Adding proactive telephone counselling to internet treatment in smoking cessation outperforms internet interventions alone, finds a US study in the Archives of Internal Medicine.

The internet's interactive and social networking features offer a new approach for tailoring smoking cessation treatments to individual patients, delivering the potential to reach millions of smokers each year.

In the Quit Using Internet and Telephone Treatment (iQUITT) study, Alison Graham and colleagues from the Schroeder Institute for Tobacco Research (Washington DC) recruited 2005 subjects, with a mean age of 35.9 years, who smoked five or more cigarettes a day and had clicked on a link to a smoking cessation website.

Between March 2005 and November 2008, participants were randomised to basic internet intervention with a static information only web sites that lacked tailoring and social networking functions (BI, n=679); enhanced internet with strong social networking allowing participants to set quit dates and track motivation (EI, n=651); or to enhanced internet together with telephone counselling (EI+P, n=675). In the study the investigators used QUITNET.com, a website with more than 60,000 monthly users.

Results show that the 30-day multiple point prevalence abstinence rate at 18 months was 3.5% for those allocated BI, 4.5% for those allocated EI, and 7.7% for enhanced internet plus proactive telephone counselling (EI+P).

"Our findings demonstrate the effectiveness of combined internet and telephone treatment for smoking cessation in promoting sustained abstinence, as well as the effectiveness of BI and EI treatments," write the authors, adding that the strengths of the study include real world relevance, while limitations include the possible self-selection of individuals with high levels of motivation to quit.

Future studies, they add, will need to address the optimal duration, intensity and active ingredients of treatment and assess cost-effectiveness of the interventions.

In an accompanying editorial, Nancy Rigotti from Massachusetts General Hospital writes, "If the promise holds Internet based tobacco treatment could provide an exciting new component to tobacco care management."

But whether the combination treatment is more cost effective than web based counselling will need to be addressed, she cautions.

Reference

A Graham, N Cobb, G Papandonatos A randomised trial of internet and telephone treatment for smoking cessation Arch Intern Med (2011) 171:46-53.

N Rigotti Integrating comprehensive tobacco treatment into the evolving US health care system: it's time to act Ibid 53-55