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Zhang S, Bantum EO, Owen J, Bakken S, Elhadad N. Online cancer communities as informatics intervention for social support: conceptualization, characterization, and impact. J Am Med Inform Assoc 2017; 24:451-459. [PMID: 27402140 PMCID: PMC5565989 DOI: 10.1093/jamia/ocw093] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 05/11/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives: The Internet and social media are revolutionizing how social support is exchanged and perceived, making online health communities (OHCs) one of the most exciting research areas in health informatics. This paper aims to provide a framework for organizing research of OHCs and help identify questions to explore for future informatics research. Based on the framework, we conceptualize OHCs from a social support standpoint and identify variables of interest in characterizing community members. For the sake of this tutorial, we focus our review on online cancer communities. Target audience: The primary target audience is informaticists interested in understanding ways to characterize OHCs, their members, and the impact of participation, and in creating tools to facilitate outcome research of OHCs. OHC designers and moderators are also among the target audience for this tutorial. Scope: The tutorial provides an informatics point of view of online cancer communities, with social support as their leading element. We conceptualize OHCs according to 3 major variables: type of support, source of support, and setting in which the support is exchanged. We summarize current research and synthesize the findings for 2 primary research questions on online cancer communities: (1) the impact of using online social support on an individual's health, and (2) the characteristics of the community, its members, and their interactions. We discuss ways in which future research in informatics in social support and OHCs can ultimately benefit patients.
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Affiliation(s)
- Shaodian Zhang
- Department of Biomedical Informatics, Columbia University, New York, USA
| | - Erin O'Carroll Bantum
- Cancer Prevention and Control Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Jason Owen
- Veterans Administration Palo Alto Health Care System, Menlo Park, California, USA
| | - Suzanne Bakken
- Department of Biomedical Informatics, Columbia University, New York, USA
| | - Noémie Elhadad
- Department of Biomedical Informatics, Columbia University, New York, USA
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Graham AL, Burke MV, Jacobs MA, Cha S, Croghan IT, Schroeder DR, Moriarty JP, Borah BJ, Rasmussen DF, Brookover MJ, Suesse DB, Midthun DE, Hays JT. An integrated digital/clinical approach to smoking cessation in lung cancer screening: study protocol for a randomized controlled trial. Trials 2017; 18:568. [PMID: 29179734 PMCID: PMC5704639 DOI: 10.1186/s13063-017-2312-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/01/2017] [Indexed: 01/06/2023] Open
Abstract
Background Delivering effective tobacco dependence treatment that is feasible within lung cancer screening (LCS) programs is crucial for realizing the health benefits and cost savings of screening. Large-scale trials and systematic reviews have demonstrated that digital cessation interventions (i.e. web-based and text message) are effective, sustainable over the long-term, scalable, and cost-efficient. Use of digital technologies is commonplace among older adults, making this a feasible approach within LCS programs. Use of cessation treatment has been improved with models that proactively connect smokers to treatment rather than passive referrals. Proactive referral to cessation treatment has been advanced through healthcare systems changes such as modifying the electronic health record to automatically link smokers to treatment. Methods This study evaluates the impact of a proactive enrollment strategy that links LCS-eligible smokers with an evidence-based intervention comprised of a web-based (WEB) program and integrated text messaging (TXT) in a three-arm randomized trial with repeated measures at one, three, six, and 12 months post randomization. The primary outcome is biochemically confirmed abstinence at 12 months post randomization. We will randomize 1650 smokers who present for a clinical LCS to: (1) a usual care control condition (UC) which consists of Ask–Advise–Refer; (2) a digital (WEB + TXT) cessation intervention; or (3) a digital cessation intervention combined with tobacco treatment specialist (TTS) counseling (WEB + TXT + TTS). Discussion The scalability and sustainability of a digital intervention may represent the most cost-effective and feasible approach for LCS programs to proactively engage large numbers of smokers in effective cessation treatment. We will also evaluate the impact and cost-effectiveness of adding proven clinical intervention provided by a TTS. We expect that a combined digital/clinical intervention will yield higher quit rates than digital alone, but that it may not be as cost-effective or feasible for LCS programs to implement. This study is innovative in its use of interoperable, digital technologies to deliver a sustainable, scalable, high-impact cessation intervention and to facilitate its integration within clinical practice. It will add to the growing knowledge base about the overall effectiveness of digital interventions and their role in the healthcare delivery system. Trial registration ClinicalTrials.gov, NCT03084835. Registered on 9 March 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2312-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amanda L Graham
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA. .,Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, USA.
| | - Michael V Burke
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA
| | - Megan A Jacobs
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA
| | - Sarah Cha
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA
| | - Ivana T Croghan
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA.,Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - James P Moriarty
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Bijan J Borah
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA
| | - Donna F Rasmussen
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA
| | - M Jody Brookover
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA
| | - Dale B Suesse
- Division of Research and Education Systems Support, Mayo Clinic, Rochester, MN, USA
| | - David E Midthun
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - J Taylor Hays
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA.,Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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McCrabb S, Baker AL, Attia J, Balogh ZJ, Lott N, Palazzi K, Naylor J, Harris IA, Doran CM, George J, Wolfenden L, Skelton E, Bonevski B. Hospital Smoke-Free Policy: Compliance, Enforcement, and Practices. A Staff Survey in Two Large Public Hospitals in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1358. [PMID: 29117149 PMCID: PMC5707997 DOI: 10.3390/ijerph14111358] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/05/2017] [Accepted: 11/06/2017] [Indexed: 01/03/2023]
Abstract
Background: Smoke-free hospital policies are becoming increasingly common to promote good health and quit attempts among patients who smoke. This study aims to assess: staff perceived enforcement and compliance with smoke-free policy; the current provision of smoking cessation care; and the characteristics of staff most likely to report provision of care to patients. Methods: An online cross-sectional survey of medical, nursing, and allied staff from two Australian public hospitals was conducted. Staff report of: patient and staff compliance with smoke-free policy; perceived policy enforcement; the provision of the 5As for smoking cessation (Ask, Assess, Advise, Assist, and Arrange follow-up); and the provision of stop-smoking medication are described. Logistic regressions were used to determine respondent characteristics related to the provision of the 5As and stop-smoking medication use during hospital admission. Results: A total of 805 respondents participated. Self-reported enforcement of smoke-free policy was low (60.9%), together with compliance for both patients (12.9%) and staff (23.6%). The provision of smoking cessation care was variable, with the delivery of the 5As ranging from 74.7% (ask) to 18.1% (arrange follow-up). Medical staff (odds ratio (OR) = 2.09, CI = 1.13, 3.85, p = 0.018) and full time employees (OR = 2.03, CI = 1.06, 3.89, p = 0.033) were more likely to provide smoking cessation care always/most of the time. Stop-smoking medication provision decreased with increasing age of staff (OR = 0.98, CI = 0.96, 0.99, p = 0.008). Conclusions: Smoke-free policy enforcement and compliance and the provision of smoking cessation care remains low in hospitals. Efforts to improve smoking cessation delivery by clinical staff are warranted.
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Affiliation(s)
- Sam McCrabb
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308, Australia.
| | - Amanda L Baker
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308, Australia.
| | - John Attia
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308, Australia.
- Hunter Medical Research Institute, University of Newcastle, New Lambton, New South Wales 2305, Australia.
- Department of General Medicine, John Hunter Hospital, New Lambton Heights, New South Wales 2305, Australia.
| | - Zsolt J Balogh
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308, Australia.
- Department of Traumatology, John Hunter Hospital, New Lambton Heights, New South Wales 2305, Australia.
| | - Natalie Lott
- Department of Traumatology, John Hunter Hospital, New Lambton Heights, New South Wales 2305, Australia.
| | - Kerrin Palazzi
- Hunter Medical Research Institute, University of Newcastle, New Lambton, New South Wales 2305, Australia.
| | - Justine Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, New South Wales 2170, Australia.
- South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Liverpool, New South Wales 2170, Australia.
| | - Ian A Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, New South Wales 2170, Australia.
- South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Liverpool, New South Wales 2170, Australia.
| | - Christopher M Doran
- School of Human, Health and Social Sciences, Central Queensland University, Brisbane, Queensland 4000, Australia.
| | - Johnson George
- Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria 3052, Australia.
- Hunter New England Population Health, Wallsend, New South Wales 2287, Australia.
| | - Luke Wolfenden
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308, Australia.
- Hunter New England Population Health, Wallsend, New South Wales 2287, Australia.
| | - Eliza Skelton
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308, Australia.
| | - Billie Bonevski
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308, Australia.
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Bliuc AM, Best D, Iqbal M, Upton K. Building addiction recovery capital through online participation in a recovery community. Soc Sci Med 2017; 193:110-117. [DOI: 10.1016/j.socscimed.2017.09.050] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 09/14/2017] [Accepted: 09/28/2017] [Indexed: 11/29/2022]
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Grau LE, Pham T, O'Leary T, Weiss J, Toll B, Bernstein SL. Smokers' Perspectives on Texting for Tobacco Dependence Treatment: A Qualitative Analysis. Nicotine Tob Res 2017; 19:307-313. [PMID: 27613935 DOI: 10.1093/ntr/ntw184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/12/2016] [Indexed: 12/30/2022]
Abstract
Background Numerous evidence-based pharmacologic and behavioral approaches exist for the treatment of tobacco dependence. Short-message service texting is a newer modality which shows promise, but smokers' perspectives on texting have not been widely explored. Objective To use a qualitative research approach to elicit from a sub-sample of participants in a pilot clinical trial their perspectives concerning the feasibility, acceptability, and personal relevance of a publicly available texting program for smoking cessation. Methods Adult smokers enrolled in the intervention arm in a randomized trial of tobacco treatment were interviewed by telephone. Consenting subjects engaged in a 15-30min semi-structured interview with a trained research assistant, discussing their experience with and attitudes about the texting program and how it affected their tobacco use. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Descriptive statistics were calculated for the 16 Likert-formatted items. Results Of 30 subjects in the intervention arm, 25 (83%) agreed to participate in the qualitative interviews. In general subjects found the program helpful. Common themes were that the texts served as a form of social support, provided useful strategies to reduce tobacco use, validated subjects' attempts to quit, and offered welcome distractions from cravings. Subjects were satisfied with the frequency, timing, and number of texts, although some improvements were suggested. Conclusions Texting was perceived as feasible, acceptable, and helpful in smokers' attempts to abstain from tobacco. Implications The major themes identified included the program being a valued source of external support that provided useful strategies to reduce tobacco use. Subjects were satisfied with the frequency, timing, and number of texts. Texting was perceived as feasible, acceptable, and helpful in smokers' attempts to abstain from tobacco. Suggestions to improve the program primarily concerned increasing customizable options and using simple, declarative sentences.
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Affiliation(s)
- Lauretta E Grau
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
| | - Timothy Pham
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Teresa O'Leary
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - June Weiss
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Benjamin Toll
- Department of Psychiatry, Yale School of Medicine, New Haven, CT.,Yale Cancer Center, New Haven, CT.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.,Yale Cancer Center, New Haven, CT.,Department of Health Policy, Yale School of Public Health, New Haven, CT
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Naslund JA, Kim SJ, Aschbrenner KA, McCulloch LJ, Brunette MF, Dallery J, Bartels SJ, Marsch LA. Systematic review of social media interventions for smoking cessation. Addict Behav 2017; 73:81-93. [PMID: 28499259 PMCID: PMC5556947 DOI: 10.1016/j.addbeh.2017.05.002] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 03/07/2017] [Accepted: 05/01/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Popular social media could extend the reach of smoking cessation efforts. In this systematic review, our objectives were: 1) to determine whether social media interventions for smoking cessation are feasible, acceptable, and potentially effective; 2) to identify approaches for recruiting subjects; and 3) to examine the specific intervention design components and strategies employed to promote user engagement and retention. METHODS We searched Scopus, Medline, EMBASE, Cochrane Central, PsychINFO, CINAHL, and Web of Science through July 2016 and reference lists of relevant articles. Included studies described social media interventions for smoking cessation and must have reported outcomes related to feasibility, acceptability, usability, or smoking-related outcomes. RESULTS We identified 7 studies (all were published since 2014) that enrolled 9755 participants (median=136 [range 40 to 9042]). Studies mainly used Facebook (n=4) or Twitter (n=2), and emerged as feasible and acceptable. Five studies reported smoking-related outcomes such as greater abstinence, reduction in relapse, and an increase in quit attempts. Most studies (n=6) recruited participants using online or Facebook advertisements. Tailored content, targeted reminders, and moderated discussions were used to promote participant engagement. Three studies found that active participation through posting comments or liking content may be associated with improved outcomes. Retention ranged from 35% to 84% (median=70%) across the included studies. CONCLUSIONS Our review highlights the feasibility, acceptability and preliminary effectiveness of social media interventions for smoking cessation. Future research should continue to explore approaches for promoting user engagement and retention, and whether sustained engagement translates to clinically meaningful smoking cessation outcomes.
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Affiliation(s)
- John A Naslund
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States; The Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States.
| | - Sunny Jung Kim
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Kelly A Aschbrenner
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | | | - Mary F Brunette
- The Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Jesse Dallery
- Department of Psychology, University of Florida, United States
| | - Stephen J Bartels
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Lisa A Marsch
- The Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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Cohn AM, Zhao K, Cha S, Wang X, Amato MS, Pearson JL, Papandonatos GD, Graham AL. A Descriptive Study of the Prevalence and Typology of Alcohol-Related Posts in an Online Social Network for Smoking Cessation. J Stud Alcohol Drugs 2017; 78:665-673. [PMID: 28930053 DOI: 10.15288/jsad.2017.78.665] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Alcohol use and problem drinking are associated with smoking relapse and poor smoking-cessation success. User-generated content in online social networks for smoking cessation provides an opportunity to understand the challenges and treatment needs of smokers. This study used machine-learning text classification to identify the prevalence, sentiment, and social network correlates of alcohol-related content in the social network of a large online smoking-cessation program, BecomeAnEX.org. METHOD Data were analyzed from 814,258 posts (January 2012 to May 2015). Posts containing alcohol keywords were coded via supervised machine-learning text classification for information about the user's personal experience with drinking, whether the user self-identified as a problem drinker or indicated problem drinking, and negative sentiment about drinking in the context of a quit attempt (i.e., alcohol should be avoided during a quit attempt). RESULTS Less than 1% of posts were related to alcohol, contributed by 13% of users. Roughly a third of alcohol posts described a personal experience with drinking; very few (3%) indicated "problem drinking." The majority (70%) of alcohol posts did not express negative sentiment about drinking alcohol during a quit attempt. Users who did express negative sentiment about drinking were more centrally located within the network compared with those who did not. CONCLUSIONS Discussion of alcohol was rare, and most posts did not signal the need to quit or abstain from drinking during a quit attempt. Featuring expert information or highlighting discussions that are consistent with treatment guidelines may be important steps to ensure smokers are educated about drinking risks.
