A review of web-assisted tobacco interventions (WATIs).
BACKGROUND
The Internet has great potential to provide assistance to millions of smokers who seek help with quitting smoking.


OBJECTIVE
The goals of this study were to assess the content and the quality of smoking cessation treatments most likely to be encountered by smokers seeking treatment on the Internet and to examine differences in quality between current websites and those reviewed in 2004.


METHODS
Internet searches for smoking cessation were designed to mimic the search patterns of most Internet users. PhD-level specialists in tobacco cessation treatments used standardized procedures to review the content of each website, assess the degree to which each site covered key components of evidence-based treatment as described in US national guidelines, determine the accuracy of information presented, and evaluate the use of website interactivity. Results of the current study were compared to results obtained in a prior review.


RESULTS
Most websites retrieved in the search met exclusion criteria and were not included in the final analyses in both the current (74%, 65/88) and the prior study (77%, 156/202). In both studies, the majority of websites were excluded because they sold cessation-related products but did not provide treatment recommended by the Public Health Service guidelines. Of the 23 websites included in the current study, 26% (n = 6) provided only minimal coverage (brief mention) of key components of tobacco treatment. However, compared to the earlier study, websites included in the present study scored significantly higher in quality ratings in four areas: providing advice to quit (P = .05), practical counseling (P = .02), and enhancing motivation to quit smoking through personal relevance (P = .05) and risks (P < .001). Most Web-assisted tobacco intervention (WATI) sites (69%, 16/23) contained no inaccurate information. When observed, inaccuracies primarily occurred in content related to pharmacotherapy. The percentage of sites offering at least one interactive feature increased from 39% (18/46) in 2004 to 56% (13/23) in the present study. Despite this improvement, there was a notable underutilization of the interactive capabilities of the Internet to personalize treatment, to connect users with a virtual support system, and to provide follow-up treatment contacts.


CONCLUSIONS
While the quality of treatment offered in WATIs has improved since our previous review in 2004, there is substantial room for further improvement to ensure that smokers are offered high-quality, evidence-based treatments. It is not clear what degree of informational detail and interactivity is optimal for Web-based smoking cessation treatments. Additional research is needed to understand how to maximize the interactive capabilities of the Internet to produce and sustain population-based health behavior change.
Bock
Beth C
BC
The Miriam Hospital, Providence, RI 02903, USA. Beth_Bock@Brown.edu
Graham
Amanda L
AL
Whiteley
Jessica A
JA
Stoddard
Jacqueline L
JL
D000328:Adult; D003376:Counseling; D019317:Evidence-Based Medicine; D006801:Humans; D020407:Internet; D010353:Patient Education as Topic; D018579:Patient Selection; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D012984:Software / Q000706:statistics & numerical data; D013813:Therapy, Computer-Assisted / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014584:User-Computer Interface