JMIR Publications

ABSTRACT

Background:

Web-based cessation programs are now common for intervening with smokers. However, it remains unclear how acceptable or effective these interventions are among people with affective disorders and symptoms (e.g., depression and anxiety). Research examining this is extremely limited, with mixed results on cessation rates. Additional large studies are needed to more fully understand whether web-based interventions are similarly utilized and are equally effective among people with and without affective disorder symptomology. If not, more targeted web-based interventions may be required.

Objective:

To compare web-based treatment acceptability (defined by satisfaction and utilization) and 12-month cessation outcomes between smokers with and without affective disorders and symptoms (ADS).

Methods:

Participants (n= 2,512) were adult smokers enrolled in a randomized, comparative effectiveness trial of two web-based smoking interventions designed for the general population of smokers. At baseline, participants reported demographic and smoking characteristics and completed measures assessing ADS. Participants were then classified into subgroups based on their self-reported AD symptoms—either into a No ADS group (n=574) or into six non-mutually exclusive subgroups: depression (n = 1,470), post-traumatic stress disorder (PTSD; n = 1,383), panic disorder (PD; n = 1,145), generalized anxiety disorder (GAD; n= 903), social anxiety disorder (SAD; n = 797), and more than one AD (n= 1,529). Surveys at 12-months post-randomization included subjective ratings of treatment acceptability and self-reported smoking cessation. Treatment utilization (i.e., number of logins and total duration of exposure) was assessed via automated records.

Results:

Relative to the No ADS group, all six ADS subgroups reported significantly greater satisfaction with their assigned web treatment program, but they spent less time logged in than those with no ADS. For number of logins, a treatment arm by ADS group interaction was observed across all ADS subgroups except GAD, suggesting that relative to the No ADS group, they logged in less to one website but not the other. At the 12-month follow-up, abstinence rates in the No ADS group (29%) were significantly higher than for participants who screened positive for depression (24%; p=.032), PTSD (24%; p=.034), PD (23%; p=.009), and two or more ADS (24%; p=.034). Post hoc analyses suggest the lower quit rates may be associated with differences in baseline nicotine dependence and levels of commitment to resist smoking in difficult situations. Website utilization did not explain the differential abstinence rates.

Conclusions:

Despite reporting higher levels of treatment satisfaction, most smokers with ADS used their assigned intervention less often and had lower quit rates than smokers with no ADS at treatment onset. The results support the need for developing more targeted interventions for smokers with ADS. Clinical Trial: NCT01812278