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Affiliation(s)
- Amy M Cohn
- Battelle Memorial Institute, Arlington, Virginia.,Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Kang Zhao
- Department of Management Sciences, Tippie College of Business, The University of Iowa, Iowa City, Iowa
| | - Sarah Cha
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
| | - Xi Wang
- School of Information, Central University of Finance and Economics, Beijing, China
| | - Michael S Amato
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
| | - Jennifer L Pearson
- School of Community Health Sciences, University of Nevada, Reno, Reno, Nevada.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - George D Papandonatos
- Center for Statistical Sciences, Brown University School of Public Health, Brown University, Providence, Rhode Island
| | - Amanda L Graham
- Department of Oncology, Georgetown University Medical Center, Washington, DC.,Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
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Taylor GMJ, Dalili MN, Semwal M, Civljak M, Sheikh A, Car J. Internet-based interventions for smoking cessation. Cochrane Database Syst Rev 2017; 9:CD007078. [PMID: 28869775 PMCID: PMC6703145 DOI: 10.1002/14651858.cd007078.pub5] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Tobacco use is estimated to kill 7 million people a year. Nicotine is highly addictive, but surveys indicate that almost 70% of US and UK smokers would like to stop smoking. Although many smokers attempt to give up on their own, advice from a health professional increases the chances of quitting. As of 2016 there were 3.5 billion Internet users worldwide, making the Internet a potential platform to help people quit smoking. OBJECTIVES To determine the effectiveness of Internet-based interventions for smoking cessation, whether intervention effectiveness is altered by tailoring or interactive features, and if there is a difference in effectiveness between adolescents, young adults, and adults. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, which included searches of MEDLINE, Embase and PsycINFO (through OVID). There were no restrictions placed on language, publication status or publication date. The most recent search was conducted in August 2016. SELECTION CRITERIA We included randomised controlled trials (RCTs). Participants were people who smoked, with no exclusions based on age, gender, ethnicity, language or health status. Any type of Internet intervention was eligible. The comparison condition could be a no-intervention control, a different Internet intervention, or a non-Internet intervention. To be included, studies must have measured smoking cessation at four weeks or longer. DATA COLLECTION AND ANALYSIS Two review authors independently assessed and extracted data. We extracted and, where appropriate, pooled smoking cessation outcomes of six-month follow-up or more, reporting short-term outcomes narratively where longer-term outcomes were not available. We reported study effects as a risk ratio (RR) with a 95% confidence interval (CI).We grouped studies according to whether they (1) compared an Internet intervention with a non-active control arm (e.g. printed self-help guides), (2) compared an Internet intervention with an active control arm (e.g. face-to-face counselling), (3) evaluated the addition of behavioural support to an Internet programme, or (4) compared one Internet intervention with another. Where appropriate we grouped studies by age. MAIN RESULTS We identified 67 RCTs, including data from over 110,000 participants. We pooled data from 35,969 participants.There were only four RCTs conducted in adolescence or young adults that were eligible for meta-analysis.Results for trials in adults: Eight trials compared a tailored and interactive Internet intervention to a non-active control. Pooled results demonstrated an effect in favour of the intervention (RR 1.15, 95% CI 1.01 to 1.30, n = 6786). However, statistical heterogeneity was high (I2 = 58%) and was unexplained, and the overall quality of evidence was low according to GRADE. Five trials compared an Internet intervention to an active control. The pooled effect estimate favoured the control group, but crossed the null (RR 0.92, 95% CI 0.78 to 1.09, n = 3806, I2 = 0%); GRADE quality rating was moderate. Five studies evaluated an Internet programme plus behavioural support compared to a non-active control (n = 2334). Pooled, these studies indicated a positive effect of the intervention (RR 1.69, 95% CI 1.30 to 2.18). Although statistical heterogeneity was substantial (I2 = 60%) and was unexplained, the GRADE rating was moderate. Four studies evaluated the Internet plus behavioural support compared to active control. None of the studies detected a difference between trial arms (RR 1.00, 95% CI 0.84 to 1.18, n = 2769, I2 = 0%); GRADE rating was moderate. Seven studies compared an interactive or tailored Internet intervention, or both, to an Internet intervention that was not tailored/interactive. Pooled results favoured the interactive or tailored programme, but the estimate crossed the null (RR 1.10, 95% CI 0.99 to 1.22, n = 14,623, I2 = 0%); GRADE rating was moderate. Three studies compared tailored with non-tailored Internet-based messages, compared to non-tailored messages. The tailored messages produced higher cessation rates compared to control, but the estimate was not precise (RR 1.17, 95% CI 0.97 to 1.41, n = 4040), and there was evidence of unexplained substantial statistical heterogeneity (I2 = 57%); GRADE rating was low.Results should be interpreted with caution as we judged some of the included studies to be at high risk of bias. AUTHORS' CONCLUSIONS The evidence from trials in adults suggests that interactive and tailored Internet-based interventions with or without additional behavioural support are moderately more effective than non-active controls at six months or longer, but there was no evidence that these interventions were better than other active smoking treatments. However some of the studies were at high risk of bias, and there was evidence of substantial statistical heterogeneity. Treatment effectiveness in younger people is unknown.
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Affiliation(s)
- Gemma M. J. Taylor
- University of BristolMRC Integrative Epidemiology Unit, UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology12a Priory RoadBristolUKBS8 1TU
| | | | - Monika Semwal
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences (CePHaS)SingaporeSingapore
| | | | - Aziz Sheikh
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of EdinburghAllergy & Respiratory Research Group and Asthma UK Centre for Applied ResearchTeviot PlaceEdinburghUKEH8 9AG
| | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences (CePHaS)SingaporeSingapore
- University of LjubljanaDepartment of Family Medicine, Faculty of MedicineLjubljanaSlovenia
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Smoke-Free Recovery from Trauma Surgery: A Pilot Trial of an Online Smoking Cessation Program for Orthopaedic Trauma Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14080847. [PMID: 28788089 PMCID: PMC5580551 DOI: 10.3390/ijerph14080847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/24/2017] [Accepted: 07/26/2017] [Indexed: 01/03/2023]
Abstract
Smoking increases the risk of complications associated with orthopaedic trauma surgery, however delivery of care is low. Online interventions may provide needed smoking cessation care and promote abstinence. This study aims to examine the engagement, acceptability, and retention of an online smoking cessation program (Smoke-Free Recovery; SFR) among a sample of orthopaedic trauma patients, as well as themes around the smoking cessation process. A pilot study of SFR with 31 orthopaedic trauma patients admitted to a public hospital in New South Wales, Australia took place. Semi-structured telephone interviews were conducted following hospital discharge. Thematic analysis and descriptive statistics were used. Engagement was high with 28 participants accessing SFR during admission. Twenty individuals completed follow-up phone calls. Program acceptability was rated favourably. After discharge, changes in smoking habits were noted, with program retention low. Themes on program use included: lack of time or need for additional support; computer illiteracy or technology issues; feeling unready or too stressed to quit; or feeling they had reached the boundary of what could be learnt from the program. This study highlights the difficulties faced by patients following hospital admission, the lack of follow-up support received, and the need for consumer testing prior to roll out. Continuing to develop interventions to promote hospital-initiated cessation attempts that continue post-discharge should be a priority.
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Bommelé J, Schoenmakers TM, Kleinjan M, Peters GJY, Dijkstra A, van de Mheen D. Targeting hardcore smokers: The effects of an online tailored intervention, based on motivational interviewing techniques. Br J Health Psychol 2017; 22:644-660. [PMID: 28703470 DOI: 10.1111/bjhp.12256] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 05/16/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Hardcore smokers have smoked for many years and do not intend to quit. They also seem unreceptive to information about smoking cessation. We developed a 30-min, tailored web-based intervention that includes motivational interviewing principles. It aims to increase hardcore smokers' intention to quit and their receptivity to information about smoking cessation. DESIGN In a two-arm experiment, we compared outcome scores of the experimental intervention (n = 346) with those of a control intervention (n = 411). METHODS Our main outcomes were receptivity to information about quitting, intention to quit, quitting self-efficacy, and interest in a subsequent online intervention. Our secondary outcomes were cigarettes smoked per day and quit attempts. All outcomes were measured directly post-experiment (t1 ), after 2 weeks (t2 ), and after 2 months (t3 ). RESULTS At t1 , hardcore smokers in the intervention condition were more receptive to information about quitting than controls. At both t2 and t3 , those in the experimental group had reduced the number of cigarettes more than those in the control group. At t2 , but not t3 , more participants in the experimental group had reduced their cigarette consumption by at least 50% than among controls. We found no significant differences in intention to quit, quitting self-efficacy, interest in a subsequent online quitting intervention, and number of quit attempts. CONCLUSIONS The intervention increased hardcore smokers' receptivity to information about smoking cessation and decreased their cigarette consumption by about 1 cigarette per day. Although the results are positive, the clinical relevance may be limited. We recommend further developing this intervention for practical use in health care settings. Statement of contribution What is already known on this subject? Hardcore smokers have smoked for many years and do not intend to quit. There are currently no online interventions for hardcore smokers. What does this study add? This study tested an online intervention for hardcore smokers. The intervention increased hardcore smokers' receptivity to information about quitting. It also helped to reduce the number of cigarettes per day.
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Affiliation(s)
- Jeroen Bommelé
- IVO Addiction Research Institute, Rotterdam, the Netherlands.,Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Tim M Schoenmakers
- IVO Addiction Research Institute, Rotterdam, the Netherlands.,Erasmus Medical Centre, Rotterdam, the Netherlands.,NIVEL, Netherlands Institute for Health Sciences Research, Utrecht, the Netherlands
| | | | | | - Arie Dijkstra
- Faculty of Behavioural and Social Sciences, University of Groningen, the Netherlands
| | - Dike van de Mheen
- IVO Addiction Research Institute, Rotterdam, the Netherlands.,Erasmus Medical Centre, Rotterdam, the Netherlands.,Tranzo, School of Social and Behavioral Sciences, Tilburg University, the Netherlands
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61
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Dziadkowiec O, Jenniges R. Using flow diagrams to improve tobacco cessation programs. Int J Health Care Qual Assur 2017; 30:436-444. [DOI: 10.1108/ijhcqa-05-2016-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to understand how the Wyoming Quit Tobacco Program (WQTP) is used by its subscribers and to better understand how WQTP might be connected to WQTP outcomes.
Design/methodology/approach
Provider intake and program use data corresponding to the May 2010 to March 2012 enrollment period (n=6,168) were used. All program flows were constructed using frequencies and crosstabs, based on an initial theoretical model prepared by the program provider. Data were adjusted based on analysis that explored all possible uses beyond those specified by the provider’s theoretical model.
Findings
Although the authors could replicate the structure – the theoretical model constructed by the provider – the authors were not able to replicate all relationships between program components. The authors also found that most individuals signed up and used web-based services. Only a few individuals finished their treatment regimens in the way they were designed to be used by the program.
Originality/value
This is the first case study to use a program flow method to investigate an entire comprehensive tobacco cessation program structure and delivery.
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Garde EL, Manning V, Lubman DI. Characteristics of clients currently accessing a national online alcohol and drug counselling service. Australas Psychiatry 2017; 25:250-253. [PMID: 28541729 DOI: 10.1177/1039856216689623] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Multiple barriers contribute to low rates of help-seeking for problematic alcohol and other drug (AOD) use in Australia, and highlight the importance of flexible delivery models. This study explored the characteristics of clients accessing a national AOD online counselling service (Counselling Online) over time and across jurisdictions. METHOD 2003 clients completed a brief demographics questionnaire before commencing their Counselling Online session. Demographic (e.g. gender, primary drug of concern) and service provision (timing of session, length of session) characteristics were explored to build a profile of individuals accessing online support for AOD concerns. RESULTS Service provision and client characteristics remained relatively stable over time; alcohol remained the most common drug of concern, but methamphetamines overtook cannabis as the second most common drug of concern. Consistency in characteristics was also observed across states and territories, except for clients in the Northern Territory, where amphetamines were the most common primary drug of concern, and counselling sessions were significantly longer. DISCUSSION Counselling Online continues to be a wide-reaching, easily accessible service for those concerned about their or others substance use. The characteristics of clients who access the service also suggest that it is responsive to contemporary needs and concerns.
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Affiliation(s)
- Erin L Garde
- Research Officer, Turning Point, Eastern Health, Fitzroy, VIC, Australia
| | - Victoria Manning
- Senior Research Fellow and Strategic Lead of Systems and Treatment team, Turning Point, Eastern Health, Fitzroy, VIC, and; Eastern Health Clinical School, Monash University, Clayton, VIC, Australia
| | - Dan I Lubman
- Director of Turning Point, Eastern Health, Fitzroy, VIC, and; Professor of Addiction Studies and Services, Eastern Health Clinical School, Monash University, Clayton, VIC, Australia
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Lee EE, Brecht ML, Park H, Lee J, Oh KM. Web-Based Study for Improving Mammography Among Korean American Women. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:257-263. [PMID: 26423058 DOI: 10.1007/s13187-015-0920-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Web-based culture-specific interventions for Korean American (KA) women to improve mammography utilization are not available. An established intervention developed to improve mammography utilizations for Korean American (KA) women was tested via the Web for its efficacy, feasibility, and acceptability. A randomized controlled trial, with a pretest-posttest control group design, was conducted with 136 KA women and their spouses. Intention to have a mammogram within the next 12 months increased significantly in the intervention group compare to controls. Among women whose mammograms had not been updated, 22 % of women in the intervention and 13 % of women in the control group obtained a mammogram at 2-month post-baseline, even though the difference was not statistically significant. The Web-based study educating couples was feasible and could improve KA women's breast cancer screening intention and behaviors. Combining off-line contact for recruitment/data collection with online intervention material could decrease the attrition rate in the future study because the attrition rate in this study was higher than the original study.
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Affiliation(s)
- Eunice E Lee
- School of Nursing, University of California, Los Angeles, 700 Tiverton Ave. 4-940 Factor Building, Mail Code: 691821, Los Angeles, CA, 90095-6918, USA
| | - Mary-Lynn Brecht
- School of Nursing, University of California, Los Angeles, 700 Tiverton Ave. 5-151 Factor Building, Mail Code: 691821, Los Angeles, CA, USA
| | - HanJong Park
- College of Nursing Science, Kyung Hee University, 26 Kyunghee dae-ro, Dongdaemun-gu, Seoul, 130-701, South Korea
| | - Jongwon Lee
- College of Nursing, University of New Mexico, MSC07 4380, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Kyeung Mi Oh
- School of Nursing, George Mason University, MS3C4, 4400 University Dr, Fairfax, VA, 22030, USA.
