Internet-based intervention for smoking cessation (StopAdvisor) in people with low and high socioeconomic status: a randomised controlled trial
Authors: Jamie Brown, Susan Michie, Adam WA Geraghty, Lucy Yardley, Benjamin Gardner, Lion Shahab, John A Stapleton, Robert West
Journal: The Lancet Respiratory Medicine (2014)

Background Internet-based interventions for smoking cessation could help millions of people stop smoking at very low unit costs; however, long-term biochemically verifi ed evidence is scarce and such interventions might be less eff ective for smokers with low socioeconomic status than for those with high status because of lower online literacy to engage with websites.We aimed to assess a new interactive internet-based intervention (StopAdvisor) for smoking cessation that was designed with particular attention directed to people with low socioeconomic status.Methods We did this online randomised controlled trial between Dec 6, 2011, and Oct 11, 2013, in the UK.Participants aged 18 years and older who smoked every day were randomly assigned (1:1) to receive treatment with StopAdvisor or an information-only website.Randomisation was automated with an unseen random number function embedded in the website to establish which treatment was revealed after the online baseline assessment.Recruitment continued until the required sample size had been achieved from both high and low socioeconomic status subpopulations.Participants, and researchers who obtained data and did laboratory analyses, were masked to treatment allocation.The primary outcome was 6 month sustained, biochemically verifi ed abstinence.The main secondary outcome was 6 month, 7 day biochemically verifi ed point prevalence.Analysis was by intention to treat.Homogeneity of intervention eff ect across the socioeconomic subsamples was fi rst assessed to establish whether overall or separate subsample analyses were appropriate.The study is registered as an International Standard Randomised Controlled Trial, number ISRCTN99820519.Findings We randomly assigned 4613 participants to the StopAdvisor group (n=2321) or the control group (n=2292); 2142 participants were of low socioeconomic status and 2471 participants were of high status.The overall rate of smoking cessation was similar between participants in the StopAdvisor and control groups for the primary (237 [10%] vs 220 [10%] participants; relative risk [RR] 1•06, 95% CI 0•89-1•27; p=0•49) and the secondary (358 [15%] vs 332 [15%] participants; 1•06, 0•93-1•22; p=0•37) outcomes; however, the intervention eff ect diff ered across socioeconomic status subsamples (1•44, 0•99-2•09; p=0•0562 and 1•37, 1•02-1•84; p=0•0360, respectively).StopAdvisor helped participants with low socioeconomic status stop smoking compared with the information-only website (primary outcome: 90 [8%] of 1088 vs 64 [6%] of 1054 participants; RR 1•36, 95% CI 1•00-1•86; p=0•0499; secondary outcome: 136 [13%] vs 100 [10%] participants; 1•32, 1•03-1•68, p=0•0267), but did not improve cessation rates in those with high socioeconomic status (147 [12%] of 1233 vs 156 [13%] of 1238 participants; 0•95, 0•77-1•17; p=0•61 and 222 [18%] vs 232 [19%] participants; 0•96, 0•81-1•13, p=0•64, respectively).Interpretation StopAdvisor was more eff ective than an information-only website in smokers of low, but not high, socioeconomic status.StopAdvisor could be implemented easily and made freely available, which would probably improve the success rates of smokers with low socioeconomic status who are seeking online support.