Objective: Web-based smoking cessation interventions have high reach, but low effectiveness. To address this problem, we conducted a pilot randomized controlled trial of the first web-based acceptance and commitment therapy (ACT) intervention for smoking cessation. The aims were to determine design feasibility, user receptivity, effect on 30-day point prevalence quit rate at 3 months post-randomization, and mediation by ACT theory-based processes of acceptance.Methods: Adult participants were recruited nationally into the double-blind randomized controlled pilot trial (N = 222), which compared web-based ACT for smoking cessation (WebQuit.org) with the National Cancer Institute's Smokefree.gov-the U.S. national standard for web-based smoking cessation interventions.results: We recruited 222 participants in 10 weeks. Participants spent significantly longer on the ACT WebQuit.org site per login (18.98 vs. 10.72 min; p = .001) and were more satisfied with the site (74% vs. 42%; p =.002). Using available follow-up data, more than double the fraction of participants in the ACT WebQuit.org arm had quit smoking at the 3-month follow-up (23% vs. 10%; OR = 3.05; 95% CI = 1.01-9.32; p = .050). Eighty percent of this effect was mediated by ACT theory-based increases in total acceptance of physical, cognitive, and emotional cues to smoke (p < .001). Conclusions:The trial design was feasible. Compared with Smokefree.gov, ACT had higher user receptivity and short-term cessation, and strong evidence of theory-based mechanisms of change. While results were promising, they were limited by the pilot design (e.g., limited follow-up), and thus a full-scale efficacy trial is now being conducted.

Web-based behavioral interventions for substance use are being developed at a rapid pace, yet there is a dearth of information regarding the most effective methods for recruiting participants into web-based intervention trials. In this paper, we describe our successful recruitment of participants into a pilot trial of web-based Acceptance and Commitment Therapy (ACT) for smoking cessation and compare traditional and web-based methods of recruitment in terms of their effects on baseline participant characteristics, association with study retention and treatment outcome, yield, and cost-effectiveness. Over a 10-week period starting June 15, 2010, we recruited 222 smokers for a web-based smoking cessation study using a variety of recruitment methods. The largest portion of randomized participants were recruited through Google AdWords (36%), followed by medical Internet media (23%), standard media (14%), word of mouth (12%), broadcast emails (11%), and social media (6%). Recruitment source was not related to baseline participant characteristics, 3-month data retention, or 30-day point prevalence smoking abstinence at the 3-month outcome assessment. Cost per randomized participant ranged from $5.27/participant for word of mouth to $172.76/participant for social media, with a mean cost of $42.48/participant. Our diversified approach to recruitment, including both traditional and web-based methods, enabled timely enrollment of participants into the study. Because there was no evidence of a substantive difference in baseline characteristics, retention, or outcomes based on recruitment channel, the yield and cost-effectiveness of recruitment methods may be the more critical considerations in developing a feasible recruitment plan for a web-based smoking cessation intervention study.

Objective Smokers with depressive symptoms have more difficulty quitting smoking than the general population of smokers. The present study examines a web-based treatment using Acceptance and Commitment Therapy (ACT) for smokers with depressive symptoms. The study aimed to determine participant receptivity to the intervention and its effects on smoking cessation, acceptance of internal cues, and depressive symptoms. Methods Smokers who screened positive for depressive symptoms at baseline (n = 94) were selected from a randomized controlled trial (N = 222) comparing web-based ACT for smoking cessation (Webquit.org) with Smokefree.gov. Forty-five participants (48%) completed the three-month follow-up. Results Compared to Smokefree.gov, WebQuit participants spent significantly more time on site (p = 0.001) and had higher acceptance of physical cravings (p = 0.033). While not significant, WebQuit participants were more engaged and satisfied with their program and were more accepting of internal cues overall. There was preliminary evidence that WebQuit participants had higher quit rates (20% vs. 12%) and lower depressive symptoms at follow-up (45% vs. 56%) than those in Smokefree.gov. Conclusions This was the first study of web-based ACT for smoking cessation among smokers with depressive symptoms, with promising evidence of receptivity, efficacy, impact on a theory-based change process, and possible secondary effects on depression. A fully powered trial of the ACT Webquit.org intervention specifically for depressed smokers is needed. This was part of a clinical trial registered as NCT#01166334, at www.clinicaltrials.gov.

A sizable gap exists between the availability of evidence-based psychological treatments and the number of community therapists capable of delivering such treatments. Limited time, resources, and access to experts prompt the need for easily disseminable, lower cost options for therapist training and continued support beyond initial training. A pilot randomized trial tested scalable extended support models for therapists following initial training. Thirty-five postdegree professionals (43%) or graduate trainees (57%) from diverse disciplines viewed an initial web-based training in cognitive-behavioral therapy (CBT) for youth anxiety and then were randomly assigned to 10 weeks of expert streaming (ES; viewing weekly online supervision sessions of an expert providing consultation), peer consultation (PC; non-expert-led group discussions of CBT), or fact sheet self-study (FS; weekly review of instructional fact sheets). In initial expectations, trainees rated PC as more appropriate and useful to meet its goals than either ES or FS. At post, all support programs were rated as equally satisfactory and useful for therapists' work, and comparable in increasing self-reported use of CBT strategies (b = .19, p = .02). In contrast, negative linear trends were found on a knowledge quiz (b = -1.23, p = .01) and self-reported beliefs about knowledge (b = -1.50, p < .001) and skill (b = -1.15, p < .001). Attrition and poor attendance presented a moderate concern for PC, and ES was rated as having the lowest implementation potential. Preliminary findings encourage further development of low-cost, scalable options for continued support of evidence-based training.

Objective-This study investigated to what extent the prospective relationship between parental smoking cessation and child daily smoking is mediated by child cognitions about smoking. Design-The Main Outcome Measures-Smoking status at twelfth grade.Results-Negative general attitudes toward smoking, attitude that cigarette smoke is bothersome, and tobacco refusal self-efficacy together significantly mediated 49% of the prospective relationship between parental smoking cessation and child daily smoking.Conclusion-Parental smoking cessation before children reach third grade may lead children to develop more negative cognitions about smoking which, in turn, reduce their risk of smoking.