Improving Adherence to Smoking Cessation Treatment: Smoking Outcomes in a Web-based Randomized Trial
Open accessAbstract
Background: Partial adherence in Internet smoking cessation interventions presents treatment and evaluation challenges. Increasing adherence may improve outcomes. Purpose: To present smoking outcomes from an Internet randomized trial of two strategies to encourage adherence to tobacco dependence treatment components: (i) a social network (SN) strategy to integrate smokers into an online community and (ii) free nicotine replacement therapy (NRT). In addition to intent-to-treat analyses, we used novel statistical methods to distinguish the impact of treatment assignment from treatment utilization. Methods: A total of 5,290 current smokers on a cessation website (WEB) were randomized to WEB, WEB + SN, WEB + NRT, or WEB + SN + NRT. The main outcome was 30-day point prevalence abstinence at 3 and 9 months post-randomization. Adherence measures included self-reported medication use (meds), and website metrics of skills training (sk) and community use (comm). Inverse Probability of Retention Weighting and Inverse Probability of Treatment Weighting jointly addressed dropout and treatment selection. Propensity weights were used to calculate Average Treatment effects on the Treated. Results: Treatment assignment analyses showed no effects on abstinence for either adherence strategy. Abstinence rates were 25.7%-32.2% among participants that used all three treatment components (sk+comm +meds).Treatment utilization analyses revealed that among such participants, sk+comm+meds yielded large percentage point increases in 3-month abstinence rates over sk alone across arms: WEB = 20.6 (95% CI = 10.8, 30.4), WEB + SN = 19.2 (95% CI = 11.1, 27.3), WEB + NRT = 13.1 (95% CI = 4.1, 22.0), and WEB + SN + NRT = 20.0 (95% CI = 12.2, 27.7). Conclusions: Novel propensity weighting approaches can serve as a model for establishing efficacy of Internet interventions and yield important insights about mechanisms. Clinical Trials.gov: NCT01544153.
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It remains plausible that reduced engagement with the iCanQuit app contributed, at least partially, to the diminished odds of quitting smoking among participants with two or more mental health disorders.
“Considering that engagement with an app-based intervention is a strong predictor of smoking cessation [49, 85, 86, 87, 88, 89], it remains plausible that reduced engagement with the iCanQuit app contributed, at least partially, to the diminished odds of quitting smoking among participants with two or more mental health disorders.”
From Can an Acceptance and Commitment Therapy-Based Smartphone App Help Individuals with Mental Health Disorders Quit Smoking? (2024) · cites this paper as [86]
The Discussion reports that community engagement combined with medication use was associated with significantly higher abstinence than skills training alone. But this was a website-based intervention, not an app, and strategies that increased engagement did not increase overall abstinence. The paper therefore supports a qualified link between engagement and quitting, not the broader claim that app engagement is a strong predictor; the iCanQuit explanation is the citing authors’ own inference. (LLM, conf=0.82)
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Nicotine replacement therapy versus control for smoking cessation
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“Considering that engagement with an app-based intervention is a strong predictor of smoking cessation [49, 85, 86, 87, 88, 89], it remains plausible that reduced engagement with the iCanQuit app contributed, at least partially, to the diminished odds of quitting smoking among participants with two…”
- Authors
- Graham, A. L., Papandonatos, G. D., Cha, S., Erar, B., & Amato, M. S.
- Affiliations
- Truth Initiative (US)
- Brown University (US)
- Corresponding author
- Graham, Amanda L
- Venue
- Annals of Behavioral Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-02-02
- Volume
- 52
- Issue
- 4
- Pages
- 331-341
- ISSN
- 0742-5554 (ISSN-L)
- 0883-6612
- 1532-4796
- PMC
- PMC6037305
- OpenAlex
- W2792532026
- Cited by
- 18
- References
- 53
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 1 · 2022: 2 · 2021: 4 · 2020: 4 · 2019: 1 · 2018: 2
- FWCI
- 1.89
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Annals of Behavioral Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute
- National Institutes of Health (#1R01CA155489-01A1)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Keywords
- smoking cessation, medication adherence, online intervention, nicotine replacement therapy, online communities, social networks, abstinence, propensity score weighting, inverse probability of treatment weighting, average treatment effect on the treated, dropout, tobacco dependence
- MeSH terms
- Smoking Cessation Agents, Adult, Behavior Therapy, Combined Modality Therapy, Humans, Patient Acceptance of Health Care, Patient Compliance, Models, Statistical, Smoking Cessation, Outcome Assessment, Health Care, Internet, Social Networking, Tobacco Use Cessation Devices
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