An internet-based abstinence reinforcement smoking cessation intervention in rural smokers

Abstract

The implementation of cigarette smoking abstinence reinforcement programs may be hindered by the time intensive burden placed on patients and treatment providers. The use of remote monitoring and reinforcement of smoking abstinence may enhance the accessibility and acceptability of this intervention, particularly in rural areas where transportation can be unreliable and treatment providers distant. This study determined the effectiveness of an Internet-based abstinence reinforcement intervention in initiating and maintaining smoking abstinence in rural smokers. Sixty-eight smokers were enrolled to evaluate the efficacy of an Internet-based smoking cessation program. During the 6-week intervention period, all participants were asked to record 2 videos of breath carbon monoxide (CO) samples daily. Participants also typed the value of their CO readings into web-based software that provided feedback and reinforcement based on their smoking status. Participants (n=35) in the Abstinence Contingent (AC) group received monetary incentives contingent on recent smoking abstinence (i.e., CO of 4 parts per million or below). Participants (n=33) in the Yoked Control (YC) group received monetary incentives independent of smoking status. Participants in the AC group were significantly more likely than the YC group to post negative CO samples on the study website (OR=4.56; 95% CI=2.18-9.52). Participants assigned to AC were also significantly more likely to achieve some level of continuous abstinence over the 6-week intervention compared to those assigned to YC. These results demonstrate the feasibility and short-term efficacy of delivering reinforcement for smoking abstinence over the Internet to rural populations.

Figure 1

The percentage of subjects retained in the study as a function of group assignment. The solid line represents data from the AC (Abstinence Contingent) group and the dashed line represents data from the YC (Yoked Control) group. The X axis shows the number of Day in the intervention.

Figure 2

The proportion of negative samples posted to the study website as a function of group assignment. Closed bars represent data from the AC (Abstinence Contingent) group and open bars represent data from the YC (Yoked Control) group. X axis: Week in the intervention.

Figure 3

The proportion of individuals achieving sustained abstinence based upon videos posted to the study website as a function of group assignment. Closed bars represent data from the AC (Abstinence Contingent) group and open bars represent data from the YC (Yoked Control) group. Bars are missing for 2 through 6 weeks because no YC participants achieved those durations of abstinence. X axis: Weeks of sustained abstinence. Asterisks indicate a significant difference between groups.