A Pilot Test of an Internet-Based Smoking Cessation Intervention: Outcomes Across Chronic Pain and Pain-Free Samples

Date
2017-05
Authors
Parkerson, Hollyanne Ellen Ruth
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Publisher
Faculty of Graduate Studies and Research, University of Regina
Abstract

Background: Smoking and chronic pain are major public health concerns in Canada. Contemporary models of smoking and chronic pain suggest a reciprocal and self-perpetuating cycle, wherein smoking reduces pain in the short term but indirectly exacerbates pain in the long term. Population evidence indicates that a majority of Canadian smokers want to quit smoking; however, 90% of quit attempts are unsuccessful. Quitting may be even more difficult for those with chronic pain. Pain-related anxiety and expectancies that smoking will reduce pain have been suggested as additional cessation barriers faced by some individuals with chronic pain. Internet-based interventions have been suggested as a cost-effective medium for offering broad population level cessation support. Many Internet-based interventions have emerged but few clinical trials have been conducted to assess the efficacy and mechanisms of change associated with such interventions. Purpose: The proposed investigation was designed to achieve three objectives. The first objective was to pilot test an Internet-based smoking cessation intervention (StopAdvisor) in a Canadian sample by assessing user abstinence rates, engagement, and satisfaction. The second objective was to assess whether variance in smoking dependence would be accounted for by smoking expectancies for pain reduction and pain-related anxiety. The third objective was to assess whether successful smoking abstinence would positively impact pain and pain-related disability outcomes of individuals with acute and chronic pain. Methods: Participants comprised 168 daily smokers with acute pain (n = 27; 33.3% male), chronic pain (n = 58; 46.6% male), or no pain (n = 73; 55.6% male), who were willing to make a serious quit attempt using a cessation website that offers automated interactive tailored cessation support. Results: A total of 34 participants (21.5%) remained abstinent at 8-weeks post-enrolment, double the rate observed among smokers making an unaided quit attempt. Participants who made a serious quit attempt using StopAdvisor viewed approximately 142 pages across 9 visits to the site. The majority of participants rated the program favourably across a variety of satisfaction indices. Analysis of covariance results indicated that pain-related anxiety, but not smoking expectancies for pain reduction, accounted for a significant proportion of the variance of smoking dependence scores of the total sample as indicated by a medium effect (p = .03, ηp² = .06). Results of a repeated measures analysis of variance demonstrated that individuals with acute or chronic pain who abstained from smoking experienced statistically and clinically meaningful decreases in pain and pain-related disability from pre- to post-intervention. Implications: The current investigation demonstrated that an automated tailored smoking cessation intervention improved the likelihood of short-term smoking abstinence in a Canadian sample. This type of administration format was acceptable to most participants. To our knowledge, current results are the first indicate that pain-related anxiety may be a risk factor for increased smoking dependence for all individuals regardless of pain status (i.e., chronic pain, acute pain, and pain-free groups). As such, pain-anxiety management may be a useful addition to existing smoking cessation and relapse prevention interventions for all smokers, and not just those with pain. The current investigation also provided novel evidence regarding the impact of sustained smoking abstinence on prospective pain outcomes. Such findings highlight an important role for incorporating smoking cessation interventions within pain treatment settings.

Description
A Thesis Submitted to the Faculty of Graduate Studies and Research In Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Clinical Psychology, University of Regina. x, 100 p.
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