Summary or Abstract of the Thesis

The summary or abstract of the thesis needs more work!

Smoking is a leading cause of preventable diseases and death world wide and within New Zealand.To date, a lot of previous research has been conducted and this suggests that Internet and Cell phone based interventions are effective to achieve cessation of smoking however the effects are short term.The purpose of this Meta Analysis was to investigate the effectiveness of Internet and Cell phone based interventions to achieve longer term cessation of smoking among adolescent and adult smokers.The analysis was based on the assessment of Randomied Controlled Trials whose interventions included Internet and Cellphone components and reported outcomes at six months or longer. Furthermore, this analysis was based on English Language articles published in the previous 10 years and whose comparison group received either any other intervention or an intervention inclusive of but not limited to Internet and Cell phone based interventions delivered at a lower frequency. Both a Fixed effects and a Random effects Meta Analysis between all studies were conducted to assess the length of abstinence.Morever the individual studies were grouped using an outcome theme and five subgroup analyses were conducted. Findings from both, the Fixed effects and Random effects analysis suggest great heterogeneity among the studies.Additionally some heterogeneity was found among the five subgroup but overall findings suggest that Internet and Cell phone based interventions used in smoking cessation are effective in achieving longer term cessation of smoking. Findings from the subgroup analyses suggest that both Internet and Cell phone based interventions combined with an additional intervention Nicotine Replacement Therapy are most effective in achieving longer term cessation of smoking among adolescent and adult smokers.

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Chapter 1: Introduction and Review of the Literature


This chapter provides background information about previous research on Internet and cellphone based interventions for smoking cessation. The existing literature suggests that Internet-and Cell phone-based interventions have the potential to achieve short–term cessation of smoking. In this chapter, the key studies on the effectiveness of the Internet based intervention for achieving smoking cessation is provided.

Furthermore it provides information about risk factors for smoking among adolescents and adults, benefits of Smoking Cessation and Internet- and Cell phone-based interventions, the search of the literature and information about this Meta-Analysis.

This above last paragraph was unnecessary.

Smoking among adolescents and adults

Risk factors for smoking among adolescents and adults

Smoking often starts in adolescence. The USDHHS warns that "In abstinence of intervention, adolescent smokers will most likely become adult smokers" (USDHHS, 2014).

There are many (you have provided two of them: starting to smoke at adolescence and influence of being exposed to second hand smoke early on in the household. You may want to list these right here upfront to make things clear and bring a focus as to why Internet can be a useful intervention medium) risk factors for cigarette smoking among adolescents and adults. Joffer et al. (2014) ??on the basis of what? indicated that smoking most often starts sometime during adolescence and continues through to adulthood if no intervention was sought. Findings from this research suggest (when you write findings from established research, use present tense as that is established knowledge), that peers, friends, siblings, tobacco advertisement and especially interpersonal and psychological factors inclusive of stress and low self-esteem are significant influences in smoking initiation among adolescents.

Navas-Nacher (2015) suggest ??on the basis of what study?? that exposure to cigarette smoking during childhood years is a significant risk factor for the reason that it is a learned behaviour. Exposure to household smoking behaviour also referred to as ‘living with a regular smoker who smoked in the home’ nearly doubles the risk of becoming a smoker compared to those who had never been exposed to household smoking (give OR estimates here along with 95% confidence interval). Forty percent (when you start a sentence with number, always spell out) of participants (N = ??) who reported that they had been exposed to smoking in the home they lived in during their childhood and adolescence years and 20% of them (?? 20 percent of them or the entire population? What about the children who were exposed to second hand smoking in the households? This is an important finding) were current smokers.

Inter-personal and psychological factors inclusive of stress and low self-esteem including already identified nicotine addiction are significant factors among adult smokers (Joffer, 2014). This research indicated that people smoke for a variety of reasons related to family and social pressures, risk seeking, stress reductions and more. They may pass through stages of smoking from trying a cigarette to addiction and they suffer nicotine withdrawal with abrupt decrease from cigarettes along the way (Joffer, 2014).

Need more substance here. Particularly focus on how Internet and social media can influence, because your story down the line will include Internet.

Review of Quitting Measures

Velicer et al. (1997, cited in Velicer, 2004) classifies outcomes of smoking cessation programmes into three measures as follows:

  • point prevalence abstinence. -- refers to the proportion of people not smoking at any given point in time,
  • continuous abstinence. -- refers to the proportion of people not smoking at all since the onset of the intervention
  • prolonged abstinence. -- refers to the proportion of people abstinent for some interval.

The minimum time intervals for point prevalence abstinence are 24 hours, 7-days, and 30-days. The advantages of point prevalence abstinence is that non-smoking may be biochemically validated. Write here how this can be done It includes people who have progressed through the stages of change (explain the stages of change model briefly here) and it includes people who delay action and quit at a later time after an intervention. However, point prevalence may overestimate the number of quitters as people may start smoking again at a later time and smokers who quit within the common point prevalence time frames of 24 hours, one week or one month may only experience the immediate health benefits of cessation.

Continuous abstinence is more stable over time because for longer periods of abstinence also the likelihood of relapse reduces and it allows for the evaluation of longer-term health effects of smoking cessation. However continuous abstinence includes only a small number of smokers who quit without relapses also this only decreases as more quitters relapse and it cannot be validated biochemically.

Prolonged abstinence refers to that smokers have been abstinent for a long time period inclusive of 6-12 months. This is more stable than point prevalence, it allows smokers who take delayed action to quit to be counted and it can assess long-term health benefits, however this requires a long follow up period and cannot be validated biochemically (Velicer, 2004).

