Implementation research has been conducted for this program.
Program Overview
BecomeAnEX.org provides smokers with information and activities with the goal of helping smokers separate themselves and their daily routines from smoking.
BecomeAnEX.org is a smoking cessation website developed by the American Legacy Foundation (now the Truth Initiative) in collaboration with the Mayo Clinic in accordance with the Department of Health and Human Service’s Clinical Practice Guidelines. The website includes several features to motivate smokers to quit smoking and help them disassociate their daily activities from smoking. Specific features include the ability to make a quit plan (My Quit Plan), a tracker to identify smoking triggers (Cigarette Tracker), and separating activities to promote dissociation of triggers from smoking (Beat Your Smoking Triggers), and community forums and groups.
Link to commercial site here.
Last Updated: 09/30/2024
Delivery:
Web-based
Theoretical Approach(es):
Unspecified
Target Outcome(s):
Abstinence
Target Substance:
Tobacco
Ages:
Young Adults (18-30)
Adults (30+)
Genders:
Male
Female
Races/Ethnicities:
Unspecified
Setting(s):
Remote Access
Geographic Location(s):
Unspecified
Country:
USA
Language:
English
Evaluations
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Summary: Researchers recruited 1033 new users of BecomeAnEX to participate in a study to investigate program usage and evaluate the relationship between website engagement and cessation outcomes. At baseline, participants completed assessments of smoking and cessation characteristics. Follow-up assessments of quit attempts and seven and 30-day abstinence were administered at 1- 3-, and 6 months after baseline. Similar percentages of participants visited BecomeAnEx.org one time (40.3%) and between two and five times (44.6%), 15.1% of participants visited the site more than five times. About 90% of participants reported BecomeAnEX was helpful for quitting smoking at the 1- (86.1%), 3-(88.1%), and 6-month (90.5%) follow-up assessments. Participants found the Cigarette Tracker and separation exercises to be the most helpful features. Participants reporting 7-day abstinence at the 6-month follow-up assessment had visited the site more. The numbers of visits users made to the website were related to 7- and 30-day abstinence at the follow-up assessments. Participants who used the separation exercises were at least twice as likely to make a quit attempt. Participants who accessed the separation exercises or the community at least once were more likely to report 7-day abstinence. Participants who accessed the community at least twice were more likely to report 30-day abstinence. Participants who identified and tracked triggers were less likely to make a quit attempt.
Take Away: Engagement with BecomeAnEX.org, particularly the separation exercises and the community, may help smokers achieve abstinence.
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Summary: Researchers recruited 5983 new users of BecomeAnEX.org to compare use of the website between young adults (18-34 years old) and older adults (35 years and older). Researchers examined number of visits to the site, time spent on the site, number of page views, use of separation exercises, and use of the community features as metrics of engagement with the site. Young adults were more likely to visit the site and spent more time on the site than older adults. Older adults visited more than 2.5 times as many pages than young adults on average. Older adults were more likely than younger adults to use the community and separation exercises features. Researchers note than these findings are consistent with other studies that have found that young adults are difficult to engage in internet-based intervention. Researchers also found that Hispanic people twice as likely as non-Hispanic whites to use the community features of the website, but less likely to engage with the site otherwise.
Take Away: Though young adults were more likely to visit the site and spent more time at the site, older adults interacted with the site more (e.g. visited more pages, used specific features more). More research is needed to identify the different mechanisms of engagement for internet-based interventions with different age groups.
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Summary: Researchers recruited 221 new users of BecomeAnEX.org who identified as a former smoker during registration to examine the abstinence and site usage of people who have recently quit smoking (seven or fewer days of abstinence at baseline) compared to those who have been abstinent for longer (eight or more days of abstinence at baseline). At baseline and 1 month after enrollment participants completed assessments of smoking history, cessation characteristics. At one month after baseline, participants completed assessments of seven and 30-day abstinence. Researchers also analyzed participants’ site usage data. Participants who quit recently made more visits to the website, spent more time on the website, and viewed more pages on the website. Participants who had quit recently were also more likely to have used the site to set a quit date and visited and engaged with the community functions on the website. Reporting 30-days abstinence at one month was related to being older, being abstinent for at least eight days before baseline, being healthier, and being advised by a health care provider to quit smoking. Participants who had quit smoking recently were less likely to report 30-days abstinence at one month.
Take Away: Having quit recently was related to greater engagement with the site, but having been abstinent for longer at baseline was related to greater chances of sustained abstinence at follow-up.
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Summary: Researchers recruited 5290 new users of BecomeAnEX.org and randomized them to use the site alone (WEB), use the site and receive social support from an experienced user (WEB+SS), use the site and receive four weeks of nicotine replacement therapy (WEB+NRT), or use the site with social support and NRT (WEB+SS+NRT). Researchers examined relationships between the intervention participants received and engagement with the site (returns to the site, page views, time spent on the site), use of skills-based features on the website, use of community features of the website, and use of smoking cessation medication at three-months post-randomization. The WEB+NRT, WEB+SS, and WEB+SS+NRT groups had higher levels of engagement with the site. The WEB+NRT+SS group reported higher levels of engagement with the site than the WEB+NRT or WEB+SS groups. Participants in the WEB+NRT+SS condition used all skills-based features of the website significantly more than participants in the WEB condition. Similarly, WEB+SS+NRT was related to greater engagement for all community features. The groups that received NRT reported higher use of cessation medication overall, but the WEB+SS reported greater non-study cessation medication use than the WEB+SS+NRT group.
Take Away: Combining BecomeAnEX.org with social support or NRT could improve engagement with the site.
Related Articles
Impact of seasonality on recruitment, retention, adherence, and outcomes in a web-based smoking cessation intervention: Randomized controlled trial. Graham AL, Cha S, Cobb NK, Fang Y, Niaura RS, Mushro A. Journal of Medical Internet Research. 2013. 15(11): e249. doi: 10.2196/jmir.2880
Improving adherence to web-based cessation programs: A randomized controlled trial study protocol. Graham AL, Cha S, Papandonatos GD, et al. Trials. 2013. 14(48). doi: 10.1186/1745-6215-14-48
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Online tobacco websites and online communities – who uses them and do users quit smoking? The quit-primo and national dental practice-based research network Hi-Quit studies. Cutrona SL, Sadasivam RS, DeLaughter K, et al. TBM. 2016. 6: 548-557. doi: 10.1007/s13142-015-0373-5
Engagement and attrition in internet smoking cessation interventions: Insights from a cross-sectional survey of “one-hit-wonders”. Saul JE, Amato MS, Cha S, Graham AL. Internet Interventions. 2016. 5: 23-29. doi: 10.1016/j.invent.2016.07.001
A multirelational social network analysis of an online health community for smoking cessation. Zhao K, Wang X, Cha S, et al. Journal of Medical Internet Research. 2016. 18(8): e233. doi: 10.2196/jmir.5985
Inferring Smoking Status from User Generated Content in an Online Cessation Community.Amato MS, Papandonatos GD, Cha S, et al. Nicotine Tob Res. 2019. 21(2):205-211. doi:10.1093/ntr/nty014
A Digital Smoking Cessation Program for Heavy Drinkers: Pilot Randomized Controlled Trial.Kahler CW, Cohn AM, Costantino C, Toll BA, Spillane NS, Graham AL. JMIR Form Res. 2020. 4(6):e7570. doi:10.2196/formative.7570
Weekly enrollment and usage patterns in an Internet smoking cessation intervention. Welding K, De Leon E, Cha S, Johnson M, Cohen JE, Graham AL. Internet Interv. 2017. 9:100-105. doi:10.1016/j.invent.2017.07.004