Article

Happy Ending: A Randomized Controlled Trial of a Digital Multi-Media Smoking Cessation Intervention

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Abstract

To assess the long-term efficacy of a fully automated digital multi-media smoking cessation intervention. Two-arm randomized control trial (RCT). Setting World Wide Web (WWW) study based in Norway. Subjects (n = 396) were recruited via internet advertisements and assigned randomly to conditions. Inclusion criteria were willingness to quit smoking and being aged 18 years or older. The treatment group received the internet- and cell-phone-based Happy Ending intervention. The intervention programme lasted 54 weeks and consisted of more than 400 contacts by e-mail, web-pages, interactive voice response (IVR) and short message service (SMS) technology. The control group received a self-help booklet. Additionally, both groups were offered free nicotine replacement therapy (NRT). Abstinence was defined as 'not even a puff of smoke, for the last 7 days', and assessed by means of internet surveys or telephone interviews. The main outcome was repeated point abstinence at 1, 3, 6 and 12 months following cessation. Participants in the treatment group reported clinically and statistically significantly higher repeated point abstinence rates than control participants [22.3% versus 13.1%; odds ratio (OR) = 1.91, 95% confidence interval (CI): 1.12-3.26, P = 0.02; intent-to-treat). Improved adherence to NRT and a higher level of post-cessation self-efficacy were observed in the treatment group compared with the control group. As the first RCT documenting the long-term treatment effects of such an intervention, this study adds to the promise of digital media in supporting behaviour change.

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... The introduction of computational technologies may improve health care (Alvarez, 2002). As media capable of storing digital data, computational technologies include cell phones, computers, and websites (Lopez-Olivo & Suarez-Almazor, 2019) and generate increasingly significant benefits over traditional interventions (Brendryen & Kraft, 2008) concerning reach and cost-benefits (Strecher, 1999;Walters et al., 2006). Through interactions with technologies, smokers can be more active in decision-making (Stacey et al., 2017). ...
... After applying the eligibility criteria, 40 studies were eligible for full review by the reviewers. At the end of the second stage, 13 articles were eligible for inclusion in the qualitative synthesis Alessi & Rash, 2017;Berg et al., 2014;Brendryen & Kraft, 2008;Graham et al., 2017;Harris & Reynolds, 2015;Mañanes & Vallejo, 2014;MacKay et al., 2008;Richter et al., 2015;Satterfield et al., 2018;Shuter et al., 2014;Stoddard et al., 2008;Tseng et al., 2017), and 12 articles were eligible for inclusion in the quantitative synthesis (meta-analysis) (Brendryen & Kraft, 2008;An et al., 2006;Alessi & Rash, 2017;Berg et al., 2014;Graham et al., 2017;Mañanes & Vallejo, 2014;MacKay et al., 2008;Richter et al., 2015;Satterfield et al., 2018;Shuter et al., 2014;Stoddard et al., 2008;Tseng et al., 2017). We did not identify language bias. ...
... After applying the eligibility criteria, 40 studies were eligible for full review by the reviewers. At the end of the second stage, 13 articles were eligible for inclusion in the qualitative synthesis Alessi & Rash, 2017;Berg et al., 2014;Brendryen & Kraft, 2008;Graham et al., 2017;Harris & Reynolds, 2015;Mañanes & Vallejo, 2014;MacKay et al., 2008;Richter et al., 2015;Satterfield et al., 2018;Shuter et al., 2014;Stoddard et al., 2008;Tseng et al., 2017), and 12 articles were eligible for inclusion in the quantitative synthesis (meta-analysis) (Brendryen & Kraft, 2008;An et al., 2006;Alessi & Rash, 2017;Berg et al., 2014;Graham et al., 2017;Mañanes & Vallejo, 2014;MacKay et al., 2008;Richter et al., 2015;Satterfield et al., 2018;Shuter et al., 2014;Stoddard et al., 2008;Tseng et al., 2017). We did not identify language bias. ...
Article
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Adherence to interventions, a decisive factor for the effectiveness of treatments for smoking cessation, is still a challenge. The objective of this study was to evaluate adherence to computational technologies for the treatment of smoking compared with adherence to drug therapy, behavioral therapy, or computational technology different from that of the intervention group. This is a systematic review of clinical trials and meta-analyses in which MEDLINE, Cochrane Library, Scopus, Web of Science, and Lilacs were consulted, with the last search conducted on September 5, 2020. Two reviewers performed study selection, quality assessment, and data extraction with disagreements resolved by a third reviewer. The review included 13 studies, most with a follow-up of fewer than 5 months and published between 2014 and 2018. Compared with that in the control group, the adherence to computational technology in the intervention group was higher (RR = 1.19; 95% CI = 1.03–1.37). The combination of technology and nicotine replacement resulted in greater adherence (RR = 1.18; 95%CI = 1.11–1.25) than did noncombination (RR = 0.90; 95%CI = 0.90–1.03). Smokers adhered to computational technologies for the treatment of smoking.
... Tobacco quitting outcome A total of 13 articles were found suitable for meta-analysis, with 3852 and 3908 participants in intervention and control groups. [30][31][32][33][34][35][36][37][38][39][40][41][42] All studies revealed data with a sample size ranging from 160 [32] to 2159 [39] . Baseline characteristics of included studies have respectively. ...
... [34] Two studies measured the outcome at four steps: one, three, six months, and one year. [30,312] Two studies followed up the participants only for one month. [39,42] Two studies measured the outcome at six months only. ...
... Happy ending, a digital multi-media smoking cessation intervention consists of more than 400 contacts through emails, interactive voice responses, Web pages, and short message service compared with self-help booklet, reported higher point abstinence rates in the treatment group in the long-term effect of the intervention. [30,31] A written list of internet resources for smoking cessation was found more helpful than written self-help material to quit smoking for a long-term period of one year. [33] Internet-based self-help smoking cessation program, interactive, individual advice, multiple computer-tailored smoking cessation internet interventions, and a video-based internet site presented strategies for motivational materials and smoking cessation found no effect at six months of intervention but the signi cant effect at 12 months of follow up. ...
Preprint
Full-text available
Literature reported the effectiveness of internet-based interventions over face-to-face interaction on tobacco quitting; however, limited sample size reinforces to integrate and analyze these studies' findings to reach a single conclusion. Therefore, we evaluated the effectiveness of the internet-based versus face-to-face interventions on reducing tobacco use with a systematic search through various electronic databases such as Medline, PsychInfo, PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), ResearchGate, Google Scholar, and Academia. Reference lists of the eligible articles were also screened. Full-text articles were included as per eligibility criteria (PICO framework). A total of 13 studies were selected for meta-analysis, with 3852 and 3908 participants in intervention and control groups. Forest plot favours the intervention group at one month follow up for tobacco quitting (OR: 2.37, CI: 1.86–3.02, P-0.00001, I² = 0%), at three months (OR: 1.88, CI: 1.48–2.40, P-0.00001, I² = 42%) at six months (OR: 2.02, CI: 1.64–2.50, P-0.00001, I² = 38%) and at 1 year of follow-up (OR: 1.43, CI: 1.18–1.74, P-0.00001, I² = 36%). Internet and web-based interventions are highly useful in tobacco quitting at one month, three months, six months, and one year of follow-up compared to face-to-face interaction or no intervention, although the evidence level was moderate. Prospero Registration number- CRD42020214306
... Smoking cessation interventions undertaken by healthcare professionals have encouraged smokers to stop smoking permanently [2] -it was measured by point prevalence abstinence (PPA) [3,4], and/or continuous abstinence rate (CAR) [4 -6]. Evidently, behavioral counseling for facilitating smoking cessation, especially in the primary healthcare setting has been demonstrated that it is the most significantly effective smoking cessation intervention [6][7][8][9][10][11][12][13]. For offering smoking cessation in the primary healthcare setting, nurses play crucial roles involving identifying smokers, finding out the * Corresponding author; email:kamollabhu@gmail.com most suitable strategies for each smoker, as well as monitoring the expected outcomes in order to look after closely [14,15]. ...
... The findings illustrated that only study of Ridner et al. [13] could enhance smoker to stop smoking rather than the control group. Moreover, web-based for quitting smoking was used to compare between experimental and control group in the studies of Clark, Cox [12], Brendryen and Kraft [8], Stanczyk, de Vries [23], and Skov-Ettrup, Dalum [31]. The findings revealed that only two studies [8,12] that counseling through web-based or internet devices could help the study participants to quit smoking effectively. ...
... Moreover, web-based for quitting smoking was used to compare between experimental and control group in the studies of Clark, Cox [12], Brendryen and Kraft [8], Stanczyk, de Vries [23], and Skov-Ettrup, Dalum [31]. The findings revealed that only two studies [8,12] that counseling through web-based or internet devices could help the study participants to quit smoking effectively. The comparison of effects of smoking cessation counseling-measured by PPA compared with usual care or minimal intervention is shown as Fig. 2. ...
Article
Full-text available
There are a number of smoking cessation strategies offered by healthcare providers in Thailand. Despite this, the number of Thai smokers have stopped smoking permanently as a result of the strategies is still far less than the expectation of the National Strategic Plan for Tobacco Control. It feels that this is a reflection of the fact that there are a lot of delicate issues around use of the tobacco cessation service system. This research aimed to investigate the effectiveness of strategies for smoking cessation intervention among smokers in the primary care setting on point prevalence abstinence (PPA) basis. English and Thai language articles from 1993 to 2018 available from six databases were used as data sources. Two independent reviewers assessed articles against the following eligibility criteria: experimental study, adult smokers ≥ 18 years of age, studies comparing the effectiveness of a smoking cessation intervention with no treatment or wait-list control, or usual care. Study quality was critically appraised by two reviewers using established criteria; Review Manager 5.1 was used for meta-analyses. Of the 77 eligible studies that were found, 15 had complete data for meta-analysis on PPA and/or wait-list control, or usual care. The meta-analyses indicated that smoking cessation counseling using quitline telephone counseling was the most effective strategy for smoking cessation on PPA when compared with no treatment or usual care. Conversely, other interventions resulted in nonsignificant differences between the experimental and control groups. In summary telephone counseling was found to be the most appropriate approach for facilitating smoking cessation in adult smokers in the primary healthcare setting. Further research is needed to compare the optimal course length, intensity, and long-term effectiveness for helping smokers quit in the primary healthcare setting.
... Results A total of 13 articles were found suitable for meta-analysis, with 3852 and 3908 participants in intervention and control groups. [31][32][33][34][35][36][37][38][39][40][41][42][43] All studies revealed data with a sample size ranging from 160 [33] to 2159 [40] . Baseline characteristics of included studies have been described in [38,41] Calhoun et al. had the majority of male participants in the intervention (85%) and control group (84 %). ...
... [35] Two studies measured the outcome at four steps: one, three, six months, and one year. [31,32] Two studies followed up the participants only for one month. [40,43] Two studies measured the outcome at six months only. ...
... Happy ending, a digital multi-media smoking cessation intervention consists of more than 400 contacts through emails, interactive voice response, Web pages, and short message service compared with self-help booklet, reported higher point abstinence rates in the treatment group in the long-term effect of the intervention. [31,32] A written list of internet resources for smoking cessation was found more useful than written self-help material to quit smoking for a long-term period of one year. [34] Internet-based self-help smoking cessation program, interactive, individual advice, multiple computer-tailored smoking cessation internet interventions, and a video-based internet site presented strategies for motivational materials and smoking cessation found no effect at six months of intervention but the significant effect at 12 months of follow up. ...
Preprint
Background The burden of tobacco-associated disorders is prevalent worldwide. Over the years, many innovative internet-based approaches have been utilized with variable success to quit tobacco. Though, the effectiveness of internet-based and face-to-face interventions on quitting smoking are very well reported in the literature, but due to limitations in methodology and limited sample size, it is required to integrate and analyze these studies' findings to reach a single conclusion. The study evaluated the effectiveness of the internet as an intervention approach versus face-to-face interaction on reducing tobacco use as control among adults. Methods A systematic search was performed through various electronic databases such as Medline, PsychInfo, PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), ResearchGate, Google Scholar, and Academia. Reference lists of the eligible articles were also screened. Full-text articles were included as per eligibility criteria (PICO framework). No ethnicity restriction was applied. Results A total of 13 studies were selected for meta-analysis, with 3852 and 3908 participants in intervention and control groups respectively. Forest plot favours the intervention group at one month follow up for tobacco quitting (OR: 2.37, CI: 1.86-3.02, P-0.00001, I2 =0%), at three months (OR: 1.88, CI: 1.48-2.40, P-0.00001, I2 =42%) at six months (OR: 2.02, CI: 1.64-2.50, P-0.00001, I2 =38%) and at 1 year of follow-up (OR: 1.43, CI: 1.18-1.74, P-0.00001, I2 = 36%) comparing to control group. Conclusion Internet and web-based interventions are highly useful in tobacco quitting at one month, three months, six months, and one year of follow-up compared to face-to-face interaction or no intervention, although the level of evidence was moderate. Additionally, limited availability of trials in developing countries, arising need for research of internet use in developing countries to quit tobacco.
... Smoking cessation interventions undertaken by healthcare professionals have encouraged smokers to stop smoking permanently [2] -it was measured by point prevalence abstinence (PPA) [3,4], and/or continuous abstinence rate (CAR) [4 -6]. Evidently, behavioral counseling for facilitating smoking cessation, especially in the primary healthcare setting has been demonstrated that it is the most significantly effective smoking cessation intervention [6][7][8][9][10][11][12][13]. For offering smoking cessation in the primary healthcare setting, nurses play crucial roles involving identifying smokers, finding out the * Corresponding author; email:kamollabhu@gmail.com most suitable strategies for each smoker, as well as monitoring the expected outcomes in order to look after closely [14,15]. ...
... The findings illustrated that only study of Ridner et al. [13] could enhance smoker to stop smoking rather than the control group. Moreover, web-based for quitting smoking was used to compare between experimental and control group in the studies of Clark, Cox [12], Brendryen and Kraft [8], Stanczyk, de Vries [23], and Skov-Ettrup, Dalum [31]. The findings revealed that only two studies [8,12] that counseling through web-based or internet devices could help the study participants to quit smoking effectively. ...
... Moreover, web-based for quitting smoking was used to compare between experimental and control group in the studies of Clark, Cox [12], Brendryen and Kraft [8], Stanczyk, de Vries [23], and Skov-Ettrup, Dalum [31]. The findings revealed that only two studies [8,12] that counseling through web-based or internet devices could help the study participants to quit smoking effectively. The comparison of effects of smoking cessation counseling-measured by PPA compared with usual care or minimal intervention is shown as Fig. 2. ...
Article
Full-text available
There are a number of smoking cessation strategies offered by healthcare providers in Thailand. Despite this, the number of Thai smokers have stopped smoking permanently as a result of the strategies is still far less than the expectation of the National Strategic Plan for Tobacco Control. It feels that this is a reflection of the fact that there are a lot of delicate issues around use of the tobacco cessation service system. This research aimed to investigate the effectiveness of strategies for smoking cessation intervention among smokers in the primary care setting on point prevalence abstinence (PPA) basis. English and Thai language articles from 1993 to 2018 available from six databases were used as data sources. Two independent reviewers assessed articles against the following eligibility criteria: experimental study, adult smokers ≥ 18 years of age, studies comparing the effectiveness of a smoking cessation intervention with no treatment or wait-list control, or usual care. Study quality was critically appraised by two reviewers using established criteria; Review Manager 5.1 was used for meta-analyses. Of the 77 eligible studies that were found, 15 had complete data for meta-analysis on PPA and/or wait-list control, or usual care. The meta-analyses indicated that smoking cessation counseling using quitline telephone counseling was the most effective strategy for smoking cessation on PPA when compared with no treatment or usual care. Conversely, other interventions resulted in nonsignificant differences between the experimental and control groups. In summary telephone counseling was found to be the most appropriate approach for facilitating smoking cessation in adult smokers in the primary healthcare setting. Further research is needed to compare the optimal course length, intensity, and long-term effectiveness for helping smokers quit in the primary healthcare setting.
