Despite decades of antismoking efforts, tobacco use remains the leading preventable cause of death in the United States, claiming some 440,000 lives each year. The US Public Health Service estimates 70% of current smokers want to quit and recommends counseling to help them achieve that goal.
The challenge, of course, is to provide such counseling to all who need it. Face-to face interventions may not be available everywhere, and telephone services, although widespread, may not appeal to some smokers. The enormous popularity of the Internet as a source of health information makes it an obvious solution to the problem of access, but there is little information to guide smokers—and the health care providers who advise them—in seeking out an effective program from the myriad offerings currently available.
An Internet-based clinical trial sponsored by the American Cancer Society (ACS) may help. In October 2004, the ACS began enrolling smokers in QuitLink, a study of six different online quitting services.
“We know there are a lot of smokers out there who really want to quit, and it's difficult,” said Joanne Pike, MA, LPC, Director of the ACS Quitline, a telephone-based cessation service. “[This study] will give us answers on how best to help smokers quit using online resources.”
The study will include 6,000 English-speaking smokers over age 18; enrollment information is available at www.cancer.org/quittobacco. Participants will be randomly assigned to one of the following programs: QuitNet, SmokeClinic, ProChange, the Oregon Center for Applied Science, Centre for Addiction and Mental Health VCC, or an ACS program.
Each has a different approach to smoking cessation. Some, for instance, have a heavy focus on motivating and preparing the smoker for the eventual quit day, while others rely more on providing educational materials or support from counselors and other peers.
Some of the programs (including the ACS service) are available free of charge; although others charge a fee, study participants will be given free enrollment if randomized into one of those programs. Participants' progress will be checked 3, 6, and 12 months after enrolling. The study is the largest Web-based trial of smoking cessation programs ever conducted in the United States.
“Part of the reason that we're interested in doing this and committing resources to it is that so far, we don't have a good randomized trial that looks at how effective Web services are, and there are lots of people who believe in them,” said Vance Rabius, PhD, MA, Evaluation Manager of the ACS Quitline.
Several studies have shown that telephone counseling can improve a smoker's chance of quitting successfully. In one ACS study conducted in 2000, access to counseling nearly doubled maintained quit rates over 1 year (Tobacco Control 2004;13:85–86).
Although online counseling offers many of the advantages of telephone counseling—relative anonymity, widespread and easy accessibility—it remains to be seen if online cessation services will have the same success. One problem researchers often encounter, Rabius said, is tracking down participants after they've finished an online program to find out if they're still off cigarettes. Follow-up is likely to be a challenge with the ACS study as well, he admitted.
But the information gleaned could help some of the 46 million adult smokers in the United States quit.
“If [online cessation] is as successful as telephone counseling, that would be very nice, because we think it serves a different population, and we know telephone counseling doesn't reach everyone,” Rabius said. “And once an online program is set up, it's relatively inexpensive to maintain and can reach a very large number of constituents.”