Document Detail

A review of web based interventions for managing tobacco use.
Jump to Full Text
MedLine Citation:
PMID:  25035543     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
Web based interventions (WBIs) have been developed for various health conditions. These include interventions for various psychoactive substance use disorders including tobacco and alcohol. Tobacco use has remained the single largest preventable cause of global mortality and morbidity for many years. It is responsible for around 6 million deaths annually world-wide. Ironically, most of the tobacco users reside in resource poor low and middle-income countries. The article reviews the existing literature on WBIs for management of tobacco use. The literature search was performed using MedLine, PubMed, PsycINFO, Embase and Cochrane Review for relevant English language articles published from 1998 up to 2013. There is limited support for effectiveness of WBIs for managing tobacco use among adolescents. Although most of the trials among adults found WBIs to be more effective at short term follow-up (a few days to weeks), the benefits failed to extend beyond 3 months in most of the studies. All but one interventions studied in a randomized controlled trial is for smoking forms.
Authors:
Yatan Pal Singh Balhara; Rohit Verma
Related Documents :
23082553 - Literature review of parasitoids of filth flies in thailand: a list of species with bri...
12164373 - Four cases of a secondary cushingoid state following local triamcinolone acetonide (ken...
15163883 - Spectrum of clinical presentations of vein of galen aneurysm.
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Indian journal of psychological medicine     Volume:  36     ISSN:  0253-7176     ISO Abbreviation:  Indian J Psychol Med     Publication Date:  2014 Jul 
Date Detail:
Created Date:  2014-07-18     Completed Date:  2014-07-18     Revised Date:  2014-07-21    
Medline Journal Info:
Nlm Unique ID:  7910727     Medline TA:  Indian J Psychol Med     Country:  India    
Other Details:
Languages:  eng     Pagination:  226-35     Citation Subset:  -    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Full Text
Journal Information
Journal ID (nlm-ta): Indian J Psychol Med
Journal ID (iso-abbrev): Indian J Psychol Med
Journal ID (publisher-id): IJPsyM
ISSN: 0253-7176
ISSN: 0975-1564
Publisher: Medknow Publications & Media Pvt Ltd, India
Article Information
Copyright: © Indian Journal of Psychological Medicine
open-access:
Print publication date: Season: Jul-Sep Year: 2014
Volume: 36 Issue: 3
First Page: 226 Last Page: 235
PubMed Id: 25035543
ID: 4100405
Publisher Id: IJPsyM-36-226
DOI: 10.4103/0253-7176.135367

A Review of Web Based Interventions for Managing Tobacco Use
Yatan Pal Singh Balharaaff1
Rohit Verma1
Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
1Department of Psychiatry, Lady Hardinge Medical College and SSK Hospital, New Delhi, India
Correspondence: Address for correspondence: Dr. Yatan Pal Singh Balhara Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi - 110 029, India. E-mail: ypsbalhara@gmail.com

INTRODUCTION

Since its commercialization in early 1990s internet usage has been on a constant rise.[1] Use of internet has impacted various aspects of human life. This includes use of internet in health care service delivery. Web based interventions (WBIs) have been developed for various health conditions. These include interventions for various psychoactive substance use disorders including tobacco and alcohol. Whereas a variety of online eHealth tools emerged to help people manage their health, relatively little was known about their effectiveness until the middle of the last decade.[2] However, there has been an increase in interest in assessing the effectiveness of these interventions over the past few years.

The public health impact of an intervention is a product of the program's efficacy and reach.[3] Thus, the impact is highest when an intervention is effective and has a wide reach. Web based health interventions have a potential to reach a large section of the population. This mode of delivery ensures that large numbers of individuals can be reached at lower costs than with face-to-face interventions.[4] Furthermore WBIs enables the end users to access large amounts of information at a pace and time of their own convenience.[5] Recent findings also support use of online support groups by individuals with lower income as well.[6] This finding is contrary to earlier evidence[7] and supports the public health utility of WBIs.

Tobacco use has remained the single largest preventable cause of global mortality and morbidity for many years.[8] It is responsible for around 6 million deaths annually world-wide. Ironically, most of the tobacco users reside in resource poor low and middle income countries (LMIC). There are limited health care facilities and a dearth of human resources to deliver the services in these countries. In spite of a high proportion of tobacco users’ willingness to quit (approximately 70%) only a minority are able to quit and maintain abstinence.[9] Moreover, the increasing demand of today's busy life leave little time, if any, for even those with resources to access the traditional models of health care service delivery. Hence, WBIs for tobacco use management are likely to be of potential use in various settings including high income and LMICs.

