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Web Based Programs for Smokeless Tobacco Cessation

Web Based Programs for Smokeless Tobacco Cessation. Herb Severson, Ph.D. Oregon Research Institute Eugene, Oregon. Growing Tobacco in Wisconsin. Tobacco Production in Wisconsin in Acres. National Agriculture Statistics Services: National Department of Agriculture. Use of Internet.

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Web Based Programs for Smokeless Tobacco Cessation

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  1. Web Based Programs for Smokeless Tobacco Cessation • Herb Severson, Ph.D. • Oregon Research Institute • Eugene, Oregon

  2. Growing Tobacco in Wisconsin

  3. Tobacco Production in Wisconsin in Acres National Agriculture Statistics Services: National Department of Agriculture

  4. Use of Internet • 70% of Americans use Internet – 48% are active users • Broadband in home – 103 million • Access is 52% of rural areas

  5. Web-based Health Behavior Change • Positive outcome for managing • Depression • Diabetes • Weight loss & physical activity

  6. Why Web-based Cessation for ST Users? • Most ST users are in rural areas • Few seek cessation services • Web-based can reach users 24/7 • Highest ST use in 18 – 24 age group • Previous studies show self-help quitting works for ST

  7. Web-based Tobacco Cessation • Smoking Cessation • QuitNet • Free & Clear • American Cancer Society • Other smoking cessation efficacy studies • Feil et al., 2003 • McKay et al., 2008 • Stoddard, 2005 • Etter, 2005 • Lenert et al., 2004 • Brendryen et al 2008 • Swartz et al., 2006 • Strecher et al., 2005 & 2008 • Munoz et al., 2006 & 2009

  8. What Did We Learn About Web-based Cessation? • Many studies had brief follow-up (1 – 2 months) • Most all had positive results • Some were supplemented by counseling calls and nicotine replacement • Most participants spend little time on the site – However, positive relations between exposure and outcome

  9. Key Features in Successful Web-based Health Behavior Programs • Tailored presentation of intervention to match user interests • Tracking and displaying users progress over time • Users set there own pace and access all parts of program • Enable access to virtual community of users and support from others and experts

  10. CHEWFREE.COM

  11. CHEWFREE.COM • Randomized Clinical trial for ST Cessation with Adults • Participants enroll and are randomized to tailored & non-tailored condition • Tailored has a Personal Quit Assistant (PQA) and person develops a Plan for quitting and uses the program to stay quit (relapse prevention) • All participants get help in quitting • Follow-up at 6-weeks, 6-months, and one year

  12. Basic Condition

  13. Enhanced Condition

  14. Comparison of Enhanced & Basic Conditions forChewFree.com † The Enhanced condition used a hybrid approach that combined a guided path (tunnel design) with unrestricted access to website content (matrix design) while the Basic Condition used primarily a matrix design.

  15. Participant Enrollment Total hits at Chewfree.com login page: 59,545 Total hits from unique IP addresses: 21,945 Total number starting screening process: 5,756 Total number randomized: 2,423 Randomized to Control: 1,263 Randomized to Experimental: 1,260

  16. Measures of Program Exposure

  17. Visit Details by Participant

  18. Tobacco Abstinence at Follow-up Assessments for ChewFree.com Enhanced and Basic conditions significantly different: †p < .001; ‡p = .001, * p < .01

  19. Web Page Viewing by Participants Who Accessed at Least One Web Page Containing Smokeless Tobacco Cessation Content

  20. Web Forum Activity in the Enhanced Condition (N=1,260 users)

  21. Summary - CHEWFREE.COM • Very cost effective (after development) • Minimizes need for professional --demonstrates comparable results to other self-help cessation programs for ST users • Assistance is available 24 hours per day • Can reach remote subjects • Could supplement other interventions

  22. Teen ST Cessation Research • Eakin et al, 1989 • 3 sessions group treatment • 36% abstinence at end of treatment • 16% quit at 3 month • Walsh et al, 2000 • Group treatment of baseball players in high school, self-quit guide, dental exam, brief counseling • 27% cessation for treatment • 14% for control • Chakravorty – n=83; age 14 – 18 • Nicotine gum vs mint snuff vs lecture only • Two treatment groups = 37% abstinence • Stotts et al, 2003 • Nicotine patch plus counseling = 32% abstinence but no difference in active and placebo patches

  23. MyLastDip.com Project • Targets ST users aged 14 – 25 • Compares two web sites • Interactive, targeted and tailored with social support via blogs • Generic, static, information only site • Evaluate the efficacy of the web-based cesstion program with 1500 ST users randomized to two web sites- Tailored vs Text based sites at 6 months post enrollment.

  24. Design for MyLastDip.com Project Recruit 1,500 ST Users Age 15 - 25 Screen Consent Baseline Randomize Interactive Web Site Static Information Web Site 6 week Follow Up 6 week Follow Up 6 Month Follow Up 6 Month Follow Up

  25. Inclusion Criteria – MyLastDip.com • Current use of snuff or chewing tobacco • Provide consent • U.S. or Canadian resident between 15 – 25 years old • Have used ST products for a year • Use at least one tin or pouch per week • Interested in quitting • Able to read English • Use email at least once per week • Willing to provide phone, email, & address

  26. MyLastDip.com: Program Content Getting Ready Quitting • Intro • Method • Quit Date • Set Stage • Personal Contract • Do It! My Plan

  27. MyLastDip.com: Get ReadyRemember Reasons - Health

  28. MyLastDip.com: Program Content Staying Quit • Intro • Remember Reasons • Get Support • Manage Mood • Avoid Traps • Use Substitutes • Reward Progress Blogs • Peer-to-Peer • Ask the Expert Retooling

  29. MyLastDip.com: QuittingMy Quit Date: September 17, 2009

  30. MyLastDip.com: Program Content Resources • What is Smokeless Tobacco? • What is nicotine? • History of Smokeless Tobacco? • Who uses Smokeless Tobacco? • Health Effects of Smokeless Tobacco? • Nicotine replacement products • Prescription meds for quitting smoking • Fake chew or herbal snuff • Links to other websites • Relaxation skills

  31. MyLastDip.com: Blogs

  32. MyLastDip.com: Program Content Staying Quit Blogs • Intro • Remember Reasons • Get Support • Manage Mood • Avoid Traps • Use Substitutes • Reward Progress • Peer-to-Peer • Ask the Expert Getting Ready Resources Retooling Quitting • What is Smokeless Tobacco? • What is nicotine? • History of Smokeless Tobacco? • Who uses Smokeless Tobacco? • Health Effects of Smokeless Tobacco? • Nicotine replacement products • Prescription meds for quitting smoking • Fake chew or herbal snuff • Links to other websites • Relaxation skills • Intro • Method • Quit Date • Set Stage • Personal Contract • Do It! My Plan

  33. MyLastDip Enrollment by Month 28 24 20 16 Count of Users 12 8 4 0 January 2009 June 2009 November 2008 August 2009 April 2009 Average recruits per week = 12

  34. MyLast Dip • How can you help? • Recruiting young patients who use ST to use the web site for assisting them to quit. • Distribute flyers about the MLD program to patients • Tell young adult patients between the ages of 14 and 25 about the MLD site as a resource for quitting.

  35. Summary • Web based cessation programs for ST are efficacious • Cessation rates for self help programs are similar to clinical interventions • We need to provide ST users with a variety of options fo supporting their quitting on their own

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