Translational Behavioral Medicine

, Volume 4, Issue 4, pp 382–390 | Cite as

Five population-based interventions for smoking cessation: a MOST trial

  • D Fraser
  • K Kobinsky
  • S S Smith
  • J Kramer
  • W E TheobaldEmail author
  • T B Baker
Original Research


Little is known about the relative, additive, and interactive effects of different population-based treatments for smoking cessation. The goal of this study was to evaluate the main and interactive effects of five different smoking interventions. Using the multiphase optimization strategy (MOST), 1,034 smokers who entered a Web site for smokers ( were randomly assigned to the “on” and “off” conditions of five smoking cessation interventions: the National Cancer Institute’s (NCI) Web site ( vs a “lite” Web site), telephone quitline counseling (vs none), a smoking cessation brochure (vs a lite brochure), motivational e-mail messages (vs none), and mini-lozenge nicotine replacement therapy (NRT vs none). Analyses showed that the NCI Web site and NRT both increased abstinence; however, the former increased abstinence significantly only when it was not used with the e-mail messaging intervention (messaging decreased Web site use). The other interventions showed little evidence of effectiveness. There was evidence that mailed nicotine mini-lozenges and the NCI Web site ( provide benefit as population-based smoking interventions.


Smoking cessation Web site evaluation MOST research Telephone quitline Nicotine replacement 



This was an investigator-designed study undertaken in response to a contract to the University of Wisconsin from Matthews Media Group, underwritten by ARRA funding to the National Cancer Institute. Additional funding for Timothy Baker was provided by the National Cancer Institute (5K05CA139871). The funders worked under the direction of the investigators to implement the study-required design and procedures in the Web site, providing required data reports on enrollment and Web site usage. The funders played no role in the design, conduct or analysis of the study, nor in the interpretation and reporting of the study findings. The researchers were independent from the funders. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.


The project was funded through a contract to our university from Matthews Media Group, underwritten by ARRA funding to the National Cancer Institute. Additional funding was provided by the National Cancer Institute (5K05CA139871).

Conflict of interest

David Fraser, Kate Kobinsky, Stevens Smith, Jason Kramer, Wendy Theobald, and Timothy Baker declare that they have no conflict of interest. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Supplementary material

13142_2014_278_MOESM1_ESM.docx (15 kb)
ESM 1 (DOCX 14 kb)
13142_2014_278_MOESM2_ESM.docx (19 kb)
Supplementary Table 1 (DOCX 19 kb)


