Internet bridges gap for rural residents who need anti-smoking programs
GAINESVILLE, Fla. — The Internet may soon join nicotine chewing gum, the patch and behavioral counseling as a remedy for tobacco addiction, says a University of Florida researcher who participated in a study of rural residents using their computers to kick the habit.
Remote residents were chosen as subjects because they live far from clinical services that have helped many of their urban counterparts to quit smoking, said Jesse Dallery, a UF psychologist and one of the study’s authors.
“People who live away from cities face special challenges in kicking the habit because they are served by fewer clinics offering smoking cessation programs and they usually lack public transportation,” he said. “Capitalizing on the reach of the Internet is one way to help these otherwise inaccessible smokers.”
People who tried the virtual program were able to refrain from smoking at more than twice the rate of another group who did not use it over an initial six-week period, although abstinence levels for both groups later dropped, Dallery said. The study, led by researchers in Kentucky, is published in the November issue of the journal Drug and Alcohol Dependence.
“We have developed an innovative, novel and effective abstinence-based behavioral therapy where smokers are routinely monitored using the Internet,” he said. “To the best of our knowledge, this is the first randomized controlled study to demonstrate that participating in an abstinence-based program over the Internet can help people to stop smoking.”
Cigarette smoking is most prevalent in rural areas, where it increased to 30 percent in 2006 from 23 percent in 2005, Dallery said. In rural Appalachia, where the study was done, smoking rates were as high as 34 percent in 2007, compared with 20 percent for the United States as a whole, he said. Statistics released last week by the U.S. Centers for Disease Control and Prevention for 2008 show that cigarette smoking rose slightly for the first time in nearly 15 years to a little under 21 percent.
“Because people who live in rural areas smoke at disproportionate rates and have difficulty getting access to health care, their rates of disease are much higher,” Dallery said. Among the highest incidences of cancer, cardiovascular disease and other smoking-related illnesses are recorded in rural Appalachia, he said.
The study compared two groups of rural Appalachian Kentucky residents who participated in a smoking cessation program. Both received counseling and medical information about the hazards of smoking, but only one group was randomly assigned to an Internet-based monitoring system that targeted reductions in their carbon monoxide levels throughout the testing period.
A carbon monoxide monitor and Web camera was attached to each participant’s personal computer, and participants logged on to a Web site to provide carbon monoxide samples and receive immediate feedback, he said.
“The intervention is ideal for rural residents because it minimizes the need for twice daily visits to a clinic to collect breath samples that traditional abstinence programs require, and participants need only have a computer with Internet access,” he said.
Although fewer rural residents have access to the Internet than their city counterparts, that gap is narrowing with the increase of global Internet access by more than 300 percent between 2000 and 2008, Dallery said. Kentucky, a largely rural state, leads the nation in broadband expansion, he said.
The 35 smokers who participated in the Internet-based program were much more likely to have abstained at the end of each week of the initial six-week monitoring period than the 33 smokers who received only counseling and medical information, the study found.
At the end of the first week, 30 percent of the Internet group had been smoke free compared with 18 percent of the control group, and by the end of the sixth week the gap had widened to 34 percent and 13 percent, he said.
Over a 12-week period, however, abstinence levels dropped to about 5 percent for Internet users and to zero percent for the control group, following a pattern of decline found in other smoking cessation programs, Dallery said.
“One of the problems with smoking is that it is such a long-term behavior,” he said. “People have been doing it many times a day for thousands of days, and any frequently practiced behavior is really hard to give up.”
Perhaps the Internet can be harnessed in new ways to help maintain smokers’ initial gains smokers, such as tailoring it to those who would thrive with the social support of an on-line community, Dallery said. “One approach we’re looking at is setting up a virtual group format that links smokers so they can set and share goals to quit together,” he said.