Incorporating technology in smoking cessation interventions: In-person vs. videocall formats

Inco po a ing echnology in smoking cessa ion in e en ions: In-pe son s. Video-call o ma s Ana L´ opez-Du ´ an a,b,* , Ca mela Ma ínez-Vispo a,b , Ma ía Ba oso-Hu ado a , Daniel Su´ a ez-Cas o a , Elisa do Beco˜ na a,b a Smoking and Addic i e Diso de s Uni , Depa men o Clinical Psychology and Psychobiology, Uni e si y o San iago de Compos ela, Spain b Ins i u e o Resea ch in Psychology (IPsiUS), Uni e si y o San iago de Compos ela (USC), San iago de Compos ela, Spain ARTICLE INFO Keywo ds: Eheal h Smoking cessa ion Long- e m abs inence Video call ABSTRACT In oduc ion: The use o ideo calls o p o ide heal h- ela ed in e en ions has g own signi ican ly, showing posi i e esul s in a b oad ange o psychological in e en ions. Sca ce esea ch has examined ideo-call use in smoking cessa ion ea men s. The pu pose o his s udy was o compa e wo andomised con olled ials conduc ing a cogni i e-beha io al in e en ion o qui smoking in-pe son e sus using ideo calls. Ma e ial and me hods: This s udy is a seconda y analysis o wo andomised con olled ial s udies (RCTs) conduc ed using wo deli e y o ma s: in-pe son s. ideo calls. The sample comp ised 498 adul s seeking smoking cessa ion ea men . We analysed smoking cessa ion, ciga e e educ ion, and ea men sa is ac ion ou comes acco ding o deli e y o ma . Resul s: No signi ican di e ences we e ound in sex, age, and baseline smoking- ela ed a iables. A signi ican ly highe p opo ion o pa icipan s in he ideo-call o ma had uni e si y s udies, we e ac i ely wo king, and had a his o y o dep ession compa ed o he in-pe son o ma . No signi ican di e ences we e ound in cessa ion, smoking educ ion, and sa is ac ion wi h ea men . P edic i e a iables o 12-mon h abs inence we e: baseline numbe o ciga e es smoked pe day (OR =0.93) in he case o he in-pe son o ma ; and being a woman (OR = 0.53), ciga e e dependence (OR =0.46), and las yea qui a emp (OR =0.52) in he ideo-call o ma . Conclusions: Bo h deli e y o ma s showed simila abs inence a es a 12 mon hs and sa is ac ion wi h he in e en ion. The e o e, in-pe son and ideo calls could be used o deli e smoking cessa ion ea men s. Gi en ha p edic o s o long- e m abs inence di e ed ac oss hese deli e y o ma s, u he esea ch is needed. T ials egis a ion: ClinicalT ials.go IDs: NCT02844595: NCT04765813. 1. In oduc ion The inc easing use o echnology has led o new ways o deli e ing men al heal h ea men s [1]. Teleheal h in ol es using echnologies o p o ide long-dis ance heal hca e se ices [2], and ideo calls a e one o he mos widely used modali ies. I is a synch onous o ma in e en ion ha uns in eal ime wi h p o ide s and pa ien s simul aneously in di e en places [2,3], and i is he mos simila eleheal h modali y o in- pe son in e en ions [3]. Ba as ini e al. [4] poin ed ou ha he ideo-call deli e y o ma could help b idge he gap be ween he demand and a ailabili y o men al heal h ea men s. Video-call in e en ions a e e ec i e o he ea men o anxie y, dep ession, o insomnia [5–7], ob aining simila ou comes compa ed o in-pe son ea men s [8]. Mo eo e , i has been shown o be sa is ac o y o pa ien s [7,9], accep able o he apis s and pa ien s [10], p o ides good he apeu ic alliance es ablishmen , and esul s in cos and ime sa ings [11]. Howe e , u he esea ch is needed because mos s udies ha e ocused on compa ing hese in- e en ions wi h o he long-dis ance in e en ions, such as elephone in e en ions [12]. In addi ion, s udies examining he e ec i eness o ideo-call in e en ions, including smoking cessa ion in e en ions, a e wa an ed [7]. In his ein, he use o ideo calls has se e al ad an ages o smoking cessa ion in e en ions, such as inc easing access o e ec i e ea men s o smoke s who a e eluc an o who expe ience ba ie s o seeking in- pe son ea men s [13,14]. Howe e , he e is limi ed li e a u e on he * Co esponding au ho a : Smoking and Addic i e Diso de s Uni , Uni e si y o San iago de Compos ela, Facul y o Psychology. Depa men o Clinical Psychology and Psychobiology, Campus Vida. 15782 San iago de Compos ela, Spain. E-mail add ess: [email p o ec ed] (A. L´ opez-Du ´ an). Con en s lis s a ailable a ScienceDi ec In e na ional Jou nal o Medical In o ma ics jou nal homepage: www.else ie .com/loca e/ijmedin h ps://doi.o g/10.1016/j.ijmedin .2024.105774 Recei ed 22 May 2024; Recei ed in e ised o m 29 Oc obe 2024; Accep ed 20 Decembe 2024 In e na ional Jou nal o Medical In o ma ics 195 (2025) 105774 A ailable online 24 Decembe 2024 1386-5056/© 2024 The Au ho (s). Published by Else ie B.V. This is an open access a icle unde he CC BY-NC license ( h p://c ea i ecommons.o g/licenses/by- nc/4.0/ ). e icacy o he use o ideo calls o smoking cessa ion, especially when compa ed wi h in-pe son in e en ions [15]. Fo ins ance, Bya uhanga e al. [16] ound ha sho - e m abs inence ou comes we e simila when compa ing he use o ideo calls o elephone counselling, and supe io o minimal in e en ions (e.g., w i en ma e ials). Ca lson e al. [13] examined abs inence ou comes o a smoking cessa ion ea men h ough ideo calls o u al pa icipan s compa ed o he same in- pe son in e en ion o u ban pa icipan s, inding no signi ican g oup di e ences a 3-, 6- and 12-mon h ollow-ups. Howe e , using ideo calls as a deli e y o ma o in e en ions has limi a ions. Fo ins ance, Vinci e al. [17], who adap ed an in-pe son g oup-based smoking and alcohol ea men o a ideo-call in e en- ion, poin ed ou some challenges like pa icipan s’ lack o echnical esou ces o compu e skills, he a ailabili y o a sui able place o make he ideo call, and di icul ies in ansmi ing non e bal in o ma ion. As men ioned be o e, in he las ew yea s, he use o digi al o ma s o p o ide heal h in e en ions ocused on qui ing smoking has g own exponen ially [18]. As a esul , some s udies ha e analysed he cha - ac e is ics o indi iduals who seek In e ne -based smoking cessa ion in e en ions. In his line, B own e al. [19] ound ha hose who a e younge , mo e amilia wi h he use o echnology, mo e nico ine dependen , mo e mo i a ed o qui smoking and who ha e ecen ly ied o qui a e mo e in e es ed in In e ne -based smoking cessa ion in e en ions. Gi en he sca ci y o s udies ha in es iga e he use o ideo calls o smoking cessa ion in e en ions, he main objec i e o he p esen s udy was o compa e wo andomised con olled ials conduc ing a cogni i e-beha io al in e en ion o qui smoking in pe son e sus using ideo-call o ma s. Conc e ely, ou esea ch ques ions a e: (1) a e he e di e ences in sociodemog aphic, baseline smoking beha io , and men al heal h cha ac e is ics be ween pa icipan s en olled in an in- pe son s. ideo-call smoking cessa ion ea men s?; (2) a e he e di - e ences in sa is ac ion wi h ea men a he end o he in e en ions; abs inence ou comes and smoking educ ion a 12-mon hs ollow-up be ween pa icipan s en olled in an in-pe son s. ideo call smoking cessa ion ea men s?; and (3) which a e he a iables ha p edic ed smoking cessa ion success a 12-mon hs ollow-up acco ding o he ea men deli e y o ma (in-pe son s. ideo calls)? 