... Some interventions (n = 21) included supportive one-way messages delivered through SMS, IVR, telephone call, or mobile application, which encouraged or motivated the participant. Some used inspirational quotes such as "The journey of a thousand miles starts with a single step" [49], while others displayed the length of successful adherence [68], encouraged continued engagement with the platform [115], or provided encouraging health facts, e.g., "Today your blood pressure has been reduced to that of a nonsmoker" [136]. Most were generated and sent or displayed automatically [37,111,116,125,129,135,137,138], but others were sent as part of a standardized protocol by care team members [53] or lay health support persons [139], or in response to specific behaviors such as persistently elevated adherence [54,120,140] or positive responses to therapeutic questions [55]. ...
... Educational interventions were present in 39 included studies [42,45,47,51,64,68,70,71,84,89,92,94,103,106,115,116,120,125,129,132,[136][137][138][140][141][142][143][144][148][149][150][151][152][153][154][155][156][157]163]. Modalities included websites, mobile applications, telephone calls, SMS messages, IVR calls, relational agents, and smart pill dispensers. ...
... The other major framework which emerged (n = 12) was cognitive-behavioral therapy (CBT), which is used as a major component of psychotherapy in many of the studied disorders and can help restructure maladaptive thoughts about psychoactive medication. In the included studies, CBT and strategies from it were used as part of tele-mental health care [129,145,150], as baseline / comparator [84], or as part of web-or smartphone application-delivered curricula [42,45,47,125,[136][137][138]. Another study used CBT strategies in a tailored text messaging intervention to probe for unhelpful behaviors or thought patterns, using information collected from the patient [55]. ...
Article
Full-text available
Background Medication adherence is critical to the effectiveness of psychopharmacologic therapy. Psychiatric disorders present special adherence considerations, notably an altered capacity for decision making and the increased street value of controlled substances. A wide range of interventions designed to improve adherence in mental health and substance use disorders have been studied; recently, many have incorporated information technology (eg, mobile phone apps, electronic pill dispensers, and telehealth). Many intervention components have been studied across different disorders. Furthermore, many interventions incorporate multiple components, making it difficult to evaluate the effect of individual components in isolation. Objective The aim of this study was to conduct a systematic scoping review to develop a literature-driven, transdiagnostic taxonomic framework of technology-based medication adherence intervention and measurement components used in mental health and substance use disorders. Methods This review was conducted based on a published protocol (PROSPERO: CRD42018067902) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review guidelines. We searched 7 electronic databases: MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, Web of Science, Engineering Village, and ClinicalTrials.gov from January 2000 to September 2018. Overall, 2 reviewers independently conducted title and abstract screens, full-text screens, and data extraction. We included all studies that evaluate populations or individuals with a mental health or substance use disorder and contain at least 1 technology-delivered component (eg, website, mobile phone app, biosensor, or algorithm) designed to improve medication adherence or the measurement thereof. Given the wide variety of studied interventions, populations, and outcomes, we did not conduct a risk of bias assessment or quantitative meta-analysis. We developed a taxonomic framework for intervention classification and applied it to multicomponent interventions across mental health disorders. Results The initial search identified 21,749 results; after screening, 127 included studies remained (Cohen kappa: 0.8, 95% CI 0.72-0.87). Major intervention component categories include reminders, support messages, social support engagement, care team contact capabilities, data feedback, psychoeducation, adherence-based psychotherapy, remote care delivery, secure medication storage, and contingency management. Adherence measurement components include self-reports, remote direct visualization, fully automated computer vision algorithms, biosensors, smart pill bottles, ingestible sensors, pill counts, and utilization measures. Intervention modalities include short messaging service, mobile phone apps, websites, and interactive voice response. We provide graphical representations of intervention component categories and an element-wise breakdown of multicomponent interventions. Conclusions Many technology-based medication adherence and monitoring interventions have been studied across psychiatric disease contexts. Interventions that are useful in one psychiatric disorder may be useful in other disorders, and further research is necessary to elucidate the specific effects of individual intervention components. Our framework is directly developed from the substance use disorder and mental health treatment literature and allows for transdiagnostic comparisons and an organized conceptual mapping of interventions.
... The reviewers independently assessed the quality of included studies [11][12][13][14][15][16][17][18][19][20][21][22][23] ...
... Tobacco quit at one month follow up [11,12,14 ...
... Tobacco quit at six months follow up [11][12][13]17,18,22] ...
Article
Literature reported the effectiveness of internet-based interventions over face-to-face interaction on tobacco quitting; however, limited sample size reinforces to integrate and analyze these studies' findings to reach a single conclusion. Therefore, we evaluated the effectiveness of the internet as an intervention approach versus face-to-face interaction on reducing tobacco use among adults. A systematic search was performed through various electronic databases such as Medline, PsychInfo, PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), ResearchGate, Google Scholar, and Academia. Reference lists of the eligible articles were also screened. Full-text articles were included as per eligibility criteria (PICO framework). No ethnicity restriction was applied. A total of 13 studies were selected for meta-analysis, with 3852 and 3908 participants in intervention and control groups, respectively. Forest plot favours the intervention group at one month follow up for tobacco quitting (OR: 2.37, CI: 1.86-3.02, P=0.00001, I2=0%), at three months (OR: 1.88, CI: 1.48-2.40, P=0.00001, I2=42%) at six months (OR: 2.02, CI: 1.64-2.50, P=0.00001, I2=38%) and at one year of follow-up (OR: 1.43, CI: 1.18-1.74, P=0.00001, I2=36%) comparing to control group. Conclusively, internet and web-based interventions are highly useful in tobacco quitting at one month, three months, six months, and one year of follow-up compared to face-to-face interaction or no intervention, although the level of evidence was moderate. Additionally, limited trials in developing countries, arising need for research on internet use for tobacco control in developing countries.
... Despite the considerable support for cognitive-behavioral intervention to improve sleep difficulties, it is clear that lack of access to CBT-I is a significant barrier [9,10]. This is particularly true amongst adolescents and young adults (AYAs; aged [15][16][17][18][19][20][21][22][23][24], [11]. AYAs' lack of access to empirically supported care for insomnia-type sleep difficulties is a particularly pronounced problem given that there is currently a sleep deprivation epidemic in this population [12,13]. ...
... There has been a recent and increasing groundswell of support for addressing lack of access to care with Internet-and smartphone-based applications (apps) to replace or augment in-person healthcare. Apps are available for management of a wide variety of medical and mental health conditions, from pain [20], to nicotine addiction [21], to depression [22], to weight management [23]. For those in rural areas, apps may offer a unique solution to access problems associated with lack of geographically proximate treatments or trained practitioners. ...
Preprint
BACKGROUND Sleep difficulties are prevalent and concerning for many North Americans. Despite strong empirical support for insomnia treatment, lack of access presents a significant barrier to treatment dissemination. This is particularly true amongst teens and young adults. Mobile applications (‘apps’) are uniquely suited to address this need. OBJECTIVE We conducted a scoping review to identify and appraise commercially available apps for AYAs with sleep difficulties. METHODS Proceeding in 3 phases, a comprehensive search of commercially available apps was conducted between August 2016 and January 2017. The initial phase involved a search of app stores using relevant search terms (sleep; sleeping; insomnia; sleep aid; night). In the second phase, apps were assessed for eligibility using the following inclusion criteria: 1) Goal is to provide education, tools, or advice related to management of insomnia symptoms. 2) Primary intended users are AYAs. Exclusion criteria were: 1) App is classified as an ‘e-book.’ 2) Primary utility is meditation, hypnosis, or relaxation for sleep. 3) Primary function is background sleep music or sounds. 4) Primary function is alarm clock. 5) Sole sleep aid function is tracking/monitoring, with no education, tools, or advice for insomnia. In the third phase, apps were culled for functionality information, including: A) Self-monitoring of symptoms; B) Tracking sleep; C) Education related to insomnia; D) Advice or intervention for managing insomnia symptoms. Finally, the primary investigator conducted a final review of phase 3 apps, closely examining the functionality of these apps, based on app descriptions, app content, and developer website (where available). RESULTS The initial search yielded 2036 apps; after eligibility criteria were applied, functionality information was extracted for 48 apps. Twenty-three of these were later excluded. Of the final 25 apps, 24% included self-monitoring of symptoms; 28% included a sleep tracking function; 56% provided insomnia education; and 92% provided advice or intervention for managing sleep difficulties. The majority (80%) were free. Several (20%) provided sleep interventions that are not supported by research. In the final evaluation, only 6 apps met all four of the functionality criteria; of these, none were geared towards AYA users specifically. The purported and examined functionality of these six apps are discussed. CONCLUSIONS Insomnia is a unique problem among AYAs, as non-insomnia factors must also be considered when designing an appropriate intervention (e.g., AYAs are more delayed in sleep schedule, require more sleep than adults). There are currently 6 apps that are appropriate for self-management of adult insomnia. There are 0 apps designed for AYA users. Development of an evidence-based app for managing insomnia in this population is critical. Once an appropriate app becomes available, future studies should test its usability and efficacy in AYA samples.
... The coefficient and time constant are based on relapse probabilities in smoking cessation trials (table 2). [42][43][44][45] Second, we calibrated the previously applied cessation probabilities (derived from CISNET cessation data) by a multiplier to reflect: (1) a quit attempt rather than sustained abstinence; and (2) the higher likelihood of making a quit attempt rather than attaining sustained abstinence in a given month. This multiplier represents the average number of quit attempts, lasting at least 1 month, prior to attaining sustained abstinence. ...
... From these 1997-2009 NHIS data, ¶This is based on relapse probabilities reported in smoking cessation intervention trials, focusing on placebo arms. [42][43][44][45] **For the 1950 birth cohort, some CISNET-derived former smoker mortality rates are lower than CISNET-derived never smoker mortality rates-a counterintuitive relationship otherwise unexplained. We therefore adapted former smoker mortality multipliers for the crossvalidation from Thun et al. 40 CISNET, Cancer Intervention and Surveillance Modeling Network; NHIS, National Health Interview Survey. ...
Article
Full-text available
Background and objective Simulation models can project effects of tobacco use and cessation and inform tobacco control policies. Most existing tobacco models do not explicitly include relapse, a key component of the natural history of tobacco use. Our objective was to develop, calibrate and validate a novel individual-level microsimulation model that would explicitly include smoking relapse and project cigarette smoking behaviours and associated mortality risks. Methods We developed the Simulation of Tobacco and Nicotine Outcomes and Policy (STOP) model, in which individuals transition monthly between tobacco use states (current/former/never) depending on rates of initiation, cessation and relapse. Simulated individuals face tobacco use-stratified mortality risks. For US women and men, we conducted cross-validation with a Cancer Intervention and Surveillance Modeling Network (CISNET) model. We then incorporated smoking relapse and calibrated cessation rates to reflect the difference between a transient quit attempt and sustained abstinence. We performed external validation with the National Health Interview Survey (NHIS) and the linked National Death Index. Comparisons were based on root-mean-square error (RMSE). Results In cross-validation, STOP-generated projections of current/former/never smoking prevalence fit CISNET-projected data well (coefficient of variation (CV)-RMSE≤15%). After incorporating smoking relapse, multiplying the CISNET-reported cessation rates for women/men by 7.75/7.25, to reflect the ratio of quit attempts to sustained abstinence, resulted in the best approximation to CISNET-reported smoking prevalence (CV-RMSE 2%/3%). In external validation using these new multipliers, STOP-generated cumulative mortality curves for 20-year-old current smokers and never smokers each had CV-RMSE ≤1% compared with NHIS. In simulating those surveyed by NHIS in 1997, the STOP-projected prevalence of current/former/never smokers annually (1998–2009) was similar to that reported by NHIS (CV-RMSE 12%). Conclusions The STOP model, with relapse included, performed well when validated to US smoking prevalence and mortality. STOP provides a flexible framework for policy-relevant analysis of tobacco and nicotine product use.
... StickK currently only provides a referee and a supporter as social commitment device, which respectively functions as reputational commitment and emotional supporter. In health communication, however, offering instrumental support that explains why and how to achieve recommended behavior have been considered as a successful strategy (e.g., smoke cessation [1], motivating physical activity [9]). Engineering social commitment device to provide timely, informational, and emotional feedback will be an appealing method of designing a persuasive user interface, ultimately offsetting the dominant impact of financial commitment device. ...
... As people often set health related goals with varying devices that implement mobile, wearable, and IoT technologies, instilling the concept of commitment device into such devices and demonstrating its validity and reliability seems worth exploring. Studies have shown that multi-modal and interactive nature of technology-mediated intervention creates more engaging experience and increases one's capability [1,6,11,23]. As such use of intervention tools (mobile, wearable, and IoT technologies) provides opportunities for designing novel intelligent positive computing services that address physical health and mental wellness issues, it will change the current landscape of healthcare and well-being [10]. ...
Conference Paper
Full-text available
Commitment devices-a self-imposed contract that helps an individual stick to a plan of action-have been widely used to make a positive influence on one's behavior change. We analyze commitment contract posts in StickK. com, an online behavior change support system to characterize the types of target behaviors and the effectiveness of different commitment devices for behavioral changes. We provide several practical implications for designing behavior change support systems that could inform further directions for research in behavioral economics and psychology.
... According to the Pew Research Center (Poushter, 2016), an average of 54% of respondents from 21 emerging and developing countries reported that they use the internet at least sometimes and/or own a smartphone in 2015, which increased from 45% in 2014. Due to its ubiquitous usage, many intervention programmes have relied on smartphone apps to administer the "treatment" (Brendryen & Kraft, 2008;Levine et al., 2008;Patrick et al., 2009). Although not all agreed (Free et al., 2013), interventions using mobile-health technology to affect health behaviour change or disease management have shown positive effects on health-related outcomes (Brendryen & Kraft, 2008;Levine et al., 2008;Patrick et al., 2009). ...
... Due to its ubiquitous usage, many intervention programmes have relied on smartphone apps to administer the "treatment" (Brendryen & Kraft, 2008;Levine et al., 2008;Patrick et al., 2009). Although not all agreed (Free et al., 2013), interventions using mobile-health technology to affect health behaviour change or disease management have shown positive effects on health-related outcomes (Brendryen & Kraft, 2008;Levine et al., 2008;Patrick et al., 2009). ...
Article
SafeWalking is of a prevention tool that identifies safe areas for women in public spaces in the City of Santa Rosa de Copan, Honduras. The current study examines the effect of using this phone app on users’ self-rated information about “safe places,” the number of precautionary behaviours, and victimisation. This study also examines its effect on constructs, such as fear of crime, perceived safety, and risk of victimisation. Using a pre-test and post-test design, we find that those assigned in the treatment group (i.e., the app users) experienced a significant increase in self-reported knowledge of the dangerous areas in Santa Rosa de Copan. Despite increased knowledge, there was no statistically significant effect on the number of precautionary behaviours and odds of victimisation of the app users. We discuss lessons learned, implications, and ways to improve future iterations of this and similar crime prevention applications.
... Several of these RCTs had different incentives to increase participation and decrease the loss to follow-up. This could be multiple follow-ups using the internet, email, or mobile phone if users did not respond [14][15][16][17], by payment for mobile phone use [18,19], by free Nicotine Replacement Therapy [15,20], by gift certificates [14], and by internet-based counseling from nurses [21] or tobacco treatment specialists [22]. However, as pointed out by Eysenbach, electronic health (eHealth) research studies with a high dropout or high loss to follow-up should not be looked upon as failures but rather a natural and typical feature of eHealth interventions that should be expected [23]. ...