The article reviews the existing literature on WBIs for management of tobacco use.


METHODOLOGY
Literature search

The literature search was performed using MedLine, PubMed, PsycINFO, Embase and Cochrane Review for relevant English language articles published from 1998 up to 2013. Key search terms used in the search were: ([“Online Systems” OR “Internet” OR “Web” OR “Computer”] AND [“Smoking Cessation” OR “Tobacco cessation” OR “Nicotine”] AND [“Randomized Controlled Trial”]). Only publications focused on managing smoking cessation through WBIs were included.

Selection of studies

The studies utilizing solely WBIs that were fully automated and excluded those that required additional elements, such as having face-to-face components or being delivered through intranet or mobile phone.

Titles and abstracts of all potentially relevant articles were reviewed for possible inclusion. Articles were included if (1) the primary intervention was delivered and accessed via the Internet, (2) the intervention focused on curtailing tobacco consumption and (3) the study was a randomized controlled trial (RCT) of an tobacco-related screen, assessment, or intervention with at least a no-treatment control.

Trials using internet only for recruitment or to remind participants of appointments for treatment but not for delivering tobacco cessation intervention were excluded.

Data extraction and analysis

Both authors independently carried out data extraction. The main outcome measure of interest was smoking cessation (e.g., motivation to quit, point prevalence [PP] abstinence and/or prolonged abstinence). Where data was insufficient or not available in the published paper or by contacting authors, studies were excluded from the relevant analysis. Articles describing the study protocols and dissertations were also excluded from analysis.


RESULTS

A total of 281 potentially relevant records were identified. Out of these seven were reviews or meta-analysis. A total of 28 studies evaluating internet sites with/without co-interventions were included in this review. The characteristics of the studies and participants, results of quality assessment and key findings are described below [Figure 1].


CHARACTERISTICS OF INCLUDED STUDIES
Recruitment

Fifteen studies were solely from USA.[10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24] One study each from Denmark[25] and Republic of Ireland,[26] two each from Norway[27, 28] and Switzerland;[29, 30] and four from Netherlands[31, 32, 33, 34] were found. The studies by Muñoz et al. recruited from 74[35] to 68[36] countries, whereas one study was based in both USA and Canada.[37]

Overall the studies revealed data from more than 40,000 participants with sample sizes ranging from 61[25] to nearly 12,000.[29] The participants were mostly smokers motivated to quit smoking, who chose the Internet as a tool for smoking cessation support. Only one study focused on intervention directed toward smokeless tobacco (ST) users.[37] Thirteen studies recruited adults and four studies recruited adolescents or college students.[10, 14, 15, 22] There were more female than male participants overall.

The subjects were recruited mainly from the web with the participants finding the WBI through online browsing or through search engines.[2, 3, 4, 5, 6, 7, 8, 9, 10, 13, 14, 15, 16, 17, 18, 24, 25, 26, 27, 28, 29, 30, 31, 32, 34, 35, 36, 37, 38] Other recruitment strategies included recruitment through the non-internet based advertising (such as television commercials, radio and newspaper announcements and flyers displayed in the schools and clinics at each respective site),[12, 15, 22] a combination of non-internet based advertising and personal referrals from teachers or coaches,[14] a combination of web based and non-web based advertisements,[21, 32, 33, 34] from attendees of lung cancer screening set up,[11] members of cancer research institute network,[19, 26] members of health care organization.[20]

Some studies reported use of monetary incentives to encourage adherence.[10, 14, 22, 24, 32, 33, 34, 35]

Selection bias

Risk of selection bias also varied across studies. Design of most of the studies resulted in low selection bias.[10, 13, 17, 18, 19, 20, 21, 27, 28, 29, 32, 33, 35, 36] However, some studies failed to provide details of the randomization process.[11, 12, 14, 15, 22, 24, 26, 34]

Nature of interventions

The nature of WBIs studied across these studies varied. These varied from included low intensity interventions such as list of web sites on smoking cessation with brief description of each site[11] to extensive tailored cumulative variants of an WBI.[36]

The intensity and rigorousness of interventions also varied. Some interventions used weekly visits to study web site.[10]

Some interventions included only E-mail reminders to the participants.[10] Other interventions used even more intense reminders in form of E-mail, web pages, interactive voice response, and short message service technology.[27, 28]

Although majority of the interventions used a fixed intervention module, some used a tailored approach.[20, 24, 29, 32, 33, 34, 36]

Four studies used pharmacotherapy along with WBI.[12, 28] In a study by Japuntich et al.[12] used Buprenorphine-SR (only for active arm). Three studies allowed use of NRT along with WBI.[19, 26, 28] Studies by Strecher et al.[19, 26] assessed efficacy of WBI to support NRT assisted quit attempts. Brendryen and Kraft[28] offered NRT free of charge to both active and control arms of the trial. A study done by Swan et al.[20] offered 12 week free supply of varenicline to all participants.