2. Ma e ials and me hods 2.1. S udy design The p esen s udy is a seconda y analysis o wo andomised con olled ials (clinicial ials.go #NCT02844595 and #NCT04765813). A ull desc ip ion o he wo s udies’ ec ui men , andomisa ion, in e en ions, and pa icipan cha ac e is ics has been epo ed p e iously [20,21]. Bo h s udies we e app o ed by he Bioe hics Commi ee o he Uni e si y o San iago de Compos ela and ollowed he CONSORT epo ing guideline [22]. 2.2. Pa icipan s The pooled sample o bo h RCTs comp ised a o al o 498 adul s seeking smoking cessa ion ea men in he Smoking Cessa ion and Addic i e Diso de s Uni o he Uni e si y o San iago de Compos ela (Spain) be ween Janua y 2016 and Oc obe 2023. 2.3. Inclusion and exclusion c i e ia The ollowing inclusion c i e ia we e used in bo h s udies: ≥18 yea s, p o iding w i en in o med consen , wishing o pa icipa e, illing ou he p e- ea men assessmen , and smoking a minimum o 6 ciga- e es pe day. Fu he mo e, in L´ opez-Du ´ an e al. [21], smoke s should ha e a sma phone and an e-mail add ess. The exclusion c i e ia used in bo h s udies we e: a) diagnosis o se e e men al diso de (e.g., psycho ic diso de ), b) o he subs ance use diso de (e.g., cannabis, alcoholism), c) ha e ecei ed an e ec i e ea men o smoking cessa ion o e he pas yea , d) consump ion o obacco p oduc s o he han ciga e es, e) a high li e- isk pa hology equi ing immedia e ea men (e.g., myoca dial in a c ion), and ) ailing o a end he i s in e en ion session. In L´ opez-Du ´ an e al. [24], pa icipan s wi h a isual impai men ha p e en ed hem om using a mobile App we e excluded. 2.4. P ocedu e Smoke s we e ec ui ed h ough di e en esou ces (e.g., he media, e e als om heal hca e se ices). Po en ial pa icipan s con ac ed he Smoking Cessa ion and Addic i e Diso de s Uni , unde wen a p e- ea men assessmen , and p o ided w i en in o med consen be o e he smoking cessa ion in e en ion. Pa icipan s ecei ed a psychological smoking cessa ion in e en ion comp ising eigh weekly g oup sessions. Follow-ups we e conduc ed o e he one-yea pe iod a e he las in e en ion session. Pa icipan s we e gene ally con ac ed by elephone o collec in o ma ion abou hei smoking s a us. Those in he in-pe son o ma also a ended he Uni o e i y abs inence biochemically h ough ca bon monoxide (CO) mea- su e. Those pa icipa ing in he ideo-call o ma p o ided his in o - ma ion h ough sel - epo . A comple e desc ip ion o he in e en ion cha ac e is ics o bo h s udies can be consul ed in Beco˜ na e al. [20] and Lopez-Du ´ an e al. [21]. Each s udy was conduc ed using wo di e en deli e y o ma s: a) in-pe son o ma in he Smoking Cessa ion and Addic i e Diso de s Uni acili ies [20]; and b) ideo-call o ma , using Mic oso Teams [21]. The da a om each s udy a m was combined, as he e we e no signi ican di e ences in abs inence a es be ween s udy condi ions. Speci ically, in he s udy conduc ed by Ma ínez-Vispo e al. [23] p olonged abs inence was 26.4% (28/106) o he expe imen al g oup and 18.3% (19/104) o he con ol g oup ( χ 2 =2.005, p =0.157). In con as , in he s udy conduc ed by L´ opez-Du ´ an e al. [24], i was 24.3% (34/140) o he expe imen al g oup and 31.1% (46/148) o he con ol g oup ( χ 2 =1.656; p =0.198). 2.5. Measu es A baseline, we adminis e ed he ollowing ques ionnai es: •Semi-s uc u ed clinical in e iew: o explo e da a ela ed o pa - icipan s’ obacco use and cu en o pas dep ession ea men . •Smoking Habi Ques ionnai e [25]: I collec s in o ma ion abou pa icipan s’ sociodemog aphics and smoking- ela ed a iables (e.g., amoun o ciga e es smoked/day). •Fage s ¨ om Tes o Ciga e e Dependence [26,27] (FTCD): I is sel - epo ques ionnai e o measu e ciga e e dependence. The o al sco e anges om 0 o 10 poin s, wi h a sco e ≥6 indica ing ciga e e dependence [28]. We used he Spanish adap a ion