Web Assisted Tobacco Interventions in 2009: A Review of the Current Research Findings

1. Web Assisted Tobacco Interventions in 2009: A Review of the Current Research Findings Trevor van Mierlo, BA(Hons), msCCH (C) Peter Selby, MBBS, CCFP, MCSC, ASAM, MRO

2. Trevor van Mierlo is filling in for Dr. Peter Selby Trevor is currently enrolled at the University of Toronto Dalla Lana School of Public Health Candidate: Masters of Science in Community Health with a concentration on Addictions and Mental Health Dr. Selby is advising Trevor on his practicum, this presentation is part of the practicum Potential Conflict of Interest Trevor van Mierlo is CEO of Evolution Health Systems Inc. Evolution develops, validates and licenses web- and mobile-phone based behavioral health interventions and social networking tools Evolution Health is a vendor to Canadian Cancer Society, operating the Smokers’ Helpline Online for Ontario, Manitoba, Saskatchewan, PEI, New Brunswick, Nova Scotia and Yukon. Introduction

3. 2009 Key WATI Research Findings • Most influential publications this year: • Myung, McDonnell, Kazinets, Seo, Moskowitz (2009) Effects of Web-and Computer-Based Smoking Cessation Programs. (Meta analysis) • Barrera, Perez-Stable, Delucchi and Munoz (2009) Global Reach of an Internet Smoking Cessation Intervention among Spanish- and English- Speaking Smokers from 157 Countries • Whittaker, Borland, Bullen, Lin, McRobbie, Rodgers (2009) Mobile phone-based interventions for smoking cessation (Review)

4. Effects of Web-and Computer-Based Smoking Cessation Programs Publication 1: Myung et al, Effects of Web-and Computer-Based Smoking Cessation Programs. Summary: A meta analysis demonstrates that Web- and Computer-based interventions are effective for adult smokers 1

5. Effects of Web-and Computer-Based Smoking Cessation Programs • Background Numbers • 22 RCTs selected • 29,549 participants • 16,050 randomized to a Web- or computer-based smoking cessation program and 13,499 to one of the control groups • U.S., U.K. Australia, Germany, Norway and Switzerland • 10 of the studies used supplemental interventions, such as counselling, classroom lessons, nicotine replacement therapy, Bupropion medication or quit lines • 12 trials used only the Web or computer-based smoking cessation programs • 9 used a Web-based smoking cessation program • 13 used a Computer-based smoking cessation program 1

6. Effects of Web-and Computer-Based Smoking Cessation Programs • Results of Analysis • Web- or computer based smoking cessation programs had an abstinence rate of about 1.5 times higher than the control groups. • Abstinence rate at 12-month follow up was 9.9%. • The Web- or computer-based smoking cessation programs obtained a significantly greater abstinence rate for adults (RR, 1.49; 95% CI, 1.31-1.70; I”=58.2%; n=19) but not for adolescents (RR, 1.08; 95% CI, 0.59 -1.98; I”= 65.3% n=3) • Trials reporting smoking cessation for follow-up durations of 6 months or longer had an odds ratio for successful smoking cessation of 1.53 (95% CI 1.29-1.82; I”=51.8%) 1

7. Effects of Web-and Computer-Based Smoking Cessation Programs • Discussion • Web- or computer-based smoking cessation program had no effect on smoking cessation for adolescent smokers • But this meta-analysis only included 3 RCTs for this age group so more trials are needed • Limitations of the analysis discussed: • Findings cannot be applied to Smokeless Tobacco users because literature is limited • Potential disadvantages of online health programs • potential for privacy and security breaches, low quality of information and problems with computer system performance; also limited access for groups such as seniors • Biochemcial validation techniques were not considered 2

8. Global Reach of an Internet Smoking Cessation Intervention • Publication 2: Barrera et al, Global Reach of an Internet Smoking Cessation Intervention among Spanish- and English- Speaking Smokers from 157 Countries • Summary: Smokers from many countries are interested in using web-based smoking cessation tools 2

9. Global Reach of an Internet Smoking Cessation Intervention • Methods • Participants were recruited through the World Wide Web • 18 years or older • 5+ cigarettes daily • use email at least once a week • planning to quit smoking within the next 30 days • 17,579 participants were included in the final analysis • Represented 157 countries • 56.8% Spanish speakers 2

10. Global Reach of an Internet Smoking Cessation Intervention • Results and Discussion • Smoking patterns were very similar across regions of the world among persons who speak English or Spanish • Possibility that smoking cessation programs may work similarly in different regions? • According to the researchers “it appears as though this smoking cessation Website reached smokers who were interested in quitting and who resided in countries where languages other than English and Spanish are the official languages” • Evidence that individuals who are depressed are less likely to quit smoking, and more likely to start and continue smoking • 50% of the participants had elevated symptoms of depression before they were enrolled in the study 2

11. Mobile phone-based interventions for smoking cessation • Publication 3: Whittaker et al, Mobile phone-based interventions for smoking cessation • Summary: More evidence is needed over the long term, but in the short term (6 weeks) mobile phone delivery for smoking cession, and a combined internet-mobile phone program is effective up to 12 months 3

12. Mobile phone-based interventions for smoking cessation • Background • There are more than 4 billion mobile cellular subscriptions worldwide • Mobile phone interventions seem to offer some benefits • Especially appealing to younger people • Cost-effective delivery and scalability to large populations regardless of location • The ability to tailor messages to key user characteristics (Such as age, sec, ethnicity), • Time sensitive messages • Ability to link the user with others for social support. 3

13. Mobile phone-based interventions for smoking cessation • Results and Discussion • Text message mobile phone programs are effective in the short-term (six weeks) • Combined Internet-mobile phone program to be effective up to 12 months • Limited rigorous studies conducted on mobile phone-based smoking cessation programs, therefore only short-term beneficial effects have been seen • The authors call for more rigorous long-term studies 3

14. Implications for Quitlines • What we learned in 2009: • The line between Quitlines and WATIs is beginning to blur as services become more integrated, e.g. text messaging • Future trends to watch: • Continued growth and uptake of text messaging • Leveraging the power of the Internet to offer more targeted / tailored interventions • Social Networking: message boards, blogs, Facebook, Twitter, etc. • One-on-one web-based counseling

15. Thank You!