Characteristics of study participants

The characteristics of participants also varied across the studies. Some studies included only active smokers.[10, 11, 12, 13, 15, 17, 19, 20, 21, 22, 24, 26, 27, 28, 33, 34, 35, 36] Others included both current as well as past smokers.[29, 30] Stoddard et al.[18] included active smokers and recent quitters.

Some studies included willingness to quit in near future (5 days to 30 days) as one of the inclusion criteria.[13, 18, 19, 21, 26, 27, 28, 33, 35, 36] Smit et al.[34] in their study included subjects who were willing to quit within next 6 months and Te Poel et al.[32] included smokers who were willing to quit in next 1 year.

Overall more than 50% of the study participants were females across all studies. Almost all studies had preponderance of female participants. The highest proportion of female subjects was 75.4% in control group and 70.4% in intervention group in study by An et al.[10] The lowest proportion of female subjects was 41.3% in the study by Muñoz et al.[35]

Type of tobacco products

Almost all studies focused on cigarette smokers. However, study by Te Poel et al.[32] specifically mentioned inclusion of smokers of cigarettes and/or loose-cut tobacco. Only one study included users of ST forms.[37]

Outcomes studied

Twenty-one studies assessed smoking status at follow-up lasting at least 6 months after the start of the intervention.[10, 11, 12, 13, 14, 16, 17, 19, 20, 22, 23, 24, 25, 27, 28, 32, 33, 34, 35, 36] The longest follow-up was of 18 months.[24] Most studies reported intermittent assessments also. Six studies followed participants for <6 months.[18, 21, 26, 29, 30, 31] Only one study assessed cessation for ST and made assessments at end of 3 and 6 months.[37]

Multiple definitions of abstinence were employed for attributing outcome. Mostly 7-day abstinence was the main or secondary outcome measure while 30-day and 28-day continuous abstinence rates were also used in some studies. The longest abstinence duration assessed was that of continued abstinence for 12 months[33] and the shortest duration assessed was 24-h PP of abstinence.[34] Biochemical markers (CO levels) to confirm abstinence were also used by some studies.[10, 12, 15] One study used cotinine assessments to validate reports of abstinence in a subsample.[33]

Nearly all the studies had used intent-to-treat (ITT) analysis.

Drop our rates

Proportion of the subjects completing the trial varied across the studies. It ranged from a high of 100%[11] to a low of <50%.[13, 17, 18, 29, 32, 33, 34, 35, 36] Five studies had a retention rate of more than 80%.[10, 12, 19, 27, 28] and six studies had a retention rate ranging from 50% to 80% respectively.[14, 15, 20, 21, 22, 24, 26] the study with longest follow-up of 18 months had a follow-up rate of 68.2%.[24]


WBI TRIALS AMONG ADOLESCENTS AND COLLEGE STUDENTS

A total of four studies recruited adolescents or college students [Table 1].[10, 14, 15, 22]

One cessation induction study[10] in college students compared the WBI (named RealU) with one-off untailored e-mail. It found significantly higher PP abstinence at 7 months for the WBI (RealU 59.1% vs. one-off untailored e-mail 38.5% [relative risk (RR) = 1.54, 95% of confidence interval (CI): 1.28-1.85]). However, there was no difference between groups (overall 6%) for prolonged abstinence at 7 months.

Patten et al.[15] studied adolescent smoking cessation and did not detect any difference in abstinence among the study groups. The 30-day, point-prevalence smoking abstinence rates for brief office intervention (BOI) and stomp out smokes (SOS) intervention were comparable (12% vs. 6% at week 24 and 13% vs. 6% at week 36 for BOI and SOS, respectively). Although the SOS group had a significantly greater reduction in average number of days smoked than BOI (P = 0.006).

Another study among adolescents compared American Lung Association's Not on Tobacco program (NOT) with a Web-based adjunct (NOT Plus). The study utilized hierarchical linear modeling and detected a significant effect of NOT Plus to the comparator group for smoking cessation.[14] Among the Web-based adjunct users, there was a significant association of use of the web site with smoking cessation at end-of-program (P < 0.05). However, it was not observed at 3 months.

