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

描述(由申请人提供)：降低人口吸烟流行率是一项紧迫的公共卫生优先事项，与几乎任何其他已知的预防性干预措施相比，它可以拯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，它们增加了戒烟的机会。基于网络的干预措施是烟草依赖治疗的一个很有希望的提供渠道，有可能对公共健康产生巨大影响(达到x效果)。每年有数百万吸烟者使用互联网帮助戒烟，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，大多数用户也只能进行最低限度的互动，由于有限的暴露/有效治疗组件的使用(不足的“剂量”)，其影响会减弱。在一系列互联网行为改变计划中，都记录了遵从性差的情况。提高对互联网戒烟治疗依从性的两种方法是将吸烟者纳入在线社交网络和提供免费的NRT。积极参与在线社区与显著更高的戒烟率相关。积极主动地将吸烟者纳入社交网络可以增加对支持的看法，也可能增加对在线问题解决/技能培训工具和药物治疗的坚持。消除NRT的初始成本和获得障碍可以将吸烟者引入药物治疗，否则他们可能不会尝试，并可能增加依从性使用和结果。在吸烟者寻找有关其使用或副作用的信息时，提供NRT也可能会增加对基于网络的戒烟计划中实用咨询工具的坚持，当吸烟者在戒烟时向其他人寻求支持时，也可能会增加对基于网络的社会支持的坚持。这两种策略的相互作用可能会对坚持戒烟治疗的所有三个组成部分产生最强大的影响。这项研究将比较互动的、基于证据的戒烟网站(Web)单独以及与免费的NRT和旨在将参与者整合到在线社区中的理论驱动、经验知情的社交网络(SN)协议的效果。采用2(获得免费NRT，不获得)×2(SN整合，无SN)随机对照析因设计，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Web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。假设所有三种干预条件都将优于单独使用WEB，WEB SN NRT在9个月的主要终点以及3个月和15个月的次要终点测量的30天点戒断流行率方面将优于WEB NRT和WEB SN。次要目标和探索性分析将检验关于治疗结果的中介和调节因素(例如，社会规范、社会支持、性别、动机)的理论驱动的假设。解决遵守互联网戒烟计划的问题是至关重要的，也是及时的，可以利用这种“广泛”治疗方式的潜在公共健康影响。这项拟议的研究是非常规的，在使用社会网络干预方法来改善行为和药物治疗依从性方面具有创新性，以提高戒烟结果。了解行为改变的理论和基本机制不仅对于减少烟草毁灭性的疾病负担具有重要意义，而且对于优化其他领域的行为改变也具有重要意义，在其他领域，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.