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Comparative effectiveness of intervention components for producing long-term abstinence from smoking: a factorial screening experiment.

ABSTRACT: To identify promising intervention components that help smokers attain and maintain abstinence during a quit attempt.A 2?×?2?×?2?×?2?×?2 randomized factorial experiment.Eleven primary care clinics in Wisconsin, USA.A total of 544 smokers (59% women, 86% white) recruited during primary care visits and motivated to quit.Five intervention components designed to help smokers attain and maintain abstinence: (1) extended medication (26 versus 8 weeks of nicotine patch?+?nicotine gum); (2) maintenance (phone) counseling versus none; (3) medication adherence counseling versus none; (4) automated (medication) adherence calls versus none; and (5) electronic medication monitoring with feedback and counseling versus electronic medication monitoring alone.The primary outcome was 7-day self-reported point-prevalence abstinence 1 year after the target quit day.Only extended medication produced a main effect. Twenty-six versus 8 weeks of medication improved point-prevalence abstinence rates (43 versus 34% at 6 months; 34 versus 27% at 1 year; P =?0.01 for both). There were four interaction effects at 1 year, showing that an intervention component's effectiveness depended upon the components with which it was combined.Twenty-six weeks of nicotine patch?+?nicotine gum (versus 8 weeks) and maintenance counseling provided by phone are promising intervention components for the cessation and maintenance phases of smoking treatment.

SUBMITTER: Schlam TR

PROVIDER: S-EPMC4692280 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature

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Comparative effectiveness of intervention components for producing long-term abstinence from smoking: a factorial screening experiment.

Schlam Tanya R TR Fiore Michael C MC Smith Stevens S SS Fraser David D Bolt Daniel M DM Collins Linda M LM Mermelstein Robin R Piper Megan E ME Cook Jessica W JW Jorenby Douglas E DE Loh Wei-Yin WY Baker Timothy B TB

Addiction (Abingdon, England) 20151119 1

<h4>Aims</h4>To identify promising intervention components that help smokers attain and maintain abstinence during a quit attempt.<h4>Design</h4>A 2 × 2 × 2 × 2 × 2 randomized factorial experiment.<h4>Setting</h4>Eleven primary care clinics in Wisconsin, USA.<h4>Participants</h4>A total of 544 smokers (59% women, 86% white) recruited during primary care visits and motivated to quit.<h4>Interventions</h4>Five intervention components designed to help smokers attain and maintain abstinence: (1) ext ...[more]

PMID: 26581819

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Project description:BACKGROUND:Smoking remains a leading cause of preventable death and illness. Internet interventions for smoking cessation have the potential to significantly impact public health, given their broad reach and proven effectiveness. Given the dose-response association between engagement and behavior change, identifying strategies to promote engagement is a priority across digital health interventions. Text messaging is a proven smoking cessation treatment modality and a powerful strategy to increase intervention engagement in other areas of health, but it has not been tested as an engagement strategy for a digital cessation intervention. OBJECTIVE:This study examined the impact of 4 experimental text message design factors on adult smokers' engagement with an internet smoking cessation program. METHODS:We conducted a 2×2×2×2 full factorial screening experiment wherein 864 participants were randomized to 1 of 16 experimental conditions after registering with a free internet smoking cessation program and enrolling in its automated text message program. Experimental factors were personalization (on/off), integration between the web and text message platforms (on/off), dynamic tailoring of intervention content based on user engagement (on/off), and message intensity (tapered vs abrupt drop-off). Primary outcomes were 3-month measures of engagement (ie, page views, time on site, and return visits to the website) as well as use of 6 interactive features of the internet program. All metrics were automatically tracked; there were no missing data. RESULTS:Main effects were detected for integration and dynamic tailoring. Integration significantly increased interactive feature use by participants, whereas dynamic tailoring increased the number of features used and page views. No main effects were found for message intensity or personalization alone, although several synergistic interactions with other experimental features were observed. Synergistic effects, when all experimental factors were active, resulted in the highest rates of interactive feature use and the greatest proportion of participants at high levels of engagement. Measured in terms of standardized mean differences (SMDs), effects on interactive feature use were highest for Build Support System (SMD 0.56; 95% CI 0.27 to 0.81), Choose Quit Smoking Aid (SMD 0.38; 95% CI 0.10 to 0.66), and Track Smoking Triggers (SMD 0.33; 95% CI 0.05 to 0.61). Among the engagement metrics, the largest effects were on overall feature utilization (SMD 0.33; 95% CI 0.06 to 0.59) and time on site (SMD 0.29; 95% CI 0.01 to 0.57). As no SMD >0.30 was observed for main effects on any outcome, results suggest that for some outcomes, the combined intervention was stronger than individual factors alone. CONCLUSIONS:This factorial experiment demonstrates the effectiveness of text messaging as a strategy to increase engagement with an internet smoking cessation intervention, resulting in greater overall intervention dose and greater exposure to the core components of tobacco dependence treatment that can promote abstinence. TRIAL REGISTRATION:ClinicalTrials.gov NCT02585206; https://clinicaltrials.gov/ct2/show/NCT02585206. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):RR2-10.1136/bmjopen-2015-010687.

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Comparative effectiveness of intervention components for producing long-term abstinence from smoking: a factorial screening experiment.

Publications

Comparative effectiveness of intervention components for producing long-term abstinence from smoking: a factorial screening experiment.

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