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Meta-analysis of Randomized Controlled Trials

Seung-Kwon Myung, MD, MS; Diana D. McDonnell, PhD; Gene Kazinets, PhD; Hong Gwan Seo, MD, PhD; Joel M. Moskowitz, PhD

Arch Intern Med. 2009;169(10):929-937.

Background  The effects of Web- and computer-based smoking cessation programs are inconsistent in randomized controlled trials (RCTs). We evaluated those effects using a meta-analysis.

Methods  We searched MEDLINE (PubMed), EMBASE, and the Cochrane Review in August 2008. Two evaluators independently selected and reviewed eligible studies.

Results  Of 287 articles searched, 22 RCTs, which included 29 549 participants with 16 050 enrolled in Web- or computer-based smoking cessation program groups and 13 499 enrolled in control groups, were included in the final analyses. In a random-effects meta-analysis of all 22 trials, the intervention group had a significant effect on smoking cessation (relative risk [RR], 1.44; 95% confidence interval [CI], 1.27-1.64). Similar findings were observed in 9 trials using a Web-based intervention (RR, 1.40; 95% CI, 1.13-1.72) and in 13 trials using a computer-based intervention (RR, 1.48; 95% CI, 1.25-1.76). Subgroup analyses revealed similar findings for different levels of methodological rigor, stand-alone vs supplemental interventions, type of abstinence rates employed, and duration of follow-up period, but not for adolescent populations (RR, 1.08; 95% CI, 0.59-1.98).

Conclusion  The meta-analysis of RCTs indicates that there is sufficient clinical evidence to support the use of Web- and computer-based smoking cessation programs for adult smokers.

Author Affiliations: Smoking Cessation Clinic, Center for Cancer Prevention and Detection (Drs Myung and Seo), and Division of Cancer Prevention, National Cancer Control Research Institute (Dr Myung), National Cancer Center, Goyang, South Korea; and Center for Family and Community Health, School of Public Health, University of California, Berkeley (Drs Myung, McDonnell, Kazinets, and Moskowitz).

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