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64
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Kim SJ, Marsch LA, Brunette MF, Dallery J. Harnessing Facebook for Smoking Reduction and Cessation Interventions: Facebook User Engagement and Social Support Predict Smoking Reduction. J Med Internet Res 2017; 19:e168. [PMID: 28536096 PMCID: PMC5461420 DOI: 10.2196/jmir.6681] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 03/17/2017] [Accepted: 04/02/2017] [Indexed: 01/18/2023] Open
Abstract
Background Social media technologies offer a novel opportunity for scalable health interventions that can facilitate user engagement and social support, which in turn may reinforce positive processes for behavior change. Objective By using principles from health communication and social support literature, we implemented a Facebook group–based intervention that targeted smoking reduction and cessation. This study hypothesized that participants’ engagement with and perceived social support from our Facebook group intervention would predict smoking reduction. Methods We recruited 16 regular smokers who live in the United States and who were motivated in quitting smoking at screening. We promoted message exposure as well as engagement and social support systems throughout the intervention. For message exposure, we posted prevalidated, antismoking messages (such as national antismoking campaigns) on our smoking reduction and cessation Facebook group. For engagement and social support systems, we delivered a high degree of engagement and social support systems during the second and third week of the intervention and a low degree of engagement and social support systems during the first and fourth week. A total of six surveys were conducted via Amazon Mechanical Turk (MTurk) at baseline on a weekly basis and at a 2-week follow-up. Results Of the total 16 participants, most were female (n=13, 81%), white (n=15, 94%), and between 25 and 50 years of age (mean 34.75, SD 8.15). There was no study attrition throughout the 6-time-point baseline, weekly, and follow-up surveys. We generated Facebook engagement and social support composite scores (mean 19.19, SD 24.35) by combining the number of likes each participant received and the number of comments or wall posts each participant posted on our smoking reduction and cessation Facebook group during the intervention period. The primary outcome was smoking reduction in the past 7 days measured at baseline and at the two-week follow-up. Compared with the baseline, participants reported smoking an average of 60.56 fewer cigarettes per week (SD 38.83) at the follow-up, and 4 participants out of 16 (25%) reported 7-day point prevalence smoking abstinence at the follow-up. Adjusted linear regression models revealed that a one-unit increase in the Facebook engagement and social support composite scores predicted a 0.56-unit decrease in cigarettes smoked per week (standard error =.24, P=.04, 95% CI 0.024-1.09) when baseline readiness to quit, gender, and baseline smoking status were controlled (F4, 11=8.85, P=.002). Conclusions This study is the first Facebook group–based intervention that systemically implemented health communication strategies and engagement and social support systems to promote smoking reduction and cessation. Our findings imply that receiving one like or posting on the Facebook-based intervention platform predicted smoking approximately one less cigarette in the past 7 days, and that interventions should facilitate user interactions to foster user engagement and social support.
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Affiliation(s)
- Sunny Jung Kim
- Center for Technology and Behavioral Health, Department of Biomedical Data Science, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Department of Biomedical Data Science, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - Mary F Brunette
- Center for Technology and Behavioral Health, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock, Lebanon, NH, United States
| | - Jesse Dallery
- Department of Psychology, University of Florida, Gainesville, FL, United States
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Iacoviello BM, Steinerman JR, Klein DB, Silver TL, Berger AG, Luo SX, Schork NJ. Clickotine, A Personalized Smartphone App for Smoking Cessation: Initial Evaluation. JMIR Mhealth Uhealth 2017; 5:e56. [PMID: 28442453 PMCID: PMC5424127 DOI: 10.2196/mhealth.7226] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/01/2017] [Accepted: 03/27/2017] [Indexed: 11/24/2022] Open
Abstract
Background Tobacco smoking is the leading cause of preventable death in the United States, and the annual economic burden attributable to smoking exceeds US $300 billion. Obstacles to smoking cessation include limited access and adherence to effective cessation interventions. Technology can help overcome these obstacles; many smartphone apps have been developed to aid smoking cessation, but few that conform to the US clinical practice guideline (USCPG) have been rigorously tested and reported in the literature. Clickotine is a novel smartphone app for smoking cessation, designed to deliver the essential features of the USCPG and engineered to engage smokers by personalizing intervention components. Objective Our objective was to assess the engagement, efficacy, and safety of Clickotine in an initial, single-arm study. Outcomes measured were indicators of engagement with the smartphone app (number of app opens, number of interactions with the Clickotine program, and weeks active with Clickotine), cessation outcomes of 7- and 30-day self-reported abstinence from smoking, and negative health events. Methods We recruited US residents between 18 and 65 years of age who owned an iPhone and smoked 5 or more cigarettes daily for the study via online advertising. Respondents were prescreened for eligibility by telephone and, if appropriate, directed to a Web portal to provide informed consent, confirm eligibility, and download the Clickotine app. Participants completed study assessments via the online portal at baseline and after 8 weeks. Data were collected in Amazon S3 with no manual data entry, and access to all data was maximally restrictive, logged, and auditable. Results A total of 416 participants downloaded the app and constituted the intention-to-treat (ITT) sample. On average, participants opened the Clickotine app 100.6 times during the 8-week study (median 69), logged 214.4 interactions with the Clickotine program (median 178), and remained engaged with Clickotine for 5.3 weeks (median 5). Among the ITT sample, 45.2% (188/416) reported 7-day abstinence and 26.2% (109/416) reported 30-day abstinence from smoking after 8 weeks. Completer analysis focused on 365 (87.7%) of the 416 enrolled participants who completed the 8-week questionnaire revealed that 51.5% (188/365) of completers reported 7-day abstinence and 29.9% (109/365) reported 30-day abstinence. Few adverse events, mostly consistent with nicotine withdrawal symptoms, were reported and overall no safety signal was detected. Conclusions In this initial single-arm trial, Clickotine users appeared to demonstrate encouraging indicators of engagement in terms of the number of app opens, number of program interactions, and continued engagement over time. Clickotine users reported encouraging quit rates while reporting few adverse events. Future research is warranted to assess Clickotine’s efficacy in a randomized controlled trial. Trial Registration Clinicaltrials.gov NCT02656745; https://clinicaltrials.gov/ct2/show/NCT02656745 (Archived by WebCite at http://www.webcitation.org/6peTT4x60)
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Affiliation(s)
- Brian M Iacoviello
- Click Therapeutics, Inc., New York, NY, United States.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - David B Klein
- Click Therapeutics, Inc., New York, NY, United States
| | | | - Adam G Berger
- Click Therapeutics, Inc., New York, NY, United States
| | - Sean X Luo
- Click Therapeutics, Inc., New York, NY, United States
| | - Nicholas J Schork
- Click Therapeutics, Inc., New York, NY, United States.,The Translational Genomics Research Institute, Phoenix, AZ, United States
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66
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Tarzia L, Valpied J, Koziol-McLain J, Glass N, Hegarty K. Methodological and Ethical Challenges in a Web-Based Randomized Controlled Trial of a Domestic Violence Intervention. J Med Internet Res 2017; 19:e94. [PMID: 28351830 PMCID: PMC5388827 DOI: 10.2196/jmir.7039] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/08/2017] [Accepted: 02/16/2017] [Indexed: 11/13/2022] Open
Abstract
The use of Web-based methods to deliver and evaluate interventions is growing in popularity, particularly in a health care context. They have shown particular promise in responding to sensitive or stigmatized issues such as mental health and sexually transmitted infections. In the field of domestic violence (DV), however, the idea of delivering and evaluating interventions via the Web is still relatively new. Little is known about how to successfully navigate several challenges encountered by the researchers while working in this area. This paper uses the case study of I-DECIDE, a Web-based healthy relationship tool and safety decision aid for women experiencing DV, developed in Australia. The I-DECIDE website has recently been evaluated through a randomized controlled trial, and we outline some of the methodological and ethical challenges encountered during recruitment, retention, and evaluation. We suggest that with careful consideration of these issues, randomized controlled trials can be safely conducted via the Web in this sensitive area.
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Affiliation(s)
- Laura Tarzia
- Department of General Practice, The University of Melbourne, Carlton, Australia
| | - Jodie Valpied
- Department of General Practice, The University of Melbourne, Carlton, Australia
| | - Jane Koziol-McLain
- Centre for Interdisciplinary Trauma Research, Auckland University of Technology, Auckland, New Zealand
| | - Nancy Glass
- School of Nursing & Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, Carlton, Australia
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Rogers MA, Lemmen K, Kramer R, Mann J, Chopra V. Internet-Delivered Health Interventions That Work: Systematic Review of Meta-Analyses and Evaluation of Website Availability. J Med Internet Res 2017; 19:e90. [PMID: 28341617 PMCID: PMC5384996 DOI: 10.2196/jmir.7111] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/23/2017] [Accepted: 02/25/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Due to easy access and low cost, Internet-delivered therapies offer an attractive alternative to improving health. Although numerous websites contain health-related information, finding evidence-based programs (as demonstrated through randomized controlled trials, RCTs) can be challenging. We sought to bridge the divide between the knowledge gained from RCTs and communication of the results by conducting a global systematic review and analyzing the availability of evidence-based Internet health programs. OBJECTIVES The study aimed to (1) discover the range of health-related topics that are addressed through Internet-delivered interventions, (2) generate a list of current websites used in the trials which demonstrate a health benefit, and (3) identify gaps in the research that may have hindered dissemination. Our focus was on Internet-delivered self-guided health interventions that did not require real-time clinical support. METHODS A systematic review of meta-analyses was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO Registration Number CRD42016041258). MEDLINE via Ovid, PsycINFO, Embase, Cochrane Database of Systematic Reviews, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched. Inclusion criteria included (1) meta-analyses of RCTs, (2) at least one Internet-delivered intervention that measured a health-related outcome, and (3) use of at least one self-guided intervention. We excluded group-based therapies. There were no language restrictions. RESULTS Of the 363 records identified through the search, 71 meta-analyses met inclusion criteria. Within the 71 meta-analyses, there were 1733 studies that contained 268 unique RCTs which tested self-help interventions. On review of the 268 studies, 21.3% (57/268) had functional websites. These included evidence-based Web programs on substance abuse (alcohol, tobacco, cannabis), mental health (depression, anxiety, post-traumatic stress disorder [PTSD], phobias, panic disorders, obsessive compulsive disorder [OCD]), and on diet and physical activity. There were also evidence-based programs on insomnia, chronic pain, cardiovascular risk, and childhood health problems. These programs tended to be intensive, requiring weeks to months of engagement by the user, often including interaction, personalized and normative feedback, and self-monitoring. English was the most common language, although some were available in Spanish, French, Portuguese, Dutch, German, Norwegian, Finnish, Swedish, and Mandarin. There were several interventions with numbers needed to treat of <5; these included painACTION, Mental Health Online for panic disorders, Deprexis, Triple P Online (TPOL), and U Can POOP Too. Hyperlinks of the sites have been listed. CONCLUSIONS A wide range of evidence-based Internet programs are currently available for health-related behaviors, as well as disease prevention and treatment. However, the majority of Internet-delivered health interventions found to be efficacious in RCTs do not have websites for general use. Increased efforts to provide mechanisms to host "interventions that work" on the Web and to assist the public in locating these sites are necessary.
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Affiliation(s)
- Mary Am Rogers
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Kelsey Lemmen
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Rachel Kramer
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Jason Mann
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Vineet Chopra
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
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Bricker JB, Copeland W, Mull KE, Zeng EY, Watson NL, Akioka KJ, Heffner JL. Single-arm trial of the second version of an acceptance & commitment therapy smartphone application for smoking cessation. Drug Alcohol Depend 2017; 170:37-42. [PMID: 27870987 PMCID: PMC5183543 DOI: 10.1016/j.drugalcdep.2016.10.029] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/21/2016] [Accepted: 10/23/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND The first randomized trial of a smartphone application (app) for adult smoking cessation (SmartQuit 1.0) revealed key features that predict cessation. These findings guided the revision of this Acceptance & Commitment Therapy (ACT)-based application (SmartQuit 2.0), which was primarily tested to examine participant receptivity, short-term cessation and reduction, and the relationship between program completion, smoking cessation and reduction. Secondarily, outcomes were descriptively compared with the SmartQuit1.0 trial. METHOD Adult participants (78% female, 25% with high school or less education, 30% unemployed) were recruited into the single-arm pilot trial (N=99) of SmartQuit 2.0 with a two-month follow-up (85% retention). RESULTS Regarding receptivity, 84% of participants were satisfied with SmartQuit 2.0 (vs. 59% for SmartQuit1.0), 73% would recommend it to a friend (vs. 48% for SmartQuit1.0), 81% found the ACT exercises useful for quitting (vs. 44% for SmartQuit1.0). At the 2-month follow-up, the quit rates were 21% for 7-day point prevalence (vs. 23% for SmartQuit1.0), 11% for 30-day point prevalence (vs. 13% for SmartQuit1.0), and 75% of participants reduced their smoking frequency (vs. 57% for SmartQuit1.0). Among program completers (24% of total sample), the quit rates were 33% for 7-day point prevalence, 28% for 30-day point prevalence, and 88% of participants reduced their smoking frequency. CONCLUSIONS The revised app had high user receptivity, modest quit rates, and high smoking reduction rates. Program completion may be key to boosting the app's effectiveness.
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Affiliation(s)
- Jonathan B Bricker
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA; University of Washington, Department of Psychology, Box 351525, Seattle, WA 98195, USA.
| | - Wade Copeland
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA
| | - Kristin E Mull
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA
| | - Emily Y Zeng
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA
| | - Noreen L Watson
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA
| | - Katrina J Akioka
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA
| | - Jaimee L Heffner
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA
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Alessi SM, Rash CJ. Treatment Satisfaction in a Randomized Clinical Trial of mHealth Smoking Abstinence Reinforcement. J Subst Abuse Treat 2017; 72:103-110. [PMID: 27449226 PMCID: PMC5154906 DOI: 10.1016/j.jsat.2016.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
The importance of patient satisfaction in modern healthcare is widely recognized, but research on satisfaction in the context of smoking cessation has not kept pace. The purpose of this study was to explore treatment satisfaction in a sample of smokers (N=84) randomized to one of two smoking cessation treatment interventions (mHealth reinforcement and mHealth monitoring) that used cell phone-based procedures to monitor smoking status in individuals' natural environments for 4 weeks. Starting on the target quit date, participants received usual care smoking cessation treatment consisting of 8 weeks of transdermal nicotine and 4 weeks of twice-weekly telephone counseling were also prompted 1 to 3 times daily (with exact number and timing not disclosed beforehand) to use a study cell phone and CO monitor to complete a CO self-test, video-record the process, and submit videos using multimedia messaging within 2 hours. mHealth reinforcement participants could earn prizes for smoking-negative on-time CO tests. A treatment satisfaction survey was completed at the end of the 4-week monitoring/reinforcement phase. Results indicate that participants overwhelmingly endorsed high levels of overall satisfaction in both conditions. Treatment adherence did not differ between conditions, but was positively associated with endorsing the highest satisfaction with help quitting with the intervention (p<.01 to .03). mHealth reinforcement was associated with increased longest duration of abstinence (p<.01). Controlling for relevant participant characteristics and treatment adherence, longest duration of abstinence robustly predicted highest satisfaction with help quitting and mediated the effect of treatment condition on that satisfaction. Further research on treatment satisfaction may aid the development of effective abstinence reinforcement and other smoking cessation interventions.
