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Tobacco Use: Internet-based Cessation Interventions

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What the CPSTF Found

About The Systematic Review

The CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to tobacco use cessation.

McCrabb S, Baker AL, Attia J, Skelton E, Twyman L, et al. Internet-based programs incorporating behavior change techniques are associated with increased smoking cessation in the general population: a systematic review and meta-analysis. Annals of Behavioral Medicine 2019:53(2):180-95.

The review included 45 studies (search period through September 2017). The team examined each of the studies included in the systematic review and abstracted supplemental information about study, intervention, and population characteristics.

The CPSTF finding is based on results from the published review, additional information from the included studies, and expert input from team members and the CPSTF. This recommendation updates and replaces the 2011 finding of insufficient evidence for internet-based tobacco cessation interventions pdf icon [PDF - 294 kB].

Context

The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians ask all adults about tobacco use, advise tobacco users to stop using tobacco, and provide them with behavioral interventions and U.S. Food and Drug Administration–approved pharmacotherapy (A grade recommendation External Web Site Icon; USPSTF 2015).

Smoking Cessation: A Report of the Surgeon General pdf icon [PDF - 9.82 MB] External Web Site Icon concluded there is sufficient evidence to infer that web or internet-based interventions increase smoking cessation. The report further noted that interventions are more effective when they contain behavior change techniques and interactive components (U.S. Department of Health and Human Services 2020).

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included 45 studies; 31 of these evaluated differences in tobacco use cessation when measured 6 or more months following intervention.

  • Internet-based interventions increased tobacco use cessation rates by a median of 1.2 percentage points overall (31 studies).
    • Differences in cessation rates were slightly larger when internet-based interventions were compared to no intervention, usual care, printed materials, or basic website content (median increase of 1.3 percentage points; 17 studies).
    • Differences in cessation rates were smaller when internet-based interventions were compared to other interventions that provided interactive content, cessation counseling, or evidence-based cessation medications (median increase of 0.8 percentage points; 14 studies).
    • Of this subset, 13 studies were conducted in the United States.
      • The median difference in cessation rates for U.S. studies was 0.1 percentage points (13 studies).
      • Two factors contributed to small and inconsistent effects in this subset.
        • Most studies provided internet, cessation counseling, or medication interventions to participants in the comparison group.
        • Participants in both intervention and comparison groups quit at meaningful rates, which minimized differences.

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

Based on the overall results from the review, findings should be applicable to the general population of tobacco users in the United States who are interested in quitting. Additional research is warranted for specific U.S. population groups and settings.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • How do intervention effects vary by participant characteristics, including income, level of education, and race/ethnicity in U.S. populations and settings?
  • How do intervention effects vary by internet-based content? Simplified comparisons would also allow assessments of the effectiveness of various specific behavior change techniques, alone or in combination.
  • How do internet-based interventions that use automated, interactive, and tailored guidance compare with interventions that use static websites or printed materials in U.S. populations and settings?
  • What are the most effective and efficient ways to increase recruitment and enhance retention?
  • What is the impact of these intervention approaches on long-term cessation outcomes (12 months or more following intervention)?
  • Are these interventions effective with clients who want to quit using e-cigarettes?

Study Characteristics

  • All of the included studies were randomized controlled trials (45 studies).
  • Twenty-four of the included studies were conducted in the United States. The remaining studies came from Europe, the United Kingdom, Australia, and Canada.
  • Of the 45 included studies, 15 provided web-based content only and the remaining offered combinations of web-based content and other components. Additional components included email messages, cessation medications, text messages, telephone calls or telephone support lines, one-on-one cessation counseling, and printed materials.
  • Studies from the United States reported demographic characteristics of participants. Study samples were generally representative across age (18+), gender, racial/ethnic background, and education.

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