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It's tough to quit smoking. That's why Nathan Cobb, a former tobacco cessation counselor at a Boston area health clinic, developed the idea for QuitNet, a virtual support system to help people quit smoking. Cobb, currently a fourth-year medical student at Boston University, combined his experience as a counselor and his expertise of cessation theory with his software development and programming abilities to build an innovative experiment in virtual treatment that could reach anyone in the world at any time of the day.

Cobb found that logistical obstacles often hampered smokers who wished to quit. "Most people worked and couldn't see someone during the day. The majority of people were either uncomfortable with a group, or could not attend an evening session," Cobb said. "Despite the fact that this was early in the evolution of the Internet and Web, it seemed natural to try to use it to provide services to a whole section of the population we couldn't otherwise reach."

Cobb received initial funding from the Massachusetts Department of Public Health, which enabled him to develop a prototype online quit smoking service. He found a home for QuitNet when he approached Join Together, a national resource center on substance abuse and gun violence. The organization embraced QuitNet, agreeing to host the project on its own Web server, where it has been a part of Join Together activities since 1995.

Astrid Dretler, Join Together staff member and QuitNet project manager, says their work with QuitNet has been mutually compatible, with both Web sites influencing the other, even though they serve different functions and populations. Unlike Join Together, which advocates for reduction and prevention, QuitNet focuses its efforts on providing support and treatment resources for people who have made the decision to stop smoking.

Join Together, which currently has a Web staff of six, has established a large and sophisticated Web presence. The organization manages several Web sites, which provide an array of e-newsletters, electronic mailing lists and publications. At Join Together, "I was surrounded by people very knowledgeable about public health, substance abuse and treatment - while at the same time having the latitude to try to translate traditional theories and approaches as part of the Join Together Web effort," Cobb said.

"The biggest thing Join Together did was give what seemed like a crazy idea a chance," Cobb continued. "No one really thought the Internet would penetrate the American culture the way it has, and no one thought that individuals would use a computer to try to quit smoking."

The QuitNet Web site has gone through several transformations since its inception in 1995, evolving into a highly trafficked online community and host to a number of dynamic tools: Information and guides on how to quit smoking are augmented by a chat area, self-assessment tools and surveys. A QuitDate Wizard helps smokers select a quit date and suggests tools to help along the way. The Q-Gadget calculates how much money a nonsmoker will save, as well as the likely increase in life expectancy. QuitTips and Anniversary Messages are sent out via email.

In addition, QuitNet is host to a vibrant online community, providing users with an email account, bulletin boards, instant messaging and buddy lists, all of which provide QuitNet members with unique peer-to-peer support. Within discussion areas, visitors can talk about their quitting experience, including additional forums on weight gain, spirituality, depression and other addictions.

An online database, originally developed in collaboration with the Massachusetts QuitLine, connects smokers to cessation programs nationwide. The site also includes an online expert counselor, overviews of pharmaceutical products, and a daily summary of tobacco-related news, supplied in partnership with the Advocacy Institute.

"We believe that referring people to local programs and having them use that type of support in conjunction with QuitNet and a pharmaceutical product, if necessary, is probably the most effective way that someone can successfully quit," Dretler said.

The site has welcomed more then 100,000 registered visitors since January 2001, averaging 200 new registered visitors daily. The site averages 10,000 daily visits, 2 million monthly page views and over 2,000 posted messages in its online forums. Sixty percent of users are female and nearly half are between the ages of 30- and 50-years-old.

Does QuitNet actually work?

According to a QuitNet email-based survey of its registered users just over a year ago, half of respondents had quit smoking - all of whom attributed their success in part to QuitNet. Respondents reported that the quitting guides, as well as uninterrupted access to support, as the most useful resources about the site.

"Many group programs last for six weeks and then you're done. They don't offer relapse prevention support or follow up," Dretler said. "QuitNet has no time constraints. We have some people who have been using it since day one and are still very active."

Users have also found the peer-to-peer support invaluable, enjoying the open exchange of information and variety of opinions-a strong complement to advice a doctor or counselor alone offers. Dretler attributes the real power of QuitNet to these discussion forums, referring to it as the QuitNet's "heart and soul."

While no formal evaluation of the project currently exists, Dretler says they do have plans to follow-up on their email survey with a randomized, controlled study survey.

"We would really like to know the effectiveness rate of QuitNet, other then anecdotally," she explained. "We've talked with a few researchers about setting up a retrospective and/or prospective study on whether the QuitNet is as effective as group therapy, the patch, cold turkey."

What's next for QuitNet?

QuitNet recently partnered with the New Jersey State Department of Public Health in developing New Jersey's concept for a state-focused quit smoking site. QuitNet staff tailored the need of New Jersey residents, which included translating a number of their resources into Spanish. While the user interface differs slightly from that of the original, all of the tools are the same.

"To the extent that we can work with other states, public health agencies, businesses, HMOs and insurance companies to make QuitNet more available, that is the overarching goal," Dretler said of reaching broader audiences. "We'd like to really create a system that reaches populations in need and helps people to quit smoking."

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Last updated: 22 October 2001 mff
www.benton.org/Practice/Features/quitnet.html