Improving Adherence to Web-based Cessation Programs: A Social Network Approach

描述（由申请人提供）：减少人口吸烟率是一项紧迫的公共卫生优先事项，它比几乎任何其他已知的预防干预措施都能挽救更多的生命和金钱。实际咨询、社会支持和尼古丁替代疗法（NRT）是烟草依赖治疗的组成部分，可以增加戒烟的机会。基于网络的干预措施是一种很有希望的烟草依赖治疗提供渠道，有可能产生巨大的公共卫生影响（达到x功效）。每年有数百万吸烟者使用互联网寻求戒烟帮助，研究表明戒烟率为7%至26%。然而，即使是设计最好的戒烟网站，大多数用户也只是最低限度地参与其中，由于接触/使用有效治疗成分有限（“剂量”不足），其影响减弱。在一系列的互联网行为改变项目中，都记录了不良的依从性。有两种方法可以提高戒烟治疗的依从性，一种是将吸烟者纳入在线社交网络，另一种是提供免费的NRT。积极参与网络社区与高戒烟率显著相关。积极主动地将吸烟者纳入社会网络可以增加对支持的认识，也可能增加对在线解决问题/技能培训工具和药物治疗的依从性。消除NRT的初始成本和获取障碍可以使吸烟者了解药物，否则他们可能不会尝试它，并可能增加坚持使用和结果。提供NRT还可能增加对基于网络的戒烟计划中实用咨询工具的依从性，因为吸烟者会寻找有关其使用或副作用的信息，并增加对基于网络的社会支持的依从性，因为吸烟者在戒烟时向他人寻求支持。这两种策略的相互作用可能对坚持戒烟治疗的所有三个组成部分产生最强大的影响。本研究将比较单独的交互式、基于证据的戒烟网站(WEB与免费的NRT和旨在将参与者融入在线社区的理论驱动的、基于经验的社交网络（SN）协议相结合的效果。采用2（获得免费NRT，无获得）x 2 （SN整合，无SN）随机控制因子设计，在基线、3、9和15个月重复测量，本研究将招募N=4,000名基于网络的戒烟计划的新成员，并将他们随机分为：1)WEB, 2) WEB+SN, 3) WEB+NRT或4)WEB+SN+NRT。假设在主要终点为9个月，次要终点为3个月和15个月的30天点患病率戒断上，所有三种干预条件均优于WEB单独，并且WEB+SN+NRT将优于WEB+NRT和WEB+SN。次要目标和探索性分析将检查关于治疗结果的中介和调节因素的理论驱动假设（例如，社会规范，社会支持，性别，动机）。对于利用这种“覆盖面广”治疗方式的潜在公共卫生影响而言，解决互联网戒烟方案的遵守问题至关重要，而且及时。拟议的研究在使用社会网络干预方法来改善行为和药物治疗依从性以提高戒烟结果方面是非常规和创新的。了解行为改变的理论和基本机制不仅对减少烟草的破坏性疾病负担具有重要意义，而且对优化其他领域的行为改变也具有重要意义，在这些领域，坚持治疗同样至关重要。

DESCRIPTION (provided by applicant): Reducing population smoking prevalence is an urgent public health priority that can save more lives and money than almost any other known preventive intervention. Practical counseling, social support, and nicotine replacement therapy (NRT) are components of tobacco dependence treatment that increase the chances of cessation. Web-based interventions are a promising delivery channel for tobacco dependence treatment that have the potential for enormous public health impact (reach x efficacy). Millions of smokers use the Internet for cessation assistance each year and studies have shown quit rates of 7 to 26 percent. However, most users engage only minimally with even the best designed cessation websites, diminishing their impact due to limited exposure/use of effective treatment components (an insufficient "dose"). Poor adherence is documented across a range of Internet behavior change programs. Two approaches to improve adherence to Internet cessation treatment are integrating smokers into an online social network and providing free NRT. Active participation in online communities is associated with significantly higher rates of cessation. Proactive outreach to integrate smokers into a social network can increase perceptions of support and may also increase adherence to online problem solving/skills training tools and pharmacotherapy. Removing initial cost and access barriers to NRT can introduce smokers to medication who might not otherwise try it and may increase adherent use and outcomes. Provision of NRT may also increase adherence to practical counseling tools in Web-based cessation programs as smokers look for information on its use or side effects, and adherence to Web- based social support as smokers turn to others for support while quitting. The interaction of both strategies may exert the most powerful effects on adherence to all three components of cessation treatment. This study will compare the efficacy of an interactive, evidence-based smoking cessation website (WEB) alone and in conjunction with free NRT and a theory-driven, empirically-informed social network (SN) protocol designed to integrate participants into the online community. Using a 2 (access to free NRT, no access) x 2 (SN integration, no SN) randomized, controlled factorial design with repeated measures at baseline, 3, 9, and 15 months, this study will recruit N=4,000 new members of a Web-based smoking cessation program and randomize them to: 1) WEB, 2) WEB+SN, 3) WEB+NRT, or 4) WEB+SN+NRT. Hypotheses are that all three intervention conditions will outperform WEB alone and that WEB+SN+NRT will outperform WEB+NRT and WEB+SN on 30-day point prevalence abstinence measured at the primary endpoint of 9 months and at secondary endpoints of 3 and 15 months. Secondary aims and exploratory analyses will examine theory-driven hypotheses about the mediators and moderators of treatment outcome (e.g., social norms, social support, gender, motivation). Addressing adherence to Internet cessation programs is critical and timely to leverage the potential public health impact of this "broad reach" treatment modality. The proposed study is unconventional and innovative in its use of a social network intervention approach to improve both behavioral and pharmacological treatment adherence to enhance cessation outcomes. Understanding theory and basic mechanisms of behavior change is significant not only for reducing tobacco's devastating disease burden, but also for optimizing behavior change in other arenas where treatment adherence is just as critical.