Another study among high school students utilized an Internet-based, virtual reality world intervention comparing it with motivational interviewing (MI) by a counselor.[22] Intervention participants had significantly higher 7-day abstinence rates than controls (35% vs. 22%). There was no difference among the groups in smoking abstinence at 12 month follow-up (RR 0.93, 95% CI: 0.60-1.44), although the number of quit attempts were significantly different between the groups (P < 0.05).


WBI TRIALS AMONG ADULTS

There were a total of 24 trials among adult populations.[11, 12, 16, 20, 21, 23, 24, 25, 27, 28, 31, 33, 34, 35, 36]

Comparison of WBI to non-WBIs or no interventions at all

A study among 171 smokers during lung cancer screening test found effect of self-help materials similar to a recommended written list of Internet resources. The 7-day PP quit rates were comparable between the two groups (5% vs. 10%; RR 0.45, 95% CI: 0.14-1.40) at 1-year follow-up.[11]

Another study using Comprehensive Health Enhancement Support System for Smoking Cessation and Relapse Prevention as an adjunct to counseling and bupropion (N = 284, 140 WBI, 144 control) failed to find a significant improvement in abstinence rates at 6 months (RR 1.27, 95% CI: 0.70-2.31).[12]

One short-term follow-up (90 days) study in 351 participants detected a significant effect of WBI compared with no intervention at all (24.1% vs. 8.2%; RR 2.46, 95% CI: 1.16-5.21).[21]

The Happy Endings trials recruited 290 participants (144 intervention, 146 control) via Internet advertisements.[27, 28] In the first of two studies, the intervention was delivered as 1-year smoking cessation program through the Internet and cell phone while controls received a self-help booklet.[27] The second study offered nicotine replacement therapy (NRT) to both groups.[28] WBI group was significantly more effective on sustained abstinence at 12 months compared with self-help controls without adjunct NRT (20% vs. 7%, 7%; RR 2.94, 95% CI: 1.49-5.81) as well as with adjunct NRT (22.3% vs. 13.1%, RR 1.71, 95% CI: 1.10-2.66).

The study by Oenema et al.[31] showed that the WBI was not more effective than providing no intervention at all for self-reported smoking status at 1 month (RR = 1.28, 95% CI: 0.52-3.13).

Another cessation induction study evaluated the effectiveness of Online Transtheoretical Model tailored communications and MI with the adjunct of Health Risk Intervention.[16] This study reported statistically insignificant difference in PP abstinence at 6 months between the two groups (21% vs. 35%).

In a study among general practitioners, no significant additional effect of referral to group-based (Odds ratio [OR]: 1.05; 95% CI: 0.6-1.8) or internet-based smoking cessation programs (OR: 0.91; 95% CI: 0.6-1.4) was noted among smokers (n = 760) at 1-year follow-up.[25]

Swan et al.[20] compared WBI (n = 401) to proactive telephone counseling (PTC) (n = 402), or as an adjunct (n = 399) with varenicline in all groups. The study failed to find any significant difference in 7-day point prevalent abstinence at 6 month (30.7% vs. 34.3% vs. 33.8%; RR 0.94, 95% CI: 0.79-1.13). Although the PTC group was found to be significantly more effective with regards to PP abstinence than the WBI group at 3 months follow-up (OR = 1.48, 95% CI: = 1.12, 1.96).

A similar design employed in Quit Using Internet and Telephone Treatment study comparing static WBI either to tailored WBI or as adjunct to PTC also failed to find any significant difference in 30-day single PP abstinence rates at 18 months.[24]

Quitting is Winning, a cognitive-behavioral program evaluated among Korean Americans (n = 1112), found no significant difference in 30-day smoking cessation rates between the Internet (11%) and booklet (13%) groups (ITT difference = −2%, 95% CI: = −6% to 2%).[23]

The stay quit for you study (n = 2031) reported two differently tailored web-based smoking relapse prevention programs (action planning [AP] and AP plus program) to be significantly more effective than the control group (participants with no intervention at all) for self-reported continued abstinence at 12 months follow-up (AP program [OR: 1.95, P = 0.005], AP + program [OR: 1.61, P = 0.049]).[33] The study also suggested that the number of completed program elements had a dose-response relationship to abstinence rates.