o he es , which p esen s a C onbach’s alpha o 0.66[29] A he end o ea men , he Clien Sa is ac ion Ques ionnai e (CSQ-8 [30]) was used. This sel - epo ques ionnai e measu es pa icipan s’ gene al sa is ac ion wi h he in e en ion. To al sco e anges om 8 o 32 poin s. Highe sco es indica e highe sa is ac ion wi h he in e en- ion. We used he Spanish e sion o he CSQ-8, which has a C onbach’s alpha o 0.80 [31]. The main s udy abs inence ou come was p olonged abs inence a a 12-mon h ollow-up. Pa icipan s we e conside ed abs inen when hey sel - epo ed no ha ing smoked mo e han 5 ciga e es ollowing he g ace pe iod o 15 days om qui day (end o ea men ) o he 12-mon h ollow-up assessmen [32,33]. A. L´ opez-Du ´ an e al. In e na ional Jou nal o Medical In o ma ics 195 (2025) 105774 2 2.6. S a is ical analysis The mean and s anda d de ia ion o con inuous a iables and e- quencies o ca ego ical a iables we e calcula ed o cha ac e ise he o al sample. Pea son’s chi-squa e ( χ 2) s a is ic o he ca ego ical a - iables and S uden ’s - es o he con inuous a iables we e used o compa e pa icipan s who ecei ed he in e en ion in-pe son e sus h ough ideo call. E ec sizes we e also epo ed (C ame ’s V and Cohen’s d, espec i ely) when signi ican g oup di e ences we e ound. The in luencing a iables ela ed o ea men ou comes (p olonged abs inence a he 12-mon h ollow-up wi h lapses), s a i ied by he ea men deli e y o ma , we e examined using mul i a ia e logis ic eg ession analyses wi h o wa d s epwise analysis, including he ollowing a iables: sex (0 =male, 1 = emale), age, educa ion (0 =less han uni e si y, 1 =uni e si y), wo king s a us (0 =non-wo king, 1 = ac i ely wo king), li ing wi h a smoke (0 =no, 1 =yes), ciga e es smoked pe day, ciga e e dependence (FTCD <6 =0, FTCD ≥6 =1), desi e o qui ; in en ion o qui , las yea qui a emp (0 =no, 1 =yes); cu en dep ession ea men (0 =no, 1 =yes); pas dep ession ea - men (0 =no, 1 =yes); las yea psycho-pha maco he apy use (0 =no, 1 =yes). Po en ial mul icollinea i y be ween s udy a iables was exam- ined using Spea man’s co ela ion coe icien and a iance in la ion ac o (VIF). We epo he co ela ions and VIFs o he independen a iables in Supplemen al Table 1. As indica ed in his able, co ela- ions we e all <0.65 and VIF <2.5 o all a iables, indica ing no collinea i y [34], excep o age and yea s o smoking. The e o e, he a iable yea s o smoking was no included in he logis ic models. Pseudo R 2 (Nagelke ke) and he Hosme -Lemeshow es we e used o de e mine model i ness. We ollowed an in en ion- o- ea app oach, assuming ha pa icipan s who did no p o ide in o ma ion abou hei smoking s a us a he end o he in e en ion con inued smoking. A p- alue o less han 0.05 was conside ed s a is ically signi ican . S a is ical analyses we e conduc ed using IBM SPSS e sion 27 (S a is ical Package o he Social Sciences) and e sion 27.0 (IBM Co p., A monk, New Yo k, USA). 3. Resul s O he o al sample (n=498), 62.4% we e emales (n =311), and he mean age was 45.56 yea s (SD =10.79). In addi ion, 47.2% o he pa icipan s had uni e si y s udies (n =235), and mos we e wo king (63.7%; n =317). Rega ding smoking- ela ed a iables, he mean o ciga e es smoked pe day (CPD) was 19.3 (SD =8.39), and he mean sco e on he FTCD was 4.8 (SD =2.12). 3.1. Pa icipan s’ cha ac e is ics acco ding o ea men deli e y o ma A signi ican ly highe p opo ion o pa icipan s who ecei ed he smoking cessa ion ea men h ough ideo calls had uni e si y s udies and we e ac i ely wo king han pa icipan s ecei ing he in-pe son ea men (Table 1). When examining smoking- ela ed a iables, non- signi ican di e ences we e ound be ween o ma s. Rega ding men al heal h a iables, pa icipan s ecei ing ea men h ough ideo calls epo ed a highe equency o pas and cu en his o y o dep ession ea men and cu en use o psycho-pha maco he apy han pa icipan s ecei ing he in-pe son ea men (see Table 1). 