Online support for smoking cessation: a systematic review of the literature

Abstract

Aim To examine the efficacy and acceptability of online, interactive interventions for smoking cessation and to identify treatment effect moderators and mediators. Methods A systematic review and meta-analysis of the literature (1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008) was conducted, finding 11 relevant randomized controlled trials. Data were extracted and risk ratios and risk differences estimated with a random effects model. Results There was no evidence of publication bias. Included trials were of variable methodological quality. Web-based, tailored, interactive smoking cessation interventions were effective compared with untailored booklet or e-mail interventions [rate ratio (RR) 1.8; 95% confidence interval (CI) 1.4-2.3] increasing 6-month abstinence by 17% (95% CI 12-21%). No overall effect of interactive compared with static web-based interventions was detected but there was significant heterogeneity, with one study obtaining a clear effect and another failing to find one. Few moderating or mediating factors were evaluated in studies and those that were had little effect. Pooled results suggest that only interventions aimed at smokers motivated to quit were effective (RR 1.3, 95% CI 1.0-1.7). Fully automated interventions increased smoking cessation rates (RR 1.4, 95% CI 1.0-2.0), but evidence was less clear-cut for non-automated interventions. Overall, the web-based interventions evaluated were considered to be acceptable and user satisfaction was generally high. Conclusion Interactive, web-based interventions for smoking cessation can be effective in aiding cessation. More research is needed to evaluate the relative efficacy of interactive web-based interventions compared with static websites.

A randomised controlled trial of a theory-based interactive internet-based smoking cessation intervention (‘StopAdvisor’): Study protocol

“…In that case, results might be biased by the use of an intention to treat analysis that assumes those lost to follow-up are smoking. However, trials of internet-based smoking cessations interventions have actually shown that control conditions involving less engagement do not typically result in lower follow-up rates (Shahab & McEwen, 2009). Furthermore, the current trial will use evidence-based follow-up methods that resulted in similarly low attrition between two conditions in spite of a considerable difference in treatment intensity and engagement (Edwards, et al, 2002;Free, et al, 2011).…”

“…As recommended by the Russell Standard, this potential bias will be addressed by using an intention to treat analysis, in which smokers lost to follow-up will be counted as continuing smokers. Of the studies included in a recent meta-analysis of internetbased smoking cessation interventions the rate of loss to follow-up varied substantially; the range was 6% to 61% at approximately 6-months following enrolment (Shahab & McEwen, 2009). Since the present study uses evidence-based methods for enhancing response rates, it is assumed that the figure will be toward the lower end of this range and estimated to be no more than 20%.…”

“…The potential effectiveness of internet-based smoking cessation interventions has been the subject of three recent meta-analyses (Civljak, Sheikh, Stead Lindsay, & Car, 2010;Myung, McDonnell, Kazinets, Seo, & Moskowitz, 2009;Shahab & McEwen, 2009). These all reported significant efficacy overall but also considerable heterogeneity between the different interventions.…”

Web-Based Study for Improving Mammography Among Korean American Women

“…Web-based interventions were used for improving specific behaviors such as smoking [15], alcohol consumption [16], sexual behavior [17], physical activity [18], and dietary behavior [19]. There have been relatively few studies using a Web-based intervention to promote cancer screenings.…”

Efficacy of an internet program for smoking cessation during and after inpatient rehabilitation treatment: a quasi-randomized controlled trial

“…So far, the effectiveness of Internet smoking cessation programs was tested primarily in smokers with an intention to quit smoking and in younger samples of smokers in the age range of 20-40 years (Shahab & McEwen, 2009). However, in recent years, Internet use has particularly increased in older people.…”