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Luo T, Li MS, Williams D, Fritz J, Beiter K, Phillippi S, Yu Q, Kantrow S, Lin WT, Kao YH, Chen Y, Chen L, Tseng TS. A WeChat-based smoking cessation intervention for Chinese smokers: A pilot study. Internet Interv 2022; 28:100511. [PMID: 35646606 PMCID: PMC9136339 DOI: 10.1016/j.invent.2022.100511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND China is the largest tobacco producer and has the highest number of tobacco consumers in the world. Extensive research has demonstrated the utility of social media for smoking cessation. WeChat is the most commonly used social media platform in China, but has not yet been utilized for smoking cessation interventions. The objectives of this study are (1) to evaluate the efficacy of a WeChat-based smoking cessation intervention; and (2) to examine a possible additive effect of integrating oral health and smoking-related information into a tailored, Transtheoretical Model (TTM) guided smoking cessation intervention. METHODS Eligible adults were recruited through WeChat from July 1 to August 6, 2019, to participate in a 3-arm, single-blinded, randomized controlled trial. We enrolled and randomized 403 participants into three groups: the Standard Group, Enhanced Group, or a Waitlist-Control Group. Participants in the Standard Group received 20 smoking cessation-related messages for 2 weeks; participants in the Enhanced Group received this same protocol plus 6 oral health-related messages over an additional week. Participants in the Control Group received smoking cessation-related messages, after the post-intervention assessment. The primary outcome was TTM Stage of Change, and the secondary outcomes were 7-day Point Prevalence Abstinence (PPA), 24-h PPA, daily cigarette use, and nicotine dependence at 4 weeks follow-up post intervention, comparing intervention groups with the control group. The overall program attrition rate was 46%. Paired t-tests, McNemar tests, and linear and logistic regression were used to examine differences in smoking cessation outcomes within and between groups. RESULTS Participants in the Enhanced Group (β = -1.28, 95%CI: -2.13, -0.44) and the Standard Group (β = -1.13, 95%CI: -1.95, -0.30) reported larger changes in nicotine dependence scores, compared to participants in the Waitlist Group. No statistically significant differences were found between the Enhanced Group and the Standard Group. DISCUSSION This WeChat-based intervention was effective for smoking cessation overall. The addition of oral health information did not significantly improve the intervention.
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Affiliation(s)
- Ting Luo
- Moores Cancer Center, University of California San Diego, La Jolla, California 92122, USA,Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA 70122, USA,Corresponding author at: Moores Cancer Center, University of California San Diego, California, USA.
| | - Mirandy S. Li
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA 70122, USA,School of Medicine, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA 70122, USA
| | - Donna Williams
- Moores Cancer Center, University of California San Diego, La Jolla, California 92122, USA
| | - Jackson Fritz
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA 70122, USA,School of Medicine, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA 70122, USA
| | - Kaylin Beiter
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA 70122, USA,School of Medicine, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA 70122, USA
| | - Stephen Phillippi
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA 70122, USA
| | - Qingzhao Yu
- Biostatistics, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA 70122, USA
| | - Stephen Kantrow
- School of Medicine, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA 70122, USA
| | - Wei-Ting Lin
- Department of Global Community Health and Behavioral Sciences, School of Public Health & Tropical Medicine, Tulane University, New Orleans, LA 70122, USA
| | - Yu-Hsiang Kao
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA 70122, USA
| | - Yongchun Chen
- Department of Clinical Nutrition, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan 450003, China
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California 900095, USA
| | - Tung-Sung Tseng
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA 70122, USA
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Christofferson DE, Blalock DV, Knoeppel J, Beckham JC, Hamlett-Berry K, Hertzberg JS. A real-world evaluation of a smokeless tobacco cessation text message program for veterans: Outcomes and comparison to cigarette smokers. Nicotine Tob Res 2021; 24:186-195. [PMID: 34545940 DOI: 10.1093/ntr/ntab191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/17/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Smokeless tobacco (ST) use and cessation rates have remained unchanged while cigarette smoking has declined, and cessation rates have increased. Text message programs have proved effective for cigarette smokers but have not been evaluated for ST users. The Veterans Health Administration (VHA) created a ST-specific arm of its SmokefreeVET automated text message program to help veteran ST users quit. METHODS A retrospective evaluation was conducted on a real-world sample of veteran ST users (n=1,139) who subscribed to SmokefreeVET between 2017 and 2020. Time in program, abstinence, and nicotine replacement therapy (NRT) use were evaluated and compared to 9,764 cigarette smokers who subscribed to SmokefreeVET. RESULTS Younger subscribers were more likely to opt out early; 54% of ST users and 60% of cigarette smokers completed the 6-week program. ST users were more likely to report abstinence than cigarette smokers at all time points: the primary outcome, 30-day abstinence at 6 months, was 3.9% in ST users and 2.6% in cigarette smokers (p=.05) and the secondary outcome, abstinence at 3 months, was 5.3% in ST users and 3.4% in cigarette smokers (p=.03). NRT was used by 17% of ST users and was associated with a trend toward higher abstinence compared to ST users who did not use NRT. CONCLUSION A real-world sample of ST users were more likely to report abstinence after using the SmokefreeVET text program than cigarette smokers. Automated text message programs may be effective for increasing cessation among ST users and warrant further investigation. IMPLICATIONS Smokeless tobacco (ST) cessation is an important public health priority and of importance for veteran and military populations that have higher rates of ST use. There have been relatively few studies conducted investigating the effectiveness of text message interventions for ST cessation, despite the proven efficacy for cigarette smokers. This study provides evidence from a large, real-world sample that text message programs may be effective for ST users and suggests that further research into this treatment modality for ST users is needed.