3.2. Smoking cessa ion ou comes and sa is ac ion wi h ea men acco ding o ea men deli e y o ma When examining ea men ou comes, non-signi ican di e ences we e ound a he end o he in e en ion (in-pe son 59.0% (124/210); ideo calls 65.6% (189/288); χ 2 =2.25; p =0.134) and in p olonged abs inence a he 12-mon h ollow-up be ween o ma s (in-pe son 22.4% (47/210); ideo calls 27.8% (80/288); χ 2 =1.86; p =0.172) (see Fig. 1). A simila pa e n was ound ega ding sa is ac ion wi h ea - men (see Table 2). Rega ding smoking educ ion (≥50% om baseline o end o ea men poin assessmen ), non-signi ican di e ences we e ound in Table 1 Sociodemog aphic, smoking, and men al-heal h cha ac e is ics acco ding o ea men deli e y o ma (in-pe son s. h ough ideo calls). In-pe son ea men (N ¼210) Video-call ea men (N ¼288) Sociodemog aphic cha ac e is ics M (SD)/% (n) M (SD)/% (n) χ 2 / p C ame ’s V/Cohen’s d Sex ( emale) 62.4 (131) 62.5 (180) 0.001 0.978  Age 45.2 (11.03) 45.8 (10.6) −0.577 0.564  Educa ion le el (uni e si y) 40.5 (85) 52.1 (150) 6.566 0.010 0.12 Wo king s a us (yes) 57.6 (121) 68.1 (196) 5.718 0.017 0.11 Smoking- ela ed cha ac e is ics N◦o ciga e es/day 19.0 (7.3) 19.5 (9.1) −0.645 0.519  Yea s smoking 26.3 (11.5) 26.7 (10.9) −0.394 0.694  Li ing wi h a smoke (yes) 39.0 (82) 35.2 (101) 1.357 0.507  Las yea qui a emp (yes) 37.1 (78) 33.7 (97) 0.639 0.424  Desi e o qui (0–10) 9.0 (1.4) 8.9 (1.4) 0.805 0.421  In en ion o qui (0–10) 8.7 (1.8) 9.0 (1.2) −1.929 0.054  FTCD 4.8 (2.2) 4.8 (2.1) −0.157 0.875  Ciga e e dependence (FTCD ≥6) 41.9 (88) 38.2 (110) 0.698 0.403  Men al-Heal h- ela ed cha ac e is ics Pas dep ession ea men (yes) 42.9 (90) 55.6 (160) 7.833 0.005 0.125 Cu en dep ession ea men (yes) 18.1 (38) 28.8 (83) 7.594 0.006 0.123 Cu en use o psycho-pha maco he apy (yes) 23.3 (49) 32.6 (94) 5.138 0.023 0.102 FTCD =Fage s ¨ om Tes o Ciga e e Dependence. Fig. 1. Abs inence a es acco ding o in-pe son s. ideo-call o ma s. A. L´ opez-Du ´ an e al. In e na ional Jou nal o Medical In o ma ics 195 (2025) 105774 3 he subsample o hose pa icipan s who con inued o smoke in he las session (In-pe son ea men 59.3% (n =51/86); Video-call ea men : 55.6% (n =55/99); χ 2 =0.264; p =0.607). 3.3. Va iables p edic ing p olonged abs inence ou comes a he 12-mon h ollow-up Two mul i a ia e logis ic eg ession models we e conduc ed sepa- a ely o each ea men deli e y o ma (see Table 3). Da a showed ha o pa icipan s ecei ing he in-pe son ea men , CPD was he only a iable signi ican ly associa ed wi h a lowe likelihood o p olonged abs inence a he 12-mon h ollow-up (Adjus ed Odd Ra io [AOR] = 0.93). Fo hose who ecei ed he ea men h ough ideo calls, ciga- e e dependence (AOR =0.46), being emale (AOR =0.56) and ha ing ied o qui las yea (AOR =0.52) we e associa ed wi h lowe odds o long- e m cessa ion success. A g ea e desi e o qui was posi i ely associa ed wi h qui ing (AOR =1.22), al hough his es ima e did no each s a is ical signi icance (p =0.058, 95% CI [0.99, 1.51]). 