Comparing Internet Assistance for Smoking Cessation: 13-Month Follow-Up of a Six-Arm Randomized Controlled Trial

Abstract

Background Although many smokers seek Internet-based cessation assistance, few studies have experimentally evaluated long-term cessation rates among cigarette smokers who receive Internet assistance in quitting.Objective The purpose of this study is to describe long-term smoking cessation rates associated with 6 different Internet-based cessation services and the variation among them, to test the hypothesis that interactive and tailored Internet services yield higher long-term quit rates than more static Web-posted assistance, and to explore the possible effects of level of site utilization and a self-reported indicator of depression on long-term cessation rates.Method In 2004-05, a link was placed on the American Cancer Society (ACS) website for smokers who wanted help in quitting via the Internet. The link led smokers to the QuitLink study website, where they could answer eligibility questions, provide informed consent, and complete the baseline survey. Enrolled participants were randomly assigned to receive emailed access to one of five tailored interactive sites provided by cooperating research partners or to a targeted, minimally interactive ACS site with text, photographs, and graphics providing stage-based quitting advice and peer modeling.Results6451 of the visitors met eligibility requirements and completed consent procedures and the baseline survey. All of these smokers were randomly assigned to one of the six experimental groups. Follow-up surveys done online and via telephone interviews at approximately 13 months after randomization yielded 2468 respondents (38%) and found no significant overall quit rate differences among those assigned to the different websites (P = .15). At baseline, 1961 participants (30%) reported an indicator of depression. Post hoc analyses found that this group had significantly lower 13-month quit rates than those who did not report the indicator (all enrolled, 8% vs 12%, P < .001; followed only, 25% vs 31%, P = .003). When the 4490 participants (70%) who did not report an indicator of depression at baseline were separated for analysis, the more interactive, tailored sites, as a whole, were associated with higher quitting rates than the less interactive ACS site: 13% vs 10% (P = .04) among 4490 enrolled and 32% vs 26% (P = .06) among 1798 followed.Conclusions These findings show that Internet assistance is attractive and potentially cost-effective and suggest that tailored, interactive websites may help cigarette smokers who do not report an indicator of depression at baseline to quit and maintain cessation.

Use of Non-Assigned Interventions in a Randomized Trial of Internet and Telephone Treatment for Smoking Cessation

“…Also, it was not feasible to biochemically verify self-reported abstinence since this was a national sample recruited via the Internet. Self-reported abstinence is commonly accepted in web-based cessation trials (Leykin, Aguilera, Torres, Pérez-Stable, & Muñoz, 2012;Rabius, Pike, Wiatrek, & McAlister, 2008;Strecher et al, 2008;Wangberg, Nilsen, Antypas, & Gram, 2011;Zbikowski, Hapgood, Smucker Barnwell, & McAfee, 2008) where misreporting of abstinence is expected to be minimal (SRNT Subcommittee on Biochemical Verification, 2002).…”

Integrating Positive and Clinical Psychology: Viewing Human Functioning as Continua from Positive to Negative Can Benefit Clinical Assessment, Interventions and Understandings of Resilience

“…However, research has found that therapies without client contact are at risk of high levels of drop-out (Christensen, Griffiths, Mackinnon, & Brittliffe, 2006;Farvolden, Denisoff, Selby, Bagby, & Rudy, 2005;Rabius, Pike, Wiatrek & McAlister, 2008). It is to this issue that Hyland's (2010a, 2010b) finding that people are less likely to drop out of a gratitude technique than one from classical clinical psychology becomes important.…”

Internet and Telephone Treatment for Smoking Cessation: Mediators and Moderators of Short-Term Abstinence

“…Self-reported smoking status is a commonly accepted outcome measure in Internet cessation trials, 12,[22][23][24][25][26][27] where biochemical verification of abstinence is not feasible and misreporting of abstinence is expected to be minimal given low demand characteristics.…”

“…10 Smoking variables that have emerged as moderators in web-based studies include baseline smoking rate, 11 the presence of a tobacco-related illness, 5 nonsmoking children in the household, 5 and intention to stop smoking. 10 Psychosocial moderators that have emerged in other studies include depressive symptoms, 12 a history of major depressive episodes, 13 and frequent alcohol consumption. 5 We sought to build on the limited evidence in this area by examining theory-driven mediators and moderators of treatment effectiveness in The iQUITT Study (Quit Using Internet and Telephone Treatment), a randomized controlled trial of Internet and telephone treatment for smoking cessation.…”