... Several of these RCTs had different incentives to increase participation and decrease the loss to follow-up. This could be multiple follow-ups using the internet, email, or mobile phone if users did not respond [14][15][16][17], by payment for mobile phone use [18,19], by free Nicotine Replacement Therapy [15,20], by gift certificates [14], and by internet-based counseling from nurses [21] or tobacco treatment specialists [22]. However, as pointed out by Eysenbach, electronic health (eHealth) research studies with a high dropout or high loss to follow-up should not be looked upon as failures but rather a natural and typical feature of eHealth interventions that should be expected [23]. ...
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Background: There is a need to deliver smoking cessation support at a population level, both in developed and developing countries. Studies on internet-based and mobile phone-based smoking cessation interventions have shown that these methods can be as effective as other methods of support, and they can have a wider reach at a lower cost. Objective: This randomized controlled trial (RCT) aimed to compare, on a population level, the efficacy of an identical, tailored smoking cessation intervention delivered by mobile text messaging versus email. Methods: We conducted a nationwide 2-arm, double-blinded, fully automated RCT, close to a real-world setting, in Norway. We did not offer incentives to increase participation and adherence or to decrease loss to follow-up. We recruited users of the website, slutta.no, an open, free, multi-component Norwegian internet-based smoking cessation program, from May 2010 until October 2012. Enrolled smokers were considered as having completed a time point regardless of their response status if it was 1, 3, 6, or 12 months post cessation. We assessed 7315 participants using the following inclusion criteria: knowledge of the Norwegian language, age 16 years or older, ownership of a Norwegian cell phone, having an email account, current cigarette smoker, willingness to set a cessation date within 14 days (mandatory), and completion of a baseline questionnaire for tailoring algorithms. Altogether, 6137 participants were eligible for the study and 4378 participants (71.33%) provided informed consent to participate in the smoking cessation trial. We calculated the response rates for participants at the completed 1, 3, 6, and 12 months post cessation. For each arm, we conducted an intention-to-treat (ITT) analysis for each completed time point. The main outcome was 7-day self-reported point prevalence abstinence (PPA) at the completed 6 months post cessation. We calculated effect size of the 7-day self-reported PPA in the text message arm compared with the email arm as odds ratios (ORs) with 95% CIs for the 4 time points post cessation. Results: At 6 months follow-up, 21.06% (384/1823) of participants in the text message arm and 18.62% (333/1788) in the email arm responded (P=.07) to the surveys. In the ITT analysis, 11.46% (209/1823) of participants in the text message arm compared with 10.96% (196/1788) in the email arm (OR 1.05, 95% CI 0.86-1.30) reported to have achieved 7 days PPA. Conclusions: This nationwide, double-blinded, large, fully automated RCT found that 1 in 9 enrolled smokers reported 7-day PPA in both arms, 6 months post cessation. Our study found that identical smoking cessation interventions delivered by mobile text messaging and email may be equally successful at a population level. Trial registration: ClinicalTrials.gov NCT01103427; https://clinicaltrials.gov/ct2/show/NCT01103427.
... Mobile phone possession is common among homeless people [18], and mobile technologies have been used to deliver appointment reminders to homeless veterans [19] and to collect ecological momentary assessment data from homeless smokers making a quit attempt [20,21]. Although text messaging interventions for smoking cessation have demonstrated efficacy across a range of settings and populations [22][23][24][25][26][27][28][29][30][31][32][33], no studies to our knowledge have examined text messaging interventions for homeless smokers. ...
Preprint
BACKGROUND Homeless smokers want to quit smoking but face numerous barriers to doing so, including pervasive smoking among peers and a lack of social support for quitting. A text messaging intervention could address these challenges by providing virtual daily support for homeless smokers who are trying to quit but coping with multiple triggers to smoke. OBJECTIVE We assessed whether a free text messaging program, added to evidence-based pharmacotherapy and counseling, improved smoking abstinence among homeless adult smokers. METHODS In 10/2015–06/2016, we conducted an 8-week pilot randomized controlled trial of nicotine patch therapy and weekly in-person counseling with (N=25) or without (N=25) SmokefreeTXT, a free text messaging service administered by the National Cancer Institute (NCI), at Boston Health Care for the Homeless Program. All participants were provided with a mobile phone and a 2-month prepaid voice and text plan at no cost. SmokefreeTXT enrollees were sent 1-5 automated text messages daily for up to 8 weeks and could receive on-demand tips for managing cravings, mood symptoms, and smoking lapses. The primary outcome was smoking abstinence, defined as an exhaled carbon monoxide <8 parts per million, assessed 14 times over 8 weeks of follow-up and analyzed using repeated-measures logistic regression with generalized estimating equations. Other outcomes were use of SmokefreeTXT, assessed by data obtained from NCI; perceptions of SmokefreeTXT, assessed by surveys and qualitative interviews; and mobile phone retention, assessed by self-report. RESULTS 67% of eligible individuals participated. Of SmokefreeTXT arm participants (N=25), 88% enrolled in the program but only 56% had confirmed enrollment for ≥2 weeks. Among 2-week enrollees, the median response rate to interactive messages from SmokefreeTXT was 2.1% (interquartile range 0-10.5%). Across all time points, smoking abstinence did not differ significantly between SmokefreeTXT and control arm participants (odds ratio 0.92, 95% confidence interval 0.30-2.84). Of SmokefreeTXT enrollees who completed exit surveys (N=15), two-thirds were very/extremely satisfied with the program. However, qualitative interviews (N=14) revealed that many participants preferred in-person over phone-based intervention formats, found the text messages impersonal and robotic, and felt that the messages were too frequent and repetitive. Only 40% of SmokefreeTXT arm participants retained their study-supplied mobile phone for the 8-week duration of the trial, with phone theft being most common. The logistics of storing and charging phones were cited as challenges in qualitative interviews. CONCLUSIONS SmokefreeTXT, added to nicotine patch therapy and in-person counseling, did not significantly improve smoking abstinence in this 8-week pilot RCT for homeless smokers. Text messaging interventions for this population should be better tuned to the unique circumstances of homelessness and coupled with innovative efforts to promote mobile phone retention over time. CLINICALTRIAL ClinicalTrials.gov (NCT02565381)
... Mobile phones have been proven effective in delivering interventions for various diseases and health conditions [1,2,3,4]. Over the past few decades, various studies have been conducted on how users accept or adopt information technology. ...
Article
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With the growing demand for mobile based interventions in healthcare, use of smartphone applications for disease management and prevention, especially non communicable diseases like chronic respiratory diseases, diabetes, and hypertension are on the rise. Tobacco use or smoking is the leading preventable risk factor for NCDs (Non Communicable Diseases). Although an innovative mobile based multi-feature service can be a potential tool for smokers to help them quit smoking, it is also necessary to investigate the level of acceptance as well as the factors leading to the acceptance of such a service. This study identifies some of the factors that influence acceptance of such a smartphone based multi-feature service for smoking cessation. The study utilizes the Unified Theory of Acceptance and Use of Technology (UTAUT) as the theoretical model, along with Partial Least Square (PLS) analysis. The findings indicate that factors like “performance expectancy”, “facilitating conditions”, “effort expectancy” and “Social influence” are significant determinants of intention and use of the smartphone based multi-feature service.
... Dozens of randomized controlled trials have examined websites with advanced features such as QuitNet [2][3] and/or one-way text or email messaging services such as txt2stop [4][5] , but these interventions are limited by information exchanges that are largely unilateral, noninteractive, and non-peer based. Notably while the initial results of one-way messaging services for smoking cessation looked promising [4,[6][7][8], a recent review found that only 3 of 15 randomized trials showed significant benefits [9]. ...
Article
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Background: Existing smoking cessation treatments are challenged by low engagement and high relapse rates, suggesting the need for more innovative, accessible, and interactive treatment strategies. Twitter is a Web-based platform that allows people to communicate with each other throughout the day using their phone. Objective: This study aims to leverage the social media platform of Twitter for fostering peer-to-peer support to decrease relapse with quitting smoking. Furthermore, the study will compare the effects of coed versus women-only groups on women's success with quitting smoking. Methods: The study design is a Web-based, three-arm randomized controlled trial with two treatment arms (a coed or women-only Twitter support group) and a control arm. Participants are recruited online and are randomized to one of the conditions. All participants will receive 8 weeks of combination nicotine replacement therapy (patches plus their choice of gum or lozenges), serial emails with links to Smokefree.gov quit guides, and instructions to record their quit date online (and to quit smoking on that date) on a date falling within a week of initiation of the study. Participants randomized to a treatment arm are placed in a fully automated Twitter support group (coed or women-only), paired with a buddy (matched on age, gender, location, and education), and encouraged to communicate with the group and buddy via daily tweeted discussion topics and daily automated feedback texts (a positive tweet if they tweet and an encouraging tweet if they miss tweeting). Recruited online from across the continental United States, the sample consists of 215 male and 745 female current cigarette smokers wanting to quit, aged between 21 and 59 years. Self-assessed follow-up surveys are completed online at 1, 3, and 6 months after the date they selected to quit smoking, with salivary cotinine validation at 3 and 6 months. The primary outcome is sustained biochemically confirmed abstinence at the 6-month follow-up. Results: From November 2016 to September 2018, 960 participants in 36 groups were recruited for the randomized controlled trial, in addition to 20 participants in an initial pilot group. Data analysis will commence soon for the randomized controlled trial based on data from 896 of the 960 participants (93.3%), with 56 participants lost to follow-up and 8 dropouts. Conclusions: This study combines the mobile platform of Twitter with a support group for quitting smoking. Findings will inform the efficacy of virtual peer-to-peer support groups for quitting smoking and potentially elucidate gender differences in quit rates found in prior research. Trial registration: ClinicalTrials.gov NCT02823028; https://clinicaltrials.gov/ct2/show/NCT02823028. International registered report identifier (irrid): DERR1-10.2196/16417.
... mass-media campaigns have been reported to be effective in changing behaviour, most notably for health-related behaviours [147][148][149]. The positive impact of new media interventions (e.g., websites, social networking sites) has been shown by several studies, again for health-related behaviours [150][151][152]. Such existing studies have focused on short-term campaigns rather than, for example, long-term TV shows or YouTube channels. ...
Article
Full-text available
Upcycling presents one of many opportunities for reducing consumption of materials and energy. Despite recent growth evidenced by increasing numbers of practitioners and businesses based on upcycling, it remains a niche activity and requires scaling up to realise its potential benefits. This paper investigates UK household upcycling in order to develop interventions for scaling up upcycling in the UK. Mixed methods were used in four stages: (a) Interviews to gain insights into UK upcycling; (b) a survey to discover key factors influencing UK upcycling; (c) intervention development based on the synthesis of interviews and survey; and (d) use of a semi-Delphi technique to evaluate and develop initial interventions. The results showed approaches to upcycling (e.g., wood, metal and fabric as frequently used materials, online platforms as frequently used source of materials), context for upcycling (e.g., predominant use of home for upcycling), factors influencing UK upcycling with key determinants (i.e., intention, attitude and subjective norm), important demographic characteristics considering a target audience for interventions (i.e., 30+ females) and prioritised interventions for scaling up (e.g., TV and inspirational media and community workshops as short-term high priority interventions). The paper further discusses implications of the study in terms of development of theory and practice of upcycling.
... Smartphone applications, text messaging, and interactive voice response are effective approaches to reducing the burden of substance use disorders (SUDs). [1][2][3][4] Most Americans now own smartphones (77%) and is especially popular among younger adults from 18-29 years old (92%). [5] Smartphone applications promise to enhance the reach of evidence-based interventions (cognitive behavior therapy, contingency management, therapeutic education system) for populations with SUDs with minimal disruption to health systems. ...
... Mobile phone possession is common among homeless people [18], and mobile technologies have been used to deliver appointment reminders to homeless veterans [19] and to collect ecological momentary assessment data from homeless smokers making a quit attempt [20,21]. Although text messaging interventions for smoking cessation have demonstrated efficacy across a range of settings and populations [22][23][24][25][26][27][28][29][30][31][32][33], no studies to our knowledge have examined text messaging interventions for homeless smokers. ...
Article
Background Homeless smokers want to quit smoking but face numerous barriers to doing so, including pervasive smoking among peers and a lack of social support for quitting. An SMS (short message service) text messaging intervention could address these challenges by providing virtual daily support for homeless smokers who are trying to quit but coping with multiple triggers to smoke. Objective This study aimed to assess whether a free SMS text messaging program, added to evidence-based pharmacotherapy and counseling, improved smoking abstinence among homeless adult smokers. Methods From October 2015 to June 2016, we conducted an 8-week pilot randomized controlled trial (RCT) of nicotine patch therapy and weekly in-person counseling with (n=25) or without (n=25) SmokefreeTXT, a free SMS text messaging service administered by the National Cancer Institute (NCI) at Boston Health Care for the Homeless Program. All participants were provided with a mobile phone and a 2-month prepaid voice and text plan at no cost. SmokefreeTXT enrollees were sent 1 to 5 automated SMS text messages daily for up to 8 weeks and could receive on-demand tips for managing cravings, mood symptoms, and smoking lapses. The primary outcome was smoking abstinence, defined as an exhaled carbon monoxide count of
... There is a growing interest regarding the use of modern technology for tobacco prevention, including mobile phones as intervention tools . Two studies have evaluated a programme named "Happy Ending" that is a fully automated intervention lasting 45 days with up to one year follow-up conducted in Norway (Brendryen et al., 2008a;2008b). It consists of daily websites with unique content for each day of the programme, e-mail and a comprehensive mobile system with SMS and interactive voice response. ...
Article
Background: In Europe the prevalence of tobacco use in adults and adolescents is among the highest within the WHO regions. Many resources have been allocated toward the prevention and support for smoking cessation. However, the implemented strategies in Europe have not been systematically evaluated. Methods: A systematic literature review was carried out to identify studies that analyzed the efficacy of the main smoking-prevention campaigns conducted in Europe. PRISMA guidelines were used to systematically review and extract data. Results: A total of 24 studies meeting inclusion criteria were identified. Each article was thoroughly reviewed and evaluated for quality, design, and methodology, with reference to the main areas of intervention: school (8); mass media (4) and technological tools (4); smoke-free environments (3); packaging (2) and taxes (3). The school programmes focusing on building skills to recognize and resist negative influences, the intensive use of media and technological equipments, health warnings and excise taxes have showed to be effective tools in reducing the tobacco use. Conclusions: Intervention programmes to implement tobacco control policies and smoking cessation are active in many European countries. However, these programmes need to be constantly sustained to achieve a long term efficacy.
... This process led to the identification of a handful of problems that we believed were likely to have contributed to the difficulties in getting rich data on how the participants related to the program. As we started defining these problems, we discovered that we had encountered several of them also in other eHealth studies we had been involved in [29][30][31][32][33], and we therefore believed they could be relevant beyond the specific study we were currently engaged in. ...