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Affiliation(s)
- Dana E Christofferson
- Veterans Health Administration, Office of Mental Health and Suicide Prevention, 810 Vermont Avenue NW, Washington, DC 20420, United States
| | - Dan V Blalock
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham NC.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2301 Erwin Road, Durham, NC 27705, United States
| | - Jennifer Knoeppel
- Veterans Health Administration, Office of Mental Health and Suicide Prevention, 810 Vermont Avenue NW, Washington, DC 20420, United States
| | - Jean C Beckham
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2301 Erwin Road, Durham, NC 27705, United States.,Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC 27705, United States.,VA Mid-Atlantic Mental Illness Research Education and Clinical Center, 508 Fulton Street, Durham, NC 27705, United States
| | - Kim Hamlett-Berry
- Veterans Health Administration, Office of Mental Health and Suicide Prevention, 810 Vermont Avenue NW, Washington, DC 20420, United States
| | - Jeffrey S Hertzberg
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2301 Erwin Road, Durham, NC 27705, United States.,Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC 27705, United States
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3
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Yang Q, Millette D, Zhou C, Beatty M, Carcioppolo N, Wilson G. The Effectiveness of Interactivity in Improving Mediating Variables, Behaviors and Outcomes of Web-Based Health Interventions: A Meta-Analytic Review. HEALTH COMMUNICATION 2020; 35:1334-1348. [PMID: 31240958 DOI: 10.1080/10410236.2019.1631992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Despite the increasing amount of research investigating health interventions that applies to interactive computer technology, the effect sizes in Cohen's d obtained across these studies range from -0.32 to 1.74. The lack of systematic review of interactive health interventions leaves their overall effectiveness unknown. To address this, a meta-analysis of 67 studies examining the effects of web-based interactive health interventions was conducted. Results indicated that web-based interactive health interventions were effective in general, but the effects were moderated by health topic, theoretical framework, and design of treatment and control groups. The unique advantage of interactivity was small but significant when comparing to health interventions with comparable information in non-interactive version. Theoretical and practical implications of findings were discussed.
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Affiliation(s)
- Qinghua Yang
- Department of Communication Studies, Texas Christian University
| | - Diane Millette
- Department of Communication Studies, University of Miami
| | - Chun Zhou
- Department of Communication, Florida International University
| | - Michael Beatty
- Department of Communication Studies, University of Miami
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4
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Nethan ST, Sinha DN, Sharma S, Mehrotra R. Behavioral Interventions for Smokeless Tobacco Cessation. Nicotine Tob Res 2020; 22:588-593. [PMID: 31251347 DOI: 10.1093/ntr/ntz107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/27/2019] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Consumption of smokeless tobacco (SLT) is on the rise (especially in the World Health Organization South-East Asian region) and has numerous repercussions over the consumer's health. This article reviews studies performed for SLT cessation using behavioral interventions, worldwide till 2017. METHODS A systematic review by PICO (Problem, intervention, comparison, outcome) of behavioral intervention-based SLT cessation studies with minimum 6 months' follow-up, reporting outcomes in terms of risk ratios (RRs) and 95% confidence interval (CI), published between 1992 and 2017 was performed. This was followed by a meta-analysis of the outcomes of these studies by deriving the pooled estimates by the random effects model, for those on adults and youth, categorized according to the type of country where the study was performed, that is, in terms of developed or developing. Publication bias among the included studies was assessed by the Begg's test. RESULTS Nineteen eligible studies comprising 24 498 participants, from all over the world were included. Behavioral interventions showed overall efficacy in SLT cessation in adults (RR = 1.63, 95% CI = 1.32 to 1.94) both in the developed (RR = 1.39, 95% CI = 1.16 to 1.63) and developing (RR = 2.79, 95% CI = 2.32 to 3.25) countries. However, these interventions did not prove effective for SLT cessation among youth overall (RR = 1.07, 95% CI = 0.73 to 1.41), either in the developed (RR = 1.39, 95% CI = 0.58 to 2.21) or in the developing (RR = 0.87, 95% CI = 0.68 to 1.07) countries. Publication bias was noted in all the studies among adults (p = .22) and youth (p = .05). CONCLUSION Behavioral interventions as a single modality are effective in SLT cessation, both in the developed and developing countries. Health care providers should be sensitized to provide the same. IMPLICATIONS A recent literature survey by Cochrane reviewed studies on interventions for SLT, including behavioral interventions, which included only those from the developed countries. The current analysis provides a broader, global update on the same by including studies performed both in the developed and developing countries (specifically the South-East Asian region-the high burden countries of SLT products).
