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

Abstract

Introduction: This study examined mediators and moderators of short-term treatment effectiveness from the iQUITT Study (Quit Using Internet and Telephone Treatment), a 3-arm randomized trial that compared an interactive smoking cessation Web site with an online social network (enhanced Internet) alone and in conjunction with proactive telephone counseling (enhanced Internet plus phone) to a static Internet comparison condition (basic Internet). Methods: The analytic sample was N = 1,236 participants with complete 3-month data on all mediating variables. The primary outcome was 30-day point prevalence abstinence (ppa) at 3 months. Recognizing the importance of temporal precedence in mediation analyses, we also present findings for 6-month outcomes. Purported mediators were treatment utilization and changes in psychosocial constructs. Proposed moderators included baseline demographic, smoking, and psychosocial variables. Mediation analyses examined the extent to which between-arm differences in 30-day ppa could be attributed to differential Web site utilization, telephone counseling, and associated changes in smoking self-efficacy and social support for quitting. Effect modification analyses fitted interactions between treatment and prespecified moderators on abstinence. Results: Significant mediators of 30-day ppa were changes in smoking temptations, quitting confidence, and positive and negative partner support, which were strongly associated with increased Web site utilization. The addition of telephone counseling to an enhanced Web site further improved abstinence rates, partly via an association with increased quitting confidence. Baseline smoking rate was the only significant moderator. Conclusions: Increased treatment utilization and associated changes in several psychosocial measures yielded higher abstinence rates. Findings validate the importance of treatment utilization, smoking self-efficacy, and social support to promote abstinence.

How do text‐messaging smoking cessation interventions confer benefit? A multiple mediation analysis of Text2Quit

“…Increasing smokers’ confidence in their ability to quit was the best mediator. This finding is in line with research on telephone counseling and cellphone interventions that have highlighted the importance of self‐efficacy in achieving abstinence . It extends existing evidence by showing that self‐efficacy plays a key role in text‐messaging interventions, and that utilization of outside resources was not important as a meditational pathway, with the possible exception of the use of medications.…”

“…The clear result of psychosocial processes playing a key role in conferring the benefit of Text2Quit notwithstanding, much of the variance remains unexplained, similar to other studies of treatment mechanisms underlying smoking cessation . With 65% of the effect still unaccounted for, there are still other ways in which text‐messaging confers benefit.…”

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

“…Abstinence results at 3 months favored the combined web and phone counseling condition although between-group differences did not emerge at 6 months follow-up. Moreover, in a study having relevance to the current research, Graham et al (Cobb & Graham, 2014; Cobb, Niaura, Donaldson, & Graham, 2014; Graham et al, 2013; Graham et al, 2011; Graham et al, 2014) have described results for the iQUITT study, a large smoking cessation RCT, that found a combination of Enhanced Web (interactive plus large social network) and Quitline outperformed both a Basic Web (static text webpages) and the Enhanced Web intervention.…”

Toward precision smoking cessation treatment II: Proximal effects of smoking cessation intervention components on putative mechanisms of action

“…Pharmacotherapies appear to enhance long-term abstinence primarily by suppressing withdrawal symptoms, especially craving (e.g., Bolt et al, 2012; Ferguson et al, 2006; Lerman et al, 2002), but other mechanisms may also be implicated (McCarthy et al, 2008; Piper et al, 2008). Research on counseling treatment has fairly consistently supported self-efficacy as a mediator of counseling effects (Graham et al, 2015; Hendricks et al, 2010; McCarthy et al, 2010; Schuck et al, 2014). However, only isolated findings support the roles of other putative mediators: decreased expectations of smoking reward (Schuck et al, 2014), greater avoidance of smoking cues (McCarthy et al, 2010; McCarthy et al, 2008; Schuck et al, 2014), increased perceived partner support (Graham et al, 2015), and reduced guilt and demoralization following repeated lapses (McCarthy et al, 2010).…”

“…Research on counseling treatment has fairly consistently supported self-efficacy as a mediator of counseling effects (Graham et al, 2015; Hendricks et al, 2010; McCarthy et al, 2010; Schuck et al, 2014). However, only isolated findings support the roles of other putative mediators: decreased expectations of smoking reward (Schuck et al, 2014), greater avoidance of smoking cues (McCarthy et al, 2010; McCarthy et al, 2008; Schuck et al, 2014), increased perceived partner support (Graham et al, 2015), and reduced guilt and demoralization following repeated lapses (McCarthy et al, 2010). This inconsistency may be due to variation in counseling interventions in these studies (e.g., lengths and types of treatment, control conditions, routes of counseling delivery).…”