To significantly reduce smoking prevalence, treatments must balance reach, efficacy, and cost. The Internet can reach millions of smokers cost-effectively. Many cessation Web sites exist, but few have been evaluated. As a result, the potential impact of the Internet on smoking prevalence remains unknown. The present study reports the results, challenges, and limitations of a preliminary, largescale evaluation of a broadly disseminated smoking cessation Web site used worldwide (QuitNet). Consecutive registrants (N=1,501) were surveyed 3 months after they registered on the Web site to assess 7-day point prevalence abstinence. Results must be interpreted cautiously because this is an uncontrolled study with a 25.6% response rate. Approximately 30% of those surveyed indicated they had already quit smoking at registration. Excluding these participants, an intention-to-treat analysis yielded 7% point prevalence abstinence (for the responders only, abstinence was 30%). A range of plausible cessation outcomes (9.8%-13.1%) among various subgroups is presented to illustrate the strengths and limitations of conducting Web-based evaluations, and the tensions between clinical and dissemination research methods. Process-to-outcome analyses indicated that sustained use of QuitNet, especially the use of social support, was associated with more than three times greater point prevalence abstinence and more than four times greater continuous abstinence. Despite its limitations, the present study provides useful information about the potential efficacy, challenging design and methodological issues, process-to-outcome mechanisms of action, and potential public health impact of Internet-based behavior change programs for smoking cessation.

Objectives We evaluated the social network structure of QuitNet, one of the largest online communities for behavior change, and compared its characteristics to other known social networks. Methods Using modern network analysis methods, we identified QuitNet members who were active during a 60-day period, along with their ties. We then derived multiple subgroups, such as key players and integrators, from connections and communication patterns. Results Among 7569 participants, we identified 103592 connections to other members. Metrics of social network integration were associated with increased likelihood of being female, being older, having been in the system longer, and not smoking. Conclusions The QuitNet community is a large-scale social network with the characteristics required for sustainability of social support and social influence to promote smoking cessation and abstinence. These characteristics include persistence of members over time, heterogeneity of smoking status, and evidence of rich, bidirectional communications. Some of the influential subgroups we identified may provide targets for future network-level interventions.

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BACKGROUND This study aimed to determine the relative effect of Internet and Internet plus telephone treatment for smoking cessation on smoking abstinence among US adults. A priori hypotheses were that Internet enhanced with tailored content and social support would outperform basic Internet (BI) and that enhanced Internet (EI) plus proactive telephone counseling would outperform the other conditions. METHODS The Quit Using Internet and Telephone Treatment (iQUITT) study used a 3-group randomized controlled design comparing BI, EI, and EI and telephone combined (EI+P). The trial was conducted from March 8, 2005, through November 30, 2008. Current adult smokers in the United States who smoked 5 or more cigarettes per day were recruited via search engines. Characteristics of the 2005 participants include mean (SD) age of 35.9 (10.8) years, 51.1% women, and 86.5% white. The follow-up assessment rate at 18 months was 68.2%. The main outcome measure was 30-day point prevalence abstinence measured at 3, 6, 12, and 18 months after randomization using intent-to-treat analysis. RESULTS At 18 months, the 30-day multiple point prevalence abstinence rate across all follow-up intervals was 3.5% (BI), 4.5% (EI), and 7.7% (EI+P), with EI+P significantly outperforming BI and EI. At 18 months, 30-day single point prevalence abstinence rates were 19.0% (BI), 17.4% (EI), and 19.6% (EI+P) and did not differ among the groups. CONCLUSIONS Combined internet and telephone treatment outperforms static and dynamic Internet interventions. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT00282009