West (2009) proposes The Russell Standard, named after ??Russell (give a short history of this) which defines the smoking status in clinical research for monitoring the throughout success rates of stop smoking services, allowing meaningful direct comparisons between the services. The Russell Standard outlines six criteria as follows:

  • "treated smoker". -- A ‘treated smoker (TS)’is a smoker who undergoes at least one treatment session on or prior to the quit date. Smokers who attended an assessment session but fail to attend thereafter will not be counted. Neither are smokers who have already stopped smoking at the time they first came to the attention of the services;
  • ‘self-reported 4-week quitter (SR4WQ)’. -- A smoker is counted as a ‘self-reported 4-week quitter (SR4WQ)’ if he/she is a ‘treated smoker’, is assessed (face-to-face, by postal questionnaire or by telephone) 4 weeks after the designated quit date (minus 3 days or plus 14 days) and declares that he/she has not smoked even a single puff on a cigarette in the past 2 weeks,
  • "Co-verified 4-week Quitter (4WQ). -- A smoker is described as a ‘Co-verified 4-week quitter (4WQ) if he/she is a ‘self-reported 4-week quitter’ and his/her expired air CO is assessed 4 weeks after the designated quit date (minus 3 days or plus 14 days) and found to be less than 10ppm;
  • Lost to follow up at 4 weeks (LFU4W). -- A smoker is counted as ‘lost to follow up at 4 weeks (LFU4W)’ if on attempting to determine the 4 –week quitter status, he/she cannot be contacted;
  • 52-week Quitter (52WQ). -- A smoker is counted as a ’52-weeks quitter (52WQ)’ if he/ she is a ‘treated smoker’, is assessed (Face-to face, by postal questionnaire or telephone) 52 weeks after the designated quit date (plus or minus 30days) and declares that he/she has not smoked more than five cigarettes in the past 50 weeks.
  • "Lost to Follow Up at 52 Weeks (LFU52W)". -- A ‘treated smoker’ is counted as a ‘lost to follow up at 52 weeks (LFU52W)’ if on attempting to determine the 52-week quitter status, he/she cannot be contacted.

Theory of Addiction We need a linking paragraph here as to why all of a sudden you are talking about this

Robert West(2007) developed the Theory of Addiction , a theory which put the previous used Trans-theoretical model, developed by Prochaska and DiClemente (1983) at rest.The Theory of Addiction is based on a synthetic theory of motivation that focuses on the moment-to moment control of actions through casual pathsways through varying the lengths ad levels of complexity from single reflexes, through impulses and inhibitory forces, the desires,drives and emotional states to

Trans-theoretical Model of Behaviour Change which describes the progression through which smokers go through before terminating their addiction. You still have not brought in the issue of Internet here or the role of interventions. This is the phase here where you shall bring it in**.

This model of behaviour change divides itself into the stages of change, processes of change and levels of change and it identifies five stages of readiness for changing a health behaviour including smoking behaviour among smokers: Add a figure here (see above in the preface as to how to add figures)

1) pre-contemplation, 2) contemplation, 3) preparation, 4) action and 5) maintenance (Prochaska & DiClemente, 1983).

Description of the stages in the context of smoking

// Sabine, you do not need to worry too much about the stages of change model, as Mark was commenting that this is now deprecated. Put more emphasis on the classification of the smokers //

Pre-contemplation is described as the stage in which smokers are not thinking about quitting or intending to quit in the next 6 months. The reason for this may be people may not be informed about the consequences of smoking and demoralized in their ability to make the behaviour change. They may be resistant or unmotivated for behavioural change (Prochaska & DiClemente, 1983). The next stage is the contemplation stage, in which individuals are considering quitting within the next 6 months and people in this stage are more aware of the benefits of quitting. Furthermore, the preparation stage includes smokers who are intending on quitting smoking within the next 30 days. These smokers may have taken action in the past by reducing smoking or making a quit attempt and they also have a plan for action (Prochaska & Velicer, 1997). The action stage is the stage in which smokers have quit during the past 6 months and the maintenance stage consists of people who have quit for more than 6 months. This model also recognizes that people move through the stages in a spiral pattern in which some people progress through and relapse while others progress and successfully quit. (Velicer et al, 2004).

Discussion of how Internet- and Cell phone components included in smoking cessation programmes

Start with a brief introduction to the concept of Internet and cell phones and why or how unique are these two media or two approaches to enable a smoker to quit. For example, start with a quick introduciton to the concept of Internet as a system of networked computers that was preceded by the DARPA experiments, and then following the experiments and initially confined to the scientific community, how the World Wide Web became a major channel of information dissemination. Here, mention that all smoking cessation programmes are essentially based on reaching messages and information to individuals in an effort to make the quit smoking and stay as quitters. State that Internet as a channel for connecting people who provide the message and who receive such messages can be very useful. Then in the next paragraph write about the emergence of mobile devices of communication. Start with a brief history of tailored messaging for smoking cessation (discuss the work by Matthew Kreuter and his tailored messaging through telephones) and then write about how from desktop telephones, people graduated to cell phones as ubiquitous devices. Also here discuss that cell phone usage among adolescents is very popular. If this is the target population to be aimed at for smoking cessation and control, then focus on using cell phones and Internet and social media through the Internet and the world wide web can be a very useful channel. Then start the next paragraph

More health care providers are now including Internet and Cell phone components inclusive of text messaging, emails, accessing websites, accessing video clips online, access to online discussion forums and information within their smoking cessation programmes. The Internet and Cell phone allows people to receive information and treatment at any time, wherever they are and it provides anonymity.

Internet- and Cell phone-based interventions in smoking cessation

The Internet and Cell phone have become increasingly useful in the delivery of health care including smoking cessation programmes world-wide and within New Zealand. Internet- and Cell phone-based interventions are described as interventions in which the Internet and Cell phone are a main part of the smoking cessation programme. These menti