Another recent study reported tailored WBI (n = 552) to be more effective than no intervention at all (n = 571) at 6 weeks (24-h PP abstinence [OR: 1.85, 95% CI: 1.30-2.65], 7-day PP abstinence [OR: 2.17, 95% CI: 1.44-3.27] and prolonged abstinence [OR: 1.99, 95% CI: 1.28-3.09]). However, the difference failed to extend until end of 6 months.[34]

Comparison of different WBIs

Studies comparing tailored to untailored WBIs report ambiguous findings. While few studies have found that tailored WBI is equally efficacious to untailored ones[13, 17, 18, 30, 35, 36] others have reported tailored intervention to be better.[19, 26, 32] Two studies reporting significantly effective results for tailored WBIs assessed outcomes as 24-h or 7-day PP at 6 months.[19, 32] One short term (12 weeks) study also reported better continuous abstinence rates for tailored WBIs.[26] A study by Muñoz et al.[35] found more complex intervention to be having significantly lower quit rates at 12 months.

WBIs for ST

The Chew Free trial is the only study conducted for ST cessation.[37] Participants were recruited online through MyLastDip program and provided two fully automated WBI as tailored (n = 857) or static (n = 859) text. The tailored WBI had significantly higher quit rates than static condition at 6 months assessed using complete case analysis (40.6% vs. 21.2%; P < 0.001) and ITT analysis (12.6% vs. 7.9%; P < 0.001).

Reviews and meta-analysis

We included 7 reviews and meta-analysis in the current review.[39, 40, 41, 42, 43, 44, 45]

The review by Strecher et al.[43] included 10 RCTs comparing tailored versus the general or targeted modalities. They reported of very few characteristic patterns amongst the studies, strong impact on smoking cessation by trials combining tailored materials with nicotine replacement therapy and a significant positive impact of tailored materials among pre-contemplators.

Another review identified 19 studies of computer and Internet-based interventions for smoking cessation published between 1995 and August 2004.[45] The authors reported of few patterns in terms of subject, design or intervention characteristics leading to positive outcomes. The mailed computer-generated feedback report intervention format was observed to be most consistently associated with improved outcomes.

Shahab & McEvan[42] conducted systematic review and meta-analysis of the literature (1990–2008) and included 11 RCTs. They concluded that although there was no overall effect of interactive compared with static WBIs, web-based-tailored-interactive smoking cessation interventions were effective compared with untailored booklet or e-mail interventions [rate ratio (RR) 1.8; 95% confidence interval (CI) 1.4–2.3] increasing 6-month abstinence by 17% (95% CI 12–21%) without any publication bias. Effective Interventions were those that were only aimed at smokers motivated to quit (RR 1.3, 95% CI 1.0–1.7) or were fully automated (RR 1.4, 95% CI 1.0–2.0).

One meta-analysis of 22 RCTs found that Web- or computer-based smoking cessation programs yielded an abstinence rate about 1.5 times higher than controls (RR, 1.44; 95% CI, 1.27%-1.64%).[44] Pooled analysis revealed significantly higher abstinence rate at 12-month follow-up in the intervention group (9.9%; 95% CI, 8.9%-10.9%) than the control group (5.7%; 95% CI, 5.1%-6.3%). Both stand alone or supplemental interventions were effective in adults but none was significantly effective in adolescents.

There have been multiple Cochrane reviews concerning with smoking cessation but only 2 focused on web based interventions.[39, 40] One review included 20 RCTs including trials with WBIs only.[40] It concluded that though the trials did not show consistent effects, few WBIs having tailored information or frequent automated contacts with the users can effectively assist smoking cessation. There was no benefit detected of including a mood management component or an asynchronous bulletin board. Another recent Cochrane effectiveness review concluded that computer and other electronic aids increase the likelihood of cessation (aid to cessation as well as cessation induction studies) compared with no intervention or generic self-help materials, but the effect is small (prolonged abstinence: relative risk = 1.32, 95% confidence interval 1.21 to 1.45).[39] It was also observed that the chances of sustaining abstinence increases noticeably after successfully negotiating the first month.

The review by Hutton et al.[41] included 21 RCTs with 31,481 smokers. The studies in adults were observed to be of moderate quality with retention rates ranging from 27% to 86%, ninety percent in college students and losses to follow-up in 13% to 47% among the adolescents. The authors concluded that the evidence supporting the use of WBIs for smoking cessation is insufficient to moderate in adults and insufficient in college students and adolescents.

Cost effectiveness of WBIs

Some of the RCTs assessing effectiveness of WBIs for managing tobacco use have also commented on the cost-effectiveness of the intervention.

