Internet-based tobacco cessation interventions provide information, strategies, or behavioral support to assist tobacco users who want to quit1. Such interventions include websites, computer programs, or other electronic aids2. Interventions may rely solely on internet technology or include components such as in-person counseling, pharmacotherapy (e.g., nicotine replacement therapy (NRT)), remote counseling, or text messaging3.
Note: The term “tobacco” in this strategy refers to commercial tobacco, not ceremonial or traditional tobacco. County Health Rankings & Roadmaps recognizes the important role that ceremonial and traditional tobacco play for many Tribal Nations, and our tobacco-related work focuses on eliminating the harms and inequities associated with commercial tobacco.
Expected Beneficial Outcomes (Rated)
Increased quit rates
Evidence of Effectiveness
There is strong evidence that internet-based tobacco cessation interventions help tobacco users quit2, 4, 5, 6, 7, 8, 9. Interventions for individuals who are cessation-ready and those who have not yet decided to quit both appear effective2. Interventions are effective for adults3, 10 and college students3, 10, 11; additional research is needed to determine effects for teens3, 10 and young adults12.
Internet-based interventions that include text messages13, email messages10, or a combination of the two14 have been shown to help adults quit smoking3. Effects have been demonstrated for various populations, including psychiatric patients, individuals receiving inpatient care for substance use disorders, and indigenous populations15. Interventions that are interactive, tailored to participants’ circumstances, and include automated contact via email or text message can also help adults quit3.
Internet-based interventions combined with pharmacotherapies such as nicotine replacement therapy (NRT) can increase the likelihood of successful quit attempts3. Participants better adhere to internet-based cessation programs with NRT16 or an online supportive social network than programs without these features16, 17. Early studies of interventions that use social media platforms such as Twitter and Facebook suggest they can increase quit rates and quit attempts, and reduce relapses18.
Research suggests that effective internet-based smoking cessation programs for adolescents7 and adults19 usually include combinations of multimedia and interactive features (e.g., videos or stories), content that is tailored to participants’ demographic characteristics, or feedback that reflects participants’ progress and goals7, 19. Some studies suggest that websites that are interactive or tailored to participants’ demographic characteristics are more effective than sites that are static or more general; other studies suggest equal effects3, 10. Internet-based interventions may be more effective if they include direct interaction between participants and their health care providers6. Adding internet-based components to counseling may not improve counseling’s effects on quit rates3, 10.
Internet-based interventions appear to be cost-effective2, 20. For example, Tweet2Quit, a cessation program that uses Twitter, has low associated costs21. Additional evidence is needed to determine if internet-based interventions are more cost-effective than quitlines or in-person counseling3.
Smokers with high levels of education appear more likely than smokers with lower levels of education to use internet-based programs to quit tobacco22.
Impact on Disparities
The US Department of Health and Human Services (US DHHS) provides several targeted internet-based smoking cessation interventions, including Smokefree Women, Smokefree Teen, Smokefree Vet, Smokefree Español and Smokefree 60+23; participants can build individualized quit plans and receive support as part of these programs24. Many other websites offer online cessation programs to help individuals stop smoking. Examples of such sites include the Stop Smoking Center and the American Lung Association’s Freedom from Smoking program25, 26.
Smokefree.gov - US Department of Health and Human Services (US DHHS). Smokefree.gov. Resources to quit smoking: Smokefree VET, Smokefree Women, Smokefree Teen, Smokefree Espanol, Smokefree 60+, SmokefreeTXT, QuitGuide app, and QuitSTART App.
ALA-FFS Online - American Lung Association (ALA). Freedom from smoking online.
WebMD-Smoking cessation - WebMD. Smoking cessation health center.
EX - EX. Become an Ex. A new way to think about quitting smoking.
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1 CG-Tobacco use - The Guide to Community Preventive Services (The Community Guide). Tobacco.
2 Chen 2012 - Chen Y, Madan J, Welton N, et al. Effectiveness and cost-effectiveness of computer and other electronic aids for smoking cessation: A systematic review and network meta-analysis. Health Technology Assessment (Winchester, England). 2012;16(38):1–205, iii–v.
3 Cochrane-Taylor 2017 - Taylor GMJ, Dalili MN, Semwal M, et al. Internet-based interventions for smoking cessation. Cochrane Database Systematic Reviews. 2017;(9):CD007078.
4 McCrabb 2018* - McCrabb S, Baker AL, Attia J, 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. 2018;(August):1-16.
5 Graham 2016 - Graham A, Carpenter K, Cha S, et al. Systematic review and meta-analysis of Internet interventions for smoking cessation among adults. Substance Abuse and Rehabilitation. 2016:55-69.
