Initial evaluation of a real‐world Internet smoking cessation system

Abstract

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.

Smoking cessation: Next steps for special populations research and innovative treatments.

“…E-Health, including web-based interventions and e-mail, are channels of intervention that have the potential to reach many smokers without sacrificing the ability to tailor feedback or treatment recommendations (Cobb, Graham, Bock, Papandonatos, & Abrams, 2005;Riley, Obermayer, & Mary-Jean, 2008). Researchers can use computer algorithms, online coaching, and proactive e-mail prompts to tailor treatment, or users can self-tailor by the use of chat rooms and selective browsing.…”

The feasibility of online genetic testing for lung cancer susceptibility: uptake of a web-based protocol and decision outcomes

“…3 However, a challenge for integrating such testing into smoking cessation or other behavior change interventions is that most of these interventions are self-directed, low intensity, and obliged to be low in cost to maximize dissemination. 4 Before any such integration, the feasibility of offering genetic susceptibility testing and conveying risk feedback, via alternate, user-friendly, self-directed delivery models, such as the Internet, must be assessed. 5 To our knowledge, no studies to date have offered genetic susceptibility testing using solely a web-based format.…”

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

“…Analyses were guided by our theoretical model (Figure 1), derived primarily from Social Cognitive Theory, 16 models of social support and social networks in cessation, 17 and prior empirical findings. 18,19 A priori mediator hypotheses were that Web site utilization would be higher in EI and EI + P compared with BI, and that Web site utilization would mediate the links between treatment and outcome. Similarly, we hypothesized that increases in smoking self-efficacy and positive support for quitting (i.e., encouraging, congratulating) and decreases in negative support for quitting (i.e., nagging, criticizing) would be greater in EI and EI + P compared with BI given the availability of more extensive information and support through the online social network and telephone counselors, and would reach their highest levels in EI + P given the combined intervention approach.…”