Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC, USA.
Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center/Cancer Prevention and Control Program, Washington, DC, USA.
Ann Behav Med. 2018 Mar 15;52(4):331-341. doi: 10.1093/abm/kax023.
Partial adherence in Internet smoking cessation interventions presents treatment and evaluation challenges. Increasing adherence may improve outcomes.
To present smoking outcomes from an Internet randomized trial of two strategies to encourage adherence to tobacco dependence treatment components: (i) a social network (SN) strategy to integrate smokers into an online community and (ii) free nicotine replacement therapy (NRT). In addition to intent-to-treat analyses, we used novel statistical methods to distinguish the impact of treatment assignment from treatment utilization.
A total of 5,290 current smokers on a cessation website (WEB) were randomized to WEB, WEB + SN, WEB + NRT, or WEB + SN + NRT. The main outcome was 30-day point prevalence abstinence at 3 and 9 months post-randomization. Adherence measures included self-reported medication use (meds), and website metrics of skills training (sk) and community use (comm). Inverse Probability of Retention Weighting and Inverse Probability of Treatment Weighting jointly addressed dropout and treatment selection. Propensity weights were used to calculate Average Treatment effects on the Treated.
Treatment assignment analyses showed no effects on abstinence for either adherence strategy. Abstinence rates were 25.7%-32.2% among participants that used all three treatment components (sk+comm +meds).Treatment utilization analyses revealed that among such participants, sk+comm+meds yielded large percentage point increases in 3-month abstinence rates over sk alone across arms: WEB = 20.6 (95% CI = 10.8, 30.4), WEB + SN = 19.2 (95% CI = 11.1, 27.3), WEB + NRT = 13.1 (95% CI = 4.1, 22.0), and WEB + SN + NRT = 20.0 (95% CI = 12.2, 27.7).
Novel propensity weighting approaches can serve as a model for establishing efficacy of Internet interventions and yield important insights about mechanisms.
CLINICAL TRIALS.GOV: NCT01544153.
互联网戒烟干预措施的部分依从性给治疗和评估带来了挑战。提高依从性可能会改善结果。
介绍一项互联网随机试验的吸烟结果，该试验旨在采用两种策略鼓励对烟草依赖治疗成分的依从性：（i）社交网络（SN）策略，将吸烟者纳入在线社区，以及（ii）免费尼古丁替代疗法（NRT）。除意向治疗分析外，我们还使用了新的统计方法来区分治疗分配和治疗利用的影响。
共有 5290 名正在戒烟网站（WEB）上的当前吸烟者被随机分配到 WEB、WEB + SN、WEB + NRT 或 WEB + SN + NRT。主要结局是 3 个月和 9 个月后随机分组时 30 天的点患病率戒烟率。依从性测量包括自我报告的药物使用（药物）以及技能培训（技能）和社区使用（社区）的网站指标。反向概率保留加权和反向概率治疗加权共同解决了辍学和治疗选择问题。倾向评分用于计算对治疗的平均治疗效果。
治疗分配分析显示，两种依从性策略对戒烟均无影响。在使用所有三种治疗成分（sk+comm+meds）的参与者中，戒烟率为 25.7%-32.2%。治疗利用分析显示，在这些参与者中，与仅使用 sk 相比，sk+comm+meds 在 3 个月的戒烟率上产生了较大的百分点增加，跨越各个组别：WEB = 20.6（95%CI=10.8,30.4），WEB+SN=19.2（95%CI=11.1,27.3），WEB+NRT=13.1（95%CI=4.1,22.0），WEB+SN+NRT=20.0（95%CI=12.2,27.7）。
新颖的倾向评分方法可以作为确定互联网干预措施疗效的模型，并提供有关机制的重要见解。
临床试验.gov：NCT01544153。