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Affiliation(s)
- Sheila M Alessi
- University of Connecticut School of Medicine and Calhoun Cardiology, Behavioral Health.
| | - Carla J Rash
- University of Connecticut School of Medicine and Calhoun Cardiology, Behavioral Health
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Griffiths SE, Brown KE, Fulton EA, Tombor I, Naughton F. Are digital interventions for smoking cessation in pregnancy effective? A systematic review protocol. Syst Rev 2016; 5:207. [PMID: 27906071 PMCID: PMC5131429 DOI: 10.1186/s13643-016-0390-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/22/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Behavioural support for smoking cessation in pregnancy can be effective; however, many pregnant women face barriers to seeking support to stop smoking. Some digital interventions have been found to be effective for smoking cessation in the general population and may be effective for supporting cessation in pregnancy due to their flexibility and the potential for personalisation. To date, there is limited evidence of the effectiveness of digital interventions for smoking cessation in pregnancy. This review aims to assess the following: (1) whether digital interventions are effective at promoting smoking cessation among pregnant women; (2) which behaviour change techniques (BCTs) or combinations of BCTs are associated with the effectiveness of digital interventions for smoking cessation in pregnancy; and (3) whether the number of BCTs used is associated with the effectiveness of digital interventions for smoking cessation in pregnancy. METHODS This review will include digital interventions delivered largely through computer (PC or laptop), video/DVD, mobile phone (including smartphones) or portable handheld device (e.g. tablet, iPad) and include websites, mobile or tablet applications and SMS text messages. Interventions must be randomised or quasi-randomised controlled trials aimed at women who smoke in pregnancy, with smoking cessation as a measured outcome (preferably the latest available point prevalence smoking status measure taken during pregnancy, biochemically verified if available). Electronic bibliographic databases will be searched to identify suitable studies indexed in the following: Academic Search Complete, ASSIA, CINAHL, The Cochrane Library, EMBASE, Medline, PsycINFO, Scopus, and Web of Science. The search strategy will include key words and database-specific subject headings relating to 'pregnancy' and 'smoking' and synonyms for the terms 'digital' and 'randomised controlled trial'. Where required and where possible, the first and second authors will independently code interventions and control groups for BCTs. If data allows, meta-analyses will be used to assess intervention effectiveness and the effectiveness of BCTs. DISCUSSION This systematic review will provide a detailed synthesis of the effectiveness of current research using digital interventions for smoking cessation in pregnancy, to build on the evidence base and guide the development of future research in this area. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016036201.
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Affiliation(s)
- Sarah Ellen Griffiths
- Centre for Technology Enabled Health Research, Faculty of Health and Life Sciences, Coventry University, Richard Crossman Building, Priory Street, Coventry, CV1 5FB, UK.
| | - Katherine E Brown
- Centre for Technology Enabled Health Research, Faculty of Health and Life Sciences, Coventry University, Richard Crossman Building, Priory Street, Coventry, CV1 5FB, UK
| | - Emily Anne Fulton
- Centre for Technology Enabled Health Research, Faculty of Health and Life Sciences, Coventry University, Richard Crossman Building, Priory Street, Coventry, CV1 5FB, UK
| | - Ildiko Tombor
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Edith Cavell Building, Norwich, NR4 7UL, UK
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Powell J, Newhouse N, Martin A, Jawad S, Yu LM, Davoudianfar M, Locock L, Ziebland S. A novel experience-based internet intervention for smoking cessation: feasibility randomised controlled trial. BMC Public Health 2016; 16:1156. [PMID: 27835953 PMCID: PMC5106834 DOI: 10.1186/s12889-016-3821-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 11/04/2016] [Indexed: 12/04/2022] Open
Abstract
Background The internet is frequently used to share experiences of health and illness, but this phenomenon has not been harnessed as an intervention to achieve health behaviour change. The aim of this study was to determine the feasibility of a randomised trial assessing the effects of a novel, experience-based website as a smoking cessation intervention. The secondary aim was to measure the potential impact on smoking behaviour of both the intervention and a comparator website. Methods A feasibility randomised controlled single-blind trial assessed a novel, experience-based website containing personal accounts of quitting smoking as a cessation intervention, and a comparator website providing factual information. Feasibility measures including recruitment, and usage of the interventions were recorded, and the following participant-reported outcomes were also measured: Smoking Abstinence Self-Efficacy Questionnaire, the single-item Motivation to Stop Scale, self-reported abstinence, quit attempts and health status outcomes. Eligible smokers from two English regions were entered into the trial and given access to their allocated website for two weeks. Results Eighty-seven smokers were randomised, 65 completed follow-up (75 %). Median usage was 15 min for the intervention, and 5 min for the comparator (range 0.5–213 min). Median logins for both sites was 2 (range 1–20). All participant-reported outcomes were similar between groups. Conclusions It was technically feasible to deliver a novel intervention harnessing the online sharing of personal experiences as a tool for smoking cessation, but recruitment was slow and actual use was relatively low, with attrition from the trial. Future work needs to maximize engagement and to understand how best to assess the value of such interventions in everyday use, rather than as an isolated ‘dose of information’. Trial registration ISRCTN29549695 DOI 10.1186/ISRCTN29549695. Registered 17/05/2013.
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Affiliation(s)
- John Powell
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Nikki Newhouse
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Angela Martin
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sena Jawad
- Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ly-Mee Yu
- Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mina Davoudianfar
- Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louise Locock
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sue Ziebland
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Web-Based Intervention for Transitioning Smokers From Inpatient to Outpatient Care: An RCT. Am J Prev Med 2016; 51:620-9. [PMID: 27647062 DOI: 10.1016/j.amepre.2016.04.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 04/01/2016] [Accepted: 04/08/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Smoking-cessation follow-up care after hospitalization is known to be effective. Cost-effective and disseminable interventions adoptable by hospitals are needed. DESIGN RCT. SETTING/PARTICIPANTS Fourteen hundred eighty-eight current smokers recruited during a tertiary care hospital stay were randomly assigned to Usual Care (UC) or Usual Care plus Web-Based Intervention (WI). Data were collected in 2011-2013 and analyzed in 2014-2015. INTERVENTION UC provided brief bedside advice to quit, a quit plan template, and quitline contact information. WI included access to a website with asynchronous e-message communication with a tobacco counselor, use of interactive self-assessments, helpful cessation information, and access to additional web resources, as well as automated e-mail messages tailored for health concern and readiness to quit. MAIN OUTCOME MEASURES Self-reported 30-day abstinence at 6 months was the primary outcome; a subset was verified by saliva cotinine. RESULTS Six-month follow-up was completed by 83% of participants. No difference was found between study arms for self-reported abstinence rates in intent-to-treat (25.4% WI vs 26.8% UC) and complete case (31.3% WI vs 31.4% UC) analyses. Reduced smoking was reported by 45.5% (WI, n=276) and 47% (UC, n=296) of non-abstinent responders (p=0.59). Using a 10-ng/mL cotinine cut off, abstinence was verified in 52.1% of WI and 62.5% of UC (p=0.11). Significant covariates associated with abstinence at 6 months were being male, not smoking during hospitalization, being very confident in quitting, planning to quit/stay quit, smoking fewer days in the past 30 days, fewer years of smoking, and having cerebrovascular or connective tissue rheumatic disease as primary hospital diagnosis. CONCLUSIONS Lack of difference between treatment arms suggests a strong effect for UC, WI was not effective, or both. Low intervention engagement may be partially responsible. Self-reported abstinence rates were relatively high in both arms, although the biochemically verified rates indicate over-reporting of abstinence. These findings suggest brief bedside counseling for all hospitalized smokers is beneficial. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01277250.
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73
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Smit ES, Candel MJJM, Hoving C, de Vries H. Results of the PAS Study: A Randomized Controlled Trial Evaluating the Effectiveness of a Web-Based Multiple Tailored Smoking Cessation Program Combined With Tailored Counseling by Practice Nurses. HEALTH COMMUNICATION 2016; 31:1165-1173. [PMID: 26934538 DOI: 10.1080/10410236.2015.1049727] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study investigated the effects of Web-based multiple computer tailoring and counseling by a practice nurse (MTC) compared with computer tailoring without counseling (MT) and usual care (UC) on smoking cessation rates, via a randomized controlled trial with 414 Dutch adult smokers, recruited by 91 practice nurses from May 2009 to June 2010. Logistic multilevel regression analyses were conducted with 24-hour point prevalence, 7-day point prevalence, and prolonged abstinence after 6 and 12 months as dependent variables and experimental condition as the independent variable. After 6 and 12 months, 38% and 56% of respondents were followed up, respectively. At both follow-ups, no main effects of the interventions could be identified when comparing them with care as usual and with each other-neither in analyses using available data nor in analyses using a negative scenario in which respondents lost to follow-up were considered to still be smoking. A Web-based multiple computer-tailored smoking cessation program combined with a single face-to-face counseling session by a practice nurse may not be more effective than this computer-tailored program alone or than usual smoking cessation care in the general practice setting. Yet before concluding that the addition of counseling to Web-based computer tailoring cannot be successful, more research needs to be conducted to identify the optimal number of counseling sessions to be combined with the Web-based program and to how to best attune the two modalities.
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Affiliation(s)
- E S Smit
- a Department of Communication Science, Amsterdam School of Communication Research/ASCoR , University of Amsterdam
- b CAPHRI/Department of Health Promotion , Maastricht University
| | - M J J M Candel
- c CAPHRI/Department of Methodology and Statistics , Maastricht University
| | - C Hoving
- b CAPHRI/Department of Health Promotion , Maastricht University
| | - H de Vries
- b CAPHRI/Department of Health Promotion , Maastricht University
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Bommelé J, Nagelhout GE, Kleinjan M, Schoenmakers TM, Willemsen MC, van de Mheen D. Prevalence of hardcore smoking in the Netherlands between 2001 and 2012: a test of the hardening hypothesis. BMC Public Health 2016; 16:754. [PMID: 27506600 PMCID: PMC4977697 DOI: 10.1186/s12889-016-3434-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 08/03/2016] [Indexed: 12/03/2022] Open
Abstract
Background Hardcore smokers are smokers who have smoked for many years and who do not intend to quit smoking. The “hardening hypothesis” states that light smokers are more likely to quit smoking than heavy smokers (such as hardcore smokers). Therefore, the prevalence of hardcore smoking among smokers would increase over time. If this is true, the smoking population would become harder to reach with tobacco control measures. In this study we tested the hardening hypothesis. Methods We calculated the prevalence of hardcore smoking in the Netherlands from 2001 to 2012. Smokers were ‘hardcore’ if they a) smoked every day, b) smoked on average 15 cigarettes per day or more, c) had not attempted to quit in the past 12 months, and d) had no intention to quit within 6 months. We used logistic regression models to test whether the prevalence changed over time. We also investigated whether trends differed between educational levels. Results Among smokers, the prevalence of hardcore smoking decreased from 40.8 % in 2001 to 32.2 % in 2012. In the general population, it decreased from 12.2 to 8.2 %. Hardcore smokers were significantly lower educated than non-hardcore smokers. Among the general population, the prevalence of hardcore smoking decreased more among higher educated people than among lower educated people. Conclusions We found no support for the hardening hypothesis in the Netherlands between 2001 and 2012. Instead, the decrease of hardcore smoking among smokers suggests a ‘softening’ of the smoking population.
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Affiliation(s)
- Jeroen Bommelé
- IVO Addiction Research Institute, Heemraadssingel 194, 3021 DM, Rotterdam, The Netherlands. .,Erasmus Medical Center, Dr. Molewaterplein 50, 3015 CE, Rotterdam, The Netherlands.
| | - Gera E Nagelhout
- Department of Family Medicine (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.,Department of Health Promotion (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Marloes Kleinjan
- Trimbos Institute, Da Costakade 45, 3521 VS, Utrecht, The Netherlands
| | - Tim M Schoenmakers
- IVO Addiction Research Institute, Heemraadssingel 194, 3021 DM, Rotterdam, The Netherlands.,Erasmus Medical Center, Dr. Molewaterplein 50, 3015 CE, Rotterdam, The Netherlands
| | - Marc C Willemsen
- Department of Health Promotion (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Dike van de Mheen
- IVO Addiction Research Institute, Heemraadssingel 194, 3021 DM, Rotterdam, The Netherlands.,Erasmus Medical Center, Dr. Molewaterplein 50, 3015 CE, Rotterdam, The Netherlands.,Department of Health Promotion (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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75
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Kvillemo P, Brandberg Y, Bränström R. Feasibility and Outcomes of an Internet-Based Mindfulness Training Program: A Pilot Randomized Controlled Trial. JMIR Ment Health 2016; 3:e33. [PMID: 27450466 PMCID: PMC4975795 DOI: 10.2196/mental.5457] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/11/2016] [Accepted: 06/10/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Interventions based on meditation and mindfulness techniques have been shown to reduce stress and increase psychological well-being in a wide variety of populations. Self-administrated Internet-based mindfulness training programs have the potential to be a convenient, cost-effective, easily disseminated, and accessible alternative to group-based programs. OBJECTIVE This randomized controlled pilot trial with 90 university students in Stockholm, Sweden, explored the feasibility, usability, acceptability, and outcomes of an 8-week Internet-based mindfulness training program. METHODS Participants were randomly assigned to either an intervention (n=46) or an active control condition (n=44). Intervention participants were invited to an Internet-based 8-week mindfulness program, and control participants were invited to an Internet-based 4-week expressive writing program. The programs were automated apart from weekly reminders via email. Main outcomes in pre- and postassessments were psychological well-being and depression symptoms. To assess the participant's experiences, those completing the full programs were asked to fill out an assessment questionnaire and 8 of the participants were interviewed using a semistructured interview guide. Descriptive and inferential statistics, as well as content analysis, were performed. RESULTS In the mindfulness program, 28 out of 46 students (60%) completed the first week and 18 out of 46 (39%) completed the full program. In the expressive writing program, 35 out of 44 students (80%) completed the first week and 31 out of 44 (70%) completed the full program. There was no statistically significantly stronger intervention effect for the mindfulness intervention compared to the active control intervention. Those completing the mindfulness group reported high satisfaction with the program. Most of those interviewed were satisfied with the layout and technique and with the support provided by the study coordinators. More frequent contact with study coordinators was suggested as a way to improve program adherence and completion. Most participants considered the program to be meaningful and helpful but also challenging. The flexibility in performing the exercises at a suitable time and place was appreciated. A major difficulty was, however, finding enough time to practice. CONCLUSIONS The program was usable, acceptable, and showed potential for increasing psychological well-being for those completing it. However, additional modification of the program might be needed to increase retention and compliance. CLINICALTRIAL ClinicalTrials.gov NCT02062762; https://clinicaltrials.gov/ct2/show/NCT0206276 (Archived by WebCite at http://www.webcitation.org/6j9I5SGJ4).
