A Digital Smoking Cessation Program Delivered Through Internet and Cell Phone Without Nicotine Replacement (Happy Ending): Randomized Controlled Trial

Abstract

Background Happy Ending (HE) is an intense 1-year smoking cessation program delivered via the Internet and cell phone. HE consists of more than 400 contacts by email, Web pages, interactive voice response, and short message service technology. HE includes a craving helpline and a relapse prevention system, providing just-in-time therapy. All the components of the program are fully automated.Objective The objectives were to describe the rationale for the design of HE, to assess the 12-month efficacy of HE in a sample of smokers willing to attempt to quit without the use of nicotine replacement therapy, and to explore the potential effect of HE on coping planning and self-efficacy (prior to quitting) and whether coping planning and self-efficacy mediate treatment effect.Methods A two-arm randomized controlled trial was used. Subjects were recruited via Internet advertisements and randomly assigned to condition. Inclusion criteria were willingness to quit on a prescribed day without using nicotine replacement and being aged 18 years or older. The intervention group received HE, and the control group received a 44-page self-help booklet. Abstinence was defined as “not even a puff of smoke, for the last seven days” and was assessed by means of Internet surveys or telephone interviews 1, 3, 6, and 12 months postcessation. The main outcome was repeated point abstinence (ie, abstinence at all four time points). Coping planning and self-efficacy were measured at baseline and at the end of the preparation phase (ie, after 2 weeks of treatment, but prior to cessation day).ResultsA total of 290 participants received either the HE intervention (n=144) or the control booklet (n=146). Using intent-to-treat analysis, participants in the intervention group reported clinically and statistically significantly higher repeated point abstinence rates than control participants (20% versus 7%, odds ratio [OR] = 3.43, 95% CI = 1.60-7.34, P = .002). Although no differences were observed at baseline, by the end of the preparation phase, significantly higher levels of coping planning (t 261 = 3.07, P = .002) and precessation self-efficacy (t 261 = 2.63, P = .01) were observed in the intervention group compared with the control group. However, neither coping planning nor self-efficacy mediated long-term treatment effect. For point abstinence 1 month after quitting, however, coping planning and self-efficacy showed a partial mediation of the treatment effect.Conclusions This 12-month trial documents a long-term treatment effect of a fully automated smoking cessation intervention without the use of nicotine replacement therapy. The study adds to the promise of using digital media in supporting behavior change.

A systematic review of Internet-based therapy for the treatment of addictions

“…Five studies were randomized trials that compared two interventions, one of which was intended to act as an active control (Abroms, Windsor, & Simons-Morton, 2008;Brendryen, Drozd, & Kraft, 2008;Japuntich et al, 2006;King et al, 2009;Mermelstein & Turner, 2006). Two studies included treatment users who selfselected to participate in a research evaluation with no comparison or control group (Hotta et al, 2007;Zbikowski, Hapgood, Smucker Barnwell, & McAfee, 2008).…”

“…The majority of the studies evaluated programs specifically for tobacco cessation (Abroms et al, 2008;Brendryen et al, 2008;Japuntich et al, 2006;Hotta et al, 2007;Mermelstein & Turner, 2006;Woodruff et al, 2007;Zbikowski et al, 2008), with one study examining Internet treatment for problem and pathological gamblers (Carlbring & Smit, 2008) and one for substance abuse (King et al, 2009). The target population was primarily treatment-seeking adults, although three papers evaluated programs developed specifically for adolescents or young adults (Abroms et al, 2008;Mermelstein & Turner, 2006;Woodruff et al, 2007) and one targeted university employees (Hotta et al, 2007).…”

“…CBT was the most commonly reported interventions with four programs claiming its use (Abroms et al, 2008;Brendryen et al, 2008;Carlbring & Smit, 2008;Japuntich et al, 2006). Four programs provided direct contact with therapists for support and encouragement via telephone (Brendryen et al, 2008;Carlbring & Smit, 2008;Mermelstein & Turner, 2006) or email (Abroms et al, 2008) exchange.…”

“…CBT was the most commonly reported interventions with four programs claiming its use (Abroms et al, 2008;Brendryen et al, 2008;Carlbring & Smit, 2008;Japuntich et al, 2006). Four programs provided direct contact with therapists for support and encouragement via telephone (Brendryen et al, 2008;Carlbring & Smit, 2008;Mermelstein & Turner, 2006) or email (Abroms et al, 2008) exchange. Five interventions facilitated peer-based social support by enabling contact between treatment participants through discussion forums (Japuntich et al, 2006;Zbikowski et al, 2008), emails (Hotta et al, 2007) or group therapy sessions (King et al, 2009;Woodruff et al, 2007).…”

Is it cost‐effective to provide internet‐based interventions to complement the current provision of smoking cessation services in the Netherlands? An analysis based on the EQUIPTMOD

“…A Cochrane review, however, showed inconsistent results 10. Recently, internet‐based interventions have been shown to be effective for smoking cessation 15, 16. Many effective internet‐based interventions in the Netherlands were individually computer‐tailored interventions, where health messages are tailored to input provided by the smokers via questionnaires 10, 15, 17.…”