Internet-based interventions for smoking cessation show inconsistent effects across trials, with only some trials showing a benefit
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health
- Correspondence to Carla J Berg
1518 Clifton Road NE, Room 524, Atlanta, GA 30322, USA;
Leveraging technology to achieve public health goals
Technology greatly impacts our lives and thus has fostered a burgeoning interest in how it can be used effectively to enhance public health. Because cigarette smoking is the leading preventable cause of disease and death in the United States,1 addressing this concern through technology-based approaches may have significant public health implications. The primary objective of this Cochrane review was to determine the effectiveness of Internet-based interventions for smoking cessation.
The bottom line
The authors included randomised and quasi-randomised trials of smokers using any type of Internet-based intervention in comparison to no-intervention controls or other Internet programs. Limited meta-analysis was performed due to the heterogeneity of populations, interventions and outcomes. Twenty trials met the inclusion criteria, some of which involved intensive treatments and included multiple contacts whereas others involved participant-initiated programs.
In summary, the authors concluded that some Internet-based interventions may be effective in aiding smoking cessation. Some evidence indicated that tailored and interactive sites might be more effective than static sites. Few trials reported significant results after 6 months or more, and those trials provided only limited evidence of long-term benefits. Thus, further research is warranted. The effectiveness of Internet-based programs may be bolstered if augmented by other interventions, such as nicotine replacement therapy (NRT) or other pharmacotherapy. Their findings also indicated that innovative web-based interventions may be more attractive to young people and female smokers and less attractive to smokers reporting depressive symptoms. Finally, higher abstinence rates were typically documented among participants who actively engaged with the program (ie, demonstrated greater utilisation). Thus, adherence to these programs is critical, as with other interventions.2 3
Implications for practice
It is incumbent on practitioners to assess smoking status, interest in quitting and inclination to use Internet-based approaches among smokers. If smokers indicate interest in using Internet-based approaches, it is important to highlight that tailored interventions may be more effective and that frequent engagement with the program is critical to achieving successful cessation.
Practitioners should also be knowledgeable about what Internet-based programs exist, which programs are most appropriate for different populations (based on sociodemographics and smoking patterns) and how to most effectively augment these programs. Adults who are more highly addicted might benefit from more intense tailored programs that might be augmented with NRT or other behavioural components, including more frequent contacts. This is supported by the clinical guidelines for cessation interventions which suggests that cessation success increases with utilisation of pharmacotherapy and behavioural interventions, and that using both is more effective than either alone.4
It is important to note that youth should be approached through different mechanisms, messages and intervention approaches. While daily tobacco consumption in the USA is declining,5 non-daily smoking is increasing, particularly among young adults.6 This pattern is detrimental, as non-daily smokers do not believe they are addicted and/or do not perceive the negative health consequences of non-daily smoking,7 are less likely to identify themselves as smokers8 and are less likely to attempt to quit smoking.7 8 Thus, approaching this population and other special groups, such as pregnant smokers, requires programs targeting these groups.
Implications for future research
One major benefit of using Internet-based approaches is the opportunity to cost-effectively deliver tailored communications, which are effective in increasing cessation.9 Much work remains on how to improve tailoring, which important factors to target with tailoring and how to increase adherence to tailored interventions.
Another direction for future research is to increase our knowledge of what mechanisms and messages might most appropriately address different groups defined by smoking patterns and by sociodemographic characteristics. For example, research might address the need to leverage existing social networks toward public health goals, particularly among the young adult population and other subpopulations that are increasingly developing non-daily patterns of smoking. Other populations that might be addressed include those with smoking-related illnesses or pregnant smokers.