Online Tool Shows Promise in Helping Low-Income Smokers Quit

Cigarette smoking is responsible for an estimated 480,000 deaths per year in the U.S., making smoking the leading preventable cause of death in the country. Almost seven out of 10 smokers want to quit, but the success rates for many interventions are fairly low. Some groups have less success than others in quitting smoking, including those of low income, and improving outcomes among these individuals is a priority for public health. A new study has found a potentially valuable approach for these low-income smokers, and although it’s only a preliminary finding, similar strategies may soon be used around the world if initial positive results are replicated.

The study is based on a quit-smoking approach called StopAdvisor. This is an online tool designed to be both a source of information and a guide to help smokers through the process of quitting. Sessions on the site teach users behavior change techniques, which help smokers set goals and plan for action around their chosen quit date. The site suggests how smokers can change their routines to minimize cravings, helps them devise specific coping strategies for the difficulties they expect to have in quitting and helps smokers develop realistic expectations about those difficulties. Participants receive an email on their chosen quit date, and after that the program switches its advice to focus on fighting cravings, encouraging feelings of self-efficacy, properly using medicines and anticipating stressful events. However, online approaches like this have been traditionally seen as less effective for those with low socioeconomic status due to lower Internet literacy.

Does StopAdvisor Help?

To test the effectiveness of StopAdvisor, and specifically how well it works for smokers of low socioeconomic status, researchers randomly assigned 4,613 U.K. smokers (aged 18 or over) to either receive treatment through StopAdvisor or from an information-only website. The researchers were mainly looking for sustained abstinence for six months (all abstinence was biochemically verified; they weren’t just relying on participants’ reporting), but abstinence for the previous seven days at the six-month mark was a secondary outcome. There were similar numbers of high-status and low-status participants in the sample to enable comparison between the two.

What They Found 

For the group as a whole, the results weren’t particularly promising for StopAdvisor. The quit rate for participants in the StopAdvisor and control (information-only website) groups were the same: 10 percent of both groups managed to stop for the entire six months and 15 percent of both groups managed to stop for the week before the six-month meeting. However, there was a significant difference between the two treatment methods for participants with low economic status. The researchers found that 8 percent of the low economic status smokers assigned to StopAdvisor were successful in quitting for the whole six months, in comparison to 6 percent of those assigned to the information-only site.

But overall, the high socioeconomic status smokers were more successful in quitting, with 12 percent of the StopAdvisor group and 13 percent of the information-only group being successfully abstinent from smoking for six months.

Online Interventions Effective for Low-Income Smokers

If you consider the entire group of smokers in the study, StopAdvisor is just as useful as an information-only website, meaning it has no real effect on quit rates (at least from the additional behavior-change and craving-management techniques). However, when considered for low-status individuals, it appears better than the alternative. While backing an approach because it works for one subset of smokers may seem inefficient, the low cost of offering such an intervention makes it a much more appealing strategy.

It’s also worth noting that StopAdvisor was created with low-income British smokers in mind, having been refined based on the suggestions of a low socioeconomic status focus group who tried out an early version.

Lead author Dr. Jamie Brown adds, “StopAdvisor was evaluated in England with English smokers, but we have no reason to believe it wouldn’t generalize. You wouldn’t want to recommend it confidently without doing that additional evaluation, of course.”

Future of Smoking-Cessation Support

The most effective method of helping smokers quit is with intensive face-to-face support and medication, according to Dr. Brown, but this isn’t widely utilized even in the U.K., where in many cases it’s available free of charge. This underlines the potential of approaches like StopAdvisor for reaching the low-income smokers less likely to quit, because it gives them access to vital psychological advice they otherwise wouldn’t receive. The Public Health Authority in the U.K. is working to implement a version of the approach at the national level, but at present there is no plan for a similar strategy in the U.S. However, such an approach is almost certain to become common across the Atlantic if initial versions prove successful in Britain.