Graham Amanda L, Papandonatos George D, Cha Sarah, Erar Bahar, Amato Michael S, Cobb Nathan K, Niaura Raymond S, Abrams David B
Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC.
Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC.
Nicotine Tob Res. 2017 Mar 1;19(3):324-332. doi: 10.1093/ntr/ntw282.
Web-based smoking cessation interventions can deliver evidence-based treatments to a wide swath of the population, but effectiveness is often limited by insufficient adherence to proven treatment components. This study evaluated the impact of a social network (SN) intervention and free nicotine replacement therapy (NRT) on adherence to evidence-based components of smoking cessation treatment in the context of a Web-based intervention.
A sample of adult U.S. smokers (N = 5290) was recruited via BecomeAnEX.org, a free smoking cessation Web site. Smokers were randomized to one of four arms: (1) an interactive, evidence-based smoking cessation Web site (WEB) alone; (2) WEB in conjunction with an SN intervention designed to integrate participants into the online community (WEB+SN); (3) WEB plus free NRT (WEB+NRT); and (4) the combination of all treatments (WEB+SN+NRT). Adherence outcomes assessed at 3-month follow-up were as follows: Web site utilization metrics, use of skills training components, intratreatment social support, and pharmacotherapy use.
WEB+SN+NRT outperformed all others on Web site utilization metrics, use of practical counseling tools, intratreatment social support, and NRT use. It was the only intervention to promote the sending of private messages and the viewing of community pages over WEB alone. Both social network arms outperformed WEB on most metrics of online community engagement. Both NRT arms showed higher medication use compared to WEB alone.
This study demonstrated the effectiveness of two approaches for improving adherence to evidence-based components of smoking cessation treatment. Integrated approaches to medication provision and social network engagement can enhance adherence to components known to improve cessation.
This study demonstrated that an integrated approach to medication provision and social network integration, when delivered through an online program, can enhance adherence across all three recommended components of an evidence-based smoking cessation program (skills training, social support, and pharmacotherapy use). Nicotine replacement therapy-when provided as part of an integrated program-increases adherence to other program elements, which in turn augment its own therapeutic effects. An explicit focus on approaches to improve treatment adherence is an important first step to identifying leverage points for optimizing intervention effectiveness.
基于网络的戒烟干预措施能够为广大人群提供循证治疗，但效果往往因对已证实的治疗要素依从性不足而受限。本研究评估了社交网络（SN）干预和免费尼古丁替代疗法（NRT）在基于网络的干预背景下，对戒烟治疗循证要素依从性的影响。
通过免费戒烟网站BecomeAnEX.org招募了美国成年吸烟者样本（N = 5290）。吸烟者被随机分为四组：（1）仅一个基于循证的交互式戒烟网站（网络组）；（2）网络组加上旨在将参与者融入在线社区的SN干预（网络+SN组）；（3）网络组加上免费NRT（网络+NRT组）；（4）所有治疗方法的组合（网络+SN+NRT组）。在3个月随访时评估的依从性结果如下：网站使用指标、技能培训要素的使用、治疗期间的社会支持以及药物治疗的使用。
在网站使用指标、实用咨询工具的使用、治疗期间的社会支持以及NRT使用方面，网络+SN+NRT组的表现优于所有其他组。它是唯一一种比单纯网络组更能促进私人信息发送和社区页面浏览的干预措施。在大多数在线社区参与指标上，两个社交网络组的表现均优于网络组。与单纯网络组相比，两个NRT组的药物使用量更高。
本研究证明了两种提高戒烟治疗循证要素依从性方法的有效性。药物提供和社交网络参与的综合方法可以增强对已知可改善戒烟效果要素的依从性。
本研究表明，通过在线项目提供药物和整合社交网络的综合方法，可以提高循证戒烟项目所有三个推荐要素（技能培训、社会支持和药物治疗使用）的依从性。作为综合项目一部分提供的尼古丁替代疗法会增加对其他项目要素的依从性，进而增强其自身的治疗效果。明确关注提高治疗依从性的方法是确定优化干预效果杠杆点的重要第一步。
