An Lawrence C, Schillo Barbara A, Saul Jessie E, Wendling Ann H, Klatt Colleen M, Berg Carla J, Ahulwalia Jasjit S, Kavanaugh Annette M, Christenson Matthew, Luxenberg Michael G
University of Minnesota, Department of Internal Medicine, Division of General Medicine, Minneapolis, MN 55455, USA.
J Med Internet Res. 2008 Dec 20;10(5):e55. doi: 10.2196/jmir.1018.
The association between greater utilization of Web-assisted tobacco interventions and increased abstinence rates is well recognized. However, there is little information on how utilization of specific website features influences quitting.
To determine the association between utilization of informational, interactive, and online community resources (eg. bulletin boards) and abstinence rates, with the broader objective to identify potential strategies for improving outcomes for Web-assisted tobacco interventions.
In Spring 2004, a cohort of 607 quitplan.com users consented to participate in an evaluation of quitplan.com, a Minnesota branded version of QuitNet.com. We developed utilization measures for different site features: general information, interactive diagnostic tools and quit planning tools, online expert counseling, passive (ie, reading of bulletin boards) and active (ie, public posting) online community engagement, and one-to-one messaging with other virtual community members. Using bivariate, multivariate, and path analyses, we examined the relationship between utilization of specific site features and 30-day abstinence at 6 months.
The most commonly used resources were the interactive quit planning tools (used by 77% of site users). Other informational resources (ie, quitting guides) were used more commonly (60% of users) than passive (38%) or active (24%) community features. Online community engagement through one-to-one messaging was low (11%) as was use of online counseling (5%). The 30-day abstinence rate among study participants at 6 months was 9.7% (95% Confidence Interval [CI] 7.3% - 12.1%). In the logistic regression model, neither the demographic data (eg, age, gender, education level, employment, or insurance status) nor the smoking-related data (eg, cigarettes per day, time to first morning cigarette, baseline readiness to quit) nor use of smoking cessation medications entered the model as significant predictors of abstinence. Individuals who used the interactive quit planning tools once, two to three times, or four or more times had an odds of abstinence of 0.65 (95% Confidence Interval [CI] 0.22 - 1.94), 1.87 (95% CI 0.77 - 4.56), and 2.35 (95% CI 1.0 - 5.58), respectively. The use of one-to-one messages (reference = none vs 1 or more) entered the final model as potential predictor for abstinence, though the significance of this measure was marginal (OR = 1.91, 95% CI 0.92 - 3.97, P = .083). In the path analysis, an apparent association between active online community engagement and abstinence was accounted for in large part by increased use of interactive quitting tools and one-to-one messaging.
Use of interactive quitting tools, and perhaps one-to-one messaging with other members of the online community, was associated with increased abstinence rates among quitplan.com users. Designs that facilitate use of these features should be considered.
网络辅助烟草干预措施的更多使用与戒断率提高之间的关联已得到充分认可。然而，关于特定网站功能的使用如何影响戒烟的信息却很少。
确定信息、互动和在线社区资源（如公告栏）的使用与戒断率之间的关联，更广泛的目标是确定改善网络辅助烟草干预效果的潜在策略。
2004年春季，607名quitplan.com用户组成的队列同意参与对quitplan.com（明尼苏达州版的QuitNet.com）的评估。我们针对不同的网站功能制定了使用指标：一般信息、互动诊断工具和戒烟计划工具、在线专家咨询、被动（即阅读公告栏）和主动（即公开发帖）在线社区参与，以及与其他虚拟社区成员进行一对一消息传递。我们使用双变量、多变量和路径分析，研究特定网站功能的使用与6个月时30天戒断情况之间的关系。
最常用的资源是互动戒烟计划工具（77%的网站用户使用）。其他信息资源（即戒烟指南）的使用比被动（38%）或主动（24%）社区功能更为普遍（60%的用户使用）。通过一对一消息传递进行的在线社区参与度较低（11%），在线咨询的使用率也较低（5%）。6个月时研究参与者的30天戒断率为9.7%（95%置信区间[CI]7.3% - 12.1%）。在逻辑回归模型中，人口统计学数据（如年龄、性别、教育水平、就业或保险状况）、与吸烟相关的数据（如每天吸烟量、起床后第一支烟的时间、基线戒烟意愿）以及戒烟药物的使用均未作为戒断的显著预测因素进入模型。使用互动戒烟计划工具一次、两到三次或四次及以上的个体，戒断几率分别为0.65（95%置信区间[CI]0.22 - 1.94）、1.87（95%CI 0.77 - 4.56）和2.35（95%CI 1.0 - 5.58）。一对一消息传递的使用（参考 = 无与1次或更多次）作为戒断的潜在预测因素进入最终模型，尽管该指标的显著性很微弱（OR = 1.91，95%CI 0.92 - 3.97，P = 0.083）。在路径分析中，主动在线社区参与与戒断之间的明显关联在很大程度上是由互动戒烟工具和一对一消息传递使用的增加所解释的。
互动戒烟工具的使用，或许还有与在线社区其他成员的一对一消息传递，与quitplan.com用户戒断率提高相关联。应考虑设计便于使用这些功能的方案。