  1. 1.
    World Health Organization. WHO global report: mortality attributable to tobacco. Geneva, Switzerland: WHO Press; 2012.Google Scholar
  2. 2.
    Fiore MC, Jaen CR, Baker TB, et al. Treating tobacco use and dependence: 2008 update. Rockville, MD: U.S. Department of Health and Human Services, U.S. Public Health Service; 2008.Google Scholar
  3. 3.
    Fiore MC, Baker TB. Treating smokers in the health care setting. N Engl J Med. 2011;365(13):1222-1231.PubMedCrossRefGoogle Scholar
  4. 4.
    Aveyard P, Begh R, Parsons A, et al. Brief opportunistic smoking cessation interventions: a systematic review and meta-analysis to compare advice to quit and offer of assistance. Addiction. 2012;107(6):1066-1073.PubMedCrossRefGoogle Scholar
  5. 5.
    Gollust SE, Schroeder SA, Warner KE. Helping smokers quit: understanding the barriers to utilization of smoking cessation services. Milbank Q. 2008;86(4):601-627.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Raupach T, West R, Brown J. The most “successful” method for failing to quit smoking is unassisted cessation. Nicotine Tob Res. 2013;15(3):748-749.PubMedCrossRefGoogle Scholar
  7. 7.
    Borland R, Partos TR, Yong HH, et al. How much unsuccessful quitting activity is going on among adult smokers? Data from the International Tobacco Control Four Country cohort survey. Addiction. 2012;107(3):673-682.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Centers for Disease Control and Prevention. Quitting smoking among adults - United States 2001-2010. MMWR. 2011;60(44):1513-1519.Google Scholar
  9. 9.
    Lichtenstein E, Zhu SH, Tedeschi GJ. Smoking cessation quitlines: an underrecognized intervention success story. Am Psychol. 2010;65(4):252-261.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    McAfee TA. Quitlines a tool for research and dissemination of evidence-based cessation practices. Am J Prev Med. 2007;33(6 Suppl):S357-S367.PubMedCrossRefGoogle Scholar
  11. 11.
    North American Quitline Consortium. All quitline facts: an overview of the NAQC 2009 Annual Survey of Quitlines 2010. Available from: Accessibility verified April 28, 2014.
  12. 12.
    Hyland A, editor Perceptions of NRT safety and efficacy: results from the International Tobacco Control (ITC) Four Country Collaboration. Society for Research on Nicotine and Tobacco (SRNT) Preconference Symposium; 2007; Austin, TX.Google Scholar
  13. 13.
    Stead LF, Perera R, Bullen C, et al. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2008;1, CD000146.PubMedGoogle Scholar
  14. 14.
    Hughes JR, Peters EN, Naud S. Effectiveness of over-the-counter nicotine replacement therapy: a qualitative review of nonrandomized trials. Nicotine Tob Res. 2011;13(7):512-522.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Schlam TR, Baker TB. Interventions for tobacco smoking. Invited review. Annu Rev Clin Psychol. 2013;9:675-702.PubMedCrossRefGoogle Scholar
  16. 16.
    Bennett GG, Glasgow RE. The delivery of public health interventions via the internet: actualizing their potential. Annu Rev Public Health. 2009;30:273-292.PubMedCrossRefGoogle Scholar
  17. 17.
    Civljak M, Sheikh A, Stead LF, et al. Internet-based interventions for smoking cessation. Cochrane Database Syst Rev. 2010;9, CD007078.PubMedGoogle Scholar
  18. 18.
    Devries KM, Kenward MG, Free CJ. Preventing smoking relapse using text messages: analysis of data from the txt2stop trial. Nicotine Tob Res. 2013;15(1):77-82.PubMedCrossRefGoogle Scholar
  19. 19.
    Whittaker R, McRobbie H, Bullen C, et al. Mobile phone-based interventions for smoking cessation. Cochrane Database Syst Rev. 2012;11, CD006611.PubMedGoogle Scholar
  20. 20.
    Graham AL, Cobb NK, Papandonatos GD, et al. A randomized trial of internet and telephone treatment for smoking cessation. Arch Intern Med. 2011;171(1):46-53.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Collins LM, Baker TB, Mermelstein RJ, et al. The multiphase optimization strategy for engineering effective tobacco use interventions. Ann Behav Med. 2011;41(2):208-226.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Collins LM, Murphy SA, Nair VN, et al. A strategy for optimizing and evaluating behavioral interventions. Ann Behav Med. 2005;30(1):65-73.PubMedCrossRefGoogle Scholar
  23. 23.
    National Cancer Institute. Clearing the air: how to quit smoking . . . and quit for keeps. (NIH publication no. 95-1647.). 1993.Google Scholar
  24. 24.