Article
Full-text available
Future development of electronic health (eHealth) programs (automated Web-based health interventions) will be furthered if program design can be based on the knowledge of eHealth’s working mechanisms. A promising and pragmatic method for exploring potential working mechanisms is qualitative interview studies, in which eHealth working mechanisms can be explored through the perspective of the program user. Qualitative interview studies are promising as they are suited for exploring what is yet unknown, building new knowledge, and constructing theory. They are also pragmatic, as the development of eHealth programs often entails user interviews for applied purposes (eg, getting feedback for program improvement or identifying barriers for implementation). By capitalizing on these existing (applied) user interviews to also pursue (basic) research questions of how such programs work, the knowledge base of eHealth’s working mechanisms can grow quickly. To be useful, such interview studies need to be of sufficient quality, which entails that the interviews should generate enough data of sufficient quality relevant to the research question (ie, rich data). However, getting rich interview data on eHealth working mechanisms can be surprisingly challenging, as several of the authors have experienced. Moreover, when encountering difficulties as we did, there are few places to turn to, there are currently no guidelines for conducting such interview studies in a way that ensure their quality. In this paper, we build on our experience as well as the qualitative literature to address this need, by describing 5 challenges that may arise in such interviews and presenting methodological tools to counteract each challenge. We hope the ideas we offer will spark methodological reflections and provide some options for researchers interested in using qualitative interview studies to explore eHealth’s working mechanisms.
... Background Tobacco use remains one of the biggest threats to public health and the leading preventable cause of mortality and morbidity worldwide [1]. Interventions on web-based platforms and mobile apps, among them smoking cessation apps, can deliver effective interventions for various diseases and behavioral disorders [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Smartphone-based smoking cessation apps can provide an important channel for offering interventions to the entire population [17]. ...
Preprint
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BACKGROUND Obstacles to current tobacco cessation programs include limited access and adherence to effective interventions. Digital interventions offer a great opportunity to overcome these difficulties, yet virtual reality has not been used as a remote and self-administered tool to help increase adherence and effectiveness. OBJECTIVE This study aimed to evaluate participant adherence and smoking cessation outcomes in a randomized pilot trial of the digital intervention Mindcotine® utilizing a self-administered treatment using virtual reality combined with mindfulness. METHODS A sample of 120 participants was recruited in the City of Buenos Aires, Argentina (age M = 43.20 years, SD = 9.50; 57/120 (47.5%) female). Participants were randomly assigned to a treatment group (TG), which received a self-assisted 21-day program based on Virtual Reality Mindful Exposure Therapy (VR-MET) sessions, daily surveys, and online peer-to-peer support moderated by psychologists; and a control group (CG), which received a smoking cessation manual from the Argentine Ministry of Health. Follow-up assessments were conducted by online surveys at days 1 and 90 post-intervention. The primary outcome was abstinence at day 1 follow-up, with missing data assumed as still smoking. Secondary outcomes included sustained abstinence at 90-day follow-up, adherence to the program, and readiness to quit. RESULTS Follow-up rates at day-1 were 93% (56/60) for the TG and 100% (60/60) for the CG. At day-1 follow-up, the TG reported 23.3% (14/60) abstinence on that day compared to 5.0% (3/60) in the CG. This difference was statistically significant (Chi2 (1) =8.3; P = .004). The TG reported sustained abstinence of 33% (20/60) at 90 days. Among participants still smoking at day-1 follow-up, the TG was significantly more ready to quit compared to the CG (TG: M = 7.71; SD = 0.13; CG: M = 7.16; SD = 0.13; P = 0.005). A total of 41.1% (23/56) of participants completed the treatment in the time frame recommended by the program. CONCLUSIONS Results provide initial support for participant adherence and efficacy of Mindcotine® and warrant testing the intervention in a fully powered randomized trial. Further research is needed on ways to promote app engagement. CLINICALTRIAL ID ISRCTN50586181
... Prior research has examined the role of web-based health interventions in promoting positive changes in general health-related behaviors (Portnoy et al., 2008;Bennett and Glasgow, 2009;Maher et al., 2014;Pereira et al., 2016) and specific health-related issues such as reducing alcohol consumption (Chiauzzi et al., 2005), smoking cessation (Strecher et al., 2005;Brendryen and Kraft, 2008), and promoting physical exercise (McConnon et al., 2007;Williams et al., 2014). Notwithstanding the insights offered in prior studies, the literature has yet to provide a theory-driven account of health-related interventions, coupled with empirical corroboration of their effectiveness in achieving purported outcomes (Webb et al., 2010;Korda and Itani, 2013). ...
Article
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Drawing on the notion of parasocial interaction (PSI) and the social comparison theory, this experimental research examines how nutritionist video bloggers (vloggers) influence consumer compliance intentions toward healthy, weight-loss diets. Drawing on two samples (Mexican Americans and White Caucasians) and using structural equation modeling and mediation analysis, this research highlights vloggers' credibility and physical attractiveness, but not homophily, as salient source characteristics that influence PSI, which in turn reinforces compliance intention. Moreover, consumer readiness, consisting of role clarity, ability, and motivation, serves as a partial mediator of the PSI-compliance intention relationship. Lastly, consumer health consciousness emerged as a significant moderator of the PSI-compliance intention relationship among White Caucasians, but not among Mexican Americans. The findings and their implications are discussed.
... m-Health based strategies have the potential to be an inexpensive and easily accessible tool to increase compliance and bridge the communication gap between health care providers and users. [14] Cellular phone technologies have been used in the past to increase medication adherence in HIV [15], smoking cessation [16], diabetes [17], maternal and child health care. [18] According to the Pakistan Telecommunication Authority, the total cellular density in Pakistan is reported to be 77% and 92% of Pakistan has internet coverage. ...
Article
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Background We developed and tested the effectiveness of a tailored health information technology driven intervention: “Talking Prescriptions” (Talking Rx) to improve medication adherence in a resource challenged environment. Methods We conducted a parallel, randomized, controlled, assessor-blinded trial at the Aga Khan University (AKU), Karachi, Pakistan. Adults with diagnosis of cerebrovascular accident (CVA) or coronary artery disease (CAD) diagnosed least one month before enrollment, on anti-platelets and statins, with access to a mobile phone were enrolled. The intervention group received a) Daily Interactive Voice Response (IVR) call services regarding specific statin and antiplatelet b) Daily tailored medication reminders for statin and antiplatelet and c) Weekly lifestyle modification messages for a period of 3 months. We assessed Medication adherence to statin and antiplatelets by a validated version of the 8-item Morisky Medication Adherence scale 8 (MMAS-8) at 3 months by a blinded assessment officer. Analysis was conducted by intention-to-treat principle (ITT). Results Between April 2015 and December 2015, 197 participants (99 in intervention and 98 in the usual care group) enrolled in the Talking Rx Study. The dropout rate was 9.6%. Baseline group characteristics were similar. At baseline, the mean MMAS-8 was 6.68 (SD = 1.28) in the intervention group and 6.77 (SD = 1.36) in usual care group. At end of follow-up, the mean MMAS-8 increased to 7.41(0.78) in the intervention group compared with 7.38 (0.99) in usual care group with mean difference of 0.03 (S.D 0.13) (95% C.I [-0.23, 0.29]), which was not statistically significant. (P-Value = 0.40) CVA patients showed a relatively greater magnitude of adherence via the MMAS-8 at the end of follow up where the mean MMAS-8 increased to 7.29 (S.D 0.82) in the intervention group as compared to 7.07(S.D 1.24) in usual care group with mean difference of 0.22 (SD = 0.22) 95% C.I (-0.20, 0.65) with (P-value = 0.15). Around 84% of those on intervention arm used the service, calling at least 3 times and listening to their prescriptions for an average of 8 minutes. No user was excluded due to technologic reasons. Conclusion The use of a phone based medication adherence program was feasible in LMIC settings with high volume clinics and low patient literacy. In this early study, with limited follow up, the program did not achieve any statistically significant differences in adherence behavior as self—reported by the MMAS-8 Scale. Trial registration Clinical Trials.gov NCT02354040.
... For instance, mass consumption of tobacco, a consumption heavily influenced by social engineering (Hughes 2003), has led to the contemporary need to, as it were, de-learn the indoctrinated habit of smoking, as it has been acknowledged that the associated health risks create severe social and economic problems. Such de-learning is, in turn, in many ways connected to new techniques and practices of social control and regimentation, which have links to especially information technologies (Brendryen and Kraft 2008). The main point here is that automation of production, especially as it is intensely associated with mass production, will produce effects in unpredictable ways, which are then mostly 'dealt' with by introducing new (automated) technological 'solutions'. ...
Chapter
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The thoughts presented and discussed in this essay all point to the critical conception that technology is never in any general sense 'neutral', although, as I will try to show, modern technology and its (techno)scientific base is quite largely, although sometimes implicitly and unconsciously, understood to be so. The reason for this non-neutrality is, as I will argue, that technology and its science is always and inescapably rooted in and informed by human interpersonal relationships. Moreover, technology is thus also always embedded in a cultural context. Or differently put, an irreducible part of social organization and its imagination, worldview and ideology. Throughout the essay I will place in dialogue contemporary issues and phenomena revolving around (especially) automation technology with the visions, claims and notions of Francis Bacon and René Descartes, two of the most influential programmatic pioneers of modern technoscience. In sections two and three this dialogical exchange centers on social, political and economic issues with a special focus on the themes of labor and equality. The fourth and final section transitions over to a critical discussion on how the modern technoscientific imagination, with its technological understanding of truth/nature/being, is conceived as answering and overcoming existential concerns about human life and its mindedness.
... To identify these windows of vulnerability, researchers have employed various strategies that trigger JIT cessation support prompted either by users, programmed schedules or algorithms, or combination of both. Some mobile cessation apps have relied on smokers themselves to request JIT support when they experience craving although such usertriggered methods typically lead to low use [8][9][10]. Others have employed automated methods where support is sent out on fixed or variable schedules [11,12] or sensor-assisted, context-sensitive systems [13][14][15]. ...
Article
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Identifying vulnerable windows for a given problematic behavior and providing timely and appropriate support are critical for building an effective just-in-time (JIT) intervention for behavioral change. We developed and evaluated an implementation intention (II) based, JIT cessation intervention prototype to support Asian American young adult smokers to prevent lapses in their cessation attempts in real-time. We examined how a JIT II reminder may prevent lapses during self-identified high-risk smoking situation (HRSS) as a microtemporal process. We also tested whether the effect of JIT reminder changes over the course of study and differed between those who used their own versus project loan phones. Asian American young adult smokers (N = 57) who were interested in quitting or reducing smoking participated in a 4 week, mobile-based, cessation study (MyQuit USC, MQU). MQU is a JIT mobile app that deploys a user-specified II reminder at user-specified HRSS and assesses momentary lapse status. Generalized mixed linear models were conducted to assess the effect of the JIT intervention on lapse prevention. We found a significant interaction effect (p = .03) such that receiving JIT reminder reduced the likelihood of lapses for participants using their own phones but not for the loaners. The results also showed that when participants enacted the suggested II, they were less likely to lapse (p < .001). The JIT effect did not change over time in study (p = .21). This study provides evidence that receiving a reminder of a smoker’s own plan just before a self-identified risky situation on a familiar device and successfully executing specified plans can be helpful in preventing lapses. Our results highlighted factors to consider when designing and refining a JIT intervention.
... Prior research in online health services have focused on different website and social networking site based health interventions in promoting positive changes related to general health behaviors (Bennett and Glasgow, 2009;Korda and Itani, 2013;Portnoy et al., 2008;Wantland et al., 2004;) or specific health-related issues such as reducing alcohol consumption (Chiauzzi, et al., 2005), smoking cessation (Brendryen and Kraft, 2008;Strecher, Shiffman, and West 2005), and promoting physical exercise/weight loss (McConnon et al., 2007;Williams et al., 2014). While, recent research in this area have investigated other relevant factors such as people's pattern of activities in social media platforms related to health information purposes (Benetoli, Chen, and Aslani, 2017), expert vs. common users' knowledge sharing motivations in online health communities (Zhang et al., 2017), people's trust issues toward the health information available in online health communities (Daraz et al., 2019;Fan and Lederman, 2018), and how people evaluate those health information (Walther, Jang, and Hanna Edwards, 2018). ...
Thesis
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Drawing on the notion of parasocial interaction (PSI) theory (Horton and Wohl, 1956), this dissertation provides a framework to demonstrate how YouTube health vloggers can influence viewer compliance intention toward a prescribed health behavior (i.e., weight-loss diet to lose weight). Initially, drawing on the discounting principles of attribution theory (Kelly, 1973), physical attractiveness stereotype (Eagly et al., 1991), and the black sheep effect (Marques and Yzerbyt, 1988), the interaction effects of three vlogger characteristics on viewer PSI experience were conceptualized and examined (Study 1). Then by using a scenario-based experiment, viewer PSI experience with the vlogger was manipulated (high vs. low) and drawing on social comparison theory (Festinger, 1954), PSI’s effect on the core dependent variable of this research, compliance intention was tested (Study 2). In the process, this research also accounted for the mediating role of viewer readiness (role clarity, ability, and motivation), the moderating and the mediated moderating role of viewer health consciousness through viewer readiness in the PSI – compliance intention relationship. Overall, results indicated the dominance of vloggers’ credibility over the other two vlogger characteristics – physical attractiveness and ethnic similarity in engendering PSI experience with the viewers. While no main or interaction effects of vloggers’ physical attractiveness and ethnic similarity were found in generating viewers’ PSI experience with vloggers. The positive influence of PSI on compliance intention was found both as a direct effect and also through the mediating role of viewer readiness. While viewer health consciousness is found to have no moderating influence in the PSI – compliance relationship both in the direct effect and also in the indirect effect mediated through viewer readiness. The findings and their implications are discussed.
... Background Tobacco use remains one of the biggest threats to public health and the leading preventable cause of mortality and morbidity worldwide [1]. Interventions on web-based platforms and mobile apps, among them smoking cessation apps, can deliver effective interventions for various diseases and behavioral disorders [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Smartphone-based smoking cessation apps can provide an important channel for offering interventions to the entire population [17]. ...
Article
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Background: Obstacles to current tobacco cessation programs include limited access and adherence to effective interventions. Digital interventions offer a great opportunity to overcome these difficulties, yet virtual reality has not been used as a remote and self-administered tool to help increase adherence and effectiveness of digital interventions for tobacco cessation. Objective: This study aimed to evaluate participant adherence and smoking cessation outcomes in a pilot randomized controlled trial of the digital intervention Mindcotine (MindCotine Inc) using a self-administered treatment of virtual reality combined with mindfulness. Methods: A sample of 120 participants was recruited in the city of Buenos Aires, Argentina (mean age 43.20 years, SD 9.50; 57/120, 47.5% female). Participants were randomly assigned to a treatment group (TG), which received a self-assisted 21-day program based on virtual reality mindful exposure therapy (VR-MET) sessions, daily surveys, and online peer-to-peer support moderated by psychologists, or a control group (CG), which received the online version of the smoking cessation manual from the Argentine Ministry of Health. Follow-up assessments were conducted by online surveys at postintervention and 90-day follow-up. The primary outcome was self-reported abstinence at postintervention, with missing data assumed as still smoking. Secondary outcomes included sustained abstinence at 90-day follow-up, adherence to the program, and readiness to quit. Results: Follow-up rates at day 1 were 93% (56/60) for the TG and 100% (60/60) for the CG. At postintervention, the TG reported 23% (14/60) abstinence on that day compared with 5% (3/60) in the CG. This difference was statistically significant (χ21=8.3; P=.004). The TG reported sustained abstinence of 33% (20/60) at 90 days. Since only 20% (12/60) of participants in the CG completed the 90-day follow-up, we did not conduct a statistical comparison between groups at this follow-up time point. Among participants still smoking at postintervention, the TG was significantly more ready to quit compared to the CG (TG: mean 7.71, SD 0.13; CG: mean 7.16, SD 0.13; P=.005). A total of 41% (23/56) of participants completed the treatment in the time frame recommended by the program. Conclusions: Results provide initial support for participant adherence to and efficacy of Mindcotine and warrant testing the intervention in a fully powered randomized trial. However, feasibility of trial follow-up assessment procedures for control group participants needs to be improved. Further research is needed on the impact of VR-MET on long-term outcomes. Trial registration: ISRCTN Registry ISRCTN50586181; http://www.isrctn.com/ISRCTN50586181.
