Phone and Web-Based Tobacco Cessation Treatment: Real-World Utilization Patterns and Outcomes for 11,000 Tobacco Users

Abstract

Background Phone-based tobacco cessation programs have been proven effective and widely adopted. Web-based solutions exist; however, the evidence base is not yet well established. Many cessation treatments are commercially available, but few integrate the phone and Web for delivery and no published studies exist for integrated programs.Objective This paper describes a comprehensive integrated phone/Web tobacco cessation program and the characteristics, experience, and outcomes of smokers enrolled in this program from a real-world evaluation.Methods We tracked program utilization (calls completed, Web log-ins), quit status, satisfaction, and demographics of 11,143 participants who enrolled in the Free & Clear Quit For Life Program between May 2006 and October 2007. All participants received up to five proactive phone counseling sessions with Quit Coaches, unlimited access to an interactive website, up to 20 tailored emails, printed Quit Guides, and cessation medication information. The program was designed to encourage use of all program components rather than asking participants to choose which components they wanted to use while quitting.Results We found that participants tended to use phone services more than Web services. On average, participants completed 2-2.5 counseling calls and logged in to the online program 1-2 times. Women were more adherent to the overall program; women utilized Web and phone services significantly (P = .003) more than men. Older smokers (> 26 years) and moderate smokers (15-20 cigarettes/day) utilized services more (P < .001) than younger (< 26 years) and light or heavy smokers. Satisfaction with services was high (92% to 95%) and varied somewhat with Web utilization. Thirty-day quit rates at the 6-month follow-up were 41% using responder analysis and 21% using intent-to-treat analysis. Web utilization was significantly associated with increased call completion and tobacco abstinence rates at the 6-month follow-up evaluation.Conclusions This paper expands our understanding of a real-world treatment program combining two mediums, phone and Web. Greater adherence to the program, as defined by using both the phone and Web components, is associated with higher quit rates. This study has implications for reaching and treating tobacco users with an integrated phone/Web program and offers evidence regarding the effectiveness of integrated cessation programs.

A systematic review of Internet-based therapy for the treatment of addictions

“…Five studies were randomized trials that compared two interventions, one of which was intended to act as an active control (Abroms, Windsor, & Simons-Morton, 2008;Brendryen, Drozd, & Kraft, 2008;Japuntich et al, 2006;King et al, 2009;Mermelstein & Turner, 2006). Two studies included treatment users who selfselected to participate in a research evaluation with no comparison or control group (Hotta et al, 2007;Zbikowski, Hapgood, Smucker Barnwell, & McAfee, 2008).…”

“…The majority of the studies evaluated programs specifically for tobacco cessation (Abroms et al, 2008;Brendryen et al, 2008;Japuntich et al, 2006;Hotta et al, 2007;Mermelstein & Turner, 2006;Woodruff et al, 2007;Zbikowski et al, 2008), with one study examining Internet treatment for problem and pathological gamblers (Carlbring & Smit, 2008) and one for substance abuse (King et al, 2009). The target population was primarily treatment-seeking adults, although three papers evaluated programs developed specifically for adolescents or young adults (Abroms et al, 2008;Mermelstein & Turner, 2006;Woodruff et al, 2007) and one targeted university employees (Hotta et al, 2007).…”

“…Four programs provided direct contact with therapists for support and encouragement via telephone (Brendryen et al, 2008;Carlbring & Smit, 2008;Mermelstein & Turner, 2006) or email (Abroms et al, 2008) exchange. Five interventions facilitated peer-based social support by enabling contact between treatment participants through discussion forums (Japuntich et al, 2006;Zbikowski et al, 2008), emails (Hotta et al, 2007) or group therapy sessions (King et al, 2009;Woodruff et al, 2007). Information to assist in quitting was provided by the majority of programs on websites (Brendryen et al, 2008;Carlbring & Smit, 2008;Japuntich et al, 2006;Hotta et al, 2007;Mermelstein & Turner, 2006;Zbikowski et al, 2008), some of which included interactive tools and exercises for education and practical strategies (Carlbring & Smit, 2008;Japuntich et al, 2006;Zbikowski et al, 2008).…”

“…Five interventions facilitated peer-based social support by enabling contact between treatment participants through discussion forums (Japuntich et al, 2006;Zbikowski et al, 2008), emails (Hotta et al, 2007) or group therapy sessions (King et al, 2009;Woodruff et al, 2007). Information to assist in quitting was provided by the majority of programs on websites (Brendryen et al, 2008;Carlbring & Smit, 2008;Japuntich et al, 2006;Hotta et al, 2007;Mermelstein & Turner, 2006;Zbikowski et al, 2008), some of which included interactive tools and exercises for education and practical strategies (Carlbring & Smit, 2008;Japuntich et al, 2006;Zbikowski et al, 2008). Programs also reported incorporating motivational interviewing (MI) strategies (Hotta et al, 2007;Mermelstein & Turner, 2006Woodruff et al, 2007 and behavioural approaches (Woodruff et al, 2007) in their programs.…”

“…Of the seven tobacco trials, four included access to smoking cessation websites (Brendryen et al, 2008;Japuntich et al, 2006;Mermelstein & Turner, 2006;Zbikowski et al, 2008), three included counseling telephone calls to supplement website use (Brendryen et al, 2008;Mermelstein & Turner, 2006;Zbikowski et al, 2008) and one included printed self-help workbooks in addition to website use and telephone counselling (Carlbring & Smit, 2008). One smoking cessation program for young adults used tailored emails in addition to in-person counseling and self-help kits (Abroms et al, 2008).…”