Etter[29] reported that the cost of implementing WBI for management of tobacco sue for a reach of 8000 participants in computer tailored programs (with 600,000 visitors per year to the website) is comparable to the cost of running a small smoking cessation clinic which would treat about 50 smokers a month.

Rabius et al.[17] in their study have reported WBI for management of tobacco use to be cost effective. In this study, 4 days of programming at a cost of less than US $2000 allowed approximately 5000 additional users for services from the five tailored interactive service providers. The cost was much less than the cost of serving 1000 new clients with telephone counseling amounting to approximately US $100,000.


CONCLUSIONS

Recent years have seen a significant growth in number of WBIs in field of health care service delivery. The same is true for psychoactive substance use disorders. The WBIs for some substances of abuse (alcohol and tobacco) is more researched than others.

Limited number of specialized health care professional, busy schedules due to demands of profession and increasing penetration of internet to cities as well as villages make the WBIs an option worth exploring in LMIC settings. These interventions are expected to be cost effective due to limited recurring and maintenance cost, especially keeping in mind the large consumer base. Although a limited number of studies have commented on the cost-effectiveness of WBIs for management of tobacco use, the findings are suggestive of substantial lower cost of offering such services.[17, 29]

Accessibility of internet through the hand held devices has offered even cheaper alternatives to computers and laptops. The freedom to access the service at one's own convenient time and pace also makes these a lucrative area to invest and investigate.

Previous estimates of potential reach of WBIs for smoking cessation were criticized for being based on either national figures for Internet access or reported interest among non-representative samples.[39] However, even the newer studies, assessing a representative sample of smokers, have estimated that 40-46% was interested in using a WBI for smoking cessation.[40, 41] Thus in this era of internet usage the applicability of WBIs for managing tobacco use is encouraging.

However, the existing evidence on WBIs for management of tobacco use is limited. These are restricted mainly to the developed world. Most of the interventions are in English. None have been developed in other languages spoken in LMICs. In addition, all but one intervention studied in a RCT is for smoking forms. ST use constitutes a major fraction of the tobacco used in LMICs including India.

In addition, the quality of trials is also heterogeneous. Some of the studies are likely to have high/uncertain risk of selection bias. Some of the studies have relatively small follow-up duration. Only a few studies have included biochemical markers as objective measure for ongoing tobacco use. Only a handful of studies have assessed the WBIs in combination with pharmacotherapy (including NRT, bupropion-SR and varenicline).[12, 19, 20, 26, 28]

There is limited support for effectiveness of WBIs for managing tobacco use among adolescents. Although most of the trials among adults found WBIs to be more effective at short term follow-up (a few days to weeks), the benefits failed to extend beyond 3 months in most of the studies. The notable exception to this were studies by Brendryen et al.[27, 28] and Prochaska et al.[16] Even among the studies that have reported superiority of WBIs, the effect size is small.[42]

Randomized trials of WBIs are also limited by weakness due to generalized factors applicable to internet use itself. People who choose to participate in the WBIs based trials may be unrepresentative of the people who use websites in real life thereby raising concern about whether the same type of result would be obtained by all users of the website. The qualitative value of WBI may also be hindered by the fact that having WBI at health care setting may make participant compelled to fill out rather than when used the same service at home.

The findings from the exiting RCTs can help develop more refined WBIs for managing tobacco use. Use of tailored materials among pre-contemplators; combining tailored materials with NRT, mailed computer-generated feedback report intervention format; and successful negotiation of the 1st month have been found to be effective strategies and approaches across the existing studies.


Notes

Source of Support: Nil

Conflict of Interest: None.

