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Originalia

Wirksamkeit internetbasierter Programme zum Tabakrauchen

Eine systematische Literaturübersicht

Published Online:October 10, 2011https://doi.org/10.1026/0943-8149/a000052

Abstract

Zusammenfassung. Ziel dieser systematischen Literaturübersicht ist, die Wirksamkeit internetbasierter Programme zur Förderung des Rauchausstiegs, zur Verhinderung des Raucheinstiegs und zum Schutz vor Passivrauch anhand der vorliegenden empirischen Evidenz zu beurteilen. Die Literatursuche erfolgte im Juli 2010 und umfasste die Datenbanken PubMed, MEDLINE, Web of Science, PsycINFO sowie das Cochrane Register of Controlled Trials. Randomisiert-kontrollierte Studien, die Ergebnisse zur Wirksamkeit einer Intervention im Vergleich zu einer Kontrollgruppe oder einer Standardintervention berichten, wurden eingeschlossen. Von 359 Publikationen, die in den Literaturdatenbanken recherchiert wurden, konnten 17 in diese Übersicht eingeschlossen werden. Diese beschrieben 16 Studien: 14 Studien überprüften Programme zur Förderung des Rauchausstiegs, 2 Studien überprüften kombinierte Programme zur Förderung des Ausstiegs und zur Verhinderung des Einstiegs bei Jugendlichen. Von den 14 Rauchausstiegs-Interventionen erwiesen sich sechs als wirksam zur Erhöhung der Rate Rauchabstinenter gegenüber einer Kontrollgruppe. Aufgrund der Heterogenität der Studien v.a. hinsichtlich der verwendeten Kontrollgruppen wurden keine gepoolten Effektgrößen über alle Studien hinweg berechnet. Eine separate Berechnung von Effektgrößen für Studien mit ähnlichen Kontrollgruppen, ergab eine tendenziell, aber nicht signifikant höhere Rate Rauchabstinenter bei Internetinterventionen im Vergleich zu Kontrollgruppen ohne Intervention (Relatives Risiko (RR) 1.42; 95%-Konfidenzintervall (KI) 0.85–2.37). Ein Vergleich der Internetinterventionen mit Kontrollgruppen, die eine Minimalintervention erhielten, ergab einen signifikanten Interventionseffekt (RR 1.31; KI 1.09–1.57). Beim Vergleich der Internetinterventionen mit persönlichen Beratungsinterventionen ergab sich kein signifikanter Interventionseffekt (RR 0.86; KI 0.72–1.04); tendenziell waren die persönlichen Beratungsinterventionen überlegen. Im Vergleich zu einer Standardintervention allein, erwies sich eine Standardintervention mit zusätzlichem Internetprogramm nicht als wirksamer (RR 1.27; KI 0.70–2.31). Interventionen, die ausschließlich aufhörbereite Raucher adressierten, erwiesen sich eher als erfolgversprechend als Interventionen, welche sich an alle Raucher einer bestimmten Population richteten. Die beiden kombinierten Programme zur Förderung des Ausstiegs und zur Verhinderung des Einstiegs bei Jugendlichen waren auf einzelnen, aber nicht allen Zielkriterien wirksam. Zur Förderung des Rauchausstiegs bei aufhörbereiten Rauchern liegen international bereits wirksame Programme vor, allerdings wurde keines dieser Programme im deutschsprachigen Raum überprüft. Die empirische Evidenz zu Internetprogrammen zur Verhinderung des Raucheinstiegs ist bislang sehr gering; Wirksamkeitsstudien zu Internetprogrammen zum Schutz vor Passivrauch liegen bislang keine vor.


Efficacy of Internet programs for tobacco smoking: A systematic review

Abstract. The aim of this study is to systematically review the published literature on the efficacy of Internet programs for smoking cessation, smoking prevention, and prevention of passive smoking. Electronic searches of PubMed, MEDLINE, Web of Science, PsycINFO, and the Cochrane Register of Controlled Trials were conducted in July 2010. Randomized controlled trials reporting results about the efficacy of internet interventions for tobacco prevention compared to a control group or a standard intervention were included in the review. Initial searches in the literature databases identified 359 articles, of which 17 were eligible for inclusion in this review. In these articles, 16 studies were described: 14 studies addressed the efficacy of smoking cessation interventions, 2 studies reported results of combined smoking prevention and cessation programs. From the 14 smoking cessation interventions, 6 were effective to increase smoking abstinence rates in comparison to control groups. Due to the heterogeneity of the studies, particularly concerning the control groups, we did not pool study results overall. However, we pooled study results and calculated effect sizes for studies with similar control conditions. Compared to control groups without intervention, there was a trend but no statistically significant effect of Internet programs to increase abstinence rates (relative risk (RR) 1.42; 95%-confidence interval (CI) 0.85–2.37). Compared with minimal interventions, online smoking cessation interventions were effective (RR1.31; CI 1.09–1.57). Internet interventions were not effective compared with personal counseling interventions (RR 0.86; CI 0.72–1.04), with a tendency of personal interventions to be more effective. In comparison with a standard intervention, the standard intervention combined with an additional internet program was not more effective (RR 1.27; CI 0.70–2.31). Internet interventions which addressed smokers motivated to quit were more often effective than Internet interventions addressing unselected populations of smokers. The combined smoking prevention and cessation programs were effective on single, but not on all outcome criteria in comparison to assessment only groups. Effective Internet programs exist, particularly for smoking cessation in smokers motivated to quit. However, none of these programs was evaluated in German speaking countries. The empirical evidence for the efficacy of Internet based smoking prevention programs is marginal and, so far, no evidence exists for programs for the prevention of passive smoking.

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