Randomized controlled trial of the combined effects of Web and Quitline interventions for smokeless tobacco cessation

Abstract

Background Use of smokeless tobacco (moist snuff and chewing tobacco) is a significant public health problem but smokeless tobacco users have few resources to help them quit. Web programs and telephone-based programs (Quitlines) have been shown to be effective for smoking cessation. We evaluate the effectiveness of a Web program, a Quitline, and the combination of the two for smokeless users recruited via the Web. Objectives To test whether offering both a Web and Quitline intervention for smokeless tobacco users results in significantly better long-term tobacco abstinence outcomes than offering either intervention alone; to test whether the offer of Web or Quitline results in better outcome than a self-help manual only Control condition; and to report the usage and satisfaction of the interventions when offered alone or combined. Methods Smokeless tobacco users (N= 1,683) wanting to quit were recruited online and randomly offered one of four treatment conditions in a 2×2 design: Web Only, Quitline Only, Web + Quitline, and Control (printed self-help guide). Point-prevalence all tobacco abstinence was assessed at 3- and 6-months post enrollment. Results 69% of participants completed both the 3- and 6-month assessments. There was no significant additive or synergistic effect of combining the two interventions for Complete Case or the more rigorous Intent To Treat (ITT) analyses. Significant simple effects were detected, individually the interventions were more efficacious than the control in achieving repeated 7-day point prevalence all tobacco abstinence: Web (ITT, OR = 1.41, 95% CI = 1.03, 1.94, p = .033) and Quitline (ITT: OR = 1.54, 95% CI = 1.13, 2.11, p = .007). Participants were more likely to complete a Quitline call when offered only the Quitline intervention (OR = 0.71, 95% CI = .054, .093, p = .013), the number of website visits and duration did not differ when offered alone or in combination with Quitline. Rates of program helpfulness (p <.05) and satisfaction (p <.05) were higher for those offered both interventions versus offered only quitline. Conclusion Combining Web and Quitline interventions did not result in additive or synergistic effects, as have been found for smoking. Both interventions were more effective than a self-help control condition in helping motivated smokeless tobacco users quit tobacco. Intervention usage and satisfaction were related to the amount intervention content offered. Usage of the Quitline intervention decreased when offered in combination, though rates of helpfulness and recommendations were higher when offered in combination. Trial Registration Clinicaltrials.gov NCT00820495; http://clinicaltrials.gov/ct2/show/NCT00820495

Randomized controlled trial examining the adjunctive use of nicotine lozenges with MyLastDip: An eHealth smokeless tobacco cessation intervention

“…This level of assessment completion is consistent with the follow-up completion results reported for other Web-based smokeless tobacco cessation intervention RCTs Danaher et al, 2014;Severson et al, 2008) and somewhat higher than some smoking cessation studies (e.g., Bricker et al, 2013;McKay et al, 2008;Munoz et al, 2009;Smit, de Vries and Hoving, 2012) but lower than others (e.g., Graham et al, 2011).…”

“…They could be incorporated into stepped care tobacco cessation programs (Abrams et al, 1996) as well as an important option in established tobacco Quitline services (Abrams et al, 2010;Danaher et al, 2014;Graham et al, 2011). However, the cost of lozenges (their purchase price, shipping and handling costs) will need to be considered when deciding to use them as treatment adjuncts.…”

Online community use predicts abstinence in combined Internet/phone intervention for smoking cessation.

“…The combined Internet/phone arm outperformed the other two arms at the initial 3-month follow-up, roughly doubling the odds of abstinence, and maintained its advantage throughout the remaining 15-month of follow-up. In the smokeless tobacco trial, Danaher and colleagues (Danaher et al, 2015) randomized participants recruited online to Internet-only, Phone-only, Internet+Phone, or a self-help print control arm. ITT analyses showed that all three interventions outperformed the control, but that the combined Internet+Phone intervention did not outperform either the Internet-only or the Phone-only arms at both 3 and 6 months.…”

Long-term effects of smoking cessation support in primary care: results of a two-year longitudinal study in Brazil

“…Several studies point that there was a reduction of cigarette use in recent years after different government initiatives to decrease the prevalence of smokers [11][12][13] . According to a systematic review, group therapy is more effective than self-help to quit smoking, and nicotine replacement therapy doubles the chance of quitting 14 .…”