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Affiliation(s)
- Pia Kvillemo
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
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Cantrell J, Ilakkuvan V, Graham AL, Richardson A, Xiao H, Mermelstein RJ, Curry SJ, Sporer AK, Vallone DM. Young Adult Utilization of a Smoking Cessation Website: An Observational Study Comparing Young and Older Adult Patterns of Use. JMIR Res Protoc 2016; 5:e142. [PMID: 27401019 PMCID: PMC4960403 DOI: 10.2196/resprot.4881] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 12/28/2015] [Accepted: 02/09/2016] [Indexed: 11/13/2022] Open
Abstract
Background There is little research on how young adults or young adult subgroups utilize and engage with Web-based cessation interventions when trying to quit smoking. Addressing this knowledge gap is important to identify opportunities to optimize the effectiveness of online cessation programs across diverse young adult users. Objective This study examines utilization of the BecomeAnEX.org smoking cessation website among young adults and young adult subgroups compared with older adults to identify patterns of use by age, gender, and race/ethnicity. Methods Study participants were 5983 new registered users on a free smoking cessation website who were aged 18 to 70 years. Website utilization was tracked for 6 months; metrics of use included website visits, pages per visit, length of visit, and interaction with specific website features. Differences in website use by age were examined via bivariate analyses and multivariate logistic regression adjusted for age, gender, and race/ethnicity. Interactions were examined to determine differences by gender and race/ethnicity within young (18- to 24-year-olds and 25- to 34-year-olds) and older (35 years and older) adult segments. Results A greater percentage of young adults aged 18 to 34 years visited the site only once compared with older adults aged 35 years and older (72.05% vs 56.59%, respectively; P<.001). Young adults also spent less time on the site and viewed fewer pages than older adults. In adjusted analyses, young adults were significantly less likely than older adults to visit the site more than once (18-24 years: adjusted odds ratio [AOR] 0.58, 95% CI 0.49-0.68, P<.001; 25-34 years: AOR 0.56, 95% CI 0.50-0.64, P<.001), spend more than 3 minutes on the site (18-24 years: AOR 0.67, 95% CI 0.57-0.79, P<.001; 25-34 years: AOR 0.56, 95% CI 0.49-0.64, P<.001), view 12 or more pages (18-24 years: AOR 0.72, 95% CI 0.61-0.83; P<.001; 25-34 years: AOR 0.67, 95% CI 0.59-0.76, P<.001), utilize the BecomeAnEX.org community (18-24 years: AOR 0.61, 95% CI 0.48-0.79, P<.001; 25-34 years: AOR 0.73, 95% CI 0.60-0.88, P<.001), or utilize Separation Exercises (18-24 years: AOR 0.68, 95% CI 0.51-0.89, P<.01; 25-34 years: AOR 0.77, 95% CI 0.63-0.94, P<.01). Gender differences in utilization were more pronounced among young adults compared with older adults, with lower levels of utilization among young men than young women. For all age groups, utilization was higher among whites and African Americans than among Hispanics and other racial minorities, with one exception—BecomeAnEX.org community utilization was significantly higher among Hispanic young adults compared with white and African American young adults. Conclusions Results point to important areas of inquiry for future research and development efforts. Research should focus on enhancing demand and increasing engagement among younger adults and men, examining strategies for capitalizing on young adult developmental needs, and increasing utilization of effective site features among diverse young adult users.
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Affiliation(s)
- Jennifer Cantrell
- Evaluation Science and Research, Truth Initiative, Washington, DC, United States.
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77
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Mavrot C, Stucki I, Sager F, Etter JF. Efficacy of an Internet-based, individually tailored smoking cessation program: A randomized-controlled trial. J Telemed Telecare 2016; 23:521-528. [PMID: 27365318 DOI: 10.1177/1357633x16655476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Self-help computer-based programs are easily accessible and cost-effective interventions with a great recruitment potential. However, each program is different and results of meta-analyses may not apply to each new program; therefore, evaluations of new programs are warranted. The aim of this study was to assess the marginal efficacy of a computer-based, individually tailored program (the Coach) over and above the use of a comprehensive Internet smoking cessation website. Methods A two-group randomized controlled trial was conducted. The control group only accessed the website, whereas the intervention group received the Coach in addition. Follow-up was conducted by e-mail after three and six months (self-administrated questionnaires). Of 1120 participants, 579 (51.7%) responded after three months and 436 (38.9%) after six months. The primary outcome was self-reported smoking abstinence over four weeks. Results Counting dropouts as smokers, there were no statistically significant differences between intervention and control groups in smoking cessation rates after three months (20.2% vs. 17.5%, p = 0.25, odds ratio (OR) = 1.20) and six months (17% vs. 15.5%, p = 0.52, OR = 1.12). Excluding dropouts from the analysis, there were statistically significant differences after three months (42% vs. 31.6%, p = 0.01, OR = 1.57), but not after six months (46.1% vs. 37.8%, p = 0.081, OR = 1.41). The program also significantly increased motivation to quit after three months and self-efficacy after three and six months. Discussion An individually tailored program delivered via the Internet and by e-mail in addition to a smoking cessation website did not significantly increase smoking cessation rates, but it increased motivation to quit and self-efficacy.
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Affiliation(s)
- Céline Mavrot
- 1 Center of Competence for Public Management, University of Bern, Bern, Switzerland
| | - Iris Stucki
- 1 Center of Competence for Public Management, University of Bern, Bern, Switzerland
| | - Fritz Sager
- 1 Center of Competence for Public Management, University of Bern, Bern, Switzerland
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Perret JL, Bonevski B, McDonald CF, Abramson MJ. Smoking cessation strategies for patients with asthma: improving patient outcomes. J Asthma Allergy 2016; 9:117-28. [PMID: 27445499 PMCID: PMC4928655 DOI: 10.2147/jaa.s85615] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Smoking is common in adults with asthma, yet a paucity of literature exists on smoking cessation strategies specifically targeting this subgroup. Adverse respiratory effects from personal smoking include worse asthma control and a predisposition to lower lung function and chronic obstructive pulmonary disease. Some data suggest that individuals with asthma are more likely than their non-asthmatic peers to smoke regularly at an earlier age. While quit attempts can be more frequent in smokers with asthma, they are also of shorter duration than in non-asthmatics. Considering these asthma-specific characteristics is important in order to individualize smoking cessation strategies. In particular, asthma-specific information such as "lung age" should be provided and longer-term follow-up is advised. Promising emerging strategies include reminders by cellular phone and web-based interventions using consumer health informatics. For adolescents, training older peers to deliver asthma education is another promising strategy. For smokers who are hospitalized for asthma, inpatient nicotine replacement therapy and counseling are a priority. Overall, improving smoking cessation rates in smokers with asthma may rely on a more personalized approach, with the potential for substantial health benefits to individuals and the population at large.
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Affiliation(s)
- Jennifer L Perret
- Allergy and Lung Health Unit, The University of Melbourne, Melbourne, VIC
- Institute for Breathing & Sleep, Melbourne, VIC
- Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, VIC
| | - Billie Bonevski
- School of Medicine & Public Health, University of Newcastle, NSW
| | - Christine F McDonald
- Institute for Breathing & Sleep, Melbourne, VIC
- Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, VIC
- Department of Medicine, The University of Melbourne, Melbourne, VIC
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC
- Allergy, Immunology & Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia
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van Genugten L, Dusseldorp E, Webb TL, van Empelen P. Which Combinations of Techniques and Modes of Delivery in Internet-Based Interventions Effectively Change Health Behavior? A Meta-Analysis. J Med Internet Res 2016; 18:e155. [PMID: 27268104 PMCID: PMC4936795 DOI: 10.2196/jmir.4218] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 04/27/2015] [Accepted: 05/24/2015] [Indexed: 11/26/2022] Open
Abstract
Background Many online interventions designed to promote health behaviors combine multiple behavior change techniques (BCTs), adopt different modes of delivery (MoD) (eg, text messages), and range in how usable they are. Research is therefore needed to examine the impact of these features on the effectiveness of online interventions. Objective This study applies Classification and Regression Trees (CART) analysis to meta-analytic data, in order to identify synergistic effects of BCTs, MoDs, and usability factors. Methods We analyzed data from Webb et al. This review included effect sizes from 52 online interventions targeting a variety of health behaviors and coded the use of 40 BCTs and 11 MoDs. Our research also developed a taxonomy for coding the usability of interventions. Meta-CART analyses were performed using the BCTs and MoDs as predictors and using treatment success (ie, effect size) as the outcome. Results Factors related to usability of the interventions influenced their efficacy. Specifically, subgroup analyses indicated that more efficient interventions (interventions that take little time to understand and use) are more likely to be effective than less efficient interventions. Meta-CART identified one synergistic effect: Interventions that included barrier identification/ problem solving and provided rewards for behavior change reported an average effect size that was smaller (ḡ=0.23, 95% CI 0.08-0.44) than interventions that used other combinations of techniques (ḡ=0.43, 95% CI 0.27-0.59). No synergistic effects were found for MoDs or for MoDs combined with BCTs. Conclusions Interventions that take little time to understand and use were more effective than those that require more time. Few specific combinations of BCTs that contribute to the effectiveness of online interventions were found. Furthermore, no synergistic effects between BCTs and MoDs were found, even though MoDs had strong effects when analyzed univariately in the original study.
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Minian N, Noormohamed A, Dragonetti R, Maher J, Lessels C, Selby P. Blogging to Quit Smoking: Sharing Stories from Women of Childbearing Years in Ontario. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2016; 10:21-6. [PMID: 27199562 PMCID: PMC4866799 DOI: 10.4137/sart.s34551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/06/2016] [Accepted: 03/09/2016] [Indexed: 11/05/2022]
Abstract
This study examined the degree to which the pregnant or postpartum women, in the process of quitting smoking, felt that writing in a blog about their smoking cessation journeys helped them in their efforts to become or remain smoke free. Five women who blogged for Prevention of Gestational and Neonatal Exposure to Tobacco Smoke (a website designed to help pregnant and postpartum women quit smoking) were interviewed about their experiences as bloggers. Participants were asked to complete an online survey, which had closed-ended questions regarding their sociodemographic and smoking characteristics. Once they completed the survey, semistructured qualitative interviews were conducted over the phone. Findings suggest that blogging might combine several evidence-based behavioral strategies for tobacco cessation, such as journaling and getting support from others who use tobacco. Being part of a blogging community of women who have experienced or are experiencing similar challenges can be therapeutic and help women gain confidence in their ability to quit smoking. In conclusion, blogging may help pregnant and postpartum women quit smoking by increasing their social support and promoting self-reflection.
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Affiliation(s)
| | | | | | | | | | - Peter Selby
- Centre for Addiction and Mental Health; Department of Family and Community Medicine, University of Toronto; Department of Psychiatry, University of Toronto; Dalla Lana School of Public Health, University of Toronto; Ontario Tobacco Research Unit
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Brunette MF, Ferron JC, Gottlieb J, Devitt T, Rotondi A. Development and usability testing of a web-based smoking cessation treatment for smokers with schizophrenia. Internet Interv 2016; 4:113-119. [PMID: 30135797 PMCID: PMC6096117 DOI: 10.1016/j.invent.2016.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Over half of people with schizophrenia and other psychotic disorders smoke tobacco. Web-based approaches to cessation have been effective for the general population, but are not usable by many with schizophrenia disorders due to cognitive impairments and low computer experience. We developed a prototype smoking cessation treatment website for this group of smokers with features to reduce cognitive load. Here we report results from initial office-based usability testing and home-based field testing. METHOD Five people were observed using the prototype website in the office with think-aloud cognitive interviewing. The website was modified based on these data. Six people then used the website on a home laptop after a single training session, with further coaching if needed. RESULTS Office-based testing showed that the website was usable, but required minor modifications. Further editing provided labels that were more explicit and concrete, limited the conceptual content on each page, and modified features of the support group forum. Home-based field-testing identified further functionality issues that were rapidly modified. Over half of users needed more than a single session of training to use the computer and website. Eighty three then used it independently and were very satisfied with the web-based program. Among the five smokers who field tested the prototype, 60% cut down and 20% had quit smoking after three weeks of home use. CONCLUSION The prototype website was usable and satisfactory. With training and support, home use of this cessation website appears to be feasible and promising for cessation among smokers with schizophrenia. Further research is needed to evaluate web-based cessation treatment in people with psychotic disorders.
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Affiliation(s)
- Mary F. Brunette
- Department of Psychiatry and Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 105 Pleasant St, Concord, NH 03301, United States
| | - Joelle C. Ferron
- Department of Psychiatry and Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 105 Pleasant St, Concord, NH 03301, United States
| | - Jennifer Gottlieb
- Boston University Center for Psychiatric Rehab, 940 Commonwealth Ave W. Boston, MA 02215, United States
| | - Timothy Devitt
- Thresholds Inc., 4101 N. Ravenswood Ave, Chicago, IL 60613, United States
| | - Armando Rotondi
- Department of Critical Care Medicine, University of Pittsburgh, 3550 Terrace St, Pittsburgh, PA 15261, United States
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Dalum P, Brandt CL, Skov-Ettrup L, Tolstrup J, Kok G. The Systematic Development of an Internet-Based Smoking Cessation Intervention for Adults. Health Promot Pract 2016; 17:490-500. [PMID: 27101996 DOI: 10.1177/1524839916631536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives The objective of this project was to determine whether intervention mapping is a suitable strategy for developing an Internet- and text message-based smoking cessation intervention. Method We used the Intervention Mapping framework for planning health promotion programs. After a needs assessment, we identified important changeable determinants of cessation behavior, specified objectives for the intervention, selected theoretical methods for meeting our objectives, and operationalized change methods into practical intervention strategies. Results We found that "social cognitive theory," the "transtheoretical model/stages of change," "self-regulation theory," and "appreciative inquiry" were relevant theories for smoking cessation interventions. From these theories, we selected modeling/behavioral journalism, feedback, planning coping responses/if-then statements, gain frame/positive imaging, consciousness-raising, helping relationships, stimulus control, and goal-setting as suitable methods for an Internet- and text-based adult smoking cessation program. Furthermore, we identified computer tailoring as a useful strategy for adapting the intervention to individual users. Conclusion The Intervention Mapping method, with a clear link between behavioral goals, theoretical methods, and practical strategies and materials, proved useful for systematic development of a digital smoking cessation intervention for adults.
