A digital smoking cessation program delivered through internet and cell phone without nicotine replacement (happy ending): randomized controlled trial.
A digital smoking cessation program delivered through internet and cell phone without nicotine replacement (happy ending): randomized controlled trial.
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DOI：
10.2196/jmir.1005
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发表时间：
2008-11-28
影响因子：
7.4
通讯作者：
Kraft P
中科院分区：
文献类型：
--
作者：
Brendryen H;Drozd F;Kraft P
快乐戒烟（HE）是一个为期1年的高强度戒烟项目，通过互联网和手机实施。HE包括通过电子邮件、网页、交互式语音应答和短信服务技术进行的400多次联系。HE设有渴望求助热线和复发预防系统，提供即时治疗。该项目的所有组成部分都是完全自动化的。
目的是阐述HE设计的基本原理，评估HE在一组愿意尝试在不使用尼古丁替代疗法的情况下戒烟的吸烟者样本中12个月的疗效，并探究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。
采用了双臂随机对照试验。通过互联网广告招募受试者，并随机分配到不同条件组。纳入标准为愿意在规定日期戒烟且不使用尼古丁替代物，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“在过去七天内甚至没有吸一口烟”，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。主要结果是重复时点戒断（即在所有四个时间点都戒断）。在基线和准备阶段结束时（即治疗2周后，但在戒烟日之前）测量应对计划和自我效能。
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时点戒断率在临床和统计学上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 = 0.002）。尽管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（t₂₆₁ = 3.07，P = 0.002）和戒烟前自我效能（t₂₆₁ = 2.63，P = 0.01）显著更高。然而，应对计划和自我效能都没有介导长期治疗效果。然而，对于戒烟1个月后的时点戒断，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个月的试验证明了一种完全自动化的戒烟干预措施在不使用尼古丁替代疗法的情况下的长期治疗效果。该研究增加了利用数字媒体支持行为改变的可能性。
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.
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