... After initial screening, a total of 20 articles were considered for full-text review (Supporting information, Fig. S1). However, eight articles were excluded for various reasons (Supporting information, Fig. S1 and Table S3) [22,[51][52][53][54][55][56][57]. Finally, 12 articles were included in the current study (Supporting information, Table S4). ...
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Background and aims Nicotine is a highly addictive substance in tobacco products that dysregulates several neurotransmitters in the brain and impairs executive function. Non-invasive brain stimulation (NIBS) methods such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are promising treatments for nicotine dependence. We investigated the efficacy and acceptability of NIBS in managing smoking cessation through a systematic review and network meta-analysis (NMA). Methods We conducted a systematic review to identify randomized controlled trials (RCTs) that investigated the efficacy of NIBS for smoking cessation. All pairwise meta-analyses and NMA procedures were conducted using random-effects and frequentist models. The co-primary outcomes were (1) the change in number of cigarettes smoked per day (change in frequency of smoking) in patients with nicotine dependence after NIBS and (2) acceptability (the dropout rate). The effect sizes for co-primary outcomes of change in frequency of smoking and acceptability were assessed according to standardized mean difference (SMD) and odds ratio, respectively. Results Twelve RCTs with 710 participants (mean age: 44.2 years, 31.2% female) were included. Compared with the sham control, 10-Hz rTMS over the left dorsolateral prefrontal cortex (DLPFC) was associated with the largest changes in smoking frequency [SMD = −1.22, 95% confidence interval (95% CI) = −1.77 to −0.66]. The 2-mA bifrontal tDCS (SMD = −0.97, 95% CI = −1.32 to −0.62) and 10-Hz deep rTMS over the bilateral DLPFC with cue provocation (SMD = −0.77, 95% CI = −1.20 to −0.34) were associated with a significantly larger decrease in smoking frequency versus the sham. None of the investigated NIBSs was associated with dropout rates significantly different from those of the sham control groups. Conclusion Prefrontal non-invasive brain stimulation interventions appear to reduce the number of cigarettes smoked with good acceptability.
... However, only a few interventions have also been designed to deliver customized motivational messages that lead to smoking cessation through behavior change. [11][12][13] These interventions vary from sending customized motivational messages to multimedia messages. The advantages of mobile phones for the interventions were found to be low cost, better reach, increased interaction between researcher and participants and easier as well as faster ways to send tailored and personalized messages. ...
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Introduction The primary purpose of this research is to investigate the adoption process of mobile smoking cessation apps for Korean American smokers with the eventual purpose of proposing a new combined model of smartphone smoking cessation adoption. Methods From September 2018 to March 2019, a total of 227 Korean American smokers responded to surveys regarding the effectiveness of mobile applications for smoking cessation. A path analysis was used to analyze the predictors of adopting and using smoking cessation applications available via smartphones. Results Perceived benefits and self-efficacy were important factors for influencing the perceived usefulness of a smoking cessation mobile app. Moreover, the perceived usefulness of a smoking cessation mobile app was also positively related to intention to use a smoking cessation mobile app. Conclusion Although mobile smoking cessation apps can help many individuals quit smoking, most Korean American smokers are not current users of smoking cessation mobile apps. Therefore, there is a strong need to use strategic evidence-based communication interventions for promoting the widespread adoption of smoking cessation applications.
... These encouraging results are consistent with evaluations of similar campaigns to reduce smoking behaviors. For example, Brendryen et al. [3] documented that the use of multi-channel, automated and interactive digital media had positive and long-term effects on smoking abstinence rates and on the level of post-cessation self-efficacy. Similarly, Baskerville et al. [2] showed that a multicomponent web-based and social media approach increased higher 7-day and 30-day smoking quit rates among youth. ...
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Background Given the long-term health effects of smoking during adolescence and the substantial role that tobacco-related morbidity and mortality play in the global burden of disease, there is a worldwide need to design and implement effective youth-focused smoking prevention interventions. While smoking prevention interventions that focus on both social competence and social influence have been successful in preventing smoking uptake among adolescents in developed countries, their effectiveness in developing countries has not yet been clearly demonstrated. SKY Girls is a multimedia, empowerment and anti-smoking program aimed at 13–16-year old girls in Accra, Ghana. The program uses school and community-based events, a magazine, movies, a radio program, social media and other promotional activities to stimulate normative and behavioral change. Methods This study uses pre/post longitudinal data on 2625 girls collected from an interviewer-administered questionnaire. A quasi-experimental matched design was used, incorporating comparison cities with limited or no exposure to SKY Girls (Teshie, Kumasi and Sunyani). Fixed-effects modeling with inverse probability weighting was used to obtain doubly robust estimators and measure the causal influence of SKY Girls on a set of 15 outcome indicators. Results Results indicate that living and studying in the intervention city was associated with an 11.4 percentage point (pp) (95% CI [2.1, 20.7]) increase in the proportion of girls perceiving support outside their families; an 11.7 pp. decrease (95% CI [− 20.8, − 2.6]) in girls’ perception of pressure to smoke cigarettes; a 12.3 pp. increase (95% CI [2.1, 20.7]) in the proportion of girls who had conversations with friends about smoking; an 11.7 pp. increase (95% CI [3.8, 20.8]) in their perceived ability to make choices about what they like and do not like, and 20.3 pp. (95% CI [− 28.4, − 12.2]) and 12.1 pp. (95% CI [− 20.7, − 3.5]) reductions in the proportion agreeing with the idea that peers can justify smoking shisha and cigarettes, respectively. An analysis of the dose-effect associations between exposure to multiple campaign components and desired outcomes was included and discussed. Conclusion The study demonstrates the effectiveness of a multimedia campaign to increase perceived support, empowerment and improve decision-making among adolescent girls in a developing country.
... Всички компоненти на програмата са напълно автоматизирани. Резултатите показват, че психологическата подкрепа може да бъде ефективно медиирана чрез модерна технология за комуникация от разстояние и, че автоматизирана подкрепа, като самостоятелна интервенция, може да въздейства за дългосрочната промяна в поведението [32]. 4Вследствие на интернет-базирани интервенции са наблюдавани положителни въздействия върху знанията и нагласите, а също и промяна в поведението за здраве по от ношение на храненето, тютюнопушене, физическа активност и безопасно сексуално поведение [33,34,35,36,37]. ...
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Summary . The article highlights the relevance of a healthy diet, food safety and morbidity associated with these factors that continue to be the leading public health issues and challenges. The major legislative and institutional changes in the organization of health control and supervision on food and nutrition have been analysed in the article. Health legislation in Bulgaria in this field is fully harmonized with the EU and continues to evolve in line with the development of the EU regulatory legislation. The established Bulgarian Agency for Food Safety has a very wide range of activities, but at this stage does not fully put under control some of the problems, solution of which necessarily requires the direct participation of qualified medical specialists – healthy nutrition and health risks of chemical and biological contaminants. The new draft of the food law limits the authority of health professionals in the control of most important food groups for population nutrition. There is a positive trend for modernization of Bulgarian food standards in order to return to the most demanding criteria for their composition and quality. Special attention is paid to the importance of media in promotion of healthy eating and limiting the dissemination of unscientific dietary conceptions and ideas.
... Mobile health (mHealth), defined as the use of mobile and wireless technologies for health promotion [7•], offers a promising approach for addressing these barriers. mHealth tools such as smartphone apps, text messaging, and interactive voice response are effective approaches for extending addiction treatment outside of the clinic [8][9][10][11]. Indeed, mobile apps hold promise as smartphone use has become increasingly ubiquitous, including among individuals with limited access to treatment as a way to reduce substance use [12][13][14]. A key advantage of mHealth interventions is the potential to deliver efficacious strategies in response to rapid changes in an individual's circumstances by identifying when, for whom, and to what extent an intervention is needed [15,16]. ...
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Purpose of Review Addiction is a serious and prevalent problem across the globe. An important challenge facing intervention science is how to support addiction treatment and recovery while mitigating the associated cost and stigma. A promising solution is the use of mobile health (mHealth) just-in-time adaptive interventions (JITAIs), in which intervention options are delivered in situ via a mobile device when individuals are most in need. Recent Findings The present review describes the use of mHealth JITAIs to support addiction treatment and recovery, and provides guidance on when and how the micro-randomized trial (MRT) can be used to optimize a JITAI. We describe the design of five mHealth JITAIs in addiction and three MRT studies, and discuss challenges and future directions. Summary This review aims to provide guidance for constructing effective JITAIs to support addiction treatment and recovery.
... Other EMI approaches merge several therapeutic elements, including audio recordings and online modules, with text messages. Participants in one such program, Happy Ending, found significantly higher repeated-point abstinence rates than participants who were given a selfhelp book (32). Therefore, developers of smoking-based EMI programs may find benefit in combining several different tools from which clients may choose on the basis of their individual needs. ...
Article
This article reviews the use of ecological momentary assessment (EMA) and ecological momentary intervention (EMI) in clinical research applications. EMA refers to a method of data collection that attempts to capture respondents' activities, emotions, and thoughts in the moment, in their natural environment. It typically uses prompts administered through a personal electronic device, such as a smartphone or tablet. EMI extends this technique and includes the use of microlevel interventions administered through personal electronic devices. These technological developments hold promise for enhancing psychological treatments by prompting the patient outside of therapy sessions in his or her day-to-day environment. Research suggests that EMI may be beneficial to participants and that this effect is amplified when EMI is delivered in the context of ongoing psychotherapy. EMI may reflect a cost-effective mechanism to enhance therapeutic outcomes.
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Background Cognitive behavioral group therapy has developed several techniques in order to make the treatment of depressive and anxiety disorders more effective. Particularly, the “homework” is a tool in order to practice therapeutic skills in ecological settings. When working with this aim, it is often necessary to support patient compliance. Researches have shown the efficacy of sending a text to the patients in order to support the patient compliance, but only a few data are available on the effectiveness of sending text in the treatment of depression and anxiety. Objective Verify the effectiveness of sending text in the treatment of depression and anxiety in order to support patient compliance. Methods Participants were enrolled for cognitive behavioral group therapy. Once completed the treatment, a sub-group of participants (Yes SMS group) was reached by a weekly text message for the whole 3 months time between the end of the intervention and the scheduled follow-up session. All the participants were assessed for the overall psychopathological symptoms, depression, and anxiety before and after the group intervention, and at the 3 months follow up. Results Both groups improved from pre to post-treatment in all the assessed dimensions; the enhancement endures up to the 3 months follow up. Comparing the two groups regardless of the diagnosis, the Yes SMS group shows significant better outcomes in depression at follow-up and in anxiety both at post-treatment and at follow-up. Conclusion The weekly SMS as prompt seems to enhance the patient’s compliance.
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Many telemedicine interventions fail to be implemented in medical care with non-use and discontinued use by patients being among the major reasons. The aim of this scoping review was to provide an overview of barriers associated with non-use and discontinued use of telemedicine. An electronic search was conducted in Pubmed in October 2019 and updated in November 2020, followed by a hand search in the beginning of 2021. All potential articles were screened by two independent reviewers based on predefined inclusion and exclusion criteria. A qualitative content analysis according to Mayring was carried out. The topics ‘intervention’, ‘context of use’ and ‘user’ were chosen as overarching themes. Out of 1377 potentially relevant articles, 73 were included. User-related barriers were mentioned in most of the analysed studies, followed by barriers related to the intervention. The analysis provides the basis for overcoming non-use issues in telemedicine.
Article
Introduction: Most smokers see a physician each year, but few use any assistance when they try to quit. Text messaging programs improve smoking cessation in community and school settings; however, their efficacy in a primary care setting is unclear. The current trial assesses the feasibility and preliminary clinical outcomes of text messaging and mailed nicotine replacement therapy (NRT) among smokers in primary care. Methods: In this single-center pilot randomized trial, eligible smokers in primary care are offered brief advice by phone and randomly assigned to one of four interventions: (1) Brief advice only, (2) text messages targeted to primary care patients and tailored to quit readiness, (3) a 2-week supply of nicotine patches and/or lozenges (NRT), and (4) both text messaging and NRT. Randomization is stratified by practice and intention to quit. The text messages (up to 5/day) encourage those not ready to quit to practice a quit attempt, assist those with a quit date through a quit attempt, and promote NRT use. The 2-week supply of NRT is mailed to patients' homes. Results: Feasibility outcomes include recruitment rates, study retention, and treatment adherence. Clinical outcomes are assessed at 1, 2, 6, and 12-weeks post-enrollment. The primary outcome is ≥1self-reported quit attempt(s). Secondary clinical outcomes include self-reported past 7- and 30-day abstinence, days not smoked, NRT adherence, and exhaled carbon monoxide. Conclusions: This pilot assesses text messaging plus NRT, as a proactively offered intervention for smoking cessation support in smokers receiving primary care and will inform full-scale randomized trial planning. Trial registration: ClinicalTrials.govNCT03174158.
Article
Issues With the advancement and rapid increase in the public's interest in utilisation of Internet and mobile phones, technology‐based interventions are being implemented across a range of health conditions to improve patient outcomes. The aim of this review was to summarise findings from systematic reviews that evaluated the effectiveness of technology‐based smoking cessation interventions and to critically appraise their methodological qualities. Approach An umbrella review was conducted using studies identified from a comprehensive literature search of six databases and grey literature. All included systematic reviews were checked for eligibility criteria and quality using the Assessment of Multiple Systematic Reviews tool. The level of evidence for each intervention category was assessed, citation matrices were generated and corrected covered area was calculated. Key Findings Five systematic reviews with a total of 212 randomised controlled trials and 237 760 participants were included. Fourteen intervention approaches were identified and classified into three categories: stand‐alone web‐based; stand‐alone mobile phone‐based and multicomponent interventions. Incorporating web and/or mobile‐based interventions with face‐to‐face approach improved the rate of smoking cessation. However, there was no consistent evidence regarding the effectiveness of stand‐alone Internet or mobile‐based interventions. Implications Policymakers are recommended to develop strategies that enable health professionals to integrate these approaches with face‐to‐face smoking cessation support. Health professionals are recommended to be trained and equipped for online and mobile‐based interventions. Conclusion Adding technology‐based intervention to face‐to‐face smoking cessation support improves smoking cessation. Further research is needed to evaluate stand‐alone web‐based and mobile phone‐based interventions.
Article
Introduction: Smoking during pregnancy poses serious risks to baby and mother. Few disseminable programs exist to help pregnant women quit or reduce their smoking. We hypothesized that an SMS text-delivered scheduled gradual reduction (SGR) program plus support texts would outperform SMS support messages alone. Methods: We recruited 314 pregnant women from 14 prenatal clinics. Half of the women received theory-based support messages throughout their pregnancy to promote cessation and prevent relapse. The other half received the support messages plus alert texts that gradually reduced their smoking more than 3-5 weeks. We conducted surveys at baseline, end of pregnancy, and 3 months postpartum. Our primary outcome was biochemically validated 7-day point prevalence abstinence at late pregnancy. Our secondary outcome was reduction in cigarettes per day. Results: Adherence to the SGR was adequate with 70% responding to alert texts to smoke within 60 minutes. Women in both arms quit smoking at the same rate (9%-12%). Women also significantly reduced their smoking from baseline to the end of pregnancy from nine cigarettes to four; we found no arm differences in reduction. Conclusions: Support text messages alone produced significant quit rates above naturally occurring quitting. SGR did not add significantly to helping women quit or reduce. Sending support messages can reach many women and is low-cost. More obstetric providers might consider having patients who smoke sign up for free texting programs to help them quit. Implications: A disseminable texting program helped some pregnant women quit smoking.Clinical Trial Registration number: NCT01995097.