REFERENCES
1. World Internet Users and Population Statistics 2012. Internet World StatsYear: 2012Last accessed on June 06, 2012 Available from: http://www.internetworldstats.com/stats.htm.
2. Lorence DP,Park H,Fox S. Assessing health consumerism on the Web: A demographic profile of information-seeking behaviorsJ Med SystYear: 200630251816978004
3. de Vries H,Brug J. Computer-tailored interventions motivating people to adopt health promoting behaviours: Introduction to a new approachPatient Educ CounsYear: 1999369910510223015
4. Marcus BH,Nigg CR,Riebe D,Forsyth LH. Interactive communication strategies: Implications for population-based physical-activity promotionAm J Prev MedYear: 200019121610913903
5. Napolitano MA,Marcus BH. Targeting and tailoring physical activity information using print and information technologiesExerc Sport Sci RevYear: 200230122812150571
6. Atkinson NL,Saperstein SL,Pleis J. Using the internet for health-related activities: Findings from a national probability sampleJ Med Internet ResYear: 200911e419275980
7. Bansil P,Keenan NL,Zlot AI,Gilliland JC. Health-related information on the Web: Results from the HealthStyles Survey, 2002-2003Prev Chronic DisYear: 20063A3616539777
8. WHOWorld Health Report: Shaping the FutureYear: 2003GenevaWorld Health Organisation
9. Schroeder SA. Conflicting dispatches from the tobacco warsN Engl J MedYear: 20023471106912362014
10. An LC,Klatt C,Perry CL,Lein EB,Hennrikus DJ,Pallonen UE,et al. The RealU online cessation intervention for college smokers: A randomized controlled trialPrev MedYear: 200847194918565577
11. Clark MM,Cox LS,Jett JR,Patten CA,Schroeder DR,Nirelli LM,et al. Effectiveness of smoking cessation self-help materials in a lung cancer screening populationLung CancerYear: 200444132115013579
12. Japuntich SJ,Zehner ME,Smith SS,Jorenby DE,Valdez JA,Fiore MC,et al. Smoking cessation via the internet: A randomized clinical trial of an internet intervention as adjuvant treatment in a smoking cessation interventionNicotine Tob ResYear: 20068Suppl 1S596717491172
13. McKay HG,Danaher BG,Seeley JR,Lichtenstein E,Gau JM. Comparing two web-based smoking cessation programs: Randomized controlled trialJ Med Internet ResYear: 200810e4019017582
14. Mermelstein R,Turner L. Web-based support as an adjunct to group-based smoking cessation for adolescentsNicotine Tob ResYear: 20068Suppl 1S697617491173
15. Patten CA,Croghan IT,Meis TM,Decker PA,Pingree S,Colligan RC,et al. Randomized clinical trial of an Internet-based versus brief office intervention for adolescent smoking cessationPatient Educ CounsYear: 2006642495816616449
16. Prochaska JO,Butterworth S,Redding CA,Burden V,Perrin N,Leo M,et al. Initial efficacy of MI, TTM tailoring and HRI's with multiple behaviors for employee health promotionPrev MedYear: 2008462263118155287
17. Rabius V,Pike KJ,Wiatrek D,McAlister AL. Comparing internet assistance for smoking cessation: 13-month follow-up of a six-arm randomized controlled trialJ Med Internet ResYear: 200810e4519033146
18. Stoddard JL,Augustson EM,Moser RP. Effect of adding a virtual community (bulletin board) to smokefree. gov: Randomized controlled trialJ Med Internet ResYear: 200810e5319097974
19. Strecher VJ,McClure JB,Alexander GL,Chakraborty B,Nair VN,Konkel JM,et al. Web-based smoking-cessation programs: Results of a randomized trialAm J Prev MedYear: 2008343738118407003
20. Swan GE,McClure JB,Jack LM,Zbikowski SM,Javitz HS,Catz SL,et al. Behavioral counseling and varenicline treatment for smoking cessationAm J Prev MedYear: 2010384829020409497
21. Swartz LH,Noell JW,Schroeder SW,Ary DV. A randomised control study of a fully automated internet based smoking cessation programmeTob ControlYear: 20061571216436397
22. Woodruff SI,Conway TL,Edwards CC,Elliott SP,Crittenden J. Evaluation of an Internet virtual world chat room for adolescent smoking cessationAddict BehavYear: 20073217698617250972
23. McDonnell DD,Kazinets G,Lee HJ,Moskowitz JM. An internet-based smoking cessation program for Korean Americans: Results from a randomized controlled trialNicotine Tob ResYear: 2011133364321330285
24. Graham AL,Cobb NK,Papandonatos GD,Moreno JL,Kang H,Tinkelman DG,et al. A randomized trial of Internet and telephone treatment for smoking cessationArch Intern MedYear: 2011171465321220660
25. Pisinger C,Jørgensen MM,Møller NE,Døssing M,Jørgensen T. A cluster randomized trial in general practice with referral to a group-based or an Internet-based smoking cessation programmeJ Public Health (Oxf)Year: 201032627019617300