4. Discussion This seconda y analysis om wo RCTs in ended o examine cha - ac e is ics o ea men -seeking smoke s acco ding o ea men deli e y o ma : in-pe son e sus h ough ideo calls. We also analysed di e - ences in p olonged abs inence ou comes a he 12-mon h ollow-up, ea men sa is ac ion, and he a iables ha p edic ed long- e m cessa ion success acco ding o he ea men deli e y o ma . Ou esul s e ealed no signi ican di e ences in smoking- ela ed a iables, including ciga e e dependence, acco ding o he ea men deli e y o ma . Rega ding sociodemog aphic a iables, a signi ican ly highe p opo ion o pa icipan s in he ideo-call o ma had uni e si y s udies and we e ac i ely wo king compa ed o he in-pe son o ma . This inding is consis en wi h Ma˜ nanes e al. [35], who ound low pa icipa ion o indi iduals wi h lowe educa ion le els in an online in e en ion. P e ious s udies ha e shown ha indi iduals wi h highe educa ion le els end o be mo e digi ally li e a e and mo e in e es ed in e-Heal h in e en ions [36,37]. Fu he esea ch is needed o analyse he exis ence o speci ic ba ie s o seeking ea men h ough digi al o ma s o smoke s wi h non-uni e si y educa ion. We also ound ha a signi ican ly highe p opo ion o pa icipan s in he ideo-call o ma we e ac i ely wo king. This could be ela ed o he p e iously men ioned le el o educa ion because indi iduals wi h highe educa ion a e mo e likely o be wo king [38]. In addi ion, ac i ely wo king people may ace speci ic ba ie s o a ending in-pe son in e en ions associ- a ed wi h wo k and amily schedules, which can be o e come h ough ideo calls o online in e en ions [14,39]. Da a also showed ha a highe p opo ion o pa icipan s epo ed a his o y o ea men o dep ession in he ideo-call o ma compa ed o he in-pe son o ma . This inding could be ela ed o he ac ha he ea men h ough ideo calls was conduc ed a e Co id-19, which could ha e impac ed on pa icipan s’ men al heal h [40]. Ano he possible explana ion is ha a e Co id-19, mos heal h se ices we e adap ed o digi al o ma s, inc easing he amilia i y o using echnology in a wide ange o si ua ions. This could ul ima ely be associa ed wi h a highe in e es in his ype o in e en ion by pa icipan s wi h a his o y o ea men o dep ession [41]. Rega ding 1-yea abs inence, no signi ican di e ences we e ound be ween o ma s, which aligns wi h p e ious s udies ocused on smoking cessa ion [13] and o he psychological p oblems [42,43]. The e o e, using ideo calls o deli e smoking cessa ion in e en ions could be a p omising op ion o smoke s expe iencing ba ie s o pa icipa ing in in-pe son in e en ions, such as he ime and cos equi ed o each he ea men loca ion, and wo k schedules and amily esponsibili ies [17,44]. Howe e , u he esea ch is needed, as he e a e s ill chal- lenges associa ed wi h ideo calls [17], including echnology- ela ed p oblems, pa icipan s’ low echnology li e acy, p i acy- ela ed p ob- lems, o engagemen issues. Ou esul s also show no di e ences in sa is ac ion wi h he in e - en ion be ween o ma s, wi h pa icipan s epo ing high sa is ac ion sco es. This is in line wi h p e ious esea ch, showing simila he a- peu ic alliance in online and in-pe son o ma s [1]. Finally, he esul s o he p esen s udy showed ha he a iables p edic ing long- e m cessa ion success di e ed depending on he o ma used. Pa icipan s who smoked mo e ciga e es pe day be o e he in e en ion we e less likely o be abs inen a 12 mon hs in he in- pe son o ma , whe eas in he ideo-call o ma , being a woman, being ciga e e dependen , and ha ing made a qui a emp in las yea we e associa ed wi h a lowe likelihood o p olonged abs inence. Ou indings a e consis en wi h p e ious li e a u e, as bo h ciga e e dependence and he numbe o ciga e es smoked pe day a e a iables Table 2 T ea men sa is ac ion acco ding o ea men deli e y o ma (in-pe son s. h ough ideo calls). In-pe son ea men (N ¼210) Video-call ea men (N ¼288) % (n) % (n) χ 2 p CSQ-8–1: How would you a e he quali y o se ice you ecei ed? (Excellen ) 89.7 (157) 88.3 (218) 0.34 0.845 CSQ-8–2: Did