Article
Background: The prevalence of smoking is declining; however, it continues to be a major public health burden. In England, primary care is the health setting that provides smoking cessation support to most smokers. However, this setting has one of the lowest success rates. The iQuit in practice intervention (iQuit) is a tailored web-based and text message intervention developed for use in primary care consultations as an adjunct to routine smoking cessation support with the aim of increasing success rates. iQuit has demonstrated feasibility, acceptability, and potential effectiveness. Objective: This definitive trial aims to determine the effectiveness and cost-effectiveness of iQuit when used as an adjunct to the usual support provided to patients who wish to quit smoking, compared with usual care alone. Methods: The iQuit in Practice II trial is a two-arm, parallel-group, randomized controlled trial (RCT) with a 1:1 individual allocation comparing usual care (ie, pharmacotherapy combined with multisession behavioral support)-the control-with usual care plus iQuit-the intervention. Participants were recruited through primary care clinics and talked to a smoking cessation advisor. Participants were randomized during the initial consultation, and those allocated to the intervention group received a tailored advice report and 90 days of text messaging in addition to the standard support provided to all patients. Results: The primary outcome is self-reported prolonged abstinence biochemically verified using saliva cotinine at 6 months after the quit date. A sample size of 1700 participants, with 850 per arm, would yield 90% power to detect a 4.3% difference in validated quit rates between the groups at the two-sided 5% level of significance. The Cambridge East Research Ethics Committee approved the study in February 2016, and funding for the study was granted from May 2016. In total, 1671 participants were recruited between August 2016 and July 2019. Follow-up for all participants was completed in January 2020. Data analysis will begin in the summer of 2020. Conclusions: iQuit in Practice II is a definitive, pragmatic RCT assessing whether a digital intervention can augment the impact of routine smoking cessation support in primary care. Previous research has found good acceptability and feasibility for delivering iQuit among smoking cessation advisors working in primary care. If demonstrated to be cost-effective, iQuit could be delivered across primary care and other settings, such as community pharmacies. The potential benefit would likely be highest where less behavioral support is delivered. Trial registration: International Standard Randomized Controlled Trial Number (ISRCTN): 44559004; http://www.isrctn.com /ISRCTN44559004. International registered report identifier (irrid): DERR1-10.2196/17160.
Article
Background: Pharmacological treatments for tobacco dependence, such as nicotine replacement therapy (NRT), have been shown to be safe and effective interventions for smoking cessation. Higher levels of adherence to these medications increase the likelihood of sustained smoking cessation, but many smokers use them at a lower dose and for less time than is optimal. It is important to determine the effectiveness of interventions designed specifically to increase medication adherence. Such interventions may address motivation to use medication, such as influencing beliefs about the value of taking medications, or provide support to overcome problems with maintaining adherence. Objectives: To assess the effectiveness of interventions aiming to increase adherence to medications for smoking cessation on medication adherence and smoking abstinence compared with a control group typically receiving standard care. Search methods: We searched the Cochrane Tobacco Addiction Group Specialized Register, and clinical trial registries (ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform) to the 3 September 2018. We also conducted forward and backward citation searches. Selection criteria: Randomised, cluster-randomised or quasi-randomised studies in which adults using active pharmacological treatment for smoking cessation were allocated to an intervention arm where there was a principal focus on increasing adherence to medications for tobacco dependence, or a control arm providing standard care. Dependent on setting, standard care may have comprised minimal support or varying degrees of behavioural support. Included studies used a measure that allowed assessment of the degree of medication adherence. Data collection and analysis: Two authors independently screened studies for eligibility, extracted data for included studies and assessed risk of bias. For continuous outcome measures, we calculated effect sizes as standardised mean differences (SMDs). For dichotomous outcome measures, we calculated effect sizes as risk ratios (RRs). In meta-analyses for adherence outcomes, we combined dichotomous and continuous data using the generic inverse variance method and reported pooled effect sizes as SMDs; for abstinence outcomes, we reported and pooled dichotomous outcomes. We obtained pooled effect sizes with 95% confidence intervals (CIs) using random-effects models. We conducted subgroup analyses to assess whether the primary focus of the adherence treatment ('practicalities' versus 'perceptions' versus both), the delivery approach (participant versus clinician-centred) or the medication type were associated with effectiveness. Main results: We identified two new studies, giving a total of 10 studies, involving 3655 participants. The medication adherence interventions studied were all provided in addition to standard behavioural support.They typically provided further information on the rationale for, and emphasised the importance of, adherence to medication or supported the development of strategies to overcome problems with maintaining adherence (or both). Seven studies targeted adherence to NRT, two to bupropion and one to varenicline. Most studies were judged to be at high or unclear risk of bias, with four of these studies judged at high risk of attrition or detection bias. Only one study was judged to be at low risk of bias.Meta-analysis of all 10 included studies (12 comparisons) provided moderate-certainty evidence that adherence interventions led to small improvements in adherence (i.e. the mean amount of medication consumed; SMD 0.10, 95% CI 0.03 to 0.18; I² = 6%; n = 3655), limited by risk of bias. Subgroup analyses for the primary outcome identified no significant subgroup effects, with effect sizes for subgroups imprecisely estimated. However, there was a very weak indication that interventions focused on the 'practicalities' of adhering to treatment (i.e. capabilities, resources, levels of support or skills) may be effective (SMD 0.21, 95% CI 0.03 to 0.38; I² = 39%; n = 1752), whereas interventions focused on treatment 'perceptions' (i.e. beliefs, cognitions, concerns and preferences; SMD 0.10, 95% CI -0.03 to 0.24; I² = 0%; n = 839) or on both (SMD 0.04, 95% CI -0.08 to 0.16; I² = 0%; n = 1064), may not be effective. Participant-centred interventions may be effective (SMD 0.12, 95% CI 0.02 to 0.23; I² = 20%; n = 2791), whereas those that are clinician-centred may not (SMD 0.09, 95% CI -0.05 to 0.23; I² = 0%; n = 864).Five studies assessed short-term smoking abstinence (five comparisons), while an overlapping set of five studies (seven comparisons) assessed long-term smoking abstinence of six months or more. Meta-analyses resulted in low-certainty evidence that adherence interventions may slightly increase short-term smoking cessation rates (RR 1.08, 95% CI 0.96 to 1.21; I² = 0%; n = 1795) and long-term smoking cessation rates (RR 1.16, 95% CI 0.96 to 1.40; I² = 48%; n = 3593). In both cases, the evidence was limited by risk of bias and imprecision, with CIs encompassing minimal harm as well as moderate benefit, and a high likelihood that further evidence will change the estimate of the effect. There was no evidence that interventions to increase adherence to medication led to any adverse events. Studies did not report on factors plausibly associated with increases in adherence, such as self-efficacy, understanding of and attitudes toward treatment, and motivation and intentions to quit. Authors' conclusions: In people who are stopping smoking and receiving behavioural support, there is moderate-certainty evidence that enhanced behavioural support focusing on adherence to smoking cessation medications can modestly improve adherence. There is only low-certainty evidence that this may slightly improve the likelihood of cessation in the shorter or longer-term. Interventions to increase adherence can aim to address the practicalities of taking medication, change perceptions about medication, such as reasons to take it or concerns about doing so, or both. However, there is currently insufficient evidence to confirm which approach is more effective. There is no evidence on whether such interventions are effective for people who are stopping smoking without standard behavioural support.
Article
Background: Cardiovascular disease (CVD) remains the leading cause of death globally. Seven health factors are associated with ideal cardiovascular health: being a non-smoker; not overweight; physically active; having a healthy diet; and normal blood pressure; fasting plasma glucose and cholesterol. Whereas approximately half of U.S. youth have ideal levels in at least 5 of the 7 components of cardiovascular health, this proportion falls to 16% by adulthood. Objective: We will evaluate whether the NUYou cardiovascular mHealth intervention is more effective than an active comparator to promote cardiovascular health during the transition to young adulthood. Methods: 302 incoming freshmen at a midwest university will be cluster randomized by dormitory into one of two mHealth intervention groups: 1) Cardiovascular Health (CVH), addressing behaviors related to CVD risk; or 2) Whole Health (WH), addressing behaviors unrelated to CVD. Both groups will receive smartphone applications, co-designed with students to help them manage time, interact with other participants via social media, and report health behaviors weekly. The CVH group will also have self-monitoring features to track their risk behaviors. Cardiovascular health will be assessed at the beginning of freshman year and the end of freshman and sophomore years. Linear mixed models will be used to compare groups on a composite of the seven cardiovascular-related health factors. Significance: This is the first entirely technology-mediated multiple health behavior change intervention delivered to college students to promote cardiovascular health. Findings will inform the potential for primordial prevention in young adulthood. Trial registration number: clinicaltrials.gov #NCT02496728.
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Background: The use of technology to support healthcare in Indonesia holds new promise in light of decreasing costs of owning mobile devices and ease of access to internet. However, it is necessary to assess end-user perceptions regarding mobile health interventions prior to its implementation. This would throw light on the acceptability of mobile phone communication in bringing about behavioral changes among the target Indonesian population. The aim of this study was to explore the perceived usefulness of receiving a potential smoking cessation intervention via mobile phones. Methods: This is an exploratory cross-sectional study involving current and former adult tobacco smokers residing in Indonesia. Online advertisement and snowballing were used to recruit respondents. Data was collected using a web-based survey over a period of 4 weeks. Those willing to participate signed an online consent and were subsequently directed to the online questionnaire that obtained demographics, tobacco usage patterns, perceived usefulness of a mobile phone smoking cessation application and its design. Results: A total of 161 people who smoked tobacco responded to the online survey. The mean age of the participants was 29.4. Of the 123 respondents, 102 were men. Prior experience with using a mobile phone for health communication (OR 3.6, P =0.014) and those willing to quit smoking (OR 5.1, P =0.043) were likely to perceive a mobile phone smoking cessation intervention as useful. A smartphone application was preferred over text messages, media messages or interactive voice response technology. Content consisting of motivational messages highlighting the methods and benefits of quitting smoking were requested. Conclusion: People who smoke in Indonesia perceived receiving a potential smoking cessation intervention via mobile phones as useful. A multi-component, personalized smartphone application was the desired intervention technique. Such an intervention developed and implemented within a public health program could help address the tobacco epidemic in Indonesia.
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A just-in-time, adaptive intervention (JITAI) is an emerging type of intervention that provides tailored support at the exact time of need. It does so using enabling new technologies (e.g., mobile phones, sensors) that capture the changing states of individuals. Extracting effect sizes of primary outcomes produced by 33 empirical studies that used JITAIs, we found moderate to large effect sizes of JITAI treatments compared to (1) waitlist-control conditions (k = 9), Hedges’s g = 1.65 and (2) non-JITAI treatments (k = 21), g = 0.89. Also, participants of JITAI interventions showed significant changes (k = 13) in the positive direction (g = 0.79). A series of sensitivity tests suggested that those effects persist. Those effects also persist despite differences in the behaviors of interests (e.g., blood glucose control, recovering alcoholics), duration of the treatments, and participants’ age. Two aspects of tailoring, namely: (1) tailoring to what (i.e., both people’s previous behavioral patterns and their current need states; with these effects additive) and (2) approach to tailoring (i.e., both using a human agent and an algorithm to decide tailored feedback; with these effects additive), are significantly associated with greater JITAI efficacy.
Article
IntroductionMost pregnant women know that smoking poses serious risks to baby and mother, yet many still smoke. We conducted a large randomized controlled trial and found that an SMS text-delivered program helped about 10% of these women quit smoking. In this paper, we describe the feasibility of disseminating a text-based intervention to pregnant women who smoke.Methods We tested dissemination in two ways from prenatal clinics and compared recruitment rates to those found in our large randomized controlled trial. The first method involved “direct texting” where study staff identified women who smoked and sent them a text asking them to text back if they wanted to receive texts to help them quit. The second involved “nurse screening” where clinic staff from county health departments screened women for smoking and asked them to send a text to the system if they wanted to learn more about the program. Our primary outcome was feasibility assessed by the number of women who texted back their baby’s due date, which served as “enrolling” in the texting program, which we compared to the recruitment rate we found in our large trial.ResultsOver 4 months, we texted 91 women from the academic health system. Of those, 17 texted back and were counted as “enrolled.” In the health departments, across the 4 months, 12 women texted the system initially. Of those, 10 were enrolled. This rate was similar to the rate enrolled in the randomized controlled trial.DiscussionTwo different methods connected pregnant women who smoke to a texting program. One of these methods can be automated further and have the potential of helping many women quit smoking with minimal effort.Clinical Trial # NCT01995097
Article
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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Background: The use of technology to support healthcare in Indonesia holds new promise in light of decreasing costs of owning mobile devices and ease of access to internet. However, it is necessary to assess end-user perceptions regarding mobile health interventions prior to its implementation. This would throw light on the acceptability of mobile phone communication in bringing about behavioural changes among the target Indonesian population. The aim of this study was to explore the perceived usefulness of receiving a potential smoking cessation intervention via mobile phones. Methods: This is an exploratory cross-sectional study involving current and former adult tobacco smokers residing in Indonesia. Online advertisement and snowballing were used to recruit respondents. Data was collected using a web-based survey over a period of 4 weeks. Those willing to participate signed an online consent and were subsequently directed to the online questionnaire that obtained demographics, tobacco usage patterns, perceived usefulness of a mobile phone smoking cessation application and its design. Results: A total of 161 people who smoked tobacco responded to the online survey. The mean age of the participants was 29.4. Of the 123 respondents, 102 were men. Prior experience with using a mobile phone for health communication (OR 3.6, P =0.014) and those willing to quit smoking (OR 5.1, P =0.043) were likely to perceive a mobile phone smoking cessation intervention as useful. A smartphone application was preferred over text messages, media messages or interactive voice response technology. Content comprising of motivational messages highlighting the methods and benefits of quitting smoking were requested. Conclusion: People who smoke in Indonesia perceived receiving a potential smoking cessation intervention via mobile phones as useful. A multi-component, personalized smartphone application was the desired intervention technique. Such an intervention developed and implemented within a public health program could help address the tobacco epidemic in Indonesia.
