WATI europe

1. WATI europe QUIT LINES OR QUIT SITES ? Amsterdam 2008

2. Main Reason • Set up to answer the questions: • What is the effectiveness (includes cost effectiveness) of internet, PC and other electronic aids to help people stop smoking? • How do we cherry-pick successful interventions and promote them?

3. Case study 1 • In 1999 and 2000, the NHS smoking treatment services were established to deliver evidence based services to individual smokers wanting to quit. These services have been going on for some 8 years now (1) • They have a 12 month quit rate of 15% (2) • However, less than 2 per cent of the adult smoking population typically access these services (3) • Operation only cost/quitter at 4 weeks (!) is average € 250/quitter. If taken from same figures but at 12 months is on average €730/quitter. • Raw M, McNeill A, Coleman T. Lessons from the English smoking treatment services. Addiction 2005;100:84-91. • Ferguson J, Bauld L, Chesterman J, Judge K. The English smoking treatment services: one-year outcomes. Addiction 2005;100:59-69 • Bauld L, Chesterman J, Judge K, Pound E, Coleman T. Impact of UK National Health Service smoking cessation services: variations in outcomes in England. Tob Control 2003 Sep;12(3):296-301. • NHS Department of Health (2oo7) Staistics on NHS Stop Smoking Services Apr 2005-Mar 2006

4. Smoking cessation in the UK: 2004 Smokers Sources: 1 ONS October/November 2004 2 Hughes et al, Tob Con 2003, 12, 21-27 3. Shiffman et al, 2002, Addiction, 97, 505-512 4. Addiction supplement March 2005 5. Hughes et al, 2004, Addiction, 99, 29-38 OTC means from shop or pharmacist 33% Attempt to quit1 21% use treatment1 12% go ‘cold turkey’ 10% buy NRT OTC1 4% use prescription only1 7% use a smokers’ clinic1 Quit for at least 12 months 8%2 8%3 15%4 4%5 + 0.32% + 1.05% + 0.48% 0.8% = 2.65% stop smoking

5. IMPACT • IMPACT= REACH x EFFICACY • High Impact= Big Reach x High Efficacy • Low Impact= Small Reach x Low Efficacy What permutation is acceptable? • big reach x small efficacy? • or: small reach x high efficacy? • or: modest reach x modest efficacy? • or: cost per quitter?

6. REACH BENCH MARK • 1ST TIER MEDIA CAMPAIGN AND LEGISLATION: Smokers can be encouraged to quit using large-scale public health promotion programmes and legislative controls. The effectiveness of such large scale initiatives in supporting individual quitters can be low, since they lack the personal element that drives the effectiveness of counselling approaches (1). • 1. Gilbert H, Nazareth I, Sutton S, Morris R, Godfrey C. Effectiveness of computer-tailored Smoking Cessation Advice in Primary Care (ESCAPE): a Randomised Trial. Trials 2008;9:23.

7. EFFICACY BENCH MARK • 1ST TIER Self-help- Efficacy 0-3% Standard self help materials have been shown to have small but significant effects in helping smokers to quit (1) • Computer systems that tailor the content of self-help materials to individual smoker characteristics and “tailor-made” self-help material delivered by letter or by email, websites and mobile phone text messaging combine the benefits of the personally tailored behaviour-change techniques from clinical approaches with the high population reach of large-scale public health initiatives. (2) (3) (4) (5) • Tailored advice 3-5.8% quit rate versus control group 1.5-2.7% at 6 months (6) (1) Lancaster T, Stead LF. Self-help interventions for smoking cessation. Cochrane Database of Systematic Reviews 2005;(3). (2) Kreuter MW, Strecher VJ, Glassman B. One size does not fit all: the case for tailoring print materials. Ann Behav Med 1999;21(4):276-83. (3) Dijkstra A, De Vries H. The development of computer-generated tailored interventions. Patient EducCouns 1999 Feb;36(2):193-203. (4) Strecher VJ. Computer-tailored smoking cessation materials: A review and discussion. Patient Education and Counseling 1999;36:107-17 (5) Sutton S, Gilbert H. Effectiveness of individually tailored smoking cessation advice letters as an adjunct to telephone counselling and generic self-help materials: randomized controlled trial. Addiction 2007 Jun;102(6):994-1000. (6) Lennox A, Osman L et al Cost effectiveness of computer tailored and non-tailored smoking cessation letters in general practice: randomised controlled trial BMJ 2001;322:1396

8. REACH EXTENSION • Many Europeans say that they use the internet. But, strongly shaped according to education level, with 55 per cent use among those educated to secondary school level and 90 per cent use among graduates (1) • Mobile phone ownership is also increasing, as is the trend for individuals to access the internet via mobile devices(2) (3) • Dutton W, Helsper EJ. The Internet in Britain: 2007. Oxford, UK: Oxford Internet Institute, University of Oxford; 2007. • Shepherd A. Use of ICT among Households and Individuals. In: Avery V, Chamberlain E, Summerfield C, Zealey L, editors. FOCUS ON: the Digital Age. 2007 ed. Basingstoke, UK: Palgrave Macmillan; 2007. p. 1-6. • Walters ST, Wright JA, Shegog R. A review of computer and Internet-based interventions for smoking behavior. Addictive Behaviors 2006 Feb;31(2):264-77.

9. IMPROVING EFFICACY • When the first generation of telephone counselling was reviewed, a modest 2.5-3% quit rate was attributable. (1) • With the latest review, improved protocols and practice means that proactive counselling is now quoted by Cochrane to have up to 8% quit rates (2) • Similarly, a slow improvement in computer based interventions is also emerging (3) • West R et al Smoking cessation Guidelines and update • Stead LF, Perera R, Lancaster T,. Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews 2001, Issue 2 • Walters ST, Wright JA, Shegog R. A review of computer and Internet-based interventions for smoking behavior. Addictive Behaviors 2006 Feb;31(2):264-77.

10. What exactly can be done? • Setting a quit date and diary of appointments thereof with timely reminders of treatment e-mails and alerts- simple outlook type of programme