Mediators of a successful web‐based smokeless tobacco cessation program
Open accessAbstract
Aim To examine self‐efficacy and program exposure as possible mediators observed treatment effects for a web‐based tobacco cessation intervention. Design The ChewFree trial used a two‐arm design to compare tobacco abstinence at both the 3‐ and 6‐month follow‐up for participants randomized to either an enhanced intervention condition or a basic information‐only control condition. Setting Internet in US and Canada. Participants Our secondary analyses focused upon 402 participants who visited the web‐based program at least once, whose baseline self‐efficacy rating showed room for improvement, who reported that they were still using tobacco at the 6‐week assessment, and for whom both 3‐ and 6‐month follow‐up data were available. Intervention An enhanced web‐based behavioral smokeless tobacco cessation intervention delivered program content using text, interactive activities, testimonial videos and an ask‐an‐expert forum and a peer forum. The basic control condition delivered tobacco cessation content using static text only. Measurements Change in self‐efficacy and program exposure from baseline to 6 weeks were tested as simple and multiple mediators on the effect of treatment condition on point‐prevalence tobacco abstinence measured at 3‐ and 6‐month follow‐up. Findings While both participant self‐efficacy and program exposure satisfied the requirements for simple mediation, only self‐efficacy emerged as a mediator when we used the more robust test of multiple mediation. Conclusions Results confirm the importance of self‐efficacy change as a probable underlying mechanism in a successful web‐based behavioral intervention. While program exposure was found to be a simple mediator of tobacco abstinence, it failed to emerge as a mediator when tested with self‐efficacy change in a multiple mediator test suggesting that self‐efficacy and program exposure share a complex, possibly reciprocal relationship with the tobacco abstinence outcome. Our results underscore the utility of searching for mediators in research on web‐based interventions.
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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 [85]
The Results (Simple mediation) and Conclusion report that program exposure was associated with abstinence in a web-based smokeless-tobacco cessation study. But exposure was not a significant mediator after accounting for self-efficacy (Results, Multiple mediation). The paper does not study cigarette smoking, the iCanQuit app, or participants with multiple mental health disorders, so it supports the general engagement premise only with those limits. (LLM, conf=0.86)
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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
- Danaher, B. G., Smolkowski, K., Seeley, J. R., & Severson, H. H.
- Affiliations
- Oregon Research Institute (US)
- Corresponding author
- Danaher, Brian G.
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2008-09-05
- Volume
- 103
- Issue
- 10
- Pages
- 1706-1712
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- PMC
- PMC3782377
- OpenAlex
- W2096394900
- Cited by
- 45
- References
- 44
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2022: 3 · 2020: 3 · 2019: 2 · 2018: 6 · 2017: 3 · 2016: 3 · 2015: 4 · 2014: 6 · 2013: 3 · 2012: 1
- FWCI
- 1.58
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Addiction (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (R01 CA 84225, R01CA084225)
- 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
- online intervention, self-efficacy, mediation analysis, smoking abstinence, tobacco use
- MeSH terms
- Adult, Behavior Therapy, Canada, Follow-Up Studies, Humans, Patient Compliance, Therapy, Computer-Assisted, Tobacco, Smokeless, United States, Program Evaluation, Health Behavior, Tobacco Use Cessation, Self Efficacy, Internet
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