Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2018 Mar 15;52(4):331-341.
doi: 10.1093/abm/kax023.

Improving Adherence to Smoking Cessation Treatment: Smoking Outcomes 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
Affiliations
Randomized Controlled Trial

Improving Adherence to Smoking Cessation Treatment: Smoking Outcomes in a Web-based Randomized Trial

Amanda L Graham et al. Ann Behav Med. .

Abstract

Background: Partial adherence in Internet smoking cessation interventions presents treatment and evaluation challenges. Increasing adherence may improve outcomes.

Purpose: To present smoking outcomes from an Internet randomized trial of two strategies to encourage adherence to tobacco dependence treatment components: (i) a social network (SN) strategy to integrate smokers into an online community and (ii) free nicotine replacement therapy (NRT). In addition to intent-to-treat analyses, we used novel statistical methods to distinguish the impact of treatment assignment from treatment utilization.

Methods: A total of 5,290 current smokers on a cessation website (WEB) were randomized to WEB, WEB + SN, WEB + NRT, or WEB + SN + NRT. The main outcome was 30-day point prevalence abstinence at 3 and 9 months post-randomization. Adherence measures included self-reported medication use (meds), and website metrics of skills training (sk) and community use (comm). Inverse Probability of Retention Weighting and Inverse Probability of Treatment Weighting jointly addressed dropout and treatment selection. Propensity weights were used to calculate Average Treatment effects on the Treated.

Results: Treatment assignment analyses showed no effects on abstinence for either adherence strategy. Abstinence rates were 25.7%-32.2% among participants that used all three treatment components (sk+comm +meds).Treatment utilization analyses revealed that among such participants, sk+comm+meds yielded large percentage point increases in 3-month abstinence rates over sk alone across arms: WEB = 20.6 (95% CI = 10.8, 30.4), WEB + SN = 19.2 (95% CI = 11.1, 27.3), WEB + NRT = 13.1 (95% CI = 4.1, 22.0), and WEB + SN + NRT = 20.0 (95% CI = 12.2, 27.7).

Conclusions: Novel propensity weighting approaches can serve as a model for establishing efficacy of Internet interventions and yield important insights about mechanisms.

Clinical trials.gov: NCT01544153.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
CONSORT Diagram
See this image and copyright information in PMC

References

    1. van Dulmen S, Sluijs E, van Dijk L, de Ridder D, Heerdink R, Bensing J. Patient adherence to medical treatment: A review of reviews. BMC Health Serv Res. 2007;7:55 https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-7-55 - DOI - PMC - PubMed
    1. World Health Organization. Adherence to long-term therapies: Evidence for action Available at http://whqlibdoc.who.int/publications/2003/9241545992.pdf. Accessibility verified May 31, 2017.
    1. Thorpe KE, Zwarenstein M, Oxman AD et al. A pragmatic-explanatory continuum indicator summary (PRECIS): A tool to help trial designers. CMAJ. 2009;180(10):E47–E57. - PMC - PubMed
    1. Eysenbach G. The law of attrition. J Med Internet Res. 2005;7(1): e11. - PMC - PubMed
    1. Danaher BG, Boles SM, Akers L, Gordon JS, Severson HH. Defining participant exposure measures in web-based health behavior change programs. J Med Internet Res. 2006;8(3):e15. - PMC - PubMed

Publication types

MeSH terms

Substances

Associated data