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A Review of the Evidence on Technology-Based Interventions for the Treatment of Tobacco Dependence in College Health

Authors

  • Joanne Brown APRN, DNP, WHNP, FNP, CTTS

    Corresponding author
    • Doctor of Nursing Practice, University Health Service, University of Kentucky, Lexington, KY
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  • The author is grateful for the mentorship and guidance of Carolyn A. Williams, RN, PhD, FAAN, and Ellen J. Hahn, RN, PhD, FAAN, University of Kentucky, College of Nursing.

Address correspondence to Joanne Brown, University Health Service, University of Kentucky, 830 South Limestone Street, Lexington, KY 40536-0582; joanne.brown@uky.edu

ABSTRACT

Background

The college years are a critical time in the development of smoking behavior and tobacco use. Smoking is linked to 30% of cancer deaths, 80% of deaths from chronic obstructive pulmonary disease, and early cardiovascular disease and death. Effective cessation interventions at this time provide an opportunity to drastically reduce premature morbidity and mortality.

Aims

To review available evidence on Internet interventions with young adults, including methodology, theoretical frameworks and outcome measures for tobacco treatment to guide the development of a program in college health.

Methods

A comprehensive literature search for studies published from January 1999 to February 2011, in multiple databases was conducted, along with hand-searching of reference lists. Inclusion criteria were: participants aged 18–30 years, intervention involved the Internet through either Web sites or e-mail or texting, and outcome measurement of tobacco cessation/abstinence. Studies were evaluated utilizing a tool synthesized from guidelines presented by the Cochrane Collaboration.

Findings

Eight studies met the inclusion criteria (four randomized controlled trials, four cohort studies). Theoretical frameworks utilized were the Transtheoretical Model of Change, Health Belief Model, Theory of Social Support, and social cognitive theory. Interventions varied and included computer-generated advice letters, Web-based cessation guides, computer-generated text messages, and peer e-mail support. With smoking abstinence as the primary outcome measure, there was a statistically significant improvement in quit rates. Because of the use of multiple components, differences in interventions and the number of contacts, it is not clear what types of computer-based applications are most effective. Small sample sizes, lack of control groups, and inconsistency in outcome measures limit the ability to provide conclusive evidence to support these interventions—but support the feasibility to use in the design of future programs.

Conclusions

Use of technology-based interventions, such as the Internet, may be an effective tool for tobacco treatment interventions, especially with college students. There is great potential to reach large numbers of students, many who may not identify themselves as smokers or seek traditional methods for treatment. Additional research is needed to determine which technology-based interventions are most effective and to provide more conclusive evidence.

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