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. 2019 May 2;2019(5):CD002850. doi: 10.1002/14651858.CD002850.pub4

Graham 2011.

Methods Setting: USA
Recruitment: US residents searching for stop‐smoking advice on a major internet search engine who clicked on a link to www.quitnet.com, assumed to be motivated
Participants 2005 adult smokers of 5 or more cigs/day. 48.9% , av. age 35.9, av. cigs/day 20, av. FTND 5.0. 1326 contribute to this review
Interventions 1. Free 6 m access to www.quitnet.com (interactive commercial cessation website)
2. As 1, + up to 5 sessions of proactive TC for 3 m; counsellors had access to www.quitnet.com info and encouraged participants’ use of it; counsellors sent individual emails after counselling sessions to reinforce key points
3. Control: access to static, info‐only (non‐interactive) version of the content on QuitNet (not used in this review)
Outcomes Multiple 30‐day PP (at 3, 6, 12 and 18 m).
Validation: none
Notes Arm 2 versus 1
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Quote: "random numbers table…stratified by sex and baseline motivation to quit"
Allocation concealment (selection bias) Unclear risk Method not specified
Blinding of outcome assessment (detection bias) 
 All outcomes High risk Self‐reported outcome measure from participants not blinded to treatment condition. Level of personal contact differed between arms
Incomplete outcome data (attrition bias) 
 All outcomes High risk Participants missing data counted as smokers. Sustained PP data not available for 46% EI, 49% EI+P 49% and 43% BI. Difference due to differential rate of follow‐up at 3 m.
Quote: "The lower follow‐up assessment rate among EI+P participants at 3 months may have been owing to ‘telephone fatigue’...Telephone counselling was providing within the first 3 months of the study, which was the only assessment period for which higher loss to follow‐up was observed. If present, this bias could have attenuated the effectiveness of the combined intervention."