    Lehto T, Oinas-Kukkonen H. Persuasive features in web-based alcohol and smoking interventions: a systematic review of the literature. J Med Internet Res. 2011;13(3):e46.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Abroms LC, Padmanabhan N, Thaweethai L, et al. iPhone apps for smoking cessation: a content analysis. Am J Prev Med. 2011;40(3):279-285.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Etter JF. A list of the most popular smoking cessation web sites and a comparison of their quality. Nicotine Tob Res. 2006;8(Suppl 1):S27-S34.PubMedCrossRefGoogle Scholar
  27. 27.
    Mermelstein R, Hedeker D, Wong SC. Extended telephone counseling for smoking cessation: does content matter? J Consult Clin Psychol. 2003;71(3):565-574.PubMedCrossRefGoogle Scholar
  28. 28.
    Bush TM, McAfee T, Deprey M, et al. The impact of a free nicotine patch starter kit on quit rates in a state quit line. Nicotine Tob Res. 2008;10(9):1511-1516.PubMedCrossRefGoogle Scholar
  29. 29.
    Krupski L, Cummings KM, Hyland A, et al. Nicotine replacement therapy distribution to light daily smokers calling a quitline. Nicotine Tob Res. 2013;15(9):1572-1577.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Heatherton TF, Kozlowski LT, Frecker RC, et al. The fagerstrom test for nicotine dependence: a revision of the fagerstrom tolerance questionnaire. Br J Addict. 1991;86(9):1119-1127.PubMedCrossRefGoogle Scholar
  31. 31.
    Smith SS, Piper ME, Bolt DM, et al. Development of the brief Wisconsin inventory of smoking dependence motives. Nicotine Tob Res. 2010;12(5):489-499.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Bolt DM, Piper ME, McCarthy DE, et al. The Wisconsin predicting patients’ relapse questionnaire. Nicotine Tob Res. 2009;11(5):481-492.PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Welsch SK, Smith SS, Wetter DW, et al. Development and validation of the Wisconsin Smoking Withdrawal Scale. Exp Clin Psychopharmacol. 1999;7(4):354-361.PubMedCrossRefGoogle Scholar
  34. 34.
    Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol. 1988;54(6):1063-1070.PubMedCrossRefGoogle Scholar
  35. 35.
    Gibbons RD, Hedeker D, DuToit S. Advances in analysis of longitudinal data. Annu Rev Clin Psychol. 2010;6:79-107.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Corporation IBM. IBM SPSS statistics for windows, version 22.0. Armonk, NY: IBM Corporation; 2013.Google Scholar
  37. 37.
    Smith SS, Keller PA, Kobinsky KH, et al. Enhancing tobacco quitline effectiveness: identifying a superior pharmacotherapy adjuvant. Nicotine Tob Res. 2013;15(3):718-728.PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Hughes JR, Cummings KM, Foulds J, et al. Effectiveness of nicotine replacement therapy–a rebuttal. Addiction. 2012;107(8):1527-1528.PubMedCrossRefGoogle Scholar
  39. 39.
    Jamison J, Sutton S, Gilbert H. Delivering tailored smoking cessation support via mobile phone text messaging: a feasibility and acceptability evaluation of the Quittext program. J Appl Biobehav Res. 2012;17(1):38-58.CrossRefGoogle Scholar
  40. 40.
    Lancaster T, Stead LF. Self-help interventions for smoking cessation. Cochrane Database Syst Rev. 2005;3, CD001118.PubMedGoogle Scholar
  41. 41.
    Riley W, Augustson EM. Mobile phone-based smoking cessation interventions increase long-term quit rates compared with control programmes, but effects of the interventions are heterogeneous. Evid Based Nurs. 2013;16(4):108-109.PubMedCrossRefGoogle Scholar
  42. 42.
    Glasgow RE, Magid DJ, Beck A, et al. Practical clinical trials for translating research to practice: design and measurement recommendations. Med Care. 2005;43(6):551-557.PubMedCrossRefGoogle Scholar
  43. 43.
    March J, Kraemer HC, Trivedi M, et al. What have we learned about trial design from NIMH-funded pragmatic trials? Neuropsychopharmacology. 2010;35(13):2491-2501.PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    Patrick DL, Cheadle A, Thompson DC, et al. The validity of self-reported smoking: a review and meta-analysis. Am J Public Health. 1994;84(7):1086-1093.PubMedCentralPubMedCrossRefGoogle Scholar
  45. 45.
    SRNT Subcommittee on Biochemical Verification. Biochemical verification of tobacco use and cessation. Nicotine Tob Res. 2002;4:149-159.CrossRefGoogle Scholar

Copyright information

© Society of Behavioral Medicine 2014

Authors and Affiliations

  • D Fraser
    • 1
  • K Kobinsky
    • 1
  • S S Smith
    • 1
  • J Kramer
    • 1
  • W E Theobald
    • 1
    Email author
  • T B Baker
    • 1
  1. 1.Center for Tobacco Research and InterventionUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA

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