Website. Strecher et al. (2008) found that a Web-based behavioral smoking-cessation program was less effective for participants who were younger, male, and had less formal education (Strecher et al., 2008). Feil et al. (2003) designed a Web-based cessation site and studied recruitment approaches, use patterns, retention incentives, satisfaction, and cessation rate. The program included social support and cognitive–behavioral coping skills. Of the 370 subjects followed for 3 months, the 7-day point-prevalence abstinence rate was 18% on the basis of intent-to-treat analysis (Feil et al., 2003).

One example of a computer-based service is QuitNet® that includes personalized interactive materials for members, provides proactive telephone counselors, and hosts an online support community of other smokers and ex-smokers (Cobb et al., 2005). One version of the program is available free to the public, and the other is an enhanced version available to commercial organizations. Other computer-based tobacco-use cessation programs include Quit For Life, offered by Free and Clear, Inc.; Freedom From Smoking®, developed by the American Lung Association; and BecomeAnEX, sponsored by the National Alliance for Tobacco Cessation. SmokeFree.gov offers an online smoking-cessation program that includes text messaging with an NCI tobacco-cessation counselor. The SmokeFree.gov site also contains a referral for military personnel to DoD’s “Quit Tobacco. Make Everyone Proud” program. According to the National Institutes of Health Web site (www.clinicaltrials.gov), formal assessments of QuitNet and other online smoking-cessations programs are under way.

Finding: Computer-based tobacco-use cessation programs may be able to reach a large audience of tobacco users, but there is insufficient evidence of their effectiveness.

Provider Education

Many people see a health-care professional (such as a primary-care physician or dentist) at least once a year. Each visit can be an opportunity to ask patients about their tobacco use and educate them about adverse health effects and available interventions. But first, healthcare providers must themselves be aware of tobacco-cessation interventions and be comfortable in providing advice on these matters to their patients.

The use of evidence-based interventions may be enhanced by educating providers on the 5 A’s to increase the rate of asking, advising, and assisting patients with tobacco cessation. The National Ambulatory Medical Care Survey of office-based physicians in the United States



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