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BackgroundThe benefits of physical activity are well documented, but scalable programs to promote activity are needed. Interventions that assign tailored and dynamically adjusting goals could effect significant increases in physical activity but have not yet been implemented at scale.ObjectiveOur aim was to examine the effectiveness of an open access, Internet-based walking program that assigns daily step goals tailored to each participant.MethodsA two-arm, pragmatic randomized controlled trial compared the intervention to no treatment. Participants were recruited from a workplace setting and randomized to a no-treatment control (n=133) or to treatment (n=132). Treatment participants received a free wireless activity tracker and enrolled in the walking program, Walkadoo. Assessments were fully automated: activity tracker recorded primary outcomes (steps) without intervention by the participant or investigators. The two arms were compared on change in steps per day from baseline to follow-up (after 6 weeks of treatment) using a two-tailed independent samples t test.ResultsParticipants (N=265) were 66.0% (175/265) female with an average age of 39.9 years. Over half of the participants (142/265, 53.6%) were sedentary (<5000 steps/day) and 44.9% (119/265) were low to somewhat active (5000-9999 steps/day). The intervention group significantly increased their steps by 970 steps/day over control (P<.001), with treatment effects observed in sedentary (P=.04) and low-to-somewhat active (P=.004) participants alike.ConclusionsThe program is effective in increasing daily steps. Participants benefited from the program regardless of their initial activity level. A tailored, adaptive approach using wireless activity trackers is realistically implementable and scalable.Trial RegistrationClinicaltrials.gov NCT02229409, https://clinicaltrials.gov/ct2/show/NCT02229409 (Archived by WebCite at http://www.webcitation.org/6eiWCvBYe)

BackgroundWeb-based smoking cessation interventions can have a public health impact because they are both effective in promoting cessation and can reach large numbers of smokers in a cost-efficient manner. Their potential impact, however, has not been realized. It is still unclear how such interventions promote cessation, who benefits most, and how to improve their population impact.ObjectiveTo examine the effectiveness of a highly promoted Web-based smoking cessation intervention to promote quit behavior over time, identify the most effective features, and understand who is most likely to use those features by using unweighted and weighted analyses to estimate the impact in the broader pool of registered site users.MethodsA sample of 1033 new adult registrants was recruited from a Web-based smoking cessation intervention by using an automated study management system. Abstinence was assessed by self-report through a mixed-mode follow-up (online survey with telephone follow-up for nonrespondents) at 1, 3, and 6 months. Software tracked respondents’ online activity. Generalized estimating equations (GEE) were used to examine predictors of website utilization and how utilization promoted abstinence using unweighted and weighted data.ResultsThe 7-day point prevalence abstinence rates at 6 months ranged from 20.68% to 11.13% in the responder and intent-to-treat samples, respectively. Predictors of abstinence in unweighted analyses included number of visits to the website as well as accessing specific interactive or engaging features. In weighted analyses, only number of visits was predictive of abstinence. Motivation to quit was a key predictor of website utilization, whereas negative partner support decreased the likelihood of increasing visits or accessing engaging features.ConclusionsEngagement is critical to promoting smoking cessation. The next generation of Web-based smoking cessation interventions needs to maximize the initial engagement of all new visitors and work to retain those smokers who proceed to register on the site.

BackgroundSmoking remains one of the most pressing public health problems in the United States and internationally. The concurrent evolution of the Internet, social network science, and online communities offers a potential target for high-yield interventions capable of shifting population-level smoking rates and substantially improving public health.ObjectiveOur objective was to convene leading practitioners in relevant disciplines to develop the core of a strategic research agenda on online social networks and their use for smoking cessation, with implications for other health behaviors.MethodsWe conducted a 100-person, 2-day, multidisciplinary workshop in Washington, DC, USA. Participants worked in small groups to formulate research questions that could move the field forward. Discussions and resulting questions were synthesized by the workshop planning committee.ResultsWe considered 34 questions in four categories (advancing theory, understanding fundamental mechanisms, intervention approaches, and evaluation) to be the most pressing.ConclusionsOnline social networks might facilitate smoking cessation in several ways. Identifying new theories, translating these into functional interventions, and evaluating the results will require a concerted transdisciplinary effort. This report presents a series of research questions to assist researchers, developers, and funders in the process of efficiently moving this field forward.