6 Afshin 2016 - Afshin A, Babalola D, Mclean M, et al. Information technology and lifestyle: A systematic evaluation of internet and mobile interventions for improving diet, physical activity, obesity, tobacco, and alcohol use. Journal of the American Heart Association. 2016;5(9).
7 Park 2015* - Park E, Drake E. Systematic review: Internet-based program for youth smoking prevention and cessation. Journal of Nursing Scholarship. 2015;47(1):43-50.
8 Danaher 2015* - Danaher BG, Severson HH, Crowley R, et al. Randomized controlled trial examining the adjunctive use of nicotine lozenges with MyLastDip: An eHealth smokeless tobacco cessation intervention. Internet Interventions. 2015;2(1):69-76.
9 Brown 2014c* - Brown J, Michie S, Geraghty AWA, et al. Internet-based intervention for smoking cessation (StopAdvisor) in people with low and high socioeconomic status: A randomised controlled trial. The Lancet Respiratory Medicine. 2014;2(12):997-1006.
10 Hutton 2011* - Hutton HE, Wilson LM, Apelberg BJ, et al. A systematic review of randomized controlled trials: Web-based interventions for smoking cessation among adolescents, college students, and adults. Nicotine & Tobacco Research. 2011;13(4):227–38.
11 Gulliver 2015 - Gulliver A, Farrer L, Chan J, et al. Technology-based interventions for tobacco and other drug use in university and college students: A systematic review and meta-analysis. Addiction Science & Clinical Practice. 2015;10(1):5.
12 Cochrane-Fanshawe 2017* - Fanshawe TR, Halliwell W, Lindson N, Aveyard P. Tobacco cessation interventions for young people. Cochrane Database of Systematic Reviews. 2017;(11).
13 Brown 2013a* - Brown J. A review of the evidence on technology-based interventions for the treatment of tobacco dependence in college health. Worldviews on Evidence-Based Nursing. 2013;10(3):150–62.
14 Danielsson 2014* - Danielsson AK, Eriksson AK, Allebeck P. Technology-based support via telephone or web: A systematic review of the effects on smoking, alcohol use and gambling. Addictive Behaviors. 2014;39(12):1846-1868.
15 Boland 2018* - Boland VC, Stockings EA, Mattick RP, McRobbie H, Brown J, Courtney RJ. The methodological quality and effectiveness of technology-based smoking cessation interventions for disadvantaged groups: A systematic review and meta-analysis. Nicotine & Tobacco Research. 2018;20(3):276–285.
16 Graham 2017* - Graham AL, Papandonatos GD, Cha S, et al. Improving adherence to smoking cessation treatment: Intervention effects in a web-based randomized trial. Nicotine & Tobacco Research. 2017;19(3):324–332.
17 Papandonatos 2016 - Papandonatos GD, Erar B, Stanton CA G AL. Online community use predicts abstinence in combined internet/phone intervention for smoking cessation. Journal of Consulting and Clinical Psychology. 2016;84(7):633-644.
18 Naslund 2017* - Naslund JA, Kim SJ, Aschbrenner KA, et al. Systematic review of social media interventions for smoking cessation. Addictive Behaviors. 2017;73:81-93.
19 Newman 2011* - Newman MG, Szkodny LE, Llera SJ, Przeworski A. A review of technology-assisted self-help and minimal contact therapies for drug and alcohol abuse and smoking addiction: Is human contact necessary for therapeutic efficacy? Clinical Psychology Review. 2011;31(1):178-186.
20 Graham 2013* - Graham AL, Chang Y, Fang Y, et al. Cost-effectiveness of internet and telephone treatment for smoking cessation: An economic evaluation of The iQUITT Study. Tobacco Control. 2013;22(6):e11.
21 Pechmann 2017* - Pechmann C, Delucchi K, Lakon CM, Prochaska JJ. Randomised controlled trial evaluation of tweet2quit: A social network quit-smoking intervention. Tobacco Control. 2017;26(2):188-194.
22 Hill 2014b - Hill S, Amos A, Clifford D, Platt S. Impact of tobacco control interventions on socioeconomic inequalities in smoking: Review of the evidence. Tobacco Control. 2014;23:e89-e97
23 Smokefree.gov - US Department of Health and Human Services (US DHHS). Smokefree.gov. Resources to quit smoking: Smokefree VET, Smokefree Women, Smokefree Teen, Smokefree Espanol, Smokefree 60+, SmokefreeTXT, QuitGuide app, and QuitSTART App.
24 Smokefree.gov-Quit Plan - US Department of Health and Human Services (US DHHS). Smokefree.gov. Create My Quit Plan. 2018.
25 Stop Smoking Center - Stop Smoking Center.
26 ALA-FFS Online - American Lung Association (ALA). Freedom from smoking online.
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