Article
Background: Mobile phone-based smoking cessation support (mCessation) offers the opportunity to provide behavioural support to those who cannot or do not want face-to-face support. In addition, mCessation can be automated and therefore provided affordably even in resource-poor settings. This is an update of a Cochrane Review first published in 2006, and previously updated in 2009 and 2012. Objectives: To determine whether mobile phone-based smoking cessation interventions increase smoking cessation rates in people who smoke. Search methods: For this update, we searched the Cochrane Tobacco Addiction Group's Specialised Register, along with clinicaltrials.gov and the ICTRP. The date of the most recent searches was 29 October 2018. Selection criteria: Participants were smokers of any age. Eligible interventions were those testing any type of predominantly mobile phone-based programme (such as text messages (or smartphone app) for smoking cessation. We included randomised controlled trials with smoking cessation outcomes reported at at least six-month follow-up. Data collection and analysis: We used standard methodological procedures described in the Cochrane Handbook for Systematic Reviews of Interventions. We performed both study eligibility checks and data extraction in duplicate. We performed meta-analyses of the most stringent measures of abstinence at six months' follow-up or longer, using a Mantel-Haenszel random-effects method, pooling studies with similar interventions and similar comparators to calculate risk ratios (RR) and their corresponding 95% confidence intervals (CI). We conducted analyses including all randomised (with dropouts counted as still smoking) and complete cases only. Main results: This review includes 26 studies (33,849 participants). Overall, we judged 13 studies to be at low risk of bias, three at high risk, and the remainder at unclear risk. Settings and recruitment procedures varied across studies, but most studies were conducted in high-income countries. There was moderate-certainty evidence, limited by inconsistency, that automated text messaging interventions were more effective than minimal smoking cessation support (RR 1.54, 95% CI 1.19 to 2.00; I2 = 71%; 13 studies, 14,133 participants). There was also moderate-certainty evidence, limited by imprecision, that text messaging added to other smoking cessation interventions was more effective than the other smoking cessation interventions alone (RR 1.59, 95% CI 1.09 to 2.33; I2 = 0%, 4 studies, 997 participants). Two studies comparing text messaging with other smoking cessation interventions, and three studies comparing high- and low-intensity messaging, did not show significant differences between groups (RR 0.92 95% CI 0.61 to 1.40; I2 = 27%; 2 studies, 2238 participants; and RR 1.00, 95% CI 0.95 to 1.06; I2 = 0%, 3 studies, 12,985 participants, respectively) but confidence intervals were wide in the former comparison. Five studies compared a smoking cessation smartphone app with lower-intensity smoking cessation support (either a lower-intensity app or non-app minimal support). We pooled the evidence and deemed it to be of very low certainty due to inconsistency and serious imprecision. It provided no evidence that smartphone apps improved the likelihood of smoking cessation (RR 1.00, 95% CI 0.66 to 1.52; I2 = 59%; 5 studies, 3079 participants). Other smartphone apps tested differed from the apps included in the analysis, as two used contingency management and one combined text messaging with an app, and so we did not pool them. Using complete case data as opposed to using data from all participants randomised did not substantially alter the findings. Authors' conclusions: There is moderate-certainty evidence that automated text message-based smoking cessation interventions result in greater quit rates than minimal smoking cessation support. There is moderate-certainty evidence of the benefit of text messaging interventions in addition to other smoking cessation support in comparison with that smoking cessation support alone. The evidence comparing smartphone apps with less intensive support was of very low certainty, and more randomised controlled trials are needed to test these interventions.
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In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators. (46 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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We examine and refine the Fagerström Tolerance Questionnaire (FTQ; Fagerström, 1978). The relation between each FTQ item and biochemical measures of heaviness of smoking was examined in 254 smokers. We found that the nicotine rating item and the inhalation item were unrelated to any of our biochemical measures and these two items were primary contributors to psychometric deficiencies in the FTQ. We also found that a revised scoring of time to the first cigarette of the day (TTF) and number of cigarettes smoked per day (CPD) improved the scale. We present a revision of the FTQ: the Fagerström Test for Nicotine Dependence (FTND).
Article
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We examine and refine the Fagerström Tolerance Questionnaire (FTQ: Fagerström, 1978). The relation between each FTQ item and biochemical measures of heaviness of smoking was examined in 254 smokers. We found that the nicotine rating item and the inhalation item were unrelated to any of our biochemical measures and these two items were primary contributors to psychometric deficiencies in the FTQ. We also found that a revised scoring of time to the first cigarette of the day (TTF) and number of cigarettes smoked per day (CPD) improved the scale. We present a revision of the FTQ: the Fagerström Test for Nicotine Dependence (FTND).
Article
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In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators.
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To determine the effectiveness of a mobile phone text messaging smoking cessation programme. Randomised controlled trial New Zealand 1705 smokers from throughout New Zealand who wanted to quit, were aged over 15 years, and owned a mobile phone were randomised to an intervention group that received regular, personalised text messages providing smoking cessation advice, support, and distraction, or to a control group. All participants received a free month of text messaging; starting for the intervention group on their quit day to assist with quitting, and starting for the control group at six months to encourage follow up. Follow up data were available for 1624 (95%) at six weeks and 1265 (74%) at six months. The main trial outcome was current non-smoking (that is, not smoking in the past week) six weeks after randomisation. Secondary outcomes included current non-smoking at 12 and 26 weeks. More participants had quit at six weeks in the intervention compared to the control group: 239 (28%) v 109 (13%), relative risk 2.20 (95% confidence interval 1.79 to 2.70), p < 0.0001. This treatment effect was consistent across subgroups defined by age, sex, income level, or geographic location (p homogeneity > 0.2). The relative risk estimates were similar in sensitivity analyses adjusting for missing data and salivary cotinine verification tests. Reported quit rates remained high at six months, but there was some uncertainty about between group differences because of incomplete follow up. This programme offers potential for a new way to help young smokers to quit, being affordable, personalised, age appropriate, and not location dependent. Future research should test these findings in different settings, and provide further assessment of long term quit rates.
Article
Background: The workplace has potential as a setting through which large groups of people can be reached to encourage smoking cessation. Objectives: 1. To categorize workplace interventions for smoking cessation tested in controlled studies and to determine the extent to which they help workers to stop smoking.2. To collect and evaluate data on costs and cost effectiveness associated with workplace interventions. Search methods: We searched the Cochrane Tobacco Addiction Group Specialized Register (July 2013), MEDLINE (1966 - July 2013), EMBASE (1985 - June 2013), and PsycINFO (to June 2013), amongst others. We searched abstracts from international conferences on tobacco and the bibliographies of identified studies and reviews for additional references. Selection criteria: We selected interventions conducted in the workplace to promote smoking cessation. We included only randomized and quasi-randomized controlled trials allocating individuals, workplaces, or companies to intervention or control conditions. Data collection and analysis: One author extracted information relating to the characteristics and content of all kinds of interventions, participants, outcomes and methods of the studies, and a second author checked them. For this update we have conducted meta-analyses of the main interventions, using the generic inverse variance method to generate odds ratios and 95% confidence intervals. Main results: We include 57 studies (61 comparisons) in this updated review. We found 31 studies of workplace interventions aimed at individual workers, covering group therapy, individual counselling, self-help materials, nicotine replacement therapy, and social support, and 30 studies testing interventions applied to the workplace as a whole, i.e. environmental cues, incentives, and comprehensive programmes. The trials were generally of moderate to high quality, with results that were consistent with those found in other settings. Group therapy programmes (odds ratio (OR) for cessation 1.71, 95% confidence interval (CI) 1.05 to 2.80; eight trials, 1309 participants), individual counselling (OR 1.96, 95% CI 1.51 to 2.54; eight trials, 3516 participants), pharmacotherapies (OR 1.98, 95% CI 1.26 to 3.11; five trials, 1092 participants), and multiple intervention programmes aimed mainly or solely at smoking cessation (OR 1.55, 95% CI 1.13 to 2.13; six trials, 5018 participants) all increased cessation rates in comparison to no treatment or minimal intervention controls. Self-help materials were less effective (OR 1.16, 95% CI 0.74 to 1.82; six trials, 1906 participants), and two relapse prevention programmes (484 participants) did not help to sustain long-term abstinence. Incentives did not appear to improve the odds of quitting, apart from one study which found a sustained positive benefit. There was a lack of evidence that comprehensive programmes targeting multiple risk factors reduced the prevalence of smoking. Authors' conclusions: 1. We found strong evidence that some interventions directed towards individual smokers increase the likelihood of quitting smoking. These include individual and group counselling, pharmacological treatment to overcome nicotine addiction, and multiple interventions targeting smoking cessation as the primary or only outcome. All these interventions show similar effects whether offered in the workplace or elsewhere. Self-help interventions and social support are less effective. Although people taking up these interventions are more likely to stop, the absolute numbers who quit are low.2. We failed to detect an effect of comprehensive programmes targeting multiple risk factors in reducing the prevalence of smoking, although this finding was not based on meta-analysed data. 3. There was limited evidence that participation in programmes can be increased by competitions and incentives organized by the employer, although one trial demonstrated a sustained effect of financial rewards for attending a smoking cessation course and for long-term quitting. Further research is needed to establish which components of this trial contributed to the improvement in success rates.4. Further research would be valuable in low-income and developing countries, where high rates of smoking prevail and smoke-free legislation is not widely accepted or enforced.
Article
Tailored smoking cessation materials combine many of the interactive, diagnostic elements of a clinical encounter with the dissemination potential of mass media. In this article, the differences between general, targeted and tailored smoking cessation materials are discussed, and the impact of tailored versus the general or targeted modalities is examined. A review of ten randomized trials of tailored materials found a significant impact of these materials in a majority of the studies. Very few patterns, in terms of the characteristics associated with the tailored materials, subject recruitment, subject characteristics, or follow-up procedures were found when comparing positive versus negative trials. The two trials that combined tailored materials with nicotine replacement therapy found a strong impact on smoking cessation; studies that examine the combined effects of tailored behavioral and pharmacological interventions are suggested. Another notable finding was the effect tailored materials had among precontemplators. Most studies that included precontemplators found a significant positive impact of materials tailored to this group. Taken together, these findings suggest important new avenues for reaching smokers.
Article
Telephone counselling can help as part of a program to help people stop smoking Smoking contributes to many health problems including cancers and lung diseases. People trying to quit smoking can be helped with medication or through behavioural support such as specialist counselling and group therapy. Support, information and counselling are offered either face to face or by telephone. Counselling via telephone hotlines can be provided as part of a program or separately and gives access to more people than face to face. The review of trials found telephone counselling is effective compared to a program with no personal contact.
Article
Background: The aim of nicotine replacement therapy (NRT) is to replace nicotine from cigarettes. This reduces withdrawal symptoms associated with smoking cessation thus helping resist the urge to smoke cigarettes. Objectives: The aims of this review were:to determine the effectiveness of the different forms of NRT (chewing gum, transdermal patches, nasal spray, inhalers and tablets) in achieving abstinence from cigarettes, or a sustained reduction in amount smoked; to determine whether the effect is influenced by the clinical setting in which the smoker is recruited and treated, the dosage and form of the NRT used, or the intensity of additional advice and support offered to the smoker; to determine whether combinations of NRT are more effective than one type alone; to determine its effectiveness compared to other pharmacotherapies. Search strategy: We searched the Cochrane Tobacco Addiction Group trials register in March 2004. Selection criteria: Randomized trials in which NRT was compared to placebo or to no treatment, or where different doses of NRT were compared. We excluded trials which did not report cessation rates, and those with follow up of less than six months. Data collection and analysis: We extracted data in duplicate on the type of participants, the dose, duration and form of nicotine therapy, the outcome measures, method of randomization, and completeness of follow up. The main outcome measure was abstinence from smoking after at least six months of follow up. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. For each study we calculated summary odds ratios. Where appropriate, we performed meta-analysis using a Mantel-Haenszel fixed effect model. Main results: We identified 123 trials; 103 contributing to the primary comparison between NRT and a placebo or non-NRT control group. The odds ratio (OR) for abstinence with NRT compared to control was 1.77 (95% confidence intervals (CI): 1.66 to 1.88). The ORs for the different forms of NRT were 1.66 (95% CI: 1.52 to 1.81) for gum, 1.81 (95% CI: 1.63 to 2.02) for patches, 2.35 (95% CI: 1.63 to 3.38) for nasal spray, 2.14 (95% CI: 1.44 to 3.18) for inhaled nicotine and 2.05 (95% CI: 1.62 to 2.59) for nicotine sublingual tablet/lozenge. These odds were largely independent of the duration of therapy, the intensity of additional support provided or the setting in which the NRT was offered. In highly dependent smokers there was a significant benefit of 4 mg gum compared with 2 mg gum (OR 2.20, 95% CI: 1.85 to 3.25). There was weak evidence that combinations of forms of NRT are more effective. Higher doses of nicotine patch may produce small increases in quit rates. Only one study directly compared NRT to another pharmacotherapy. In this study quit rates with bupropion were higher than with nicotine patch or placebo. Reviewers' conclusions: All of the commercially available forms of NRT (gum, transdermal patch, nasal spray, inhaler and sublingual tablets/lozenges) are effective as part of a strategy to promote smoking cessation. They increase the odds of quitting approximately 1.5 to 2 fold regardless of setting. The effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the smoker. Provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT.
Article
Healthcare professionals frequently advise patients to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. The aims of this review were to assess the effectiveness of advice from physicians in promoting smoking cessation; to compare minimal interventions by physicians with more intensive interventions; to assess the effectiveness of various aids to advice in promoting smoking cessation and to determine the effect of anti-smoking advice on disease-specific and all-cause mortality. We searched the Cochrane Tobacco Addiction Group trials register and the Cochrane Central Register of Controlled Trials (CENTRAL). Date of the most recent searches: March 2004. Randomized trials of smoking cessation advice from a medical practitioner in which abstinence was assessed at least six months after advice was first provided. We extracted data in duplicate on the setting in which advice was given, type of advice given (minimal or intensive), and whether aids to advice were used, the outcome measures, method of randomization and completeness of follow up. The main outcome measures were abstinence from smoking after at least six months follow up and mortality. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Subjects lost to follow up were counted as smokers. Where possible, meta-analysis was performed using a Mantel-Haenszel fixed effect model. We identified 39 trials, conducted between 1972 and 2003, including over 31,000 smokers. In some trials, subjects were at risk of specified diseases (chest disease, diabetes, ischaemic heart disease), but most were from unselected populations. The most common setting for delivery of advice was primary care. Other settings included hospital wards and outpatient clinics, and industrial clinics. Pooled data from 17 trials of brief advice versus no advice (or usual care) revealed a small but significant increase in the odds of quitting (odds ratio 1.74, 95% confidence interval 1.48 to 2.05). This equates to an absolute difference in the cessation rate of about 2.5%. There was insufficient evidence, from indirect comparisons, to establish a significant difference in the effectiveness of physician advice according to the intensity of the intervention, the amount of follow up provided, and whether or not various aids were used at the time of the consultation in addition to providing advice. Direct comparison of intensive versus minimal advice showed a small advantage of intensive advice (odds ratio 1.44, 95% confidence interval 1.24 to 1.67). Direct comparison also suggested a small benefit of follow-up visits. Only one study determined the effect of smoking advice on mortality. It found no statistically significant differences in death rates at 20 years follow up. Simple advice has a small effect on cessation rates. Additional manoeuvres appear to have only a small effect, though more intensive interventions are marginally more effective than minimal interventions.
Article
Individual counselling from a smoking cessation specialist may help smokers to make a successful attempt to stop smoking. The objective of the review is to determine the effects of individual counselling. We searched the Cochrane Tobacco Addiction Group Specialized Register for studies with counsel* in any field. Date of the most recent search: December 2004. Randomized or quasi-randomized trials with at least one treatment arm consisting of face-to-face individual counselling from a healthcare worker not involved in routine clinical care. The outcome was smoking cessation at follow up at least six months after the start of counselling. Both authors extracted data. The intervention and population, method of randomization and completeness of follow up were recorded. We identified 21 trials with over 7000 participants. Eighteen trials compared individual counselling to a minimal behavioural intervention, four compared different types or intensities of counselling. Individual counselling was more effective than control. The odds ratio for successful smoking cessation was 1.56 (95% confidence interval 1.32 to 1.84). In a subgroup of three trials where all participants received nicotine replacement therapy the point estimate of effect was smaller and did not reach significance (odds ratio 1.34, 95% confidence interval 0.98 to 1.83). We failed to detect a greater effect of intensive counselling compared to brief counselling (odds ratio 0.98, 95% confidence interval 0.61 to 1.56). Smoking cessation counselling can assist smokers to quit.
