An Internet-based abstinence reinforcement smoking cessation intervention in rural smokers

doi:10.1016/j.drugalcdep.2009.06.010

Drug and Alcohol Dependence

Volume 105, Issues 1–2, 1 November 2009, Pages 56-62

https://doi.org/10.1016/j.drugalcdep.2009.06.010 Get rights and content

Abstract

The implementation of cigarette smoking abstinence reinforcement programs may be hindered by the time intensive burden placed on patients and treatment providers. The use of remote monitoring and reinforcement of smoking abstinence may enhance the accessibility and acceptability of this intervention, particularly in rural areas where transportation can be unreliable and treatment providers distant. This study determined the effectiveness of an Internet-based abstinence reinforcement intervention in initiating and maintaining smoking abstinence in rural smokers. Sixty-eight smokers were enrolled to evaluate the efficacy of an Internet-based smoking cessation program. During the 6-week intervention period, all participants were asked to record 2 videos of breath carbon monoxide (CO) samples daily. Participants also typed the value of their CO readings into web-based software that provided feedback and reinforcement based on their smoking status. Participants (n = 35) in the Abstinence Contingent (AC) group received monetary incentives contingent on recent smoking abstinence (i.e., CO of 4 parts per million or below). Participants (n = 33) in the Yoked Control (YC) group received monetary incentives independent of smoking status. Participants in the AC group were significantly more likely than the YC group to post negative CO samples on the study website (OR = 4.56; 95% CI = 2.18–9.52). Participants assigned to AC were also significantly more likely to achieve some level of continuous abstinence over the 6-week intervention compared to those assigned to YC. These results demonstrate the feasibility and short-term efficacy of delivering reinforcement for smoking abstinence over the Internet to rural populations.

Section snippets

Tobacco use and smoking-related disease

Tobacco use and smoking-related disease is a top public health problem in the United States. In 2007, an estimated 60.1 million adults (24.2% of the population) in the United States were current (i.e., using within the past month) cigarette smokers (Substance Abuse and Mental Health Administration [SAMHSA], 2008). Cigarette smoking is more prevalent in rural areas than in non-rural areas and actually increased in prevalence in completely rural areas from 23.3% in 2005 to 30.1% in 2006 (SAMHSA,

Participants

Sixty-eight smokers, ages 18 and older, were randomly assigned to either the AC or YC group (described below). An additional 16 smokers were screened but were not enrolled either because they did not meet criteria or decided they did not want to take part in the intervention. Subjects were recruited by advertisement in local media and by word of mouth. Table 1 displays demographic characteristics for the two groups. To be considered eligible, participants had to report smoking 10 or more

Study retention and data collection rates

Cox survival analysis failed to detect a difference in terms of study retention across groups (hazard ratio = 1.49, p = 0.54). A total of 10 participants withdrew during participation, 6 from the AC group and 4 from the YC group. Fig. 1 shows the retention curves for both groups. Participants in the AC group completed an average of 36.3 ± 2.3 days and those in the YC group completed an average of 38.7 ± 1.7 days in the intervention.

GEE did not reveal a significant effect of group on odds of posting

Discussion

The results of this study demonstrate the feasibility of using the Internet to promote smoking cessation in rural Kentuckians. To the best of our knowledge, this is the first study to use a randomized, controlled design to also demonstrate that participation in the active portion of an abstinence reinforcement intervention over the Internet promotes smoking cessation. Participants were retained for over 85% of study days on average and over two-thirds of expected videos were recorded. Given

Conflicts of interest

All authors declare no conflicts of interest pertaining to this project.

Acknowledgements

This study was funded by NCI grant R21CA124881; the NCI had no further role in study design; in the collection, analysis or interpretation of data; in the writing of this report; or in the decision to submit the paper for publication.

Authors Wong and Dallery designed the study with guidance in conducting smoking cessation research in rural communities from Authors Schoenberg and Martin. Author Fields collected all data. Author Casey provided the infrastructure necessary for the conduct of the

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An Internet-based abstinence reinforcement smoking cessation intervention in rural smokers

Abstract

Section snippets

Tobacco use and smoking-related disease

Participants

Study retention and data collection rates

Discussion

Conflicts of interest

Acknowledgements

Drug Alcohol Depend.

Drug Alcohol Depend.

Addict. Behav.

Addict. Behav.

Soc. Sci. Med.

Preventing relapse in the treatment of nicotine addiction: current issues and future directions

J. Psychoactive Drugs

The use of contingency management to reduce cigarette smoking among college students

Exp. Clin. Psychopharmacol.

Effects of a voucher reinforcement program for smoking cessation: a feasibility study

J. Appl. Behav. Anal.

Randomized controlled trial using social support and financial incentives for high risk pregnant smokers: significant other support (SOS) program

Tob. Control

The importance of place of residence: examining health in rural and nonrural areas

Am. J. Public Health

Community cancer control in a rural, underserved population: the Appalachian leadership initiative on cancer project

J. Health Care Poor Underserved

Mental health and substance abuse services among rural minorities

J. Rural Health

Effects of internet-based voucher reinforcement and a transdermal nicotine patch on cigarette smoking

J. Appl. Behav. Anal.

A pilot study on voucher-based incentives to promote abstinence from cigarette smoking during pregnancy and postpartum

Nicotine Tob Res.

Cut-off levels for breath carbon monoxide as a marker for cigarette smoking

Addiction

Shaping reduced smoking in smokers without cessation plans

Exp. Clin. Psychopharmacol.