QUIT LINES OR QUIT SITES ?

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WATI europe

• QUIT LINES OR QUIT SITES ?
• Amsterdam 2008

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Main Reason

• Set up to answer the questions
• What is the effectiveness (includes cost
  effectiveness) of internet, PC and other
  electronic aids to help people stop smoking?
• How do we cherry-pick successful interventions
  and promote them?

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Case study 1

• In 1999 and 2000, the NHS smoking treatment
  services were established to deliver evidence
  based services to individual smokers wanting to
  quit. These services have been going on for some
  8 years now (1)
• They have a 12 month quit rate of 15 (2)
• However, less than 2 per cent of the adult
  smoking population typically access these
  services (3)
• Operation only cost/quitter at 4 weeks (!) is
  average 250/quitter. If taken from same figures
  but at 12 months is on average 730/quitter.
• Raw M, McNeill A, Coleman T. Lessons from the
  English smoking treatment services. Addiction
  200510084-91.
• Ferguson J, Bauld L, Chesterman J, Judge K. The
  English smoking treatment services one-year
  outcomes. Addiction 200510059-69
• Bauld L, Chesterman J, Judge K, Pound E, Coleman
  T. Impact of UK National Health Service smoking
  cessation services variations in outcomes in
  England. Tob Control 2003 Sep12(3)296-301.
• NHS Department of Health (2oo7) Staistics on NHS
  Stop Smoking Services Apr 2005-Mar 2006

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IMPACT

• IMPACT REACH x EFFICACY
• High Impact Big Reach x High Efficacy
• Low Impact Small Reach x Low Efficacy
• What permutation is acceptable?
• big reach x small efficacy?
• or small reach x high efficacy?
• or modest reach x modest efficacy?
• or cost per quitter?

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REACH BENCH MARK

• 1ST TIER MEDIA CAMPAIGN AND LEGISLATION Smokers
  can be encouraged to quit using large-scale
  public health promotion programmes and
  legislative controls. The effectiveness of such
  large scale initiatives in supporting individual
  quitters can be low, since they lack the personal
  element that drives the effectiveness of
  counselling approaches (1).
• 1. Gilbert H, Nazareth I, Sutton S, Morris R,
  Godfrey C. Effectiveness of computer-tailored
  Smoking Cessation Advice in Primary Care
  (ESCAPE) a Randomised Trial. Trials 2008923.

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EFFICACY BENCH MARK

• 1ST TIER Self-help- Efficacy 0-3 Standard self
  help materials have been shown to have small but
  significant effects in helping smokers to quit
  (1)
• Computer systems that tailor the content of
  self-help materials to individual smoker
  characteristics and tailor-made self-help
  material delivered by letter or by email,
  websites and mobile phone text messaging combine
  the benefits of the personally tailored
  behaviour-change techniques from clinical
  approaches with the high population reach of
  large-scale public health initiatives. (2) (3)
  (4) (5)
• Tailored advice 3-5.8 quit rate versus control
  group 1.5-2.7 at 6 months (6)
• (1) Lancaster T, Stead LF. Self-help
  interventions for smoking cessation. Cochrane
  Database of Systematic Reviews 2005(3).
• (2) Kreuter MW, Strecher VJ, Glassman B. One size
  does not fit all the case for tailoring print
  materials. Ann Behav Med 199921(4)276-83.
• (3) Dijkstra A, De Vries H. The development of
  computer-generated tailored interventions.
  Patient Educ Couns 1999 Feb36(2)193-203.
• (4) Strecher VJ. Computer-tailored smoking
  cessation materials A review and discussion.
  Patient Education and Counseling 199936107-17
• (5) Sutton S, Gilbert H. Effectiveness of
  individually tailored smoking cessation advice
  letters as an adjunct to telephone counselling
  and generic self-help materials randomized
  controlled trial. Addiction 2007
  Jun102(6)994-1000.
• (6) Lennox A, Osman L et al Cost effectiveness
  of computer tailored and non-tailored smoking
  cessation letters in general practice randomised
  controlled trial BMJ 20013221396

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REACH EXTENSION

• Many Europeans say that they use the internet.
  But, strongly shaped according to education
  level, with 55 per cent use among those educated
  to secondary school level and 90 per cent use
  among graduates (1)
• Mobile phone ownership is also increasing, as is
  the trend for individuals to access the internet
  via mobile devices(2) (3)
• Dutton W, Helsper EJ. The Internet in Britain
  2007. Oxford, UK Oxford Internet Institute,
  University of Oxford 2007.
• Shepherd A. Use of ICT among Households and
  Individuals. In Avery V, Chamberlain E,
  Summerfield C, Zealey L, editors. FOCUS ON the
  Digital Age. 2007 ed. Basingstoke, UK Palgrave
  Macmillan 2007. p. 1-6.
• Walters ST, Wright JA, Shegog R. A review of
  computer and Internet-based interventions for
  smoking behavior. Addictive Behaviors 2006
  Feb31(2)264-77.

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IMPROVING EFFICACY

• When the first generation of telephone
  counselling was reviewed, a modest 2.5-3 quit
  rate was attributable. (1)
• With the latest review, improved protocols and
  practice means that proactive counselling is now
  quoted by Cochrane to have up to 8 quit rates
  (2)
• Similarly, a slow improvement in computer based
  interventions is also emerging (3)
• West R et al Smoking cessation Guidelines and
  update
• Stead LF, Perera R, Lancaster T,. Telephone
  counselling for smoking cessation. Cochrane
  Database of Systematic Reviews 2001, Issue 2
• Walters ST, Wright JA, Shegog R. A review of
  computer and Internet-based interventions for
  smoking behavior. Addictive Behaviors 2006
  Feb31(2)264-77.

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What exactly can be done?

• Setting a quit date and diary of appointments
  thereof with timely reminders of treatment
  e-mails and alerts- simple outlook type of
  programme