoring an Internet-based intervention for smoking cessation seems to increase the success rates in the short term, but not in the long term.

Internet-based interventions for smoking cessation

Internet-based interventions for smoking cessation

If It Is As Simple As AAAAA B C, Why Don’t We Do It?

In 2000, the U.S. Public Health Service released a clinical practice guideline for promoting smoking cessation that called on health care providers to follow a 5-A protocol: Ask about smoking at every visit; Advise all tobacco users to quit; Assess willingness to make a quit attempt; Assist the patient in quitting (i.e., helping set a quit date, referring to a special program, and prescribing pharmacotherapy tailored to their addiction level and habits); and Arrange a follow-up contact within one week after quit date to provide further assistance.1 The updated 2008 guideline confirmed the effectiveness of treatments and highlighted the importance of the healthcare system in the success of tobacco treatment strategies.2 Although the majority of smokers are identified at clinic visits and report receiving advice during these visits, effective smoking cessation assistance such as counseling and pharmacotherapy are generally underutilized.3 There is much room for improvement to increase the reach of existing evidenced-based smoking cessation practices. In the current issue of JGIM, Quinn et al. present findings from HMOs Investigating Tobacco (HIT) study conducted within the National Cancer Institute-funded Cancer Research Network.4 More than 4,000 smokers were identified from nine HMOs. A 12-month follow-up survey (65% response rate), among smokers who had a primary care visit, assessed smoking status and report of tobacco treatments offered by their provider. Smokers were more often offered Advice (77%) than Assist (33-41%) and Arrange (13%). At follow-up, 9% were abstinent for 30 days or longer. Smokers who used classes/counseling or pharmacotherapy (Assist) were twice as likely to quit compared with smokers not using these services. The major strength of these findings is documenting the utilization and effectiveness of the 5-A model in a non-research setting. Unfortunately, these results are based on reports from patients (collected 1999-2001) and do not reflect the perspective of clinicians or notations from the medical record. If it is as simple as AAAAA B C, why don’t we do it? The study by Quinn et al. highlights that smoking cessation treatment using the 5-A protocol relies, in part, on a provider’s willingness and time to Assist and Arrange which may explain why these treatments are not highly utilized in primary care.4 Next steps should include the implementation of standardized 5-A protocols that do not rely on physicians and can be administered by nursing or administrative staff. Modified 5-A protocols (shortcuts) have been proposed to achieve this goal. At check in, a patient could receive Ask, Advise, and Refer.5 This referral could involve a fax to a telephone quit line or an appointment for a nurse-based or pharmacy-based smoking cessation clinic. Quit lines are now available in all 50 States. This effective method of providing counseling increases the odds of smoking cessation by 60% compared to no counseling.2 Because the most successful treatments combine counseling and pharmacotherapy, standardized protocols for prescribing nicotine replacement therapies (available without prescription) could also be administered by non-physician staff. Another potential approach is Ask, Advise, and e-mail.6 A member of the health care team could send an e-mail to the patient with links to Internet-based smoking cessation programs or offer to provide ongoing e-mail support. Smoking cessation treatment may be particularly well suited to delivery via the Internet through on-line chat groups, bulletin boards, e-mail contacts with experts, individually tailored information and feedback regarding behavioral skills, problem solving training, and advice regarding medication usage.7 Initial evidence examining the Internet-based smoking cessation interventions have documented cessation rates ranging from 13% to 43%.8 The U.S. Surgeon General’s report “Reducing Tobacco Use” (http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2000/index.htm) concluded the lack of progress in tobacco control is attributable more to the failure to implement proven strategies than it is about what to do. Many practices have now developed systems to Ask and Advise. Since we know that successful interventions involve systematic processes using multiple members of the primary care team, and not just relying on the physician alone, more systems need to be developed to either shortcut or address Assess, Assist and Arrange.

Development of a Tailored, Internet-based Smoking Cessation Intervention for Adolescents

Computer-assisted interventions represent an innovative approach to adolescent smoking cessation that may offer advantages over traditional smoking interventions in their potential to provide adolescents with a variety of appropriate cessation-related activities, as well as interactive feedback tailored to their developmental, psychosocial, behavioral, and biological needs. As part of a larger project to evaluate the effectiveness of an Internet-based approach to smoking cessation among adolescents, this paper will describe the intervention development process. Stomp Out Smokes (S.O.S.), an Internet-based information and support system, was created to address the specific needs and experiences of adolescents who want to quit smoking. The development of S.O.S. involved an iterative process with five distinct yet often overlapping phases: Phase 1: review of the adolescent development, smoking cessation, and health literature; Phase 2: development and implementation of a needs assessment; Phase 3: construction of a site development strategy; Phase 4: development, review, and revision of content; and Phase 5: development of the website architecture and graphic design.