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Randomized Controlled Trial
. 2017 Mar 1;19(3):324-332.
doi: 10.1093/ntr/ntw282.

Improving Adherence to Smoking Cessation Treatment: Intervention Effects in a Web-Based Randomized Trial

Amanda L Graham  1   2 , George D Papandonatos  3 , Sarah Cha  1 , Bahar Erar  3 , Michael S Amato  1 , Nathan K Cobb  4   5 , Raymond S Niaura  1   2   6 , David B Abrams  1   2   6
Affiliations
Randomized Controlled Trial

Improving Adherence to Smoking Cessation Treatment: Intervention Effects in a Web-Based Randomized Trial

Amanda L Graham et al. Nicotine Tob Res. .

Erratum in

Abstract

Background: Web-based smoking cessation interventions can deliver evidence-based treatments to a wide swath of the population, but effectiveness is often limited by insufficient adherence to proven treatment components. This study evaluated the impact of a social network (SN) intervention and free nicotine replacement therapy (NRT) on adherence to evidence-based components of smoking cessation treatment in the context of a Web-based intervention.

Methods: A sample of adult U.S. smokers (N = 5290) was recruited via BecomeAnEX.org, a free smoking cessation Web site. Smokers were randomized to one of four arms: (1) an interactive, evidence-based smoking cessation Web site (WEB) alone; (2) WEB in conjunction with an SN intervention designed to integrate participants into the online community (WEB+SN); (3) WEB plus free NRT (WEB+NRT); and (4) the combination of all treatments (WEB+SN+NRT). Adherence outcomes assessed at 3-month follow-up were as follows: Web site utilization metrics, use of skills training components, intratreatment social support, and pharmacotherapy use.

Results: WEB+SN+NRT outperformed all others on Web site utilization metrics, use of practical counseling tools, intratreatment social support, and NRT use. It was the only intervention to promote the sending of private messages and the viewing of community pages over WEB alone. Both social network arms outperformed WEB on most metrics of online community engagement. Both NRT arms showed higher medication use compared to WEB alone.

Conclusions: This study demonstrated the effectiveness of two approaches for improving adherence to evidence-based components of smoking cessation treatment. Integrated approaches to medication provision and social network engagement can enhance adherence to components known to improve cessation.

Implications: This study demonstrated that an integrated approach to medication provision and social network integration, when delivered through an online program, can enhance adherence across all three recommended components of an evidence-based smoking cessation program (skills training, social support, and pharmacotherapy use). Nicotine replacement therapy-when provided as part of an integrated program-increases adherence to other program elements, which in turn augment its own therapeutic effects. An explicit focus on approaches to improve treatment adherence is an important first step to identifying leverage points for optimizing intervention effectiveness.

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References

    1. Fiore M, Jaén C, Baker T; Tobacco Use and Dependence Guideline Panel Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service; 2008.
    1. Graham AL, Chang Y, Fang Y, et al. Cost-effectiveness of internet and telephone treatment for smoking cessation: an economic evaluation of The iQUITT Study. Tob Control. 2013;22(6):e11. - PMC - PubMed
    1. Smit ES, Evers SM, de Vries H, Hoving C. Cost-effectiveness and cost-utility of Internet-based computer tailoring for smoking cessation. J Med Internet Res. 2013;15(3):e57. - PMC - PubMed
    1. Stanczyk NE, Smit ES, Schulz DN, et al. An economic evaluation of a video- and text-based computer-tailored intervention for smoking cessation: a cost-effectiveness and cost-utility analysis of a randomized controlled trial. PLoS One. 2014;9(10):e110117. - PMC - PubMed
    1. Graham AL, Carpenter KM, Cha S, et al. Systematic review and meta-analysis of Internet interventions for smoking cessation among adults. Subst Abuse Rehabil. 2016;7:55–69. - PMC - PubMed

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