title: Phone and web-based tobacco cessation treatment: real-world utilization patterns and outcomes for 11,000 tobacco users.
abstract: BACKGROUND
  Phone-based tobacco cessation programs have been proven effective and widely adopted. Web-based solutions exist; however, the evidence base is not yet well established. Many cessation treatments are commercially available, but few integrate the phone and Web for delivery and no published studies exist for integrated programs.
  
  
  OBJECTIVE
  This paper describes a comprehensive integrated phone/Web tobacco cessation program and the characteristics, experience, and outcomes of smokers enrolled in this program from a real-world evaluation.
  
  
  METHODS
  We tracked program utilization (calls completed, Web log-ins), quit status, satisfaction, and demographics of 11,143 participants who enrolled in the Free & Clear Quit For Life Program between May 2006 and October 2007. All participants received up to five proactive phone counseling sessions with Quit Coaches, unlimited access to an interactive website, up to 20 tailored emails, printed Quit Guides, and cessation medication information. The program was designed to encourage use of all program components rather than asking participants to choose which components they wanted to use while quitting.
  
  
  RESULTS
  We found that participants tended to use phone services more than Web services. On average, participants completed 2-2.5 counseling calls and logged in to the online program 1-2 times. Women were more adherent to the overall program; women utilized Web and phone services significantly (P = .003) more than men. Older smokers (> 26 years) and moderate smokers (15-20 cigarettes/day) utilized services more (P < .001) than younger (< 26 years) and light or heavy smokers. Satisfaction with services was high (92% to 95%) and varied somewhat with Web utilization. Thirty-day quit rates at the 6-month follow-up were 41% using responder analysis and 21% using intent-to-treat analysis. Web utilization was significantly associated with increased call completion and tobacco abstinence rates at the 6-month follow-up evaluation.
  
  
  CONCLUSIONS
  This paper expands our understanding of a real-world treatment program combining two mediums, phone and Web. Greater adherence to the program, as defined by using both the phone and Web components, is associated with higher quit rates. This study has implications for reaching and treating tobacco users with an integrated phone/Web program and offers evidence regarding the effectiveness of integrated cessation programs.
authors.affiliation: Free & Clear, Inc, 999 Third Avenue, Suite 2100, Seattle, WA 98104, USA. susan.zbikowski@freeclear.com
authors.forename: Susan M
authors.initials: SM
authors.lastname: Zbikowski
authors.forename: Jenny
authors.initials: J
authors.lastname: Hapgood
authors.forename: Sara
authors.initials: S
authors.lastname: Smucker Barnwell
authors.forename: Tim
authors.initials: T
authors.lastname: McAfee
mesh_terms: D000293:Adolescent; D015928:Cognitive Behavioral Therapy; D003376:Counseling; D034742:Electronic Mail; D006801:Humans; D007258:Informed Consent; D020407:Internet; D007398:Interpersonal Relations; D009862:Online Systems; D011369:Professional-Patient Relations; D055502:Secondary Prevention; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology*; D013689:Telephone; D013813:Therapy, Computer-Assisted; D016896:Treatment Outcome; D014584:User-Computer Interface