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Affiliation(s)
- Suzanne Tanya Nethan
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research (NICPR), Noida, Uttar Pradesh, India
| | | | - Shashi Sharma
- Division of Epidemiology & Biostatistics, ICMR-National Institute of Cancer Prevention and Research (NICPR), Noida, Uttar Pradesh, India
| | - Ravi Mehrotra
- ICMR-National Institute of Cancer Prevention and Research (NICPR), Noida, Uttar Pradesh, India
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Lewis CS, Nazir N, Daley SM, Pacheco J, Goeckner RT, Hale JW, Gunville JA, Rahman F, Choi WS, Daley CM. Baseline characteristics of American Indian smokeless tobacco users participating in two pilot cessation studies. J Community Health 2020; 45:812-819. [PMID: 32279158 DOI: 10.1007/s10900-020-00797-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
American Indians have higher rates of smokeless tobacco (SLT) use than other racial/ethnic groups in the US, yet no efficacious cessation program exists for them. Because tobacco is a sacred plant to many American Indians, it is imperative that a program respect the scared nature of tobacco while encouraging quitting recreational use. All Nations Snuff Out Smokeless (ANSOS) was designed to help American Indian SLT users quit recreational tobacco use while still using it for traditional purposes. We pilot tested the ANSOS 6-month group-based counseling program (N = 48) and a shortened version consisting of a one-time education session (N = 80). Here, we discuss the tobacco characteristics of participants at baseline in both studies. Participants across studies were more likely to be male (74.2%) and have at least a college education (65%). Participants in the one-time education sessions were younger (age 35 vs age 39) and used SLT fewer days per week (4.9 vs 5.7). Two-thirds of those in the full program reported that they often substitute SLT in locations where smoking is not allowed compared to 26%. Participants in the education sessions were more likely to report daily use of traditional tobacco (20% versus 0%). Results suggest that dual use of SLT and cigarettes needs to be addressed, as does the use of SLT to circumvent public smoking rules. The role of traditional tobacco and its relationship to lower SLT use also warrants further investigation.
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Affiliation(s)
- Charley S Lewis
- American Indian Health Research & Education Alliance, Inc, Kansas City, KS, USA. .,Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS, USA. .,Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Niaman Nazir
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Sean M Daley
- American Indian Health Research & Education Alliance, Inc, Kansas City, KS, USA.,Center for American Indian Studies, Johnson County Community College, Overland Park, KS, USA.,Department of Anthropology, Johnson County Community College, Overland Park, KS, USA
| | - Joseph Pacheco
- American Indian Health Research & Education Alliance, Inc, Kansas City, KS, USA.,Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Ryan T Goeckner
- American Indian Health Research & Education Alliance, Inc, Kansas City, KS, USA.,Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jason W Hale
- American Indian Health Research & Education Alliance, Inc, Kansas City, KS, USA.,Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jordyn A Gunville
- American Indian Health Research & Education Alliance, Inc, Kansas City, KS, USA.,Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Fatima Rahman
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Won S Choi
- American Indian Health Research & Education Alliance, Inc, Kansas City, KS, USA.,Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Christine Makosky Daley
- American Indian Health Research & Education Alliance, Inc, Kansas City, KS, USA.,Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA.,Indigenous Studies Program, University of Kansas, Lawrence, KS, USA
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6