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Affiliation(s)
- Peter Dalum
- University of Southern Denmark, Odense, Denmark Danish Cancer Society, Copenhagen, Denmark
| | | | | | | | - Gerjo Kok
- Maastricht University, Maastricht, Netherlands
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83
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Papandonatos GD, Erar B, Stanton CA, Graham AL. Online community use predicts abstinence in combined Internet/phone intervention for smoking cessation. J Consult Clin Psychol 2016; 84:633-44. [PMID: 27100127 DOI: 10.1037/ccp0000099] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To estimate the causal effects of online community use on 30-day point prevalence abstinence at 3 months among smokers that received a combined Internet/phone intervention for smoking cessation. METHOD Participants were 399 adult smokers selected from the combined Internet/phone arm of The iQUITT Study (Graham et al., 2011), a randomized trial of Internet and proactive telephone counseling for smoking cessation. All selected participants had accessed a web-based smoking-cessation program with an established online community and received at least one telephone counseling call. Automated tracking metrics of passive (e.g., reading posts, viewing profiles) and active (e.g., writing posts, sending messages) community use were extracted at 3 months. Self-selected community use defined the groups of interest as None, Passive, and Both (passive and active). Inverse probability of treatment weighting corrected for baseline imbalances on demographic, smoking, and psychosocial variables. Propensity weights estimated via generalized boosted models were used to calculate average treatment effects (ATE) and average treatment effects on the treated (ATT). RESULTS Patterns of community use were None = 145 (36.3%), Passive = 82 (20.6%), and Both = 172 (43.1%). ATE-weighted abstinence rates were None = 12.2% (95% CI = 6.7-17.7), Passive = 25.2% (95% CI = 15.1-35.2), and Both = 35.5% (95% CI = 28.1-42.9). ATT-weighted abstinence rates indicated even greater benefits of passive community use by nonusers. CONCLUSIONS More than 1/3 of the participants who used the community both passively and actively achieved abstinence. Participation in an established online community as part of a combined Internet/phone intervention has the potential to promote short-term abstinence. Results also demonstrated that information and support that originate in the community can serve as a resource for all users. (PsycINFO Database Record
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Affiliation(s)
| | - Bahar Erar
- Center for Statistical Sciences, Brown University
| | | | - Amanda L Graham
- Truth Initiative, Schroeder Institute for Tobacco Research and Policy Studies
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84
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Drost RMWA, Paulus ATG, Jander AF, Mercken L, de Vries H, Ruwaard D, Evers SMAA. A Web-Based Computer-Tailored Alcohol Prevention Program for Adolescents: Cost-Effectiveness and Intersectoral Costs and Benefits. J Med Internet Res 2016; 18:e93. [PMID: 27103154 PMCID: PMC4858595 DOI: 10.2196/jmir.5223] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/23/2015] [Accepted: 01/07/2016] [Indexed: 11/13/2022] Open
Abstract
Background Preventing excessive alcohol use among adolescents is important not only to foster individual and public health, but also to reduce alcohol-related costs inside and outside the health care sector. Computer tailoring can be both effective and cost-effective for working with many lifestyle behaviors, yet the available information on the cost-effectiveness of computer tailoring for reducing alcohol use by adolescents is limited as is information on the costs and benefits pertaining to sectors outside the health care sector, also known as intersectoral costs and benefits (ICBs). Objective The aim was to assess the cost-effectiveness of a Web-based computer-tailored intervention for reducing alcohol use and binge drinking by adolescents from a health care perspective (excluding ICBs) and from a societal perspective (including ICBs). Methods Data used were from the Alcoholic Alert study, a cluster randomized controlled trial with randomization at the level of schools into two conditions. Participants either played a game with tailored feedback on alcohol awareness after the baseline assessment (intervention condition) or received care as usual (CAU), meaning that they had the opportunity to play the game subsequent to the final measurement (waiting list control condition). Data were recorded at baseline (T0=January/February 2014) and after 4 months (T1=May/June 2014) and were used to calculate incremental cost-effectiveness ratios (ICERs), both from a health care perspective and a societal perspective. Stochastic uncertainty in the data was dealt with by using nonparametric bootstraps (5000 simulated replications). Additional sensitivity analyses were conducted based on excluding cost outliers. Subgroup cost-effectiveness analyses were conducted based on several background variables, including gender, age, educational level, religion, and ethnicity. Results From both the health care perspective and the societal perspective for both outcome measures, the intervention was more costly and more effective in comparison with CAU. ICERs differed for both perspectives, namely €40 and €79 from the health care perspective to €62 and €144 for the societal perspective per incremental reduction of one glass of alcohol per week and one binge drinking occasion per 30 days, respectively. Subgroup analyses showed, from both perspectives and for both outcome measures, that the intervention was cost-effective for older adolescents (aged 17-19 years) and those at a lower educational level and, from a health care perspective, the male and nonreligious adolescent subgroups. Conclusions Computer-tailored feedback could be a cost-effective way to target alcohol use and binge drinking among adolescents. Including ICBs in the economic evaluation had an impact on the cost-effectiveness results of the analysis. It could be worthwhile to aim the intervention specifically at specific subgroups. Trial Registration Nederlands Trial Register: NTR4048; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4048 (Archived by Webcite at http://www.webcitation.org/6c7omN8wG)
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Affiliation(s)
- Ruben M W A Drost
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.
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85
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Bottorff JL, Oliffe JL, Sarbit G, Sharp P, Caperchione CM, Currie LM, Schmid J, Mackay MH, Stolp S. Evaluation of QuitNow Men: An Online, Men-Centered Smoking Cessation Intervention. J Med Internet Res 2016; 18:e83. [PMID: 27097991 PMCID: PMC4856882 DOI: 10.2196/jmir.5076] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/16/2016] [Accepted: 02/20/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Men continue to smoke cigarettes in greater numbers than women. There is growing evidence for the value of developing targeted, men-centered health promotion programs. However, few smoking cessation interventions have been designed for men. A gender-specific website, QuitNow Men, was developed based on focus group interview findings, stakeholder feedback, and evidence-based cessation strategies. The website was designed to incorporate a masculine look and feel through the use of images, direct language, and interactive content. Usability experts and end-users provided feedback on navigation and functionality of the website prior to pilot testing. OBJECTIVES The objectives of the pilot study were to describe (1) men's use and evaluations of the interactive resources and information on the QuitNow Men website, and (2) the potential of QuitNow Men to engage men in reducing and quitting smoking. METHODS A one-group, pretest-posttest study design was used. Men who were interested in quitting were recruited and invited to use the website over a 6-month period. Data were collected via online questionnaires at baseline, 3-month, and 6-month follow-up. A total of 117 men completed the baseline survey. Over half of those (67/117, 57.3%) completed both follow-up surveys. RESULTS At baseline, participants (N=117) had been smoking for an average of 24 years (SD 12.1) and smoked on average 15 cigarettes a day (SD 7.4). The majority had not previously used a quit smoking website (103/117, 88.0%) or websites focused on men's health (105/117, 89.7%). At the 6-month follow-up, the majority of men used the QuitNow Men website at least once (64/67, 96%). Among the 64 users, 29 (43%) reported using the website more than 6 times. The men using QuitNow Men agreed or strongly agreed that the website was easy to use (51/64, 80%), the design and images were appealing (42/64, 66%), they intended to continue to use the website (42/64, 66%), and that they would recommend QuitNow Men to others who wanted to quit (46/64, 72%). Participants reported using an average of 8.76 (SD 4.08) of the 15 resources available on the website. At 6-month follow-up, 16 of the 67 participants (24%) had quit, 27 (40%) had reduced their smoking and 24 (36%) had not changed their smoking habits. Repeated measures general linear model showed a significant decrease in the number of cigarettes smoked between the 3-month and 6-month follow-up (F1,63=6.41, P=.01, eta squared=0.09). Number of resources used on the website, quit confidence, nicotine dependence and age significantly predicted number of quit attempts by those still smoking at 6 months (F4,45=2.73, P=.04), with number of resources used being the strongest predictor (P=.02). CONCLUSIONS The results of this research support efforts to integrate gender-sensitive approaches in smoking cessation interventions and indicate that this novel Web-based resource has potential in supporting men's smoking cessation efforts.
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Affiliation(s)
- Joan L Bottorff
- Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia, Kelowna, BC, Canada.
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Cobb NK, Jacobs MA, Wileyto P, Valente T, Graham AL. Diffusion of an Evidence-Based Smoking Cessation Intervention Through Facebook: A Randomized Controlled Trial. Am J Public Health 2016; 106:1130-5. [PMID: 27077358 DOI: 10.2105/ajph.2016.303106] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine the diffusion of an evidence-based smoking cessation application ("app") through Facebook social networks and identify specific intervention components that accelerate diffusion. METHODS Between December 2012 and October 2013, we recruited adult US smokers ("seeds") via Facebook advertising and randomized them to 1 of 12 app variants using a factorial design. App variants targeted components of diffusion: duration of use (t), "contagiousness" (β), and number of contacts (Z). The primary outcome was the reproductive ratio (R), defined as the number of individuals installing the app ("descendants") divided by the number of a seed participant's Facebook friends. RESULTS We randomized 9042 smokers. App utilization metrics demonstrated between-variant differences in expected directions. The highest level of diffusion (R = 0.087) occurred when we combined active contagion strategies with strategies to increase duration of use (incidence rate ratio = 9.99; 95% confidence interval = 5.58, 17.91; P < .001). Involving nonsmokers did not affect diffusion. CONCLUSIONS The maximal R value (0.087) is sufficient to increase the numbers of individuals receiving treatment if applied on a large scale. Online interventions can be designed a priori to spread through social networks.
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Affiliation(s)
- Nathan K Cobb
- Nathan K. Cobb is with the Department of Pulmonary and Critical Care, Georgetown University Medical Center, Washington, DC, and the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Megan A. Jacobs is with the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC. Paul Wileyto is with the Department of Biostatistics & Epidemiology, University of Pennsylvania School of Medicine, Philadelphia. Thomas Valente is with the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Amanda L. Graham is with the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC, and the Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Megan A Jacobs
- Nathan K. Cobb is with the Department of Pulmonary and Critical Care, Georgetown University Medical Center, Washington, DC, and the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Megan A. Jacobs is with the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC. Paul Wileyto is with the Department of Biostatistics & Epidemiology, University of Pennsylvania School of Medicine, Philadelphia. Thomas Valente is with the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Amanda L. Graham is with the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC, and the Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Paul Wileyto
- Nathan K. Cobb is with the Department of Pulmonary and Critical Care, Georgetown University Medical Center, Washington, DC, and the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Megan A. Jacobs is with the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC. Paul Wileyto is with the Department of Biostatistics & Epidemiology, University of Pennsylvania School of Medicine, Philadelphia. Thomas Valente is with the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Amanda L. Graham is with the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC, and the Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Thomas Valente
- Nathan K. Cobb is with the Department of Pulmonary and Critical Care, Georgetown University Medical Center, Washington, DC, and the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Megan A. Jacobs is with the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC. Paul Wileyto is with the Department of Biostatistics & Epidemiology, University of Pennsylvania School of Medicine, Philadelphia. Thomas Valente is with the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Amanda L. Graham is with the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC, and the Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Amanda L Graham
- Nathan K. Cobb is with the Department of Pulmonary and Critical Care, Georgetown University Medical Center, Washington, DC, and the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Megan A. Jacobs is with the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC. Paul Wileyto is with the Department of Biostatistics & Epidemiology, University of Pennsylvania School of Medicine, Philadelphia. Thomas Valente is with the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Amanda L. Graham is with the Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC, and the Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
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Lorencatto F, West R, Bruguera C, Brose LS, Michie S. Assessing the Quality of Goal Setting in Behavioural Support for Smoking Cessation and its Association with Outcomes. Ann Behav Med 2016; 50:310-8. [PMID: 26603626 PMCID: PMC4823339 DOI: 10.1007/s12160-015-9755-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Smoking cessation behavioural support can be effective but practitioners differ markedly in effectiveness, possibly due to variation in the quality of delivery of key behaviour change techniques, such as goal setting (i.e. setting a quit date). OBJECTIVES This study aimed to (i) develop a reliable method for assessing the quality of practitioners' support in setting quit dates and (ii) assess whether quality predicts initiation of abstinence as a first step to quitting. METHODS A scale for scoring the quality of goal setting was developed from national guidance documents and applied to 85 transcribed behavioural support sessions. Inter-rater reliability was assessed. Associations between quality scores and quit attempts were assessed. RESULTS The 10-item scale produced had good inter-rater reliability (Kappa = 0.68). Higher quality goal setting was associated with increased self-reported quit attempts (p < .001; OR = 2.60, 95 % CI 1.54-4.40). The scale components 'set a clear quit date' (χ (2) (2, N = 85) = 22.3, p < .001) and 'within an appropriate timeframe' (χ (2) (2, N = 85) = 15.5, p < .001) were independently associated with quit attempts. CONCLUSIONS It is possible to reliably assess the quality of goal setting in smoking cessation behavioural support. Higher quality of goal setting is associated with greater likelihood of initiating quit attempts.
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Affiliation(s)
- Fabiana Lorencatto
- School of Health Sciences, City University London, London, EC1V 0HB, UK.
| | - Robert West
- Department of Epidemiology & Public Health, University College London, London, WC1E 6BT, UK
| | - Carla Bruguera
- Department of Epidemiology & Public Health, University College London, London, WC1E 6BT, UK
| | - Leonie S Brose
- National Addictions Centre, UK Centre for Tobacco and Alcohol Studies, Institute of Psychiatry, King's College London, London, SE5 8BB, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 6BT, UK
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Graham AL, Jacobs MA, Cohn AM, Cha S, Abroms LC, Papandonatos GD, Whittaker R. Optimising text messaging to improve adherence to web-based smoking cessation treatment: a randomised control trial protocol. BMJ Open 2016; 6:e010687. [PMID: 27029775 PMCID: PMC4823397 DOI: 10.1136/bmjopen-2015-010687] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Millions of smokers use the Internet for smoking cessation assistance each year; however, most smokers engage minimally with even the best designed websites. The ubiquity of mobile devices and their effectiveness in promoting adherence in other areas of health behaviour change make them a promising tool to address adherence in Internet smoking cessation interventions. Text messaging is used by most adults, and messages can proactively encourage use of a web-based intervention. Text messaging can also be integrated with an Internet intervention to facilitate the use of core Internet intervention components. METHODS AND ANALYSIS We identified four aspects of a text message intervention that may enhance its effectiveness in promoting adherence to a web-based smoking cessation programme: personalisation, integration, dynamic tailoring and message intensity. Phase I will use a two-level full factorial design to test the impact of these four experimental features on adherence to a web-based intervention. The primary outcome is a composite metric of adherence that incorporates general utilisation metrics (eg, logins, page views) and specific feature utilisation shown to predict abstinence. Participants will be N=860 adult smokers who register on an established Internet cessation programme and enrol in its text message programme. Phase II will be a two-arm randomised trial to compare the efficacy of the web-based cessation programme alone and in conjunction with the optimised text messaging intervention on 30-day point prevalence abstinence at 9 months. Phase II participants will be N=600 adult smokers who register to use an established Internet cessation programme and enrol in text messaging. Secondary analyses will explore whether adherence mediates the effect of treatment condition on outcome. ETHICS AND DISSEMINATION This protocol was approved by Chesapeake IRB. We will disseminate study results through peer-reviewed manuscripts and conference presentations related to the methods and design, outcomes and exploratory analyses. TRIAL REGISTRATION NUMBER NCT02585206.