you ge he kind o se ice you wan ed? (Yes, de ini ely) 82.9 (145) 83.0 (205) 0.09 0.956 CSQ-8–3: To wha ex en has ou se ice me you needs? (All o almos all) 72.6 (127) 74.5 (184) 3.11 0.211 CSQ-8–4: I a iend we e in need o simila help, would you ecommend ou se ice o hem? (Yes, de ini ely) 89.7 (157) 91.1 (225) 1.58 0.664 CSQ-8–5: How sa is ied a e you wi h he amoun o help you ecei ed? (Ve y sa is ied) 81.7 (143) 85.4 (211) 1.06 0.589 CSQ-8–6: Ha e he se ices you ecei ed helped you o deal mo e e ec i ely wi h you p oblems? (Yes, de ini ely) 77.1 (135) 72.5 (179) 1.68 0.432 CSQ-8–7: In an o e all, gene al sense, how sa is ied a e you wi h he se ice you ecei ed? (Ve y sa is ied) 81.7 (143) 85.4 (211) 2.41 0.300 CSQ-8–8: I you we e o seek help again, would you come back o ou se ice? (Yes, de ini ely) 90.3 (158) 87.0 (215) 2.12 0.549 CSQ-8 =Clien Sa is ac ion Ques ionnai e. Table 3 P edic o s o smoking p olonged abs inence a he 12-mon h ollow-up o each ea men deli e y o ma . In-pe son ea men Exp(B) p95 % CI Lowe Uppe CPD 0.93 0.017 0.88 0.98 Cons an 0.95 0.926   Hosme −Lemeshow Tes =4.548; p =0.473; Nagelke ke R 2 =0.047 Video-call ea men Exp(B) p95 % CI    Lowe Uppe Sex ( emale) 0.56 0.034 0.32 0.96 Desi e o qui 1.22 0.058 0.99 1.51 Ciga e e dependence (FTCD ≥6) 0.46 0.009 0.26 0.83 Pas qui a emp (yes) 0.52 0.029 0.29 0.93 Cons an 0.15 0.053   Hosme -Lemeshow Tes =2.186; p =0.975; Nagelke ke R 2 =0.085. CPD =ciga e es pe day; FTCD =Fage s ¨ om Tes o Ciga e e Dependence. CI =Con idence In e al. A. L´ opez-Du ´ an e al. In e na ional Jou nal o Medical In o ma ics 195 (2025) 105774 4 gene ally associa ed wi h a lowe likelihood o sho and long- e m abs inence [45,46]. We also ound ha ha ing made a qui a emp in he las yea was ela ed o a lowe likelihood o cessa ion success o hose ecei ing he ideo call in e en ion, which aligns wi h p e ious s udies [47,48]. Finally, he ac ha being a woman was ela ed o lowe abs inence odds in he case o he ideo-call o ma is an aspec ha should be analysed in g ea e dep h, as p e ious li e a u e has shown ha women expe ience mo e di icul ies in main aining long- e m abs inence han men, especially in clinical se ings [49]. Se e al s udy limi a ions should be acknowledged. Fi s , he cu en s udy in es iga ed di e ences be ween wo ials using a sligh ly di e en in e en ion p o ocol. In addi ion, he s udy using he ideo- call o ma was conduc ed a e he Co id-19 pandemic, which could ha e a ec ed smoke s, as obacco use s may be pa icula ly sensi ised o being an especially a - isk g oup. Second, abs inence ou comes o he ideo-call o ma we e no biochemically alida ed due o he social dis ance measu es o Co id-19 and he emo e na u e o he in e en- ion. This could ha e led o in la ed cessa ion success a es in his g oup, al hough p e ious esea ch has indica ed ha sel - epo ed abs inence is a eliable measu e [50]. Thi d, we used sel - epo ed ques ionnai es, which implied a isk o bias ela ed o social desi abili y. Finally, his s udy is a seconda y analysis o wo RCTs, and he e o e, he me hod- ology does no allow o he en i e es ablishmen o he e ec s o hese deli e y o ma s. The e o e, u u e non-in e io i y andomised con olled ials a e needed o con i m he p esen indings. In conclusion, his s udy showed non-signi ican di e ences in smoking- ela ed cha ac e is ics o pa icipan s ecei ing a smoking cessa ion in e en ion in pe son e sus h ough ideo calls. Howe e , he e we e di e ences in educa ion, employmen s a us, and his o y o dep ession ea men among he pa icipan s. These a iables should be add essed when deli e ing he in e en ion using emo e p ocedu es. Non-signi ican di e ences we e ound in long- e m abs inence a es and sa is ac ion wi h he in e en ion, meaning ha bo h deli e y o - ma s could be used wi hou impac ing cessa ion success. Finally, p e- dic o s o long- e m abs inence di e ed ac oss he wo deli e y o ma s. Pa icula a en ion should be paid o women, ciga e e-dependen pa icipan s, and hose wi h ecen qui a emp s when ecei ing he in e en ion h ough ideo calls. 