Article
Background: Group therapy offers individuals the opportunity to learn behavioural techniques for smoking cessation, and to provide each other with mutual support. Objectives: We aimed to determine the effects of smoking cessation programmes delivered in a group format compared to self-help materials, or to no intervention; to compare the effectiveness of group therapy and individual counselling; and to determine the effect of adding group therapy to advice from a health professional or nicotine replacement. We also aimed to determine whether specific components increased the effectiveness of group therapy. We aimed to determine the rate at which offers of group therapy are taken up. Search strategy: We searched the Cochrane Tobacco Addiction Group trials register, with additional searches of PsycInfo and MEDLINE, including the terms behavior therapy, cognitive therapy, psychotherapy or group therapy, in December 2001. Selection criteria: We considered randomised trials that compared group therapy with self-help, individual counselling, another intervention or no intervention (including usual care or a waiting list control). We also considered trials that compared more than one group programmes. We included those trials with a minimum of two group meetings, and follow-up of smoking status at least six months after the start of the programme. We excluded trials in which group therapy was provided to both active therapy and placebo arms of trials of pharmacotherapies, unless they had a factorial design. Data collection and analysis: We extracted data in duplicate on the people recruited, the interventions provided to the groups and the controls, including programme length, intensity and main components, the outcome measures, method of randomisation, and completeness of follow-up. The main outcome measure was abstinence from smoking after at least six months follow-up in patients smoking at baseline. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Subjects lost to follow-up were counted as smokers. Where possible, we performed meta-analysis using a fixed effects (Peto) model. Main results: A total of fifty two trials met inclusion criteria for one or more of the comparisons in the review. Sixteen studies compared a group programme with a self-help programme. There was an increase in cessation with the use of a group programme (N=4,395, odds ratio 1.97, 95% confidence interval 1.57 to 2.48). Group programmes were more effective than no intervention controls (six trials, N=775, odds ratio 2.19, 95% confidence interval 1.42 to 3.37). There was no evidence that group therapy was more effective than a similar intensity of individual counselling. There was limited evidence that the addition of group therapy to other forms of treatment, such as advice from a health professional or nicotine replacement produced extra benefit. There was variation in the extent to which those offered group therapy accepted the treatment. There was limited evidence that programmes which included components for increasing cognitive and behavioural skills and avoiding relapse were more effective than same length or shorter programmes without these components. This analysis was sensitive to the way in which one study with multiple conditions was included. There was no evidence that manipulating the social interactions between participants in a group programme had an effect on outcome. Reviewer's conclusions: Groups are better than self-help, and other less intensive interventions. There is not enough evidence on their effectiveness, or cost-effectiveness, compared to intensive individual counselling. The inclusion of skills training to help smokers avoid relapse appears to be useful although the evidence is limited. There is not enough evidence to support the use of particular components in a programme beyond the support and skills training normally included.
Article
To assess the efficacy of World Wide Web-based tailored behavioral smoking cessation materials among nicotine patch users. Two-group randomized controlled trial. World Wide Web in England and Republic of Ireland. A total of 3971 subjects who purchased a particular brand of nicotine patch and logged-on to use a free web-based behavioral support program. Web-based tailored behavioral smoking cessation materials or web-based non-tailored materials. Twenty-eight-day continuous abstinence rates were assessed by internet-based survey at 6-week follow-up and 10-week continuous rates at 12-week follow-up. Using three approaches to the analyses of 6- and 12-week outcomes, participants in the tailored condition reported clinically and statistically significantly higher continuous abstinence rates than participants in the non-tailored condition. In our primary analyses using as a denominator all subjects who logged-on to the treatment site at least once, continuous abstinence rates at 6 weeks were 29.0% in the tailored condition versus 23.9% in the non-tailored condition (OR = 1.30; P = 0.0006); at 12 weeks continuous abstinence rates were 22.8% versus 18.1%, respectively (OR = 1.34; P = 0.0006). Moreover, satisfaction with the program was significantly higher in the tailored than in the non-tailored condition. The results of this study demonstrate a benefit of the web-based tailored behavioral support materials used in conjunction with nicotine replacement therapy. A web-based program that collects relevant information from users and tailors the intervention to their specific needs had significant advantages over a web-based non-tailored cessation program.
Article
This article reviews studies of computer and Internet-based interventions for smoking behavior, published between 1995 and August 2004. Following electronic and manual searches of the literature, 19 studies were identified that used automated systems for smoking prevention or cessation, and measured outcomes related to smoking behavior. Studies varied widely in methodology, intervention delivery, participant characteristics, follow-up period, and measurement of cessation. Of eligible studies, nine (47%) reported statistically significant or improved outcomes at the longest follow-up, relative to a comparison group. Few patterns emerged in terms of subject, design or intervention characteristics that led to positive outcomes. The "first generation" format, where participants were mailed computer-generated feedback reports, was the modal intervention format and the one most consistently associated with improved outcomes. Future studies will need to identify whether certain patients are more likely to benefit from such interventions, and which pharmacological and behavioral adjuncts can best promote cessation.
Article
Background: Many smokers give up smoking on their own, but materials giving advice and information may help them and increase the number who quit successfully. Objectives: The aims of this review were to determine: the effectiveness of different forms of print-based self-help materials, compared with no treatment and with other minimal contact strategies; the effectiveness of adjuncts to print-based self help, such as computer-generated feedback, telephone hotlines and pharmacotherapy; and the effectiveness of approaches tailored to the individual compared with non-tailored materials. Search methods: We searched the Cochrane Tobacco Addiction Group trials register. Date of the most recent search April 2014. Selection criteria: We included randomized trials of smoking cessation with follow-up of at least six months, where at least one arm tested a print-based self-help intervention. We defined self help as structured programming for smokers trying to quit without intensive contact with a therapist. Data collection and analysis: We extracted data in duplicate on the participants, the nature of the self-help materials, the amount of face-to-face contact given to intervention and to control conditions, outcome measures, method of randomization, and completeness of follow-up.The main outcome measure was abstinence from smoking after at least six months follow-up in people smoking at baseline. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates when available. Where appropriate, we performed meta-analysis using a fixed-effect model. Main results: We identified 74 trials which met the inclusion criteria. Many study reports did not include sufficient detail to judge risk of bias for some domains. Twenty-eight studies (38%) were judged at high risk of bias for one or more domains but the overall risk of bias across all included studies was judged to be moderate, and unlikely to alter the conclusions.Thirty-four trials evaluated the effect of standard, non-tailored self-help materials. Pooling 11 of these trials in which there was no face-to-face contact and provision of structured self-help materials was compared to no intervention gave an estimate of benefit that just reached statistical significance (n = 13,241, risk ratio [RR] 1.19, 95% confidence interval [CI] 1.04 to 1.37). This analysis excluded two trials with strongly positive outcomes that introduced significant heterogeneity. Six further trials without face-to-face contact in which the control group received alternative written materials did not show evidence for an effect of the smoking self-help materials (n = 7023, RR 0.88, 95% CI 0.74 to 1.04). When these two subgroups were pooled, there was no longer evidence for a benefit of standard structured materials (n = 20,264, RR 1.06, 95% CI 0.95 to 1.18). We failed to find evidence of benefit from providing standard self-help materials when there was brief contact with all participants (5 trials, n = 3866, RR 1.17, 95% CI 0.96 to 1.42), or face-to-face advice for all participants (11 trials, n = 5365, RR 0.97, 95% CI 0.80 to 1.18).Thirty-one trials offered materials tailored for the characteristics of individual smokers, with controls receiving either no materials, or stage matched or non-tailored materials. Most of the trials used more than one mailing. Pooling these showed a benefit of tailored materials (n = 40,890, RR 1.28, 95% CI 1.18 to 1.37) with moderate heterogeneity (I² = 32%). The evidence is strongest for the subgroup of nine trials in which tailored materials were compared to no intervention (n = 13,437, RR 1.35, 95% CI 1.19 to 1.53), but also supports tailored materials as more helpful than standard materials. Part of this effect could be due to the additional contact or assessment required to obtain individual data, since the subgroup of 10 trials where the number of contacts was matched did not detect an effect (n = 11,024, RR 1.06, 95% CI 0.94 to 1.20). In two trials including a direct comparison between tailored materials and brief advice from a health care provider, there was no evidence of a difference, but confidence intervals were wide (n = 2992, RR 1.13, 95% CI 0.86 to 1.49).Only four studies evaluated self-help materials as an adjunct to nicotine replacement therapy, with no evidence of additional benefit (n = 2291, RR 1.05, 95% CI 0.88 to 1.25). A small number of other trials failed to detect benefits from using additional materials or targeted materials, or to find differences between different self-help programmes. Authors' conclusions: Standard, print-based self-help materials increase quit rates compared to no intervention, but the effect is likely to be small. We did not find evidence that they have an additional benefit when used alongside other interventions such as advice from a healthcare professional, or nicotine replacement therapy. There is evidence that materials that are tailored for individual smokers are more effective than non-tailored materials, although the absolute size of effect is still small. Available evidence tested self-help interventions in high income countries; further research is needed to investigate their effect in contexts where more intensive support is not available.
Article
The objective of this project was to test the short term (90 days) efficacy of an automated behavioural intervention for smoking cessation, the "1-2-3 Smokefree" programme, delivered via an internet website. Randomised control trial. Subjects surveyed at baseline, immediately post-intervention, and 90 days later. The study and the intervention occurred entirely via the internet site. Subjects were recruited primarily via worksites, which referred potential subjects to the website. The 351 qualifying subjects were notified of the study via their worksite and required to have internet access. Additionally, subjects were required to be over 18 years of age, smoke cigarettes, and be interested in quitting smoking in the next 30 days. Eligible subjects were randomly assigned individually to treatment or control condition by computer algorithm. The intervention consisted of a video based internet site that presented current strategies for smoking cessation and motivational materials tailored to the user's race/ethnicity, sex, and age. Control subjects received nothing for 90 days and were then allowed access to the programme. The primary outcome measure was abstinence from smoking at 90 day follow up. At follow up, the cessation rate at 90 days was 24.1% (n = 21) for the treatment group and 8.2% (n = 9) for the control group (p = 0.002). Using an intent-to-treat model, 12.3% (n = 21) of the treatment group were abstinent, compared to 5.0% (n = 9) in the control group (p = 0.015). These evaluation results suggest that a smoking cessation programme, with at least short term efficacy, can be successfully delivered via the internet.
Article
According to the US Public Health Service, all patients attempting to quit smoking should be encouraged to use one or more effective pharmacotherapy agents for cessation except in the presence of special circumstances. This article provides an overview of the pharmacologic agents for acute and critical care nurses to consider when intervening with tobacco-dependent patients. Medications addressed in this article include (1) first-line agents (nicotine replacement therapy, sustained-release bupropion) that have proven efficacy and are approved by the Food and Drug Administration (FDA) for smoking cessation, (2) second-line agents (nortriptyline, clonidine) that have proven efficacy but no FDA indication for smoking cessation, (3) approaches that use of combination or high-dose therapy, (4) herbal therapies, and (5) emerging therapies that are currently under investigation.
Article
Background: Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. Objectives: To evaluate the effect of proactive and reactive telephone support to help smokers quit. Search strategy: We searched the Cochrane Tobacco Addiction Group trials register for studies using free text term 'telephone*' or the keywords 'telephone counselling' or 'Hotlines' or 'Telephone' . Date of the most recent search: January 2006. Selection criteria: Randomized or quasi-randomized controlled trials in which proactive or reactive telephone counselling to assist smoking cessation was offered to smokers or recent quitters. Data collection and analysis: Trials were identified and data extracted by one person (LS) and checked by a second (TL). The main outcome measure was the odds ratio for abstinence from smoking after at least six months follow up. We selected the strictest measure of abstinence, using biochemically validated rates where available. We considered participants lost to follow-up to be continuing smokers. Where trials had more than one arm with a less intensive intervention we used only the most similar intervention without the telephone component as the control group in the primary analysis. We assessed statistical heterogeneity amongst sub groups of clinically comparable studies using the I(2) statistic. Where appropriate, we pooled studies using a fixed-effect model. A meta-regression was used to investigate the effect of differences in planned number of calls. Main results: Forty-eight trials met the inclusion criteria. Among smokers who contacted helplines, quit rates were higher for groups randomised to receive multiple sessions of call-back counselling (eight studies, >18,000 participants, odds ratio (OR) for long term cessation 1.41, 95% confidence interval (CI) 1.27 to 1.57). Two of these studies showed a significant benefit of more intensive compared to less intensive intervention. Telephone counselling not initiated by calls to helplines also increased quitting (29 studies, >17,000 participants, OR 1.33, 95% CI 1.21 to 1.47). A meta-regression detected a significant association between the maximum number of planned calls and the effect size. There was clearer evidence of benefit in the subgroup of trials recruiting smokers motivated to quit. Of two studies that provided access to a hotline one showed a significant benefit and one did not. Two studies comparing different counselling approaches during a single session did not detect significant differences. A further seven studies were too diverse to contribute to meta-analyses and are discussed separately. Authors' conclusions: Proactive telephone counselling helps smokers interested in quitting. There is evidence of a dose response; one or two brief calls are less likely to provide a measurable benefit. Three or more calls increases the odds of quitting compared to a minimal intervention such as providing standard self-help materials, brief advice, or compared to pharmacotherapy alone. Telephone quitlines provide an important route of access to support for smokers, and call-back counselling enhances their usefulness.
Article
Background: Health care professionals, including nurses, frequently advise patients to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. Objectives: To determine the effectiveness of nursing delivered smoking cessation interventions. Search strategy: The Cochrane Tobacco Addiction Group register was searched for studies of interventions using nurses or health visitors and an additional search made on CINAHL. Selection criteria: Randomised trials with follow-up of at least 6 months. Data collection and analysis: Two authors extracted data independently. Main results: Sixteen studies comparing nursing intervention to a control or usual care found intervention to significantly increase the odds of quitting (Peto Odds Ratio 1.50, 95% CI 1.29-1.73). There was heterogeneity between the study results, but pooling using a random effects model did not alter the estimate of effect. There was no evidence from indirect comparison that interventions classified as intensive had a larger effect than less intensive ones. There was limited evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in non hospitalised patients also showed evidence of benefit. Five studies of nurse counseling on smoking cessation during a screening health check, not included in the main meta-analysis, found that under these conditions nursing intervention had less effect. Reviewer's conclusions: The results indicate the potential benefits of smoking cessation advice and counseling given by nurses to their patients, with reasonable evidence that interventions can be effective. The challenge will be to incorporate smoking cessation intervention as part of standard practice so that all patients are given an opportunity to be queried about their tobacco use and to be given advice to quit along with reinforcement and follow-up.
Article
NRT aims to reduce withdrawal symptoms associated with stopping smoking by replacing the nicotine from cigarettes. NRT is available as skin patches that deliver nicotine slowly, and chewing gum, nasal spray, inhalers, and lozenges/tablets, all of which deliver nicotine to the brain more quickly than from skin patches, but less rapidly than from smoking cigarettes. This review includes 132 trials of NRT, with over 40,000 people in the main analysis. It found evidence that all forms of NRT made it more likely that a person's attempt to quit smoking would succeed. The chances of stopping smoking were increased by 50 to 70%. Most of the studies were performed in people smoking more than 15 cigarettes a day. What limited evidence there is suggests no overall difference in effectiveness of different forms of NRT nor a benefit for using patches beyond 8 weeks. NRT works with or without additional counselling, and does not need to be prescribed by a doctor. Heavier smokers may need higher doses of NRT. People who use NRT during a quit attempt are likely to further increase their chance of success by using a combination of the nicotine patch and a faster acting form. Preliminary data suggests that starting to use NRT shortly before the planned quit date may increase the chance of success. Adverse effects from using NRT are related to the type of product, and include skin irritation from patches and irritation to the inside of the mouth from gum and tablets. There is no evidence that NRT increases the risk of heart attacks.
Group behaviour therapy programmes for smoking cessation: CD001007. 484 Håvar Brendryen & Pål Kraft © 2008 The Authors Journal compilation © 2008 Society for the Study of Addiction Addiction
  • L F Stead
  • Lancaster
Stead L. F., Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane Database Syst Rev 2005; 2: CD001007. 484 Håvar Brendryen & Pål Kraft © 2008 The Authors. Journal compilation © 2008 Society for the Study of Addiction Addiction, 103, 478–484