Brendryen Håvar, Drozd Filip, Kraft Pål
Department of Psychology, Postboks 1094 Blindern, 0317 Oslo, Norway.
J Med Internet Res. 2008 Nov 28;10(5):e51. doi: 10.2196/jmir.1005.
Happy Ending (HE) is an intense 1-year smoking cessation program delivered via the Internet and cell phone. HE consists of more than 400 contacts by email, Web pages, interactive voice response, and short message service technology. HE includes a craving helpline and a relapse prevention system, providing just-in-time therapy. All the components of the program are fully automated.
The objectives were to describe the rationale for the design of HE, to assess the 12-month efficacy of HE in a sample of smokers willing to attempt to quit without the use of nicotine replacement therapy, and to explore the potential effect of HE on coping planning and self-efficacy (prior to quitting) and whether coping planning and self-efficacy mediate treatment effect.
A two-arm randomized controlled trial was used. Subjects were recruited via Internet advertisements and randomly assigned to condition. Inclusion criteria were willingness to quit on a prescribed day without using nicotine replacement and being aged 18 years or older. The intervention group received HE, and the control group received a 44-page self-help booklet. Abstinence was defined as "not even a puff of smoke, for the last seven days" and was assessed by means of Internet surveys or telephone interviews 1, 3, 6, and 12 months postcessation. The main outcome was repeated point abstinence (ie, abstinence at all four time points). Coping planning and self-efficacy were measured at baseline and at the end of the preparation phase (ie, after 2 weeks of treatment, but prior to cessation day).
A total of 290 participants received either the HE intervention (n=144) or the control booklet (n=146). Using intent-to-treat analysis, participants in the intervention group reported clinically and statistically significantly higher repeated point abstinence rates than control participants (20% versus 7%, odds ratio [OR] = 3.43, 95% CI = 1.60-7.34, P = .002). Although no differences were observed at baseline, by the end of the preparation phase, significantly higher levels of coping planning (t(261) = 3.07, P = .002) and precessation self-efficacy (t(261) = 2.63, P = .01) were observed in the intervention group compared with the control group. However, neither coping planning nor self-efficacy mediated long-term treatment effect. For point abstinence 1 month after quitting, however, coping planning and self-efficacy showed a partial mediation of the treatment effect.
This 12-month trial documents a long-term treatment effect of a fully automated smoking cessation intervention without the use of nicotine replacement therapy. The study adds to the promise of using digital media in supporting behavior change.
“美好结局”（HE）是一项通过互联网和手机实施的为期1年的强化戒烟计划。HE通过电子邮件、网页、交互式语音应答和短信服务技术进行400多次联系。HE包括一条渴望求助热线和一个预防复吸系统，提供即时治疗。该计划的所有组成部分均完全自动化。
目的是描述HE设计的基本原理，评估HE在一组愿意尝试不使用尼古丁替代疗法戒烟的吸烟者样本中的12个月疗效，并探讨HE对应对计划和自我效能（戒烟前）的潜在影响，以及应对计划和自我效能是否介导治疗效果。
采用双臂随机对照试验。通过互联网广告招募受试者并随机分配至相应组。纳入标准为愿意在规定日期戒烟且不使用尼古丁替代疗法，年龄在18岁及以上。干预组接受HE，对照组接受一本44页的自助手册。戒断定义为“过去七天连一口烟都没吸”，并在戒烟后1、3、6和12个月通过互联网调查或电话访谈进行评估。主要结局是重复点戒断（即四个时间点均戒断）。应对计划和自我效能在基线和准备阶段结束时（即治疗2周后，但在戒烟日之前）进行测量。
共有290名参与者接受了HE干预（n = 144）或对照手册（n = 146）。采用意向性分析，干预组参与者报告的重复点戒断率在临床和统计学上均显著高于对照组参与者（20%对7%，优势比[OR] = 3.43，95%置信区间 = 1.60 - 7.34，P = .002）。虽然在基线时未观察到差异，但到准备阶段结束时，与对照组相比，干预组的应对计划水平（t(261) = 3.07，P = .002）和戒烟前自我效能（t(261) = 2.63，P = .01）显著更高。然而，应对计划和自我效能均未介导长期治疗效果。然而，对于戒烟后1个月的点戒断，应对计划和自我效能显示出对治疗效果的部分介导作用。
这项为期12个月的试验记录了一种不使用尼古丁替代疗法的完全自动化戒烟干预的长期治疗效果。该研究增加了使用数字媒体支持行为改变的前景。
