Phone chats plus web program help smokers quit

New York: Getting personalized phone counseling along with web-based guidance makes it easier to quit smoking, suggests a new study.

After 18 months, smokers who got phone calls from experienced counselors in addition to following a web-based cessation program had nearly double the quit rates of smokers who just used the web program, according to a report published Monday in the Archives of Internal Medicine.

Numerous studies have examined the effectiveness of smoking cessation programs in the past, but "this is one of the few large trials that have looked at the internet and telephone counseling combined," lead author Amanda Graham, director for research development at the Schroeder Institute for Tobacco Research and Policy Studies at the American Legacy Foundation in Washington, D.C., told Reuters Health in an interview.

About one in five adults in the U.S. smokes, and about half of those who don't quit will die from the habit, according to the U.S. Centers for Disease Control and Prevention. The CDC estimates smoking costs the economy $193 billion every year.

National smoking rates have declined dramatically -- from about 30 percent of the population in 1985. Still, most smokers make multiple attempts before quitting successfully.

Telephone counseling has proven to be one of the more helpful interventions, the authors note, and many phone counseling programs now offer an Internet component.

For the current study, the researchers used QuitNet.com, a website established in 1995 that has more than 60,000 monthly users. One of the study's authors is a consultant to the site's owner. A basic membership on QuitNet is free, and the premium version is $99.95 a year.

The scientists randomly assigned about 2,000 smokers to one of three groups -- those who would receive phone counseling plus a premium QuitNet membership that let them set quit dates and track their motivations, those who got just the premium QuitNet membership, or those who used a static website they created for the study that offered general advice on quitting.

After 18 months, 15 percent of the QuitNet plus phone program participants reported not smoking since the start of the study. Eight percent of the QuitNet users and six percent of the static website users had reported not smoking over the same period of time.

"These were significant differences, even though they may look small," said Victor Strecher, professor of public health at the University of Michigan in Ann Arbor. Translated to the millions of people in the U.S. who still smoke, he said, it does actually make a pretty large difference.

Less than five percent of people who try to quit without medication or counseling never smoke again, according to the National Cancer Institute.

In the current study, five calls from a telephone counselor were concentrated during the first month of the smokers' quit attempts, a time when they were most prone to relapse.

Why that early support seemed to give the phone-counseling group a lasting advantage is unclear. Strecher thinks that having to attend counseling sessions in person or receiving too many phone calls might be off-putting, but the targeted calls provided just enough extra encouragement.

"Smokers tend to be mavericks," Strecher said, so they don't usually respond to an overly aggressive cessation program. But a program like this, where they can use the web at will and get an occasional phone call, seems to work well.

"I do think that smokers are very receptive to this kind of intervention," he said.

onducting the trial with a website that people currently use, rather than creating a new program as past studies have done, was also important, Graham said.

"The problem is that when you port (the new programs) out into the real world, they may flop," she said.

Graham wouldn't say how much the phone counseling costs, but said it's something her group hopes to address in the next study. Counselors used in the current study were affiliated with the National Jewish Health medical center in Denver, which provides counseling services for many state-sponsored and private smoking cessation programs across the country, including some no-cost state "quit lines."