The RealU online cessation intervention for college smokers: A randomized controlled trial Lawrence C. An a, ⁎, Colleen Klatt a , Cheryl L. Perry b , Emily B. Lein a , Deborah J. Hennrikus c , Unto E. Pallonen d , Robin L. Bliss e , Harry A. Lando c , Dana M. Farley f , Jasjit S. Ahluwalia a,g , Edward P. Ehlinger f a University of Minnesota, Department of Internal Medicine, 717 Delaware Street, Minneapolis, MN 55455, USA b University of Texas at Austin, School of Nursing, USA c University of Minnesota, School of Public Health, USA d University of Texas Health Science Center at Houston, USA e University of Minnesota Cancer Center, USA f University of Minnesota, Boynton Student Health Service, USA g University of Minnesota, Office of Clinical Research, USA ABSTRACT ARTICLE INFO Article history: Available online 2 May 2008 Keywords: Smoking Smoking cessation Universities Young adult Internet Randomized trial Objectives. To determine the efficacy of providing online cessation intervention for college smokers. Methods. This is a two-group randomized controlled trial. The intervention group received $10 weekly incentives to visit an online college life magazine that provided personalized smoking cessation messages and peer email support. Evaluation assessments occurred at baseline and 8, 20, and 30 weeks after enrollment. The primary outcome is self-reported 30-day abstinence at week 30. Carbon monoxide (CO) breath testing was performed for participants reporting 30-day abstinence at week 30. Results. Five-hundred and seventeen college smokers at the University of Minnesota were enrolled via internet health screening (control=260, intervention=257) in the fall of 2004. Intervention participants completed an average of 18.9 (SD 2.5) of 20 weekly website visits over the course of the study. The rate of 30-day abstinence at week 30 was higher for the intervention compared to the control group (41% vs. 23%, p b 0.001). CO testing showed low rates of under-reporting. There was no difference in self-reported 6-month prolonged abstinence measured at week 30. Conclusion. Providing personalized smoking cessation messages as part of a general interest online college life magazine increased 30-day abstinence by the end of this two semester intervention. Crown Copyright © 2008 Published by Elsevier Inc. All rights reserved. Introduction Young adulthood is a critical transition period in cigarette use over the life course. Among adolescents who experiment with cigarettes, the young adult years are often associated with an escalation in cig- arette consumption and the establishment of regular smoking (Kandel and Chen, 1995; Chassin et al., 1996; Orlando et al., 2004). Several studies have also raised concerns regarding increased initiation of smoking among young adults (Wechsler et al., 1998; Rigotti et al., 2000; Husten, 2007). In a recent study, Tercyak et al. found that 25% of individuals who reported never smoking in high school had initiated smoking by 1 year later (Tercyak et al., 2007). Encouraging cessation among young adults is a national health priority. Smokers who quit before the age of 30 avoid much of the harm related to cigarette use (Doll et al., 2004). Unfortunately, smokers under this age appear to be less likely to quit compared to older smokers (Lee et al., 2007). Recent work by Curry et al. offers some explanation for this finding (Curry et al., 2007). While young adult smokers are more likely to make attempts to quit compared to older smokers, they are less likely to use effective assistance when doing so. Studies of cessation programs designed for young adults have shown mixed results. Quinlan and McCaul found no benefit to providing stage-matched manuals to college smokers (Quinlan and McCaul, 2000). Ames et al. found no benefit to an expressive writing inter- vention (Ames et al., 2005). Travis and Lawrence found that providing stage tailored booklets increased abstinence at 3 months (Travis and Lawrance, 2004). Prokhorov et al. found that providing computerized feedback on “lung age” showed a marginal trend toward increased quit rates (Prokhorov et al., 2003). In a sub-analysis, Rabius et al. found an increase in short-term abstinence among young adult smokers receiving phone counseling (Rabius et al., 2004). Additional work is clearly needed to develop attractive and effective programs to help young people to quit smoking. The internet is a promising channel to improve delivery of smoking cessation services to young adults. A growing body of literature Preventive Medicine 47 (2008) 194–199 ⁎ Corresponding author. Fax: +1 612 625 2695. E-mail address: lcan@umn.edu (L.C. An). 0091-7435/$ – see front matter. Crown Copyright © 2008 Published by Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2008.04.011 Contents lists available at ScienceDirect Preventive Medicine journal homepage: www.elsevier.com/locate/ypmed