Wen, Si and Wiers, Reinout W and Boffo, Marilisa and Grasman, Raoul P P P and Pronk, Thomas and Larsen, Helle (2021) Subtypes of smokers in a randomized controlled trial of a web-based smoking cessation program and their role in predicting intervention non-usage attrition: Implications for the development of tailored interventions. Internet Interventions, 26, p. 100473. doi: 10.1016/j.invent.2021.100473.
External website: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC85694...
Introduction: Web-based smoking interventions hold potential for smoking cessation; however, many of them report low intervention usage (i.e., high levels of non-usage attrition). One strategy to counter this issue is to tailor such interventions to user subtypes if these can be identified and related to non-usage attrition outcomes. The aim of this study was two-fold: (1) to identify and describe a smoker typology in participants of a web-based smoking cessation program and (2) to explore subtypes of smokers who are at a higher risk for non-usage attrition (i.e., early dropout times).
Methods: We conducted secondary analyses of data from a large randomized controlled trial (RCT) that investigated effects of a web-based Cognitive Bias Modification intervention in adult smokers. First, we conducted a two-step cluster analysis to identify subtypes of smokers based on participants' baseline characteristics (including demographics, psychological and smoking-related variables, = 749). Next, we conducted a discrete-time survival analysis to investigate the predictive value of the subtypes on time until dropout.
Results: We found three distinct clusters of smokers: Cluster 1 (25.2%, = 189) was characterized by participants being relatively young, highly educated, unmarried, light-to-moderate smokers, poly-substance users, and relatively high scores on sensation seeking and impulsivity; Cluster 2 (41.0%, = 307) was characterized by participants being older, with a relatively high socio-economic status (SES), moderate-to-heavy smokers and regular drinkers; Cluster 3 (33.8%, = 253) contained mostly females of older age, and participants were further characterized by a relatively low SES, heavy smoking, and relatively high scores on hopelessness, anxiety sensitivity, impulsivity, depression, and alcohol use. Additionally, Cluster 1 was more likely to drop out at the early stage of the intervention compared to Cluster 2 (adjusted Hazard Ratio ( ) = 1.51, = [1.25, 1.83]) and Cluster 3 ( = 1.52, = [1.25, 1.86]).
Conclusions: We identified three clusters of smokers that differed on a broad range of characteristics and on intervention non-usage attrition patterns. This highlights the heterogeneity of participants in a web-based smoking cessation program. Also, it supports the idea that such interventions could be tailored to these subtypes to prevent non-usage attrition. The subtypes of smokers identified in this study need to be replicated in the field of e-health outside the context of RCT; based on the smoker subtypes identified in this study, we provided suggestions for developing tailored web-based smoking cessation intervention programs in future research.
HJ Treatment or recovery method > Substance disorder treatment method > Cessation of tobacco use
HJ Treatment or recovery method > Treatment outcome
J Health care, prevention, harm reduction and treatment > Treatment and maintenance > Treatment factors
N Communication, information and education > Telehealth / Telemedicine / mHealth / eHealth
N Communication, information and education > Communication > Online communication / social media > Internet / online
VA Geographic area > Europe > Netherlands
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