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Previous research has found that current smokers are less likely to have access to the Internet than nonsmokers. As access to the Internet continues to expand, does this finding remain true? Also, how many smokers are interested in Web-assisted tobacco interventions (WATIs)? These questions are important to determine the potential role that WATIs might play in promoting tobacco cessation.
The aims of the study were to determine whether smokers are less likely than nonsmokers to have access to the Internet and to establish the level of interest in WATIs among a representative sample of smokers.
A random digit dialing telephone survey was conducted of 8467 adult respondents, 18 years and older, in Ontario, Canada from September 2006 to August 2007. All respondents were asked their smoking status and whether they used the Internet (at home or work in the past 12 months; where; how often in the past 12 months). To assess the level of interest in WATIs, current daily smokers were asked whether they would be interested in a confidential program that they could access on the Internet, free of charge, that would allow them to check their smoking and compare it to other Canadians.
Smokers were marginally less likely to have used the Internet than nonsmokers (74% vs 81% in the last year), and, of those who had access to the Internet, smokers used the Internet less often than nonsmokers. Overall, 40% of smokers said they would be interested in a WATI. The number of cigarettes smoked per day was unrelated to level of interest in the WATI, but time to first cigarette after waking was. Smokers who used the Internet were more interested in the WATI than smokers who did not use the Internet (46% vs 20%).
While the difference in level of Internet use between smokers and nonsmokers was greatly reduced compared to 2002 and 2004 data, smokers still remain marginally less likely to use the Internet than nonsmokers. Overall, there was a substantial level of interest in the WATI among smokers, in particular among smokers who currently use the Internet. These results indicate that WATIs have a substantial potential audience among smokers, and, given the growing body of evidence regarding their efficacy, there is growing support that WATIs have a significant role to play in promoting tobacco cessation.
There are at least three issues of importance when considering whether Web-assisted tobacco interventions (WATIs) are a feasible way to help large numbers of people quit smoking. The first of these issues is the efficacy of the interventions. Do WATIs work? There is a growing body of research indicating that WATIs are an effective means of promoting tobacco cessation. Most notably, there have been several randomized controlled trials to date that have found that WATIs increase the rate of successful cessation from smoking cigarettes (eg, [
The other two issues of importance are whether smokers can easily access WATIs and whether they are interested in doing so. These topics are the focus of this paper. Previous research has found that cigarette smokers were less likely to have used the Internet than nonsmokers [
The third issue, smokers’ level of interest in WATIs, is important because interventions are unlikely to have an impact on the prevalence of smoking if only a small proportion of the population will access them. To a certain extent, this question can be addressed by looking at the volume of people who already access WATIs (reviewed in [
A random digit dialing survey was conducted of 8467 respondents, 18 years and older, in Ontario, Canada. The survey employed a two-stage sampling design in which random digit dialing was used to identify eligible households and then an adult was selected within the household by choosing the resident whose birth date was closest to the date of the telephone interview. Approximately 98% of Ontario households have landline telephones. Previous research has demonstrated that telephone surveys marginally over-represent younger respondents and those with more education [
As part of the survey, respondents were asked their current smoking status (daily, occasional, nonsmoker), and daily smokers were asked their number of cigarettes smoked per day and time after waking to their first cigarette [
Of the entire sample, 17% were daily smokers, 5.8% were occasional smokers, and 77.2% classified themselves as nonsmokers. (Prevalence rates are similar to those reported for the 2006 Canadian Tobacco Use Monitoring Survey [
Demographic and Internet use characteristics among daily smokers, occasional smokers, and nonsmokers (N = 8454; 13 respondents did not provide smoking status.)