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Luo T, Li MS, Williams D, Phillippi S, Yu Q, Kantrow S, Kao YH, Celestin M, Lin WT, Tseng TS. Using social media for smoking cessation interventions: a systematic review. Perspect Public Health 2020; 141:50-63. [DOI: 10.1177/1757913920906845] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Previous studies have shown that smoking tobacco significantly increases both incidence and mortality rates for many diseases. Social media has become one of the most influential platforms for various smoking cessation interventions. However, results from smoking cessation interventions have differed from study to study. Limited studies have summarised cessation outcomes from social media–based interventions. Therefore, the objective of this review is to explore the effectiveness of using social media for smoking cessation. Methods: We searched PubMed, MEDLINE, PsycINFO, and CINAHL for articles between June 2008 and June 2018, and also assessed the references of selected articles. We included studies that used social media as intervention platforms, provided a baseline assessment before the intervention, and provided smoking cessation outcomes after the intervention. Results: We identified 13 original studies that enrolled between 16 and 1698 participants; 7-day Point Prevalence Abstinence (PPA) rate was the most frequently used measure of abstinence, with a range of 7%–75%, regardless of the measurement time, study design, and analysis methods. Social media–based smoking cessation interventions were effective, because (1) smokers reported higher 7-day PPA rates after intervention compared to baseline and (2) smokers reported higher 7-day PPA rates in intervention groups than in control groups. Moreover, at each time point, approximately half of all smokers in studies reporting abstinence were found to be biochemically abstinent. There were no significant differences in the effectiveness of smoking cessation outcomes between those that used existing popular social networking platforms (e.g. Pechmann et al’s studies) and those that used individually designed interactive platforms (e.g. MyLastDip, iQuit system, Quitxt system). Conclusions: This review highlights the effectiveness of social media–based smoking cessation intervention studies. Due to the widespread use of social media, as well as its low cost, we suggest embedding smoking cessation interventions within existing popular social media platforms.
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Affiliation(s)
- T Luo
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - MS Li
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - D Williams
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - S Phillippi
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Q Yu
- Biostatistics, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - S Kantrow
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - YH Kao
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - M Celestin
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - WT Lin
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - TS Tseng
- Associate Professor, Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, 2020 Gravier Street, Room 213, New Orleans, LA 70112, USA
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Danaher BG, Tyler MS, Crowley RC, Brendryen H, Seeley JR. Outcomes and Device Usage for Fully Automated Internet Interventions Designed for a Smartphone or Personal Computer: The MobileQuit Smoking Cessation Randomized Controlled Trial. J Med Internet Res 2019; 21:e13290. [PMID: 31172967 PMCID: PMC6594213 DOI: 10.2196/13290] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/24/2019] [Accepted: 05/12/2019] [Indexed: 11/17/2022] Open
Abstract
Background Many best practice smoking cessation programs use fully automated internet interventions designed for nonmobile personal computers (desktop computers, laptops, and tablets). A relatively small number of smoking cessation interventions have been designed specifically for mobile devices such as smartphones. Objective This study examined the efficacy and usage patterns of two internet-based best practices smoking cessation interventions. Methods Overall, 1271 smokers who wanted to quit were randomly assigned to (1) MobileQuit (designed for—and constrained its use to—mobile devices, included text messaging, and embodied tunnel information architecture) or (2) QuitOnline (designed for nonmobile desktop or tablet computers, did not include text messages, and used a flexible hybrid matrix-hierarchical information architecture). Primary outcomes included self-reported 7-day point-prevalence smoking abstinence at 3- and 6-month follow-up assessments. Program visits were unobtrusively assessed (frequency, duration, and device used for access). Results Significantly more MobileQuit participants than QuitOnline participants reported quitting smoking. Abstinence rates using intention-to-treat analysis were 20.7% (131/633) vs 11.4% (73/638) at 3 months, 24.6% (156/633) vs 19.3% (123/638) at 6 months, and 15.8% (100/633) vs 8.8% (56/638) for both 3 and 6 months. Using Complete Cases, MobileQuit’s advantage was significant at 3 months (45.6% [131/287] vs 28.4% [73/257]) and the combined 3 and 6 months (40.5% [100/247] vs 25.9% [56/216]) but not at 6 months (43.5% [156/359] vs 34.4% [123/329]). Participants in both conditions reported their program was usable and helpful. MobileQuit participants visited their program 5 times more frequently than did QuitOnline participants. Consistent with the MobileQuit’s built-in constraint, 89.46% (8820/9859) of its visits were made on an intended mobile device, whereas 47.72% (691/1448) of visits to QuitOnline used an intended nonmobile device. Among MobileQuit participants, 76.0% (459/604) used only an intended mobile device, 23.0% (139/604) used both mobile and nonmobile devices, and 0.1% (6/604) used only a nonmobile device. Among QuitOnline participants, 31.3% (137/438) used only the intended nonmobile devices, 16.7% (73/438) used both mobile and nonmobile devices, and 52.1% (228/438) used only mobile devices (primarily smartphones). Conclusions This study provides evidence for optimizing intervention design for smartphones over a usual care internet approach in which interventions are designed primarily for use on nonmobile devices such as desktop computers, laptops. or tablets. We propose that future internet interventions should be designed for use on all of the devices (multiple screens) that users prefer. We forecast that the approach of designing internet interventions for mobile vs nonmobile devices will be replaced by internet interventions that use a single Web app designed to be responsive (adapt to different screen sizes and operating systems), share user data across devices, embody a pervasive information architecture, and complemented by text message notifications. Trial Registration ClinicalTrials.gov NCT01952236; https://clinicaltrials.gov/ct2/show/NCT01952236 (Archived by WebCite at http://www.webcitation.org/6zdSxqbf8)
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Affiliation(s)
- Brian G Danaher
- Prevention Science Institute, University of Oregon, Eugene, OR, United States.,Oregon Research Institute, Eugene, OR, United States
| | - Milagra S Tyler
- Prevention Science Institute, University of Oregon, Eugene, OR, United States.,Oregon Research Institute, Eugene, OR, United States
| | - Ryann C Crowley
- Oregon Research Institute, Eugene, OR, United States.,Center for Digital Mental Health, University of Oregon, Eugene, OR, United States
| | - Håvar Brendryen
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - John R Seeley
- Prevention Science Institute, University of Oregon, Eugene, OR, United States.,Oregon Research Institute, Eugene, OR, United States
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Nethan ST, Sinha DN, Chandan K, Mehrotra R. Smokeless tobacco cessation interventions: A systematic review. Indian J Med Res 2019; 148:396-410. [PMID: 30666002 PMCID: PMC6362721 DOI: 10.4103/ijmr.ijmr_1983_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background & objectives: Smokeless tobacco (SLT) consumption is a global health issue with about 350 million users and numerous adverse health consequences like oral cancer and myocardial disorders. Hence, cessation of SLT use is as essential as smoking cessation. An update on the available literature on SLT cessation intervention studies is provided here. Methods: Through an extensive literature search on SLT cessation intervention studies, using keywords such as smokeless tobacco, cessation, interventions, quitlines, brief advice, nicotine replacement therapy, nicotine gum, nicotine lozenge, nicotine patch, bupropion, varenicline, mHealth, etc., 59 eligible studies were selected. Furthermore, efficacy of the interventions was assessed from the reported risk ratios (RRs) [confidence intervals (CIs)] and quit rates. Results: Studies were conducted in Scandinavia, India, United Kingdom, Pakistan and the United States of America, with variable follow up periods of one month to 10 years. Behavioural interventions alone showed high efficacy in SLT cessation; most studies were conducted among adults and showed positive effects, i.e. RR [CI] 0.87 [0.7, 1.09] to 3.84 [2.33, 6.33], quit rate between 9-51.5 per cent, at six months. Regular telephone support/quitlines also proved beneficial. Among pharmacological modalities, nicotine lozenges and varenicline proved efficacious in SLT cessation. Interpretation & conclusions: Globally, there is limited information available on SLT cessation intervention trials, research on which must be encouraged, especially in the low-resource, high SLT burden countries; behavioural interventions are most suitable for such settings. Appropriate training/sensitization of healthcare professionals, and school-based SLT use prevention and cessation programmes need to be encouraged.
