07 October 2014

Online tool helps low-income people quit smoking

StopAdvisor, an interactive website, was designed as both a source of useful information and a guide to help the smoker through the process of quitting.


In a preliminary trial, an interactive website developed in England called StopAdvisor was found to be especially helpful to low-income people in quitting smoking.

Poorer participants

Health researchers worry that people with low income or low education levels may be left out when it comes to digital innovations in health and wellness, but in this study, poorer participants benefited even more from the online tool than wealthier ones.

Low-income populations tend to have lower success rates in quitting smoking in general, but it's not clear why, said lead study author Dr Jamie Brown of the health behaviour research centre in the department of epidemiology and public health at University College London.

They "make as many attempts to quit and report being as motivated as others, but success is lower", Brown told Reuters Health.

Read: Quit smoking by phone

"When you have other aspects of life draining your resources it might make stopping smoking even more difficult", he said.

StopAdvisor was designed as both a source of useful information and a guide to help the smoker through the process of stopping with a structured quit plan.

Abrupt cessation

Structured dialogue sessions on the interactive site presented behaviour-change techniques that focused on helping with goal setting and action planning around a quit date, emphasising the importance of abrupt cessation, acquiring appropriate medicines and how best to use them.

The site suggests changes in routines to minimise urges to smoke after the target quit date, develops specific coping strategies for anticipated difficulties in quitting and demonstrates clear expectations about the nature of those difficulties. Once a quit date goal has been set, the programme sends email reminders to the participant.

After the quit date, the programme offered new resources to support continued abstinence including battling urges to smoke, feeling self-efficacy, use of medicines and anticipating stressful or social events.

Read: Quitting smoking improves mood

For the new study, researchers assigned 4 600 online volunteers over age 18 who smoked every day to either use StopAdvisor or an information-only website. Nearly half of the participants were of low socioeconomic status.

Six months after their quit dates, participants reported whether or not they had successfully quit, meaning they had smoked no more than five cigarettes since the quit date. Their claims were verified by saliva tests.

Socioeconomic status

Overall, 10% of people in the StopAdvisor group and 10% in the comparison group had successfully quit smoking.

But when researchers looked at participants by socioeconomic status, they found that 8% of lower-income participants in the StopAdvisor group had successfully quit, compared to 6% of low-income participants using the non-interactive website.

Overall, high-socioeconomic status participants were more successful in quitting, but it didn't matter which website they were using. About 12% of those in the StopAdvisor group and those in the information-only website group stopped smoking, according to the results in the lancet respiratory medicine.

"StopAdvisor is based on behaviour change theories and techniques, which have proven efficacy", said Kamran Siddiqi, a researcher in the department of health sciences at the University of York, who co-authored an editorial accompanying the new results.

Read: Tougher for women to quit smoking

"It appears that it was those techniques that when delivered through a web-based programme worked for some of the smokers in the intervention arm," he told Reuters Health by email.

Face-to-face support

Despite their modest effect, internet-based approaches are appealing because they're low cost and might be used by smokers who would otherwise have no access to behavioural support or drugs, he wrote in the editorial.

The most effective way to quit uses intensive face-to-face support and medication, Brown said. In the UK there are actual human stop-smoking advisors readily available for a very low cost or for free, which makes England a unique environment, he said.

But even so, only a small percentage of people trying to quit smoking take advantage of that resource, he said.

"StopAdvisor was evaluated in England with English smokers but we have no reason to believe it wouldn't generalise", Brown said.

Read: Quitting smoking good for the heart

"You wouldn't want to recommend it confidently without doing that additional evaluation, of course."

The online tool probably works specifically for low-income people because it was developed with their suggestions in mind, after user testing with a group of 24 low socioeconomic status volunteers, Brown said.

Clickable content

"It involved using a think-aloud methodology where they were encouraged to say whatever came to mind as they used it, including style, imagery, navigation", he said.

Incorporating user feedback, the developers employed a professional writer to go through the site and rewrite the text, making the language more accessible. They also tried to increase the interactivity of the site including some imagery or clickable content on every page.

Read: Smoking: quitting is cost-effective

Thirdly, they worked hard to explain to users how important it is to log in even if you think things are going well.

"If you wait until you are struggling to log in, it will be too late", Brown said.

There are other web tools for quitting smoking, but none have been tailored specifically for low-income populations, Siddiqi said.

Currently the public health authority is working to implement a version of Stop Advisor at a national level in England and is working with researchers in Belgium and New Zealand, Brown said, but there is no plan for a US version.

However, if it proves effective there, it will likely be emulated elsewhere, he said.

Read more:

Obama finally quits smoking
Quit smoking: different solutions
Smoking less helps with quitting

Image: Time to quit smoking from Shutterstock




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