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


CONCLUSIONS
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.
Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC.|Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC.
Amanda L
AL
Graham
Center for Statistical Science, Brown University, Providence, RI.
George D
GD
Papandonatos
Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC.
Sarah
S
Cha
Center for Statistical Science, Brown University, Providence, RI.
Bahar
B
Erar
Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC.
Michael S
MS
Amato
MeYouHealth, Boston, MA.|Department of Pulmonary and Critical Care, Georgetown University Medical Center, Washington, DC.
Nathan K
NK
Cobb
Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC.|Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC.|Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Raymond S
RS
Niaura
Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC.|Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC.|Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
David B
DB
Abrams
D000328:Adult; D003376:Counseling; D006801:Humans; D020407:Internet; D010349:Patient Compliance / Q000706:statistics & numerical data*; D016540:Smoking Cessation / Q000379:methods*; D012944:Social Support; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000628:therapy*