AIM: To examine self-efficacy and program exposure as possible mediators observed treatment effects for a web-based tobacco cessation intervention. DESIGN: The ChewFree trial used a two-arm design to compare tobacco abstinence at both the 3- and 6-month follow-up for participants randomized to either an enhanced intervention condition or a basic information-only control condition. SETTING: Internet in US and Canada. PARTICIPANTS: Our secondary analyses focused upon 402 participants who visited the web-based program at least once, whose baseline self-efficacy rating showed room for improvement, who reported that they were still using tobacco at the 6-week assessment, and for whom both 3- and 6-month follow-up data were available. INTERVENTION: An enhanced web-based behavioral smokeless tobacco cessation intervention delivered program content using text, interactive activities, testimonial videos and an ask-an-expert forum and a peer forum. The basic control condition delivered tobacco cessation content using static text only. MEASUREMENTS: Change in self-efficacy and program exposure from baseline to 6 weeks were tested as simple and multiple mediators on the effect of treatment condition on point-prevalence tobacco abstinence measured at 3- and 6-month follow-up. FINDINGS: While both participant self-efficacy and program exposure satisfied the requirements for simple mediation, only self-efficacy emerged as a mediator when we used the more robust test of multiple mediation. CONCLUSIONS: Results confirm the importance of self-efficacy change as a probable underlying mechanism in a successful web-based behavioral intervention. While program exposure was found to be a simple mediator of tobacco abstinence, it failed to emerge as a mediator when tested with self-efficacy change in a multiple mediator test suggesting that self-efficacy and program exposure share a complex, possibly reciprocal relationship with the tobacco abstinence outcome. Our results underscore the utility of searching for mediators in research on web-based interventions.
RCT Entities:
AIM: To examine self-efficacy and program exposure as possible mediators observed treatment effects for a web-based tobacco cessation intervention. DESIGN: The ChewFree trial used a two-arm design to compare tobacco abstinence at both the 3- and 6-month follow-up for participants randomized to either an enhanced intervention condition or a basic information-only control condition. SETTING: Internet in US and Canada. PARTICIPANTS: Our secondary analyses focused upon 402 participants who visited the web-based program at least once, whose baseline self-efficacy rating showed room for improvement, who reported that they were still using tobacco at the 6-week assessment, and for whom both 3- and 6-month follow-up data were available. INTERVENTION: An enhanced web-based behavioral smokeless tobacco cessation intervention delivered program content using text, interactive activities, testimonial videos and an ask-an-expert forum and a peer forum. The basic control condition delivered tobacco cessation content using static text only. MEASUREMENTS: Change in self-efficacy and program exposure from baseline to 6 weeks were tested as simple and multiple mediators on the effect of treatment condition on point-prevalence tobacco abstinence measured at 3- and 6-month follow-up. FINDINGS: While both participant self-efficacy and program exposure satisfied the requirements for simple mediation, only self-efficacy emerged as a mediator when we used the more robust test of multiple mediation. CONCLUSIONS: Results confirm the importance of self-efficacy change as a probable underlying mechanism in a successful web-based behavioral intervention. While program exposure was found to be a simple mediator of tobacco abstinence, it failed to emerge as a mediator when tested with self-efficacy change in a multiple mediator test suggesting that self-efficacy and program exposure share a complex, possibly reciprocal relationship with the tobacco abstinence outcome. Our results underscore the utility of searching for mediators in research on web-based interventions.
Authors: Amanda L Graham; George D Papandonatos; Caroline O Cobb; Nathan K Cobb; Raymond S Niaura; David B Abrams; David G Tinkelman Journal: Nicotine Tob Res Date: 2014-08-25 Impact factor: 4.244
Authors: Susan M Zbikowski; Lisa M Jack; Jennifer B McClure; Mona Deprey; Harold S Javitz; Timothy A McAfee; Sheryl L Catz; Julie Richards; Terry Bush; Gary E Swan Journal: Nicotine Tob Res Date: 2011-01-31 Impact factor: 4.244
Authors: Sarah L Cutrona; Rajani S Sadasivam; Kathryn DeLaughter; Ariana Kamberi; Julie E Volkman; Nathan Cobb; Gregg H Gilbert; Midge N Ray; Thomas K Houston Journal: Transl Behav Med Date: 2016-12 Impact factor: 3.046
Authors: Michelle C Acosta; Kyle Possemato; Stephen A Maisto; Lisa A Marsch; Kimberly Barrie; Larry Lantinga; Chunki Fong; Haiyi Xie; Michael Grabinski; Andrew Rosenblum Journal: Behav Ther Date: 2016-09-20
Authors: Midge N Ray; Ellen Funkhouser; Jessica H Williams; Rajani S Sadasivam; Gregg H Gilbert; Heather L Coley; D Brad Rindal; Thomas K Houston Journal: Am J Prev Med Date: 2014-02 Impact factor: 5.043
Authors: Brian G Danaher; Herbert H Severson; Shu-Hong Zhu; Judy A Andrews; Sharon E Cummins; Edward Lichtenstein; Gary J Tedeschi; Coleen Hudkins; Chris Widdop; Ryann Crowley; John R Seeley Journal: Internet Interv Date: 2015-05-01