Real-time video counselling for smoking cessation in regional and remote areas

INTERVENTION: Real time video‐counselling intervention: Smokers in the video‐counselling condition will receive from smoking cessation advisors up to six video sessions via Skype, Face Time or other mode of video communication. An evidence‐based schedule that accounts for the greatest probability of relapse and involves most calls being scheduled in the critical first two weeks following a quit attempt will be used. For smokers who nominate a quit date, they will receive the initial video session, followed by video sessions on the quit date and 3‐, 7‐, 14‐ and 30‐days after the quit date. For those who are not ready to set a quit date, they will receive the initial video session followed by sessions at 2‐, 4‐ and 6‐ weeks after the initial video session. Each participant will receive a maximum of 6 video sessions and each video session will be approximately 10‐15 minutes in duration. The maximum of 6 video sessions allows the participant to complete all video sessions in the ready to quit callback schedule (i.e. initial, on quit date, 3‐, 7‐ 14‐ and 30 days after quit date). Participants will be offered up to 6 video sessions and the number of video sessions they agree to take will be recorded. During the first video counselling session the smoking cessation advisor will assess the participant’s smoking history, discuss the barriers to smoking cessation, identify potential solutions for overcoming these difficulties, and provide information about strategies that can assist the smoker to quit such as nicotine replacement therapies. For subsequent video counselling sessions, the smoking cessation advisor will: assess smoking status; discuss potential triggers for smoking (e.g., alcohol, stress, tea/coffee) and identify potential strategies for coping with triggers; reinforce the benefits of using effective quitting aids; encourage the participant to set tasks to assist with quitting (e.g., listing goals, disadvantages of smoking); and discuss relapse prevention strategies and strengthening self‐efficacy. To examine intervention adherence, the smoking cessation advisors will record the number of calls each participant receives, timing of these calls (i.e. according to the callback schedule), content discussed and the duration of each call. CONDITION: Smoking PRIMARY OUTCOME: Point prevalence abstinence: The primary outcome is 7‐day point prevalence abstinence. To achieve 7‐day point prevalence abstinence, participants will have to answer no to “Have you smoked at least part of a cigarette in the last 7 days?” and “Have you used any of those other forms of tobacco, for example pipes or cigars, in the last 7 days?” SECONDARY OUTCOME: Cost‐effectiveness: The costs of delivering the 1) real‐time video counselling; 2) proactive telephone counselling; and 3) written self‐help materials will be recorded and will vary. The measures of effectiveness for each intervention will be: 1) 7‐day point prevalence abstinence and 2) prolonged abstinence. Costs for each condition will include: ; Real‐time video counselling condition: Smoking cessation advisor labour, and internet costs ; Proactive telephone counselling condition: Smoking cessation advisor labour, and telephone costs ; Written self‐help materials condition: Cost of materials, including distribution costs (i.e. packaging and postage costs). ; ; ; Mental health: The PHQ‐4 is a 4‐item measure that contains anxiety and depression scales. The PHQ‐4 will be used to evaluate the impact of the smoking cessation support (i.e., video or telephone or written materials) on participants’ anxiety and depression. Prolonged abstinence: Prolonged abstinence will be measured from a 1‐month post‐recruitment grace period (to give smokers opportunity to quit) to each follow‐up and between surveys, resulting in 3‐, 6‐, 9‐ and 12‐months prolonged abstinence. To achieve prolonged abstinence participants will have to answer no to “Since [date] did you smoke at all, even part of a cigarette?” and “Since [date] have you used any other forms of tobacco, for example, pipes or cigars?” The [date] will relate to the end of the 1‐month post‐recruitment grace period during the 4‐month survey and the preceding follow‐up for the 7‐ and 13‐month assessments. Quit attempts: Participants will be asked if they quit for one day or longer since the last survey. The proportion of smokers making a quit attempt will be compared between groups. INCLUSION CRITERIA: Eligibility criteria for study participation will be: 1) daily tobacco use; 2) aged 18 years or older; 3) access to a mode of video‐communication (e.g. Skype, Face Time); 4) access to the internet; 5) access to a telephone; 6) a current e‐mail address; and 7) reside in a regional or remote area of New South Wales, Australia.