Web- and Computer-Based Smoking Cessation Programs May Be Effective for Adult Smokers

Web-based and computer-based smoking cessation programs may be effective for adult smokers, according to the results of a meta-analysis of randomized controlled trials (RCTs) reported in the May 25 issue of the Archives of Internal Medicine.
"The effects of Web- and computer-based smoking cessation programs are inconsistent in...RCTs," write Seung-Kwon Myung, MD, MS, from National Cancer Center in Goyang, South Korea, and colleagues. "To date, recommended smoking cessation strategies include brief tobacco dependence treatment; individual, group, and telephone counseling; numerous effective medications; and telephone quitline counseling."
The review authors identified 287 articles by searching MEDLINE (PubMed), EMBASE, and the Cochrane Review in August 2008, with 2 evaluators independently selecting and abstracting eligible studies. The final analyses included 22 RCTs, which enrolled a total of 29,549 participants (16,050 were randomly assigned to Web or computer-based smoking cessation program groups and 13,499 to control groups).
The intervention had a significant effect on smoking cessation, based on a random-effects meta-analysis of all 22 trials (relative risk [RR], 1.44; 95% confidence interval [CI], 1.27 - 1.64). Results were similar in the 9 trials of a Web-based intervention (RR, 1.40; 95% CI, 1.13 - 1.72) and in the 13 trials of a computer-based intervention (RR, 1.48; 95% CI, 1.25 - 1.76).
Results were also similar in subgroups based on different levels of methodologic study quality, stand-alone vs supplemental interventions, type of abstinence rates used as outcomes, and duration of follow-up period. However, Web-based or computer-based smoking cessation programs did not appear to be effective in adolescent populations (RR, 1.08; 95% CI, 0.59 - 1.98).
Limitations of this meta-analysis include identification of only 3 RCTs in adolescents, inability to evaluate overall socioeconomic status of the participants, lack of evaluation of smokeless tobacco use, and failure to use biochemical validation techniques for abstinence rates.
Some of the study authors noted various disadvantages of online health behavior change programs, including potential breaches of privacy and security and lack of accessibility for smokers who are elderly, less educated, or living in developing countries.
"The meta-analysis of RCTs indicates that there is sufficient clinical evidence to support the use of Web- and computer-based smoking cessation programs for adult smokers," the study authors write. "The programs increase the smoking cessation rate about 1.5 times more than in the control group and obtain an abstinence rate at 12-month follow-up of 9.9%."
Four of the review authors have received funding from the Centers for Disease Control and Prevention (CDC). The remaining review author has disclosed no relevant financial relationships. The contents of the meta-analysis are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.
Clinical Context
In 2000, smoking was reported to be responsible for an estimated 4.9 million premature deaths worldwide. It is the single greatest cause of preventable disease and premature death. According to the Clinical Practice Guideline, published by the US Public Health Service in 2008, recommended smoking cessation strategies include brief tobacco dependence treatment; individual, group, and telephone counseling; numerous effective medications (eg, nicotine replacement and bupropion); and telephone quitline counseling for treating tobacco use and dependence. In addition, some studies have found that computer-based or Web (Internet)-based smoking cessation programs are effective as well. However, the effects of Web-based and computer-based smoking cessation programs are inconsistent in RCTs.
The aim of this study was to examine the effects of Web-based and computer-based smoking cessation programs in RCTs via a meta-analytic approach.
Study Highlights
• Investigators conducted a search of MEDLINE (PubMed), EMBASE, and the Cochrane Review in August 2008.
• The keywords used for the literature search were as follows: smoking cessation, quit smoking, or tobacco cessation; Internet program, computer program, online program, or Web program; and trial or intervention.
• 2 evaluators independently selected and reviewed eligible studies.
• The outcome measures included point-prevalence abstinence, sustained abstinence, prolonged abstinence, and continuous abstinence.
• Of 287 articles searched, 22 RCTs, which included 29,549 participants with 16,050 enrolled in Web-based or computer-based smoking cessation program groups and 13,499 enrolled in control groups, were included in the final analyses.
• Of note, of the 22 trials, 10 used supplemental interventions for smoking cessation, such as counseling, classroom lessons, nicotine replacement, bupropion medication, or quitlines.
• In a random-effects meta-analysis of all 22 trials, the intervention group had a significant effect on smoking cessation, approximately 1.5 times higher than the control group (RR, 1.44; 95% CI, 1.27 - 1.64).
• When data were pooled, the abstinence rate at the 12-month follow-up was significantly higher in the intervention group (9.9%; 95% CI, 8.9% - 10.9%) vs the control group (5.7%; 95% CI, 5.1% - 6.3%), as well as at 6-month follow-up.
• Similar findings were observed in 9 trials using a Web-based intervention (RR, 1.40; 95% CI, 1.13 - 1.72) and in 13 trials using a computer-based intervention (RR, 1.48; 95% CI, 1.25 - 1.76).
• Subgroup analyses revealed similar findings for different levels of methodologic rigor, stand-alone vs supplemental interventions, type of abstinence rates used, and duration of follow-up period.
• Regarding age group, the Web-based or computer-based smoking cessation programs obtained a significant greater abstinence rate for adults (RR, 1.49; 95% CI, 1.31 - 1.70) but not for adolescent populations (RR, 1.08; 95% CI, 0.59 - 1.98).
• Limitations of the study were that the findings could not be applied to smokeless tobacco users, and there were the possible disadvantages of online health behavior change programs (such as the potential for privacy and security breaches, low quality of information, and problems with computer system performance).
• Other limitations were that access to these programs in developing countries would be problematic, there was a lack of biochemical validation techniques within the trials, and some articles may have been missed because a search was not conducted in a psychiatry-specific database.
Clinical Implications
• Smoking cessation strategies include brief tobacco dependence treatment; individual, group, and telephone counseling; numerous effective medications (eg, nicotine replacement and bupropion); and telephone quitline counseling.
• The meta-analysis of RCTs indicates sufficient clinical evidence to support the use of Web-based and computer-based smoking cessation programs for adult smokers.