The prevalence of smoking among U.S. adults has remained relatively stable for the past five years at approximately 25%. Innovative approaches are needed to reach and treat the population of smokers. Preventive interventions which rely on behavioral counseling and social support, and which have large self-help components are well-suited to delivery via the Internet. Indeed, several recent studies have demonstrated efficacy of preventive health interventions delivered via the Internet. QuitNettm is a commercial website that implements the Tobacco Cessation Guidelines from the Surgeon General and the AHRQ. A key element of these guidelines, now regarded as the standard of care, is the use of pharmacotherapy. In order to have optimal effectiveness, pharmacotherapy requires support in the form of instructions for proper use, adjunct behavioral counseling, and follow-up. The primary threat to the efficacy of pharmacotherapy stems from problems with treatment compliance. The goal of this proposal is to develop a Medication Support System (MSS) that maximizes the efficacy of pharmacotherapy by addressing threats to compliance using proven cognitive and behavioral strategies. The MSS will be implemented as part of a comprehensive smoking cessation intervention offered on QuitNet.com and will consist of the following nine inter-related modules: 1) the Withdrawal Module conducts assessment of and intervention around withdrawal symptoms; 2) the Medication Trouble Shooting Module provides information and problem solving for patients experiencing difficulties (e.g., side effects) with medication use; 3) the Incentives and Rewards Module provides rewards contingent on the achievement of small goals and large milestones related to quitting smoking; 4) the Proactive Email Reminder Module generates proactive reminder messages to subscribers regarding medication-related behavioral goals; 5) the Ask the Expert Module provides intra-treatment support and guidance regarding pharmacotherapy through access to our smoking cessation expert; 6) the Bulletin Board Module facilitates the provision of social support among members around pharmacotherapy; 7) the Customized Medication Calendar and Journal encourage subscribers to self-monitor medication use and other smoking behaviors; 8) the Frequently Asked Question Module provides basic information that prepares and educates subscribers about nicotine dependence and its treatment, as well as the expected effects, side-effects, and benefits of pharmacotherapies; 9) the Buddy System Module encourages more intensive 1:1 support between subscribers and facilitates the identification of stage-matched buddies or stage- mismatched mentors. In Phase I, we will develop detailed specifications and conduct programming of all nine modules of the MSS system. A prototype will be presented to potential consumers in two rounds of focus groups to obtain detailed feedback. Current smokers and/or recent ex-smokers (N = 30) who used nicotine replacement and/or bupropion will be invited to participate in Round I focus groups to provide feedback on the MSS design and specifications. Focus group data will be used to finalize design specifications of the MSS system. In Round II focus groups, participants (N = 30) will use a working prototype of the system and provide feedback on usability, system layout and content areas. Feedback obtained in these sessions will be used to finalize development of the MSS system prior to launching on QuitNet. The goal of Phase II is to evaluate the efficacy of the MSS with respect to medication compliance and quitting outcomes in a randomized clinical trial. ? ?