Daily Smoker |
Occasional Smoker |
Nonsmoker |
|
|
Age, mean (SD) | 42.7 (13.8) | 41.8 (15.3) | 47.3 (16.7) | .001 |
Male, % | 49.0 | 49.7 | 43.8 | .001 |
Some post-secondary education, % | 50.8 | 65.1 | 68.9 | .001 |
Married/common law, % | 59.5 | 59.4 | 70.2 | .001 |
Full- or part-time employed, % | 71.1 | 70.1 | 61.6 | .001 |
|
||||
< 30 | 16.0 | 11.8 | 10.7 | |
30-49 | 15.6 | 14.7 | 13.5 | |
50-79 | 23.6 | 19.4 | 19.9 | |
80 or more | 27.9 | 35.7 | 34.7 | |
Don’t know/refused | 16.9 | 18.4 | 21.2 | .001 |
Any Internet use in past 12 months, % | 74.5 | 78.7 | 81.0 | .001 |
Use Internet daily/almost daily, % | 47.8 | 56.2 | 58.5 | .001 |
|
||||
At home only | 36.2 | 24.2 | 33.1 | |
Elsewhere only | 7.8 | 6.8 | 5.1 | |
Both home and elsewhere | 56.0 | 69.0 | 61.8 | .001 |
Logistic regression predicting respondents who did or did not use the Internet in the last year
Predictor | B (SE) |
|
Age | −.063 (.003) | .001 |
Male | −.077 (.070) | .27 |
Some post-secondary education | 1.462 (.069) | .001 |
Married | .293 (.078) | .001 |
Employed | .281 (.080) | .001 |
Household income less than Can $30,000 | −.869 (.101) | .001 |
Daily cigarette smoker | −.547 (.190) | .001 |
As a measure of level of interest in WATIs, daily smokers were asked if they would be“interested in a confidential program that you could access on the Internet, free of charge, that would allow you to check your smoking and compare it to other Canadians.” Overall, 40% of daily smokers said that they would be interested in this type of WATI.
Demographic, smoking, and Internet use characteristics for daily smokers who were interested or not interested in the WATI (N = 1424; 9 daily smokers did not provide information on their interest in WATI).
Not Interested |
Interested |
|
|
Age, mean (SD) | 44.3 (14.4) | 40.1 (12.1) | .001 |
Male, % | 49.4 | 48.5 | |
Some post-secondary education, % | 48.7 | 54.4 | .05 |
Married/common law, % | 59.7 | 59.3 | |
Full- or part-time employed, % | 67.9 | 76.8 | .001 |
|
|||
< 30 | 16.8 | 14.3 | |
30-49 | 15.1 | 16.6 | |
50-79 | 21.5 | 27.0 | |
80 or more | 26.7 | 29.5 | |
Don’t know/refused | 19.9 | 12.7 | .01 |
Cigarettes per day, mean (SD) | 15.0 (7.9) | 15.5 (7.6) | |
Smoke within half hour of waking, % | 49.9 | 59.3 | .001 |
Any Internet use in past 12 months, % | 66.6 | 87.6 | .001 |
Use Internet daily/almost daily, % | 42.5 | 56.5 | .001 |
|
|||
At home only | 35.1 | 37.4 | |
Elsewhere only | 10.7 | 7.7 | |
Both home and elsewhere | 54.2 | 55.0 | .001 |
Logistic regression predicting daily smoking respondents who were interested or not interested in WATI
Predictor | B (SE) |
|
Age | −.013 (.005) | .02 |
Male | −.155 (.127) | .22 |
Some post-secondary education | −.146 (.130) | .26 |
Married | .152 (.132) | .25 |
Employed | .217 (.149) | .14 |
Household income less than Can $30,000 | .057 (.196) | .77 |
Used Internet in past 12 months | 1.101 (.190) | .001 |
Used Internet daily | .115 (.141) | .41 |
Cigarettes smoked per day | .014 (.009) | .14 |
Smoke within half hour of waking | .428 (.137) | .002 |
While many more smokers used the Internet in 2007 compared to that observed in 2002 [
One issue to consider is that there does not appear to be any theoretical reason why smoking cigarettes per se is causally related to Internet access. It is likely that smoking is a marker for other demographic characteristics that are related to Internet access (eg, socioeconomic status). However, while interesting, this issue is not of practical relevance to the current paper as this study examines whether smokers have access to the Internet and not the reasons why smokers might have less access than nonsmokers.
Many smokers say that they would be interested in one type of WATI, with 40% of daily smokers saying that they would be interested in an Internet-based program that would allow them to compare their smoking to other Canadians. A clear limitation of this question as a means of assessing level of interest in WATIs is that normative comparison programs (ie, comparing own smoking to that of others) are just one type of WATI available. It is possible that smokers might be more (or less) interested in other types of WATI, just as smokers indicate variation in interest in WATIs versus other types of services (eg, telephone counseling) [
Other factors related to interest in WATIs were younger age and having used the Internet in the last year. Smokers who had their first cigarette within half an hour of waking were more interested in WATIs compared to those who waited a longer time until smoking, perhaps indicating that smokers with greater dependency are more likely to be interested in WATIs. Further research could test the relationship between level of dependence and interest in WATIs. Also of relevance would be whether smokers’ readiness to change is related to interest in WATIs. Finally, while reports of the number of smokers using WATIs are impressive [
The population telephone survey employed for this study was funded by the Ontario Problem Gambling Research Centre, an arms-length funding agency sponsored by the Ontario Provincial Government (Canada).
None declared.
Web-assisted tobacco intervention