Combined Internet and Telephone Intervention May Facilitate Smoking Cessation

Laurie Barclay, MD

January 10, 2011

January 10, 2011 — Combined Internet and telephone treatment of smoking cessation outperform static and dynamic Internet interventions, according to the results of a 3-group, randomized controlled trial reported in the January 10 issue of the Archives of Internal Medicine.

"This study aimed to determine the relative effect of Internet and Internet plus telephone treatment for smoking cessation on smoking abstinence among US adults," write Amanda L. Graham, PhD, from the Schroeder Institute for Tobacco Research and Policy Studies, American Legacy Foundation, and Georgetown University Medical Center/Lombardi Comprehensive Cancer Center, in Washington, DC, and colleagues. "A priori hypotheses were that Internet enhanced with tailored content and social support would outperform basic Internet (BI) and that enhanced Internet (EI) plus proactive telephone counseling would outperform the other conditions."

From March 8, 2005, through November 30, 2008, the investigators compared basic Internet, enhanced Internet, and enhanced Internet and telephone combined (enhanced Internet plus proactive telephone counseling) in the Quit Using Internet and Telephone Treatment (iQUITT) study. They used search engines to recruit US adults who currently smoked at least 5 cigarettes per day. Mean age of the participants (n = 2005) was 35.9 ± 10.8 years; 51.1% were women, and 86.5% were white. At 18 months, 68.2% returned for follow-up evaluation. With use of intent-to-treat analysis, the primary study endpoint was 30-day point prevalence abstinence assessed at 3, 6, 12, and 18 months after randomization.

Across all follow-up intervals, the 30-day multiple point prevalence abstinence rate at 18 months was 3.5% for basic Internet, 4.5% for enhanced Internet, and 7.7% for enhanced Internet plus proactive telephone counseling, which was significantly higher vs either basic Internet or enhanced Internet. However, 30-day single point prevalence abstinence rates at 18 months were not significantly different among the groups (19.0% for basic Internet, 17.4% for enhanced Internet, and 19.6% for enhanced Internet plus proactive telephone counseling).

"[O]ur findings demonstrate the effectiveness of combined Internet and telephone treatment for smoking cessation in promoting sustained abstinence, as well as the effectiveness of BI and EI treatments, which accumulates during longer periods," the study authors write. "Future studies will need to address the optimal duration, intensity, and active ingredients of treatment and assess the cost-effectiveness of these potentially widely disseminable interventions."

Limitations of this study include lack of other comparison or no-treatment control conditions and possible self-selection of participants with unusually high motivation to quit.

"Despite these caveats, the potential public health significance ...of these findings is striking," the study authors conclude. "Combining evidence-based cessation interventions such as Internet and telephone counseling could substantially accelerate cessation in the United States."

In an accompanying commentary, Nancy A. Rigotti, MD, from Mongan Institute for Health Policy, Massachusetts General Hospital and Harvard Medical School in Boston, notes that treating tobacco use and dependence should be, but is not always, a high priority for healthcare providers.

"When exact regulations are written, they must define treatment to include all treatments endorsed by clinical treatment guidelines, including all (even nonprescription) FDA [US Food and Drug Administration]-approved medications and all cost-effective counseling methods," Dr. Rigotti writes. "These developments, along with ongoing efforts by health care systems and payers to systematize the provision of high-quality care and improve chronic disease management, make me hopeful that a comprehensive tobacco care management system can and will be integrated into the evolving health care provision system. In doing so, we will learn lessons not only about tobacco treatment but also about how to manage other health-related behaviors with major public health effects; we will save countless lives and avert untold suffering."

The National Cancer Institute of the National Institutes of Health supported this study. Some of the study authors have disclosed various financial relationships with Healthways Inc, the QuitNet system, GlaxoSmithKline plc, Pfizer Inc, sanofi-aventis LLC, and/or Novartis Pharmaceuticals. Dr. Rigotti has consulted without pay for Pfizer Inc and Free & Clear Inc. Her institution has received research grant funding from Pfizer, sanofi-aventis LLC, and Nabi Biopharmaceuticals to study investigational and/or marketed smoking cessation aids.

Arch Intern Med. 2011;171:46-53, 53-55. Abstract

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