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Affiliation(s)
- Suzanne Tanya Nethan
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention & Research, Noida, India
| | | | - Kumar Chandan
- WHO FCTC Global Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention & Research, Noida, India
| | - Ravi Mehrotra
- WHO FCTC Global Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention & Research, Noida, India
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9
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Milward J, Drummond C, Fincham-Campbell S, Deluca P. What makes online substance-use interventions engaging? A systematic review and narrative synthesis. Digit Health 2018; 4:2055207617743354. [PMID: 29942622 PMCID: PMC6001270 DOI: 10.1177/2055207617743354] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 10/27/2017] [Indexed: 01/21/2023] Open
Abstract
Background Online substance-use interventions are effective in producing reductions in harmful-use. However, low user engagement rates with online interventions reduces overall effectiveness of interventions. Identifying optimal strategies with which to engage users with online substance-use interventions may improve usage rates and subsequent effectiveness. Objectives (1) To identify the most prevalent engagement promoting strategies utilised to increase use of online substance-use interventions. (2) To determine whether the identified engagement promoting strategies increased said use of online substance-use interventions. Review methods The reviewed followed Cochrane methodology. Databases were searched for online substance-use interventions and engagement promoting strategies limited by study type (randomised controlled trial). Due to heterogeneity between engagement promoting strategies and engagement outcomes, meta-analytic techniques were not possible. Narrative synthesis methods were used. Results Fifteen studies were included. Five different engagement promoting strategies were identified: (1) tailoring; (2) delivery strategies; (3) incentives; (4) reminders; (5) social support. The most frequently reported engagement promoting strategies was tailoring (47% of studies), followed by reminders and social support (40% of studies) and delivery strategies (33% of studies). The narrative synthesis demonstrated that tailoring, multimedia delivery of content and reminders are potential techniques for promoting engagement. The evidence for social support was inconclusive and negative for incentives. Conclusions This review was the first to examine engagement promoting strategies in solely online substance-use interventions. Three strategies were identified that may be integral in promoting engagement with online substance-use interventions. However, the small number of eligible extracted studies, inconsistent reporting of engagement outcomes and diversity of engagement features prevent firmer conclusions. More high-quality trials examining engagement are required.
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Affiliation(s)
- Joanna Milward
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Colin Drummond
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - Paolo Deluca
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Ramo DE, Thrul J, Chavez K, Delucchi KL, Prochaska JJ. Feasibility and Quit Rates of the Tobacco Status Project: A Facebook Smoking Cessation Intervention for Young Adults. J Med Internet Res 2015; 17:e291. [PMID: 26721211 PMCID: PMC4736286 DOI: 10.2196/jmir.5209] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 11/09/2015] [Accepted: 11/14/2015] [Indexed: 11/17/2022] Open
Abstract
Background Young adult smokers are a challenging group to engage in smoking cessation interventions. With wide reach and engagement among users, Facebook offers opportunity to engage young people in socially supportive communities for quitting smoking and sustaining abstinence. Objective We developed and tested initial efficacy, engagement, and acceptability of the Tobacco Status Project, a smoking cessation intervention for young adults delivered within Facebook. Methods The intervention was based on the US Public Health Service Clinical Practice Guidelines and the Transtheoretical Model and enrolled participants into study-run 3-month secret Facebook groups matched on readiness to quit smoking. Cigarette smokers (N=79) aged 18-25, who used Facebook on most days, were recruited via Facebook. All participants received the intervention and were randomized to one of three monetary incentive groups tied to engagement (commenting in groups). Assessments were completed at baseline, 3-, 6-, and 12-months follow-up. Analyses examined retention, smoking outcomes over 12 months (7-day point prevalence abstinence, ≥50% reduction in cigarettes smoked, quit attempts and strategies used, readiness to quit), engagement, and satisfaction with the intervention. Results Retention was 82% (65/79) at 6 months and 72% (57/79) at 12 months. From baseline to 12-months follow-up, there was a significant increase in the proportion prepared to quit (10/79, 13%; 36/79, 46%, P<.001). Over a third (28/79, 35%) reduced their cigarette consumption by 50% or greater, and 66% (52/79) made at least one 24-hour quit attempt during the study. In an intent-to-treat analysis, 13% (10/79) self-reported 7-day abstinence (6/79, 8% verified biochemically) at 12-months follow-up. In their quit attempts, 11% (9/79) used a nicotine replacement therapy approved by the Food and Drug Administration, while 18% (14/79) used an electronic nicotine delivery system to quit (eg, electronic cigarette). A majority (48/79, 61%) commented on at least one Facebook post, with more commenting among those with biochemically verified abstinence at 3 months (P=.036) and those randomized to receive a personal monetary incentive (P=.015). Over a third of participants (28/79, 35%) reported reading most or all of the Facebook posts. Highest acceptability ratings of the intervention were for post ease (57/79, 72%) and thinking about what they read (52/79, 66%); 71% (56/79) recommended the program to others. Only 5 participants attended the optional cognitive-behavioral counseling sessions, though their attendance was high (6/7 sessions overall) and the sessions were rated as easy to understand, useful, and helpful (all 90-100% agreed). Conclusions A Facebook quit smoking intervention is attractive and feasible to deliver, and early efficacy data are encouraging. However, the 1.5-fold greater use of electronic cigarettes over nicotine replacement products for quitting is concerning.
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Affiliation(s)
- Danielle E Ramo
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States.
