Question

What is the effectiveness of Internet-based interventions for smoking cessation?

Relevance to nursing care

Tobacco smoking is a major public health problem and over 13 000 people die every day from tobacco-related diseases. The Internet is a promising vehicle for delivering smoking cessation treatment either as a stand-alone program or as an adjunct to pharmacotherapy. This review was conducted to determine the effectiveness of Internet-based interventions for smoking cessation. The outcomes of the review may be incorporated into nursing care interventions.

Study characteristics

This review included 20 randomised trials containing nearly 40 000 participants.1 The primary outcome was smoking cessation at least 6 months after the start of the intervention, and longer wherever the data were available. The review included Internet studies in all settings and from all types of provider. There was no exclusion with respect to intervention method or duration. The review included trials where the Internet intervention was evaluated as an adjunct to a pharmacotherapy such as nicotine replacement therapy (NRT), bupropion or varenicline, but only where the Internet component was the intervention being tested.

The majority of studies did not explicitly describe the way in which the randomisation sequence was generated or concealed until patient enrolment. In 11 studies, computer randomisation was used to assign participants to intervention or control conditions. Meta-analysis was undertaken where possible.

* Two trials in adult populations detected a statistically significant effect of the Internet intervention on sustained abstinence at 12 months whether it was compared with a self-help control (relative risk (RR) 2.94, 95% confidence intervals (CI) 1.49-5.81) or tested as an adjunct to NRT (RR 1.71, 95% CI 1.10-2.66).

* One trial did not detect a statistically significant effect on smoking cessation in the Internet component as an adjunct to counselling and bupropion while another trial also did not detect an effect of an Internet component either compared with, or as an adjunct to, telephone counselling and varenicline.

* There was some evidence that sites that were tailored and interactive might be more effective than static sites, but this was not detected in eight studies that explored this factor. One large trial did not detect differences between different Internet sites. One trial of a tailored intervention as an adjunct to NRT use showed a significant benefit but only had a 3-month follow up.

Implications for nursing care

Internet-based intervention programs that provide individually tailored information and support may be more effective than a static website in the cessation of smoking in adults. The Internet may have an additional benefit when used alongside other interventions, such as NRT or other pharmacotherapy.

Implications for research

Further studies should be conducted to compare the long-term effects of Internet interventions with non-Internet interventions or no intervention at all in order to determine the true long-term effectiveness of the Internet as a tool for smoking cessation. These should, where possible, assess outcomes using objective measures, and also assess cost-effectiveness considerations.

Reference