Web- and Computer-Based Smoking Cessation Programs May Be Effective for Adult Smokers

Web-based and computer-based smoking cessation programs may be effective for adult smokers, according to the results of a meta-analysis of randomized controlled trials (RCTs) reported in the May 25 issue of the Archives of Internal Medicine.

"The effects of Web- and computer-based smoking cessation programs are inconsistent in...RCTs," write Seung-Kwon Myung, MD, MS, from National Cancer Center in Goyang, South Korea, and colleagues. "To date, recommended smoking cessation strategies include brief tobacco dependence treatment; individual, group, and telephone counseling; numerous effective medications; and telephone quitline counseling."

The review authors identified 287 articles by searching MEDLINE (PubMed), EMBASE, and the Cochrane Review in August 2008, with 2 evaluators independently selecting and abstracting eligible studies. The final analyses included 22 RCTs, which enrolled a total of 29,549 participants (16,050 were randomly assigned to Web or computer-based smoking cessation program groups and 13,499 to control groups).

The intervention had a significant effect on smoking cessation, based on a random-effects meta-analysis of all 22 trials (relative risk [RR], 1.44; 95% confidence interval [CI], 1.27 - 1.64). Results were similar in the 9 trials of a Web-based intervention (RR, 1.40; 95% CI, 1.13 - 1.72) and in the 13 trials of a computer-based intervention (RR, 1.48; 95% CI, 1.25 - 1.76).

Results were also similar in subgroups based on different levels of methodologic study quality, stand-alone vs supplemental interventions, type of abstinence rates used as outcomes, and duration of follow-up period. However, Web-based or computer-based smoking cessation programs did not appear to be effective in adolescent populations (RR, 1.08; 95% CI, 0.59 - 1.98).

Limitations of this meta-analysis include identification of only 3 RCTs in adolescents, inability to evaluate overall socioeconomic status of the participants, lack of evaluation of smokeless tobacco use, and failure to use biochemical validation techniques for abstinence rates.

Some of the study authors noted various disadvantages of online health behavior change programs, including potential breaches of privacy and security and lack of accessibility for smokers who are elderly, less educated, or living in developing countries.

"The meta-analysis of RCTs indicates that there is sufficient clinical evidence to support the use of Web- and computer-based smoking cessation programs for adult smokers," the study authors write. "The programs increase the smoking cessation rate about 1.5 times more than in the control group and obtain an abstinence rate at 12-month follow-up of 9.9%."