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Abstract
BACKGROUND Use of smokeless tobacco (ST) can lead to tobacco dependence and long-term use can lead to health problems including periodontal disease, cancer, and cerebrovascular and cardiovascular disease. OBJECTIVES To assess the effects of behavioural and pharmacologic interventions for the treatment of ST use. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group specialised register in June 2015. SELECTION CRITERIA Randomized trials of behavioural or pharmacological interventions to help users of ST to quit with follow-up of at least six months. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by the Cochrane Collaboration. We summarised outcomes as risk ratios (RRs). For subgroups of trials with similar types of intervention and without substantial statistical heterogeneity, we estimated pooled effects using a Mantel-Haenszel fixed-effect method. MAIN RESULTS We identified 34 trials that met the inclusion criteria, of which nine were new for this update, representing over 16,000 participants. There was moderate quality evidence from two studies suggesting that varenicline increases ST abstinence rates (risk ratio [RR] 1.34, 95% confidence interval (CI) 1.08 to 1.68, 507 participants). Pooled results from two trials of bupropion did not detect a benefit of treatment at six months or longer (RR 0.89, 95% CI 0.54 to 1.44, 293 participants) but the confidence interval was wide. Neither nicotine patch (five trials, RR 1.13, 95% CI 0.93 to 1.37, 1083 participants) nor nicotine gum (two trials, RR 0.99, 95% CI 0.68 to 1.43, 310 participants) increased abstinence. Pooling five studies of nicotine lozenges did increase tobacco abstinence (RR 1.36, 95% CI 1.17 to 1.59, 1529 participants) but confidence in this estimate is low as the result is sensitive to the exclusion of three trials which did not use a placebo control.Statistical heterogeneity was evident among the 17 trials of behavioural interventions: eight of them reported statistically and clinically significant benefits; six suggested benefit but with wide CIs and no statistical significance; and three had similar intervention and control quit rates and relatively narrow CIs. Heterogeneity was not explained by study design (individual or cluster randomization), whether participants were selected for interest in quitting, or specific intervention components. In a post hoc subgroup analysis, trials of behavioural interventions incorporating telephone support, with or without oral examination and feedback, were associated with larger effect sizes, but oral examination and feedback alone were not associated with benefit.In one trial an interactive website increased abstinence more than a static website. One trial comparing immediate cessation using nicotine patch versus a reduction approach using either nicotine lozenge or brand switching showed greater success for the abrupt cessation group. AUTHORS' CONCLUSIONS Varenicline, nicotine lozenges and behavioural interventions may help ST users to quit. Confidence in results for nicotine lozenges is limited. Confidence in the size of effect from behavioural interventions is limited because the components of behavioural interventions that contribute to their impact are not clear.
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Affiliation(s)
- Jon O Ebbert
- Mayo ClinicDivision of Primary Care Internal Medicine200 1st Street SouthwestRochesterUSA55905
| | - Muhamad Y Elrashidi
- Mayo ClinicDivision of Primary Care Internal Medicine200 1st Street SouthwestRochesterUSA55905
| | - Lindsay F Stead
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
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Danaher BG, Severson HH, Zhu SH, Andrews JA, Cummins SE, Lichtenstein E, Tedeschi GJ, Hudkins C, Widdop C, Crowley R, Seeley JR. Randomized Controlled Trial of the Combined Effects of Web and Quitline Interventions for Smokeless Tobacco Cessation. Internet Interv 2015; 2:143-151. [PMID: 25914872 PMCID: PMC4405799 DOI: 10.1016/j.invent.2015.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Use of smokeless tobacco (moist snuff and chewing tobacco) is a significant public health problem but smokeless tobacco users have few resources to help them quit. Web programs and telephone-based programs (Quitlines) have been shown to be effective for smoking cessation. We evaluate the effectiveness of a Web program, a Quitline, and the combination of the two for smokeless users recruited via the Web. OBJECTIVES To test whether offering both a Web and Quitline intervention for smokeless tobacco users results in significantly better long-term tobacco abstinence outcomes than offering either intervention alone; to test whether the offer of Web or Quitline results in better outcome than a self-help manual only Control condition; and to report the usage and satisfaction of the interventions when offered alone or combined. METHODS Smokeless tobacco users (N= 1,683) wanting to quit were recruited online and randomly offered one of four treatment conditions in a 2×2 design: Web Only, Quitline Only, Web + Quitline, and Control (printed self-help guide). Point-prevalence all tobacco abstinence was assessed at 3- and 6-months post enrollment. RESULTS 69% of participants completed both the 3- and 6-month assessments. There was no significant additive or synergistic effect of combining the two interventions for Complete Case or the more rigorous Intent To Treat (ITT) analyses. Significant simple effects were detected, individually the interventions were more efficacious than the control in achieving repeated 7-day point prevalence all tobacco abstinence: Web (ITT, OR = 1.41, 95% CI = 1.03, 1.94, p = .033) and Quitline (ITT: OR = 1.54, 95% CI = 1.13, 2.11, p = .007). Participants were more likely to complete a Quitline call when offered only the Quitline intervention (OR = 0.71, 95% CI = .054, .093, p = .013), the number of website visits and duration did not differ when offered alone or in combination with Quitline. Rates of program helpfulness (p <.05) and satisfaction (p <.05) were higher for those offered both interventions versus offered only quitline. CONCLUSION Combining Web and Quitline interventions did not result in additive or synergistic effects, as have been found for smoking. Both interventions were more effective than a self-help control condition in helping motivated smokeless tobacco users quit tobacco. Intervention usage and satisfaction were related to the amount intervention content offered. Usage of the Quitline intervention decreased when offered in combination, though rates of helpfulness and recommendations were higher when offered in combination. TRIAL REGISTRATION Clinicaltrials.gov NCT00820495; http://clinicaltrials.gov/ct2/show/NCT00820495.
