Online tobacco websites and online communities—who uses them and do users quit smoking? The quit-primo and national dental practice-based research network Hi-Quit studies

Abstract

Online tobacco cessation communities are beneficial but underused. Our study examined whether, among smokers participating in a web-assisted tobacco intervention (Decide2quit.org), specific characteristics were associated with navigating to BecomeAnEx.org, an online cessation community, and with subsequent quit rates. Among smokers (N = 759) registered with Decide2quit.org, we identified visitors to BecomeAnEx.org, examining associations between smoker characteristics and likelihood of visiting. We then tested for associations between visits and 6-month cessation (point prevalence). We also tested for an interaction between use of other online support-seeking (Decide2quit.org tobacco cessation coaches), visiting, and 6-month cessation. One quarter (26.0 %; n = 197) of the smokers visited BecomeAnEx.org; less than one tenth (7.5 %; n = 57) registered to participate in the online forum. Visitors were more likely to be female (73.0 vs. 62.6 % of non-visitors, P < 0.01) to have visited a cessation website before (33.0 vs. 17.4 %, P < 0.01) and to report quit attempts in the previous year (62.0 vs. 53.0 %, P = 0.03). In analyses of all participants, BecomeAnEx.org visiting was not associated with 6-month quit completion. Among participants who communicated with a coach, BecomeAnEx.org visiting also lacked a significant association with 6 month quit completion, although a non-significant trend toward quit completion in visitors was noted (OR 2.21, 95 % CI 0.81-3.1). Online cessation communities attract smokers with previous cessation website experience and recent quit attempts. Community visiting was not associated with quit rates in our study, but low use may have limited our power to detect differences. Further research should explore whether an additive effect can be achieved by offering community visitors support via online coaches.

The failure to increase social support: it just might be time to stop intervening (and start rigorously observing)

“…In 1986, Lichtenstein et al [ 1 ] presented the results of five studies focused on enhancing social support for smoking cessation in community-based clinic and worksite interventions. The manuscript was titled Social Support in Smoking Cessation: In Search of Effective Interventions , and its main conclusion was that “attempts to both increase social support and to enhance treatment effectiveness have not been successful.” Thirty years later, the paper by Cutrona et al [ 2 ] draws a similar conclusion from a study focused on providing social support through an online social network for smoking cessation. In reviewing these findings—and based on our knowledge of the extensive literature on social support interventions that has been published over the past 30+ years—we believe there is a need for a fundamental shift in research on social support.…”

“…Thirty years later, the paper by Cutrona et al ( Transl Behav Med . 6(4):546–57, 2016 ) draws a similar conclusion from a study focused on providing social support through an online social network for smoking cessation. In reviewing these findings - and based on our knowledge of the extensive literature on social support interventions that has been published over the past 30+ years - we believe there is a need for a fundamental shift in research on social support.…”

“…The study by Cutrona et al [ 2 ] attempted to leverage the availability of an existing, large online social network for smoking cessation to improve quit rates. Participants enrolled in the Decide2Quit.org smoking cessation website were offered the opportunity to visit and join the online community that is part of the BecomeAnEX.org smoking cessation website.…”

“…On its face, the approach that Cutrona et al [ 2 ] took in linking to an existing online social network makes good sense. It can take years to develop and nurture an online cessation social network until it reaches a point of maturity with a critical mass of active members [ 11 ].…”

“…For online communities, in particular, the technology needs to sit quietly in the background, seamlessly facilitating these social processes. The low click-through rates and even lower engagement rates reported in Cutrona et al [ 2 ] may have little to do with the online social network itself and more to do with the implementation approach. Qualitative research has a critical role to play in understanding the user experience related to the implementation of social support interventions and evaluation of their effectiveness.…”