26. Strecher VJ,Shiffman S,West R. Randomized controlled trial of a web-based computer-tailored smoking cessation program as a supplement to nicotine patch therapyAddictionYear: 2005100682815847626
27. Brendryen H,Drozd F,Kraft P. A digital smoking cessation program delivered through internet and cell phone without nicotine replacement (happy ending): Randomized controlled trialJ Med Internet ResYear: 200810e5119087949
28. Brendryen H,Kraft P. Happy ending: A randomized controlled trial of a digital multi-media smoking cessation interventionAddictionYear: 20081034788418269367
29. Etter JF. Comparing the efficacy of two Internet-based, computer-tailored smoking cessation programs: A randomized trialJ Med Internet ResYear: 20057e215829474
30. Etter JF. Comparing computer-tailored, internet-based smoking cessation counseling reports with generic, untailored reports: A randomized trialJ Health CommunYear: 2009146465719851916
31. Oenema A,Brug J,Dijkstra A,de Weerdt I,de Vries H. Efficacy and use of an internet-delivered computer-tailored lifestyle intervention, targeting saturated fat intake, physical activity and smoking cessation: A randomized controlled trialAnn Behav MedYear: 2008351253518363076
32. Te Poel F,Bolman C,Reubsaet A,de Vries H. Efficacy of a single computer-tailored e-mail for smoking cessation: Results after 6 monthsHealth Educ ResYear: 2009249304019574405
33. Elfeddali I,Bolman C,Candel MJ,Wiers RW,de Vries H. Preventing smoking relapse via Web-based computer-tailored feedback: A randomized controlled trialJ Med Internet ResYear: 201214e10922903145
34. Smit ES,de Vries H,Hoving C. Effectiveness of a Web-based multiple tailored smoking cessation program: A randomized controlled trial among Dutch adult smokersJ Med Internet ResYear: 201214e8222687887
35. Muñoz RF,Lenert LL,Delucchi K,Stoddard J,Perez JE,Penilla C,et al. Toward evidence-based Internet interventions: A Spanish/English Web site for international smoking cessation trialsNicotine Tob ResYear: 20068778716497602
36. Muñoz RF,Barrera AZ,Delucchi K,Penilla C,Torres LD,Pérez-Stable EJ. International Spanish/English Internet smoking cessation trial yields 20% abstinence rates at 1 yearNicotine Tob ResYear: 20091110253419640833
37. Severson HH,Gordon JS,Danaher BG,Akers L. ChewFree. com: Evaluation of a Web-based cessation program for smokeless tobacco usersNicotine Tob ResYear: 2008103819118236303
38. Kreps GL. Evaluating new health information technologies: Expanding the frontiers of health care delivery and health promotionStud Health Technol InformYear: 2002802051212026130
39. Westmaas JL,Abroms L,Bontemps-Jones J,Bauer JE,Bade J. Using the internet to understand smokers’ treatment preferences: Informing strategies to increase demandJ Med Internet ResYear: 201113e5821873150
40. Cunningham JA. Access and interest: Two important issues in considering the feasibility of web-assisted tobacco interventionsJ Med Internet ResYear: 200810e3718984558
41. Brown J,Michie S,Raupach T,West R. Prevalence and characteristics of smokers interested in internet-based smoking cessation interventions: Cross-sectional findings from a national household surveyJ Med Internet ResYear: 201315e5023506944
42. Chen YF,Madan J,Welton N,Yahaya I,Aveyard P,Bauld L,et al. Effectiveness and cost-effectiveness of computer and other electronic aids for smoking cessation: A systematic review and network meta-analysisHealth Technol AssessYear: 2012161205 iii-v. 23046909
43. Civljak M,Sheikh A,Stead LF,Car J. Internet-based interventions for smoking cessationCochrane Database Syst RevYear: 20108CD00707820824856
44. Hutton HE,Wilson LM,Apelberg BJ,Tang EA,Odelola O,Bass EB,et al. A systematic review of randomized controlled trials: Web-based interventions for smoking cessation among adolescents, college students, and adultsNicotine Tob ResYear: 2011132273821350042
45. Shahab L,McEwen A. Online support for smoking cessation: A systematic review of the literatureAddictionYear: 2009104179280419832783

Figures

[Figure ID: F1]
Figure 1 

Flow chart depicting the data extraction procedure



Tables
[TableWrap ID: T1] Table 1 

Trials of WBIs for management of tobacco use (arranged alphabetically by author name)




Article Categories:
  • Review Article

Keywords: Internet based interventions, tobacco, treatment, web based interventions.

Previous Document:  Effect of Red Clover on CYP Expression: An Investigation of Herb-Drug Interaction at Molecular Level...
Next Document:  A Study on First Intake Assessments of In-patient Referrals to Psychiatric Rehabilitation Services.