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Affiliation(s)
- Brian G. Danaher
- Oregon Research Institute, 1776 Millrace Drive, Eugene, OR 97403, USA
| | | | - Shu-Hong Zhu
- Moores Cancer Center, University of California, San Diego, 9500 Gilman Drive, MC 0905, La Jolla, CA USA
| | - Judy A. Andrews
- Oregon Research Institute, 1776 Millrace Drive, Eugene, OR 97403, USA
| | - Sharon E. Cummins
- Moores Cancer Center, University of California, San Diego, 9500 Gilman Drive, MC 0905, La Jolla, CA USA
| | | | - Gary J. Tedeschi
- Moores Cancer Center, University of California, San Diego, 9500 Gilman Drive, MC 0905, La Jolla, CA USA
| | - Coleen Hudkins
- Oregon Research Institute, 1776 Millrace Drive, Eugene, OR 97403, USA
| | - Chris Widdop
- Oregon Research Institute, 1776 Millrace Drive, Eugene, OR 97403, USA
| | - Ryann Crowley
- Oregon Research Institute, 1776 Millrace Drive, Eugene, OR 97403, USA
| | - John R. Seeley
- Oregon Research Institute, 1776 Millrace Drive, Eugene, OR 97403, USA
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Danaher BG, Severson HH, Crowley R, van Meter N, Tyler MS, Widdop C, Lichtenstein E, Ebbert JO. Randomized controlled trial examining the adjunctive use of nicotine lozenges with MyLastDip: An eHealth smokeless tobacco cessation intervention. Internet Interv 2015. [DOI: 10.1016/j.invent.2014.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Severson HH, Danaher BG, Ebbert JO, van Meter N, Lichtenstein E, Widdop C, Crowley R, Akers L, Seeley JR. Randomized trial of nicotine lozenges and phone counseling for smokeless tobacco cessation. Nicotine Tob Res 2014; 17:309-15. [PMID: 25168034 DOI: 10.1093/ntr/ntu145] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Relatively few treatment programs have been developed specifically for smokeless tobacco (ST) users who want to quit. Their results suggest that self-help materials, telephone counseling, and nicotine lozenges are efficacious. This study provides the first direct examination of the separate and combined effects of telephone counseling and lozenges. METHODS We recruited ST users online (N = 1067) and randomly assigned them to 1 of 3 conditions: (a) a lozenge group (n = 356), who were mailed 4-mg nicotine lozenges; (b) a coach calls group (n = 354), who were offered 3 coaching phone calls; or (c) a lozenge + coach calls group (N = 357), who received both lozenges and coaching calls. Additionally, all participants were mailed self-help materials. Self-reported tobacco abstinence was assessed at 3 and 6 months after randomization. RESULTS Complete-case and intention-to-treat (ITT) analyses for all tobacco abstinence were performed at 3 months, 6 months, and both 3 and 6 months (repeated point prevalence). ITT analyses revealed a highly similar result: the lozenge + coach calls condition was significantly more successful in encouraging tobacco abstinence than either the lozenge group or the coach calls group, which did not differ. CONCLUSIONS Combining nicotine lozenges and phone counseling significantly increased tobacco abstinence rates compared with either intervention alone, whereas coach calls and lozenges were equivalent. The study confirms the high tobacco abstinence rates for self-help ST cessation interventions and offers guidance to providing tobacco treatment to ST users.
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