Smoking continues to be the greatest single preventable cause of premature illness and death in developed countries. Although rates of smoking have fallen, over 20% of the adult population in the UK continues to smoke. Anything which can be done to help people stop smoking will therefore have substantial public health benefits.
More and more people now have access to computers and other electronic devices (such as mobile ‘phones), and there is growing interest in whether these can be used to prompt or support attempts to stop smoking. This could be by providing a prompt to quit, reaching smokers who would otherwise use no support, and/or supporting the degree to which people use their smoking cessation medication (e.g., nicotine replacement therapy).
A recent Health Technology Assessment review assessed the effectiveness of internet sites, computer programs, mobile telephone text messages and other electronic aids for helping smokers to quit, and/or to reduce relapse to smoking among those who had quit.
The reviewers conducted a systematic review of the literature from 1980 to 2009 and found 60 randomised controlled trials (RCTs) and quasi-RCTs evaluating smoking cessation programmes that utilised computer, internet, mobile telephone or other electronic aids. The review was restricted to studies of adult smokers.
The primary outcomes were smoking abstinence, measured in two ways: Point prevalence abstinence and prolonged abstinence. The first is typically available in more studies (because it is easier to measure) but a rather liberal measure of abstinence (since the smoker need only be abstinent at the point the assessment is made to count as having quit). The latter is more conservative (since it requires the smoker to have been abstinent for an extended period to count as having quit), and is generally the preferred measure. Smoking abstinence at the longest follow-up available in each study was used, again because this is most conservative.
Combining the data from the 60 trials indicated that, overall, the use of computer and other electronic aids increased quit rates for both prolonged (pooled RR = 1.32, 95% CI 1.21 to 1.45) and point prevalence (pooled RR = 1.14, 95% CI 1.07 to 1.22) abstinence at longest follow-up, compared with no intervention or generic self-help materials.
The authors also looked at whether studies which aided cessation differed from those which prompted cessation, and found no evidence of any difference in the effect size between these. The effectiveness of the interventions also did not appear to vary with respect to mode of delivery or the concurrent use non-electronic co-interventions (e.g., nicotine replacement therapies).
The review concluded that computer and other electronic aids do indeed increase the likelihood of cessation compared with no intervention or generic self-help materials, but the effect is small. However, even a small effect is likely to have important public health benefits, given the large number of people who smoke and the impact of smoking on health. The authors also note that uncertainty remains around the comparative effectiveness of different types of electronic intervention, which will require further study.
The authors argue that further research is needed on the relative benefits of different forms of delivery for electronic aids, the content of delivery, and the acceptability of these technologies for smoking cessation with subpopulations of smokers, particularly disadvantaged groups. More evidence is also required on how electronic aids developed and tested in research settings are applied in routine practice and in the community.
Chen YF, Madan J, Welton N, Yahaya I, Aveyard P, Bauld L, Wang D, Fry-Smith A, Munafò MR. Effectiveness and cost-effectiveness of computer and other electronic aids for smoking cessation: a systematic review and network meta-analysis (PDF). Health Technol Assess 2012; 16(38): 1-205, iii-v. doi: 10.3310/hta16380.