Evaluations

• Web-based smoking-cessation programs: Results of a randomized trial.

  Strecher VJ, McClure JB, Alexander GL, Chakraborty B, Nair VN, Konkel JM, Greene SM, Collins LM, Carlier CC, Wiese CJ, Little RJ, Pomerleau CS, Pomerleau OF. American Journal of Preventive Medicine. 2008. 34(5):373-381. PMCID: PMC2697448.

  Summary: A randomized controlled trial of 1866 adults who were current smokers seriously considering quitting and medically cleared for nicotine replacement therapy (patch). Intervention conditions were a combination of whether the intervention was delivered all at one time or spread out over 5 weeks, plus 4 elements provided at high or low tailoring (outcome expectation, success story, efficacy expectation, and source personalization)(16 conditions for randomization). Participants were recruited through 2 health maintenance organizations (HMOs), provided with 10 weeks of nicotine patches, and assessed at baseline and 6-months post-quit date. Primary cessation outcome at 6 months was no smoking over the previous 7 days.

  Participants who received the intervention all at one time accessed significantly more sections within the web-based cessation program than those who received the intervention over 5 weeks. There was no significant effect of single vs. multiple exposure in 7-day cessation rates at 6-month follow-up, however both success story and source personalization were significantly related to smoking cessation at follow-up (high tailoring on these aspects was related to higher rates of cessation). Overall tailoring depth was also significantly related to cessation (the more elements that were highly tailored, the higher the cessation rates).

  Take Away: Personalized tailoring of smoking cessation interventions improved smoking cessation rates.

  Follow-Up of Previous Study:

  The role of engagement in a tailored web-based smoking cessation program: Randomized controlled trial.

  Strecher VJ, McClure J, Alexander G, Chakraborty B, Nair V, Konkel J, Greene S, Couper M, Carlier C, Wiese C, Little R, Pomerleau C, Pomerleau O. Journal of Medical Internet Research. 2008. 10(5):e36. PMCID: PMC2630833.

  Summary: This study used data from the above study to explore the relationship between engagement in the smoking cessation program and treatment outcomes to address three specific questions: 1) Was amount of program content accessed related to treatment outcomes?, 2) Were participant characteristics related to disengagement from the program?, and 3) What aspects of the intervention increased engagement?

  There was a significant relationship between engagement with program content and treatment outcomes – for each webpage accessed there was about an 18% increase in likelihood of quitting smoking. Individuals who were young, male, and less educated were more likely to disengage from the program and this effect was even stronger for those who received the intervention over 5 weeks. For those who received the intervention in a single package, higher personalization of the source and highly tailored efficacy expectation messages were related to greater engagement. None of the program components were related to engagement for those who received the intervention over time.

  Take Away: Program engagement is important for better smoking cessation outcomes, and targeting those who are more likely to disengage may improve outcomes. The study highlights important individual and intervention characteristics associated with engagement.

• Self-related neural response to tailored smoking-cessation messages predicts quitting.

  Chua HF, Ho SS, Jasinska AJ, Polk TA, Welsh RC, Liberzon I, Strecher VJ. Nature Neuroscience. 2011. 14(4):426-427. PMCID: PMC3109081.

  Summary: Self-related neural response to tailored smoking-cessation messages predicts quitting. This study explored the neural mechanisms that may explain why tailored smoking cessation messages are more effective than non-tailored messages. The authors hypothesized that, because tailored messages make references specific to a person’s life, participants receiving tailored messages will engage in self-related processing, which involves activation of certain regions of the brain. Self-related processing may allow for deeper processing and better integration of the information and health-change goals into one’s learning, self-schema and action plans.

  Ninety-one adult smokers were recruited to participate in 3 sessions and one follow-up telephone interview 4 months later. Session 1 was the baseline assessment and participants answered questions about their health, smoking, demographics, and so on. Session 2 involved the use of functional magnetic resonance imaging to measure brain activation during neutral and smoking cessation messages (untailored and tailored) and during self-appraisal tasks (responding whether a series of adjectives describe them and whether the adjectives are positive or negative). In Session 3, participants completed the web-based Project Quit tailored smoking cessation program and were told to quit smoking. At 4-month follow-up, 51.7% of participants had not smoked in the previous 7 days. Three regions of the brain, dorsomedial prefrontal cortex (dmPFC), precuneus and angular gyrus, became more activated by tailored messages and by self-related processing and the increased activation of the dmPFC was significantly related to the odds of quitting smoking.

  Take Away: Tailored smoking cessation messages activate a certain region of the brain involving self-related processing and that may partially explain why these messages are more effective than non-tailored cessation messages.