5. Summa y Table Wha was al eady known on he opic •In e en ions o anxie y, dep ession, o insomnia deli e ed ho - ough ideo-calls show simila ou comes compa ed o in-pe son ea men s. •Accep abili y and sa is ac ion wi h Teleheal h, including ideo calls, a e adequa e o he apis s and pa ien s. •Limi ed esea ch speci ically examined he use o ideo calls o smoking cessa ion in e en ions. Wha his s udy added o ou knowledge •The s udy’s indings showed no signi ican di e ences in sex, age, and baseline smoking- ela ed a iables, bu a signi ican ly highe p opo ion o pa icipan s had uni e si y s udies, we e ac i ely wo king, and had a his o y o dep ession in he ideo-call o ma compa ed o he in-pe son o ma . •Video-call and in-pe son o ma s ob ained simila abs inence a es and smoking educ ion a 12 mon hs ollow-up. Pa icipan s epo ed high sa is ac ion le els in bo h o ma s. •P edic i e a iables o 12-mon h abs inence we e di e en acco ding o deli e y o ma s: highe baseline numbe o ciga e es smoked pe day in he in-pe son o ma ; and being a woman, highe ciga e e dependence, and las yea qui a emp in he ideo-call o ma , we e associa ed wi h lowe odds o abs inence. CRediT au ho ship con ibu ion s a emen Ana L´ opez-Du ´ an: W i ing – o iginal d a , Visualiza ion, Supe i- sion, Resou ces, P ojec adminis a ion, Me hodology, Funding acqui- si ion, Concep ualiza ion. Ca mela Ma ínez-Vispo: W i ing – o iginal d a , Me hodology, Fo mal analysis, Da a cu a ion, Concep ualiza ion. Ma ía Ba oso-Hu ado: W i ing – e iew & edi ing, In es iga ion, Concep ualiza ion. Daniel Su´ a ez-Cas o: W i ing – e iew & edi ing, In es iga ion, Concep ualiza ion. Elisa do Beco˜ na: W i ing – e iew & edi ing, Supe ision, Resou ces, P ojec adminis a ion, Me hodology, Funding acquisi ion, Concep ualiza ion. Funding This esea ch was suppo ed by he Spanish Minis e io de Ciencia e Inno aci´ on (P ojec PSI2015-66755-R; P ojec PID2019-109400RB-100; h ps://doi.o g/10.13039/501100011033. A) and co- inanced by FEDER (Eu opean Regional De elopmen Fund). The Spanish Minis e io de Ciencia e Inno aci´ on had no ole in he s udy design, collec ion, analysis, o in e p e a ion o he da a, w i ing he manusc ip , o he decision o submi he pape o publica ion. Decla a ion o compe ing in e es The au ho s decla e ha hey ha e no known compe ing inancial in e es s o pe sonal ela ionships ha could ha e appea ed o in luence he wo k epo ed in his pape . Acknowledgemen s The au ho s wish o hank all he pa icipan s o con ibu ing o his wo k. The au ho s acknowlege he Spanish Minis e io de Ciencia e Inno aci´ on and FEDER o unding his s uy. Appendix A. Supplemen a y ma e ial Supplemen a y da a o his a icle can be ound online a h ps://doi. o g/10.1016/j.ijmedin .2024.105774. Da a a ailabili y Da a will be made a ailable on eques . Da a will be made a ailable upon easonable eques o he co e- sponding au ho . Re e ences [1] A. Lopez, S. Schwenk, C.D. Schneck, R.J. G i in, M.C. Mishkind, Technology-based men al heal h ea men and he impac on he he apeu ic alliance, Cu , Psych. Rep. 21 (8) (2019 Jul 8) 76. [2] C.L. Snoswell, G. Chelbe g, K.R. De Guzman, H.H. Haydon, E.E. Thomas, L. J. Ca e y, A.C. 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