The internet is the first place that many smokers turn to for help with quitting smoking. But what makes online quit-smoking programs effective?

A new study published in the Annals of Behavioral Medicine provides important insights into several factors that influence success, including participation in the website’s online community and use of a nicotine replacement therapy product, like patches or gum. But most importantly, it matters whether smokers are nudged to use these resources or seek them out on their own.

The Truth Initiative® study, supported by a grant from the National Cancer Institute, included 5,290 current smokers who registered on BecomeAnEX®, a digital quit-smoking program developed by Truth Initiative in collaboration with Mayo Clinic. In addition to offering skill-building training activities to help smokers plan and prepare for quitting, BecomeAnEX guides users in selecting and using quit-smoking medications and provides around-the-clock social support through its online community. The site has been used by more than 800,000 smokers since it launched in 2008.

The study tested the effects of two strategies designed to increase quit rates. The first strategy involved giving study participants free nicotine replacement medicines, like the patch or gum. Prior research has shown that freely available medications can increase the number of smokers who attempt to quit. The second strategy involved proactive outreach from members of the BecomeAnEX online community. Longtime members of the community who were part of the study team reached out to participants to encourage their participation in the community, which has also been shown to increase quit rates.

Participants were randomly assigned to one of four conditions:

  • Using only BecomeAnEX
  • Using BecomeAnEX and receiving proactive community outreach
  • Using BecomeAnEX and receiving free medication
  • Using BecomeAnEX and receiving proactive community outreach and free medication

Puzzling results lead to important insights.

When researchers examined smoking outcomes according to which study condition participants were assigned, they found that neither strategy increased quit rates. Participants who only used BecomeAnEX quit at roughly the same rate as those who also received both free medication and proactive outreach from the online community.

However, researchers also found that treatment use did not correspond to the treatment participants were assigned. For example, some participants who received free medication from the study reported that they did not use it; other participants who did not receive free medication said that they purchased it on their own. The same held true for online community use. Many participants who received the proactive outreach from community members never visited the community, while others who did not receive outreach took the initiative to participate in the community anyway.

When researchers examined quit rates by the actual treatments that participants used — regardless of their study assignment — they found that participants who used quitting medications and participated in the online community were two to three times more likely to be smoke-free by the end of the study, compared with participants who used neither. The highest quit rate — 32.2 percent — was observed among participants who decided to use quitting medications and participate in the online community on their own, without any additional encouragement from the study.

“Our findings are consistent with other research that has shown that the actions that smokers take that are intrinsically motivated — rather than externally encouraged — are particularly effective in helping them to quit smoking,” said Dr. Amanda Graham, the study’s lead investigator. “Nudging smokers to use treatments that they weren’t interested in simply didn’t work. What this tells us is that making a range of treatment options readily available for smokers to choose from, based on their experiences and preferences, produces the best results.”

BecomeAnEX is freely available to all smokers.

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