Preventing Smoking Relapse via Web-Based Computer-Tailored Feedback: A Randomized Controlled Trial

I. Elfeddali*, C. Bolman, M. Candel, RW Wiers, Hein de Vries

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review


    Background: Web-based computer-tailored approaches have the potential to be successful in supporting smoking cessation.
    However, the potential effects of such approaches for relapse prevention and the value of incorporating action planning strategies
    to effectively prevent smoking relapse have not been fully explored. The Stay Quit for You (SQ4U) study compared two Web-based
    computer-tailored smoking relapse prevention programs with different types of planning strategies versus a control group.
    Objectives: To assess the efficacy of two Web-based computer-tailored programs in preventing smoking relapse compared with
    a control group. The action planning (AP) program provided tailored feedback at baseline and invited respondents to do 6
    preparatory and coping planning assignments (the first 3 assignments prior to quit date and the final 3 assignments after quit date).
    The action planning plus (AP+) program was an extended version of the AP program that also provided tailored feedback at 11
    time points after the quit attempt. Respondents in the control group only filled out questionnaires. The study also assessed possible
    dose–response relationships between abstinence and adherence to the programs.
    Methods: The study was a randomized controlled trial with three conditions: the control group, the AP program, and the AP+
    program. Respondents were daily smokers (N = 2031), aged 18 to 65 years, who were motivated and willing to quit smoking
    within 1 month. The primary outcome was self-reported continued abstinence 12 months after baseline. Logistic regression
    analyses were conducted using three samples: (1) all respondents as randomly assigned, (2) a modified sample that excluded
    respondents who did not make a quit attempt in conformance with the program protocol, and (3) a minimum dose sample that
    also excluded respondents who did not adhere to at least one of the intervention elements. Observed case analyses and conservative
    analyses were conducted.
    Results: In the observed case analysis of the randomized sample, abstinence rates were 22% (45/202) in the control group versus
    33% (63/190) in the AP program and 31% (53/174) in the AP+ program. The AP program (odds ratio 1.95, P = .005) and the
    AP+ program (odds ratio 1.61, P = .049) were significantly more effective than the control condition. Abstinence rates and effects
    differed per sample. Finally, the results suggest a dose–response relationship between abstinence and the number of program
    elements completed by the respondents.
    Conclusion: Despite the differences in results caused by the variation in our analysis approaches, we can conclude that Web-based
    computer-tailored programs combined with planning strategy assignments and feedback after the quit attempt can be effective
    in preventing relapse 12 months after baseline. However, adherence to the intervention seems critical for effectiveness. Finally,
    our results also suggest that more research is needed to assess the optimum intervention dose.
    Original languageEnglish
    Article numbere109
    Number of pages16
    JournalJournal of Medical Internet Research
    Issue number4
    Publication statusPublished - 2012


    • Smoking relapse prevention
    • computer tailoring
    • multiple tailoring
    • planning strategies


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