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Affiliation(s)
- Amanda L Graham
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington DC, USA
- Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington DC, USA
| | - Megan A Jacobs
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington DC, USA
| | - Amy M Cohn
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington DC, USA
- Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington DC, USA
| | - Sarah Cha
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington DC, USA
| | - Lorien C Abroms
- Department of Prevention and Community Health, The George Washington University, Washington DC, USA
| | | | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
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Phillips JC, Rowsell DJ, Boomer J, Kwon JY, Currie LM. Personas to Guide Understanding Traditions of Gay Men Living With HIV Who Smoke. QUALITATIVE HEALTH RESEARCH 2016; 26:41-54. [PMID: 25881965 DOI: 10.1177/1049732315581614] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Gay men living with HIV (GMLWH) who smoke are less responsive to generalized smoking reduction and cessation (SRC) programs than heterosexual persons. This study explored perspectives of GMLWH during the design of a web-based SRC intervention. Participatory design techniques were used to guide the creation of personas that are composite representations of a person who would use the web-based SRC intervention. Researcher-participants (n = 13) created all data. Data analysis involved thematic coding drawing from an ethnographic perspective. Thematic analysis revealed seven intersecting themes related to SRC among participants, and an overarching theme navigating life. Concepts drawn from our ethnographic approach highlight cultural differences between GMLWH and mainstream society. Personas offer a mechanism for interpreting experiences and traditions of GMLWH. SRC interventions with GMLWH must address their social realities that include tools for navigating life, disease, and social identity.
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Affiliation(s)
| | | | - Jack Boomer
- British Columbia Lung Association, Vancouver, British Columbia, Canada
| | - Jae-Yung Kwon
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Leanne M Currie
- University of British Columbia, Vancouver, British Columbia, Canada
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90
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Prenger R, Pieterse ME, Braakman-Jansen LMA, Feenstra TL, Smit ES, Hoving C, de Vries H, van Ommeren JK, Evers SMAA, van der Palen J. Dealing With Missing Behavioral Endpoints in Health Promotion Research by Modeling Cognitive Parameters in Cost-Effectiveness Analyses of Behavioral Interventions: A Validation Study. HEALTH ECONOMICS 2016; 25:24-39. [PMID: 25448460 DOI: 10.1002/hec.3119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 05/29/2014] [Accepted: 10/08/2014] [Indexed: 06/04/2023]
Abstract
Cost-effectiveness analyses (CEAs) of behavioral interventions typically use physical outcome criteria. However, any progress in cognitive antecedents of behavior change may be seen as a beneficial outcome of an intervention. The aim of this study is to explore the feasibility and validity of incorporating cognitive parameters of behavior change in CEAs. The CEA from a randomized controlled trial on smoking cessation was reanalyzed. First, relevant cognitive antecedents of behavior change in this dataset were identified. Then, transition probabilities between combined states of smoking and cognitions at 6 weeks and corresponding 6 months smoking status were obtained from the dataset. These rates were extrapolated to the period from 6 to 12 months in a decision analytic model. Simulated results were compared with the 12 months' observed cost-effectiveness results. Self-efficacy was the strongest time-varying predictor of smoking cessation. Twelve months' observed CEA results for the multiple tailoring intervention versus usual care showed € 3188 had to be paid for each additional quitter versus € 10,600 in the simulated model. The simulated CEA showed largely similar but somewhat more conservative results. Using self-efficacy to enhance the estimation of the true behavioral outcome seems a feasible and valid way to estimate future cost-effectiveness.
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Affiliation(s)
- Rilana Prenger
- Department of Psychology, Health & Technology, University of Twente, The Netherlands
| | - Marcel E Pieterse
- Department of Psychology, Health & Technology, University of Twente, The Netherlands
| | | | - Talitha L Feenstra
- Centre for Nutrition, Prevention & Health Services Research, National Institute for Public Health & the Environment (RIVM), the Netherlands
- University Medical Center Groningen, University of Groningen, the Netherlands
| | - Eline S Smit
- Department of Health Promotion, Maastricht University/ CAPHRI School for Public Health and Primary Care, The Netherlands
- Department of Communication Science, University of Amsterdam/Amsterdam School of Communication Research (ASCoR), The Netherlands
| | - Ciska Hoving
- Department of Health Promotion, Maastricht University/ CAPHRI School for Public Health and Primary Care, The Netherlands
| | - Hein de Vries
- Department of Health Promotion, Maastricht University/ CAPHRI School for Public Health and Primary Care, The Netherlands
| | - Jan-Kees van Ommeren
- Department of Stochastic Operational Research, University of Twente, The Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, Maastricht University/ CAPHRI School for Public Health and Primary Care, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, the Netherlands
| | - Job van der Palen
- Department of Research Methodology, Measurement & Data Analysis, University of Twente, The Netherlands
- Department of Epidemiology, Medical School Twente, Medisch Spectrum Twente, The Netherlands
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Brice A, Price A, Burls A. Creating a database of internet-based clinical trials to support a public-led research programme: A descriptive analysis. Digit Health 2015; 1:2055207615617854. [PMID: 29942546 PMCID: PMC5999056 DOI: 10.1177/2055207615617854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 10/27/2015] [Indexed: 11/26/2022] Open
Abstract
Background Online trials are rapidly growing in number, offering potential benefits but also methodological, ethical and social challenges. The International Network for Knowledge on Well-being (ThinkWell™) aims to increase public and patient participation in the prioritisation, design and conduct of research through the use of technologies. Objective We aim to provide a baseline understanding of the online trial environment, determining how many trials have used internet-based technologies; how they have been used; and how use has developed over time. Methods We searched a range of bibliographic databases to March 2015, with no date limits, supplemented by citation searching and references provided by experts in the field. Results were screened against inclusion and exclusion criteria, and included studies mapped against a number of key dimensions, with key themes developed iteratively throughout the process. Results We identified 1992 internet-based trials to March 2015. The number of reported studies increased substantially over the study timeframe. The largest number of trials were conducted in the USA (49.7%), followed by The Netherlands (10.2%); Australia (8.5%); the United Kingdom (5.8%); Sweden (4.6%); Canada (4%); and Germany (2.6%). South Korea (1.5%) has the highest number of reported trials for other continents. There is a predominance of interventions addressing core public health challenges including obesity (8.6%), smoking cessation (5.9%), alcohol abuse (7.7%) and physical activity (10.2%); in mental health issues such as depression (10.9%) and anxiety (5.6%); and conditions where self-management (16.6%) or monitoring (8.1%) is a major feature of care. Conclusions The results confirm an increase in the use of the internet in trials. Key themes have emerged from the analysis and further research will be undertaken in order to investigate how the data can be used to improve trial design and recruitment, and to build an open access resource to support the public-led research agenda.
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Affiliation(s)
- Anne Brice
- Evidence-Based Health Care Programme, Department of Primary Health Care Sciences; Department of Continuing Education, Oxford, UK
| | - Amy Price
- Evidence-Based Health Care Programme, Department of Primary Health Care Sciences; Department of Continuing Education, Oxford, UK
| | - Amanda Burls
- Health Services Research and Management Division, School of Health Sciences, City University, London, UK
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O'Donnell CA, Browne S, Pierce M, McConnachie A, Deckers K, van Boxtel MPJ, Manera V, Köhler S, Redmond M, Verhey FRJ, van den Akker M, Power K, Irving K. Reducing dementia risk by targeting modifiable risk factors in mid-life: study protocol for the Innovative Midlife Intervention for Dementia Deterrence (In-MINDD) randomised controlled feasibility trial. Pilot Feasibility Stud 2015; 1:40. [PMID: 27965818 PMCID: PMC5154057 DOI: 10.1186/s40814-015-0035-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 11/04/2015] [Indexed: 02/08/2023] Open
Abstract
Background Dementia prevalence is increasing as populations live longer, with no cure and the costs of caring exceeding many other conditions. There is increasing evidence for modifiable risk factors which, if addressed in mid-life, can reduce the risk of developing dementia in later life. These include physical inactivity, low cognitive activity, mid-life obesity, high blood pressure, and high cholesterol. This study aims to assess the acceptability and feasibility and impact of giving those in mid-life, aged between 40 and 60 years, an individualised dementia risk modification score and profile and access to personalised on-line health information and goal setting in order to support the behaviour change required to reduce such dementia risk. A secondary aim is to understand participants’ and practitioners’ views of dementia prevention and explore the acceptability and integration of the Innovative Midlife Intervention for Dementia Deterrence (In-MINDD) intervention into daily life and routine practice. Methods/design In-MINDD is a multi-centre, primary care-based, single-blinded randomised controlled feasibility trial currently being conducted in four European countries (France, Ireland, the Netherlands and the UK). Participants are being recruited from participating general practices. Inclusion criteria will include age between 40 and 60 years; at least one modifiable risk factor for dementia risk (including diabetes, hypertension, obesity, renal dysfunction, current smoker, raised cholesterol, coronary heart disease, current or previous history of depression, self-reported sedentary lifestyle, and self-reported low cognitive activity) access to the Internet. Primary outcome measure will be a change in dementia risk modification score over the timescale of the trial (6 months). A qualitative process evaluation will interview a sample of participants and practitioners about their views on the acceptability and feasibility of the trial and the links between modifiable risk factors and dementia prevention. This work will be underpinned by Normalisation Process Theory. Discussion This study will explore the feasibility and acceptability of a risk profiler and on-line support environment to help individuals in mid-life assess their risk of developing dementia in later life and to take steps to alleviate that risk by tackling health-related behaviour change. Testing the intervention in a robust and theoretically informed manner will inform the development of a future, full-scale randomised controlled trial. Trial registration ISRCTN Registry: ISRCTN 98553005 (DOI: 10.1186/ISRCTN98553005). Electronic supplementary material The online version of this article (doi:10.1186/s40814-015-0035-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Catherine A O'Donnell
- General Practice and Primary Care, Institute of Health & Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX Scotland UK
| | - Susan Browne
- General Practice and Primary Care, Institute of Health & Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX Scotland UK
| | - Maria Pierce
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Kay Deckers
- School for Mental Health and Neuroscience, Alzheimer Centrum Limburg, Maastricht University, Maastricht, The Netherlands
| | - Martin P J van Boxtel
- School for Mental Health and Neuroscience, Alzheimer Centrum Limburg, Maastricht University, Maastricht, The Netherlands
| | - Valeria Manera
- CoBTeK COgnition Behaviour Technology, Université de Nice Sophia Antipolis, Nice, France
| | - Sebastian Köhler
- School for Mental Health and Neuroscience, Alzheimer Centrum Limburg, Maastricht University, Maastricht, The Netherlands
| | - Muriel Redmond
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Frans R J Verhey
- School for Mental Health and Neuroscience, Alzheimer Centrum Limburg, Maastricht University, Maastricht, The Netherlands
| | - Marjan van den Akker
- School for Mental Health and Neuroscience, Alzheimer Centrum Limburg, Maastricht University, Maastricht, The Netherlands
| | - Kevin Power
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Kate Irving
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
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93
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Patnode CD, Henderson JT, Thompson JH, Senger CA, Fortmann SP, Whitlock EP. Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Review of Reviews for the U.S. Preventive Services Task Force. Ann Intern Med 2015; 163:608-21. [PMID: 26389650 DOI: 10.7326/m15-0171] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Tobacco use is the leading cause of preventable death in the United States. PURPOSE To review the effectiveness and safety of pharmacotherapy and behavioral interventions for tobacco cessation. DATA SOURCES 5 databases and 8 organizational Web sites were searched through 1 August 2014 for systematic reviews, and PubMed was searched through 1 March 2015 for trials on electronic nicotine delivery systems. STUDY SELECTION Two reviewers examined 114 articles to identify English-language reviews that reported health, cessation, or adverse outcomes. DATA EXTRACTION One reviewer abstracted data from good- and fair-quality reviews, and a second checked for accuracy. DATA SYNTHESIS 54 reviews were included. Behavioral interventions increased smoking cessation at 6 months or more (physician advice had a pooled risk ratio [RR] of 1.76 [95% CI, 1.58 to 1.96]). Nicotine replacement therapy (RR, 1.60 [CI, 1.53 to 1.68]), bupropion (RR, 1.62 [CI, 1.49 to 1.76]), and varenicline (RR, 2.27 [CI, 2.02 to 2.55]) were also effective for smoking cessation. Combined behavioral and pharmacotherapy interventions increased cessation by 82% compared with minimal intervention or usual care (RR, 1.82 [CI, 1.66 to 2.00]). None of the drugs were associated with major cardiovascular adverse events. Only 2 trials addressed efficacy of electronic cigarettes for smoking cessation and found no benefit. Among pregnant women, behavioral interventions benefited cessation and perinatal health; effects of nicotine replacement therapy were not significant. LIMITATION Evidence published after each review's last search date was not included. CONCLUSION Behavioral and pharmacotherapy interventions improve rates of smoking cessation among the general adult population, alone or in combination. Data on the effectiveness and safety of electronic nicotine delivery systems are limited. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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Affiliation(s)
- Carrie D. Patnode
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Jillian T. Henderson
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Jamie H. Thompson
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Caitlyn A. Senger
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Stephen P. Fortmann
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Evelyn P. Whitlock
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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94
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Mañanes G, Vallejo MA, Vallejo-Slocker L. Demographic, psychological and smoking characteristics of users of an on-line smoking cessation programme in the Spanish language. GACETA SANITARIA 2015; 30:18-23. [PMID: 26318722 DOI: 10.1016/j.gaceta.2015.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/08/2015] [Accepted: 07/10/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the characteristics of users of a smoking cessation programme run by the Open University of Spain (Universidad Nacional de Educación a Distancia [UNED]). METHODS We examined the demographic, psychological and smoking characteristics of 23,763 smokers who participated in the on-line smoking cessation program of the UNED. The programme was open to any smoker, free of charge, and was fully automated and with direct access. RESULTS A total of 93.5% of the users were Spaniards, with an equal percentage of participation among men and women. The mean age was 39 years. Somewhat less than half were married and had a university education. The participants smoked a mean of 19.3 cigarettes per day, showing a mid-range level of nicotine dependence according to the Heaviness of Smoking Index. The results of the Anxiety and Depression subscales of the Symptom Checklist-90-Revised (SCL-90-R) and Perceived Stress Scale were not clinically significant. In a secondary analysis of the data, we found gender differences in all the variables measured. CONCLUSIONS The results of this study confirm the digital divide, with lower participation among people with a lower educational level. No association was observed between stress, anxiety or depression and cigarette consumption.
