Developing a Web-Based Smoking Cessation Program and Evaluating Its Effectiveness

This study, which is based on the Stages of Change Model, aimed to develop a Web-based smoking cessation program and to evaluate its effectiveness. An interventional study with 1 group was conducted with college students from Afyon Kocatepe University. First, the Web-Based Smoking Cessation Program was set up (www.sbp.aku.edu.tr). The sample in this study was composed of the 433 students who were site members. The appropriate stages of the program were then sent to members' e-mail addresses at monthly intervals over a period of 6 months. Second, the effectiveness of the program was evaluated at the baseline, the third, and the sixth months of the study. The study was completed with 314 students. The data were evaluated using descriptive statistics, 1-way analysis of variance, and analysis of variance for repeated measures. There were significant developments in the self-efficacy, cognitive, and behavioral processes of students in the third and sixth months of the study. Students (2.5%) had quit smoking by the third month and 4.5% by the sixth month. These results reveal that the program was able to help students quit smoking, increase their self-efficacy, and develop the process of change regarding smoking cessation.

Implementing tobacco dependence treatment during clinical consultations: a qualitative study of clinicians' experiences, perceptions and behaviours in a South African primary health care setting

Background

Evidence suggests that healthcare providers (HCPs) in South Africa do not consistently offer tobacco dependence treatment (TDT) during clinical consultations. In order to understand and explain this behaviour in a South African context, we conducted a qualitative exploration of HCPs’ experiences, perceptions and behaviours regarding TDT.

Methods

Individual qualitative interviews were conducted with physicians and nurses who were purposively selected. Themes were identified from interview transcripts using content analysis. Findings were triangulated and peer-reviewed, and were also verified by the participants.

Results

Fifteen physicians and four nurses were interviewed, none of whom used tobacco. These participants perceived TDT as an important task, but could not consistently implement it during clinical consultations due to health systems constraints (time-constraints because of patient-overload, the unavailability of cessation medications and a lack of support for referrals), misperceptions and misconceptions (negative outcome expectations about the effectiveness and feasibility of TDT), socio-cultural barriers (counselling older persons was perceived as challenging) and personal limitations (perceived low self-efficacy, poor knowledge and skills on implementing any evidence-based TDT framework). Patients are therefore selectively screened based on clinical relevance and offered only prescriptive brief advice. Participants recommended several systems changes, including academic detailing of tobacco status, training HCPs and incorporating tobacco cessation medications in the Essential Drug List.

Conclusion

The reported selective screening and limited TDT interventions offered by HCPs are related to interactions between health systems constraints, personal limitations, and misperceptions and misconceptions about the effectiveness and feasibility of TDT during clinical consultation. Implementing the recommended systems changes has the potential to improve the implementation of TDT in South African primary health care (PHC).

Internet-based contingency management to promote smoking cessation: a randomized controlled study

We evaluated an Internet-based contingency management intervention to promote smoking cessation. Participants in the contingent group (n = 39) earned vouchers contingent on video confirmation of breath carbon monoxide (CO) ≤ 4 parts per million (ppm). Earnings for participants in the noncontingent group (n = 38) were independent of CO levels. Goals and feedback about smoking status were provided on participants' homepages. The median percentages of negative samples during the intervention in the noncontingent and contingent groups were 25% and 66.7%, respectively. There were no significant differences in absolute CO levels or abstinence at 3- and 6-month follow-ups. Compared to baseline, however, participants in both groups reduced CO by an estimated 15.6 ppm during the intervention phases. The results suggest that the contingency for negative COs promoted higher rates of abstinence during treatment, and that other elements of the system, such as feedback, frequent monitoring, and goals, reduced smoking.

Contingency management in the 21st century: technological innovations to promote smoking cessation

Information technology represents an excellent medium to deliver contingencies of reinforcement to change behavior. Recently, we have linked the Internet with a science-based, behavioral treatment for cigarette smoking: abstinence reinforcement therapy. Under abstinence reinforcement interventions, incentives are provided for objective evidence of abstinence. Several studies suggest that the intervention is effective in initiating abstinence. The intervention addresses limitations (access, cost, sustainability, and dissemination potential) inherent in traditional abstinence reinforcement delivery models. It can also be applied to vulnerable, at-risk populations, and to other behavior to promote health. Information technologies offer unprecedented and rapidly expanding opportunities to facilitate behavior change.

Sleep and sleep ecology in the first 3 years: a web-based study

This study was designed to provide data on sleep patterns during the first 3 years, based on a large US-Canada Internet sample, to assess the prevalence of parental interventions and related factors of infant sleep ecology and to evaluate the links between sleep ecology and sleep. Five thousand six parents completed a web-based online questionnaire about their children, aged from birth to 36 months. The questionnaire included items pertaining to sleep patterns, sleep environment, sleep-related parental interventions, sleep position, and demographic information. The results reflected clear sleep-related developmental changes including a decrease in daytime sleep and total sleep time, as well as consolidation of sleep during the night, which was manifested in a decrease in night wakings and nocturnal wakefulness. Sleep ecology and parental behaviors significantly explained a portion of the variance in the child's sleep patterns. Parental interventions that encourage independence and self-soothing were associated with extended and more consolidated sleep, especially in comparison to more active interactions that were associated with shorter and more fragmented sleep. These findings provide parents and professionals reference data for assessing sleep in young children. Furthermore, the results provide information on specific ecological factors that are associated with increased risk for sleep problems.