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Affiliation(s)
- Guillermo Mañanes
- Faculty of Psychology, National Distance Education University (UNED), Madrid, Spain
| | - Miguel A Vallejo
- Faculty of Psychology, National Distance Education University (UNED), Madrid, Spain.
| | - Laura Vallejo-Slocker
- Faculty of Psychology, Complutense University of Madrid (UCM), Campus of Somosaguas, Madrid, Spain
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95
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Baskerville NB, Azagba S, Norman C, McKeown K, Brown KS. Effect of a Digital Social Media Campaign on Young Adult Smoking Cessation. Nicotine Tob Res 2015; 18:351-60. [PMID: 26045252 DOI: 10.1093/ntr/ntv119] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 05/28/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Social media (SM) may extend the reach and impact for smoking cessation among young adult smokers. To-date, little research targeting young adults has been done on the use of SM to promote quitting smoking. We assessed the effect of an innovative multicomponent web-based and SM approach known as Break-it-Off (BIO) on young adult smoking cessation. METHODS The study employed a quasi-experimental design with baseline and 3-month follow-up data from 19 to 29-year old smokers exposed to BIO (n = 102 at follow-up) and a comparison group of Smokers' Helpline (SHL) users (n = 136 at follow-up). Logistic regression analysis assessed differences between groups on self-reported 7-day and 30-day point prevalence cessation rates, adjusting for ethnicity, education level, and cigarette use (daily or occasional) at baseline. RESULTS The campaign reached 37 325 unique visitors with a total of 44 172 visits. BIO users had significantly higher 7-day and 30-day quit rates compared with users of SHL. At 3-month follow-up, BIO participants (32.4%) were more likely than SHL participants (14%) to have quit smoking for 30 days (odds ratio = 2.95, 95% CI = 1.56 to 5.57, P < .001) and BIO participants (91%) were more likely than SHL participants (79%) to have made a quit attempt (odds ratio = 2.69, 95% CI = 1.03 to 6.99, P = .04). CONCLUSION The reach of the campaign and findings on quitting success indicate that a digital/SM platform can complement the traditional SHL cessation service for young adult smokers seeking help to quit.
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Affiliation(s)
- Neill Bruce Baskerville
- Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada; Propel Centre for Population Health Impact, University of Waterloo, Waterloo, ON, Canada;
| | - Sunday Azagba
- Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada; Propel Centre for Population Health Impact, University of Waterloo, Waterloo, ON, Canada
| | - Cameron Norman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; CENSE Research + Design, Toronto, ON, Canada
| | - Kyle McKeown
- Smokers' Helpline, Canadian Cancer Society, Toronto, ON, Canada
| | - K Stephen Brown
- Propel Centre for Population Health Impact, University of Waterloo, Waterloo, ON, Canada; Statistics and Actuarial Sciences, University of Waterloo, Waterloo, ON, Canada
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96
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Alkhaldi G, Hamilton FL, Lau R, Webster R, Michie S, Murray E. The effectiveness of technology-based strategies to promote engagement with digital interventions: a systematic review protocol. JMIR Res Protoc 2015; 4:e47. [PMID: 25921274 PMCID: PMC4429223 DOI: 10.2196/resprot.3990] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/03/2014] [Accepted: 12/05/2014] [Indexed: 11/16/2022] Open
Abstract
Background Digital interventions provide effective and potentially cost-effective models for improving health outcomes as they deliver health information and services that are widely disseminated, confidential, and can be tailored to needs of the individual user. Digital interventions have been used successfully for health promotion, mental health, and for enabling self-management of long-term conditions. However, their effectiveness is limited by low usage rates, with non-engagement a major challenge. Hence, it is crucial to find effective strategies to increase user engagement with digital interventions. Objective This systematic review will aim to evaluate the effectiveness of technology-based strategies to promote engagement with digital interventions. Methods We will follow Cochrane Collaboration guidelines on systematic review methodology. The search strategy will be executed across seven e-databases (including MEDLINE, EMBASE, PsycINFO, CINAHL) using the concepts “digital intervention” and “engagement”, limited by study type (randomized controlled trial). Grey literature and reference lists of included studies will be searched. Titles and abstracts will be independently screened by 2 authors. Then the full text of potentially eligible papers will be obtained and double screened. Data from eligible papers will be extracted by 1 author and checked for accuracy by another author. Bias will be assessed using the Cochrane bias assessment tool. Narrative synthesis will report on all included studies, and where appropriate, data will be pooled using meta-analysis. All findings will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Sources of heterogeneity will be further investigated if required. Results Our research is in progress. The final draft of the systematic review is being written and will be submitted before the end of 2015. Conclusions The review findings will inform researchers and digital intervention providers about optimal use of technology-based strategies to promote engagement with digital interventions. Trial Registration PROSPERO International Prospective Register of Systematic Reviews: CRD42014010164; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014010164#.VTZmmiFViko (Archived by WebCite at http://www.webcitation.org/6XxQC8fT8).
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Affiliation(s)
- Ghadah Alkhaldi
- E-Health Unit, Research Department of Primary Care and Population Health, University College London, London, United Kingdom.
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97
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Xiao RS, Hayes RB, Waring ME, Geller AC, Churchill LC, Okuyemi KS, Adams M, Huggett KN, Ockene JK. Tobacco counseling experience prior to starting medical school, tobacco treatment self-efficacy and knowledge among first-year medical students in the United States. Prev Med 2015; 73:119-24. [PMID: 25666737 PMCID: PMC4378235 DOI: 10.1016/j.ypmed.2015.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/30/2014] [Accepted: 02/01/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To explore students' tobacco dependence counseling experiences prior to medical school and their associations with tobacco counseling self-efficacy, and familiarity with and perceived effectiveness of tobacco dependence treatment among first-year medical students in the United States. METHOD In 2010, 1266 first-year medical students from 10 US medical schools completed a survey reporting their clinical experiences with specific tobacco counseling skills (e.g., 5As) prior to medical school. The survey also included questions on tobacco counseling self-efficacy, perceived physician impact on smokers, and familiarity and effectiveness of tobacco-related treatments. RESULTS Half (50.4%) reported some tobacco counseling experiences prior to medical school (i.e. at least one 5A). Students with prior counseling experiences were more likely to have higher tobacco counseling self-efficacy, and greater familiarity with medication treatment, nicotine replacement treatment, and behavioral counseling for smoking cessation, compared to those with no prior experiences. Perceived physician impact on patient smoking outcomes did not differ by prior tobacco counseling experiences. CONCLUSIONS Many first-year medical students may already be primed to learn tobacco dependence counseling skills. Enhancing early exposure to learning these skills in medical school is likely to be beneficial to the skillset of our future physicians.
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Affiliation(s)
- Rui S Xiao
- Clinical and Population Health Research Program, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA; Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA.
| | - Rashelle B Hayes
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655, USA
| | - Molly E Waring
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
| | - Linda C Churchill
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655, USA
| | - Kolawole S Okuyemi
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Michael Adams
- Division of General Internal Medicine, Department of Medicine, Georgetown University Hospital, USA
| | | | - Judith K Ockene
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655, USA
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98
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Abstract
In the United States, the rate of cigarette smoking has significantly declined over the past 2 decades, but much more work is needed, as almost 20% of adults still smoke and smoking continues to be the leading preventable cause of death. Furthermore, rates of smoking in certain subpopulations have remained relatively stable and have historically been neglected in smoking cessation research. Pharmacotherapy (both prescription and over-the-counter) and behavioral support are known to aid cessation, and their combination is more effective than either alone. There are significant barriers to access, use, and adherence, however, especially with pharmacotherapy. Therefore, the purpose of this review is to provide an update and overview of the numerous behavioral approaches that have been used to enhance smoking cessation. The research described can be classified into the type of approach used, the setting in which it is delivered, and the population targeted. Regardless of the classification, all the approaches attempt to provide smokers with the information, motivation, and behavioral skills thought to be necessary for achieving initial cessation and sustained abstinence. Recommendations for future research on behavioral smoking cessation are also included.
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Affiliation(s)
- Joseph T. Ciccolo
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York (JTC)
- Department of Psychiatry and Human Behavior, Centers for Behavioral & Preventive Medicine, Alpert Medical School of Brown University and The Miriam Hospital, Providence, Rhode Island (AMB)
| | - Andrew M. Busch
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York (JTC)
- Department of Psychiatry and Human Behavior, Centers for Behavioral & Preventive Medicine, Alpert Medical School of Brown University and The Miriam Hospital, Providence, Rhode Island (AMB)
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99
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Gulliver A, Farrer L, Chan JKY, Tait RJ, Bennett K, Calear AL, Griffiths KM. Technology-based interventions for tobacco and other drug use in university and college students: a systematic review and meta-analysis. Addict Sci Clin Pract 2015; 10:5. [PMID: 25928221 PMCID: PMC4422468 DOI: 10.1186/s13722-015-0027-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 01/30/2015] [Indexed: 11/18/2022] Open
Abstract
Background University students have high levels of tobacco and other drug use, yet they are unlikely to seek traditional care. Technology-based interventions are highly relevant to this population. This paper comprises a systematic review and meta-analysis of published randomized trials of technology-based interventions evaluated in a tertiary (university/college) setting for tobacco and other drug use (excluding alcohol). It extends previous reviews by using a broad definition of technology. Methods PubMed, PsycInfo, and the Cochrane databases were searched using keywords, phrases, and MeSH terms. Retrieved abstracts (n = 627) were double screened and coded. Included studies met the following criteria: (1) the study was a randomized trial or a randomized controlled trial (RCT); (2) the sample was composed of students attending a tertiary (e.g., university, college) institution; (3) the intervention was either delivered by or accessed using a technological device or process (e.g., computer/internet, telephone, mobile short message services [SMS]); (4) the age range or mean of the sample was between 18 and 25 years; and (5) the intervention was designed to alter a drug use outcome relating to tobacco or other drugs (excluding alcohol). Results A total of 12 papers met inclusion criteria for the current review. The majority of included papers examined tobacco use (n = 9; 75%), two studies targeted marijuana use (17%); and one targeted stress, marijuana, alcohol, and tobacco use. A quantitative meta-analysis was conducted on the tobacco use studies using an abstinence outcome measure (n = 6), demonstrating that the interventions increased the rate of abstinence by 1.5 times that of controls (Risk Ratio [RR] = 1.54; 95% Confidence Interval [CI] = 1.20–1.98). Across all 12 studies, a total of 20 technology-based interventions were reviewed. A range of technology was employed in the interventions, including stand-alone computer programs (n = 10), internet (n = 5), telephone (n = 3), and mobile SMS (n = 2). Conclusions Although technological interventions have the potential to reduce drug use in tertiary students, very few trials have been conducted, particularly for substances other than tobacco. However, the improvement shown in abstinence from tobacco use has the potential to impact substantially on morbidity and mortality. Electronic supplementary material The online version of this article (doi:10.1186/s13722-015-0027-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amelia Gulliver
- National Institute for Mental Health Research, The Australian National University, Canberra, Australia.
| | - Louise Farrer
- National Institute for Mental Health Research, The Australian National University, Canberra, Australia.
| | - Jade K Y Chan
- School of Psychology, University of New South Wales, Sydney, Australia.
| | - Robert J Tait
- National Institute for Mental Health Research, The Australian National University, Canberra, Australia. .,National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia.
| | - Kylie Bennett
- National Institute for Mental Health Research, The Australian National University, Canberra, Australia.
| | - Alison L Calear
- National Institute for Mental Health Research, The Australian National University, Canberra, Australia.
| | - Kathleen M Griffiths
- National Institute for Mental Health Research, The Australian National University, Canberra, Australia.
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100
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Essa-Hadad J, Linn S, Rafaeli S. A web-based program to increase knowledge and reduce cigarette and nargila smoking among Arab university students in Israel: mixed-methods study to test acceptability. J Med Internet Res 2015; 17:e39. [PMID: 25707034 PMCID: PMC4376148 DOI: 10.2196/jmir.2988] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 01/13/2014] [Accepted: 12/06/2014] [Indexed: 11/30/2022] Open
Abstract
Background Among Arab citizens in Israel, cigarette and nargila (hookah, waterpipe) smoking is a serious public health problem, particularly among the young adult population. With the dramatic increase of Internet and computer use among Arab college and university students, a Web-based program may provide an easy, accessible tool to reduce smoking rates without heavy resource demands required by traditional methods. Objective The purpose of this research was to examine the acceptability and feasibility of a pilot Web-based program that provides tailored feedback to increase smoking knowledge and reduce cigarette and nargila smoking behaviors among Arab college/university students in Israel. Methods A pilot Web-based program was developed, consisting of a self-administered questionnaire and feedback system on cigarette and nargila smoking. Arab university students were recruited to participate in a mixed-methods study, using both quantitative (pre-/posttest study design) and qualitative tools. A posttest was implemented at 1 month following participation in the intervention to assess any changes in smoking knowledge and behaviors. Focus group sessions were implemented to assess acceptability and preferences related to the Web-based program. Results A total of 225 participants—response rate of 63.2% (225/356)—completed the intervention at baseline and at 1-month poststudy, and were used for the comparative analysis. Statistically significant reductions in nargila smoking among participants (P=.001) were found. The intervention did not result in reductions in cigarette smoking. However, the tailored Web intervention resulted in statistically significant increases in the intention to quit smoking (P=.021). No statistically significant increases in knowledge were seen at 1-month poststudy. Participants expressed high satisfaction with the intervention and 93.8% (211/225) of those who completed the intervention at both time intervals reported that they would recommend the program to their friends, indicating excellent acceptability and feasibility of the intervention. This was further emphasized in the focus group sessions. Conclusions A tailored Web-based program may be a promising tool to reduce nargila smoking among Arab university students in Israel. The tailored Web intervention was not successful at significantly reducing cigarette smoking or increasing knowledge. However, the intervention did increase participants’ intention to quit smoking. Participants considered the Web-based tool to be an interesting, feasible, and highly acceptable strategy. Trial Registration Trial Registration: ISRCTN registry ISRCTN59207794; http://www.isrctn.com/ISRCTN59207794 (Archived by WebCite at http://www.webcitation.org/6VkYOBNOJ).
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