Background:Tobacco consumption is a leading cause of death and disease, killing >8 million people each year. Smoking cessation significantly reduces the risk of developing smoking-related diseases. Although combined treatment for addiction is promising, evidence of its effectiveness is still emerging. Currently, there is no published research comparing the effectiveness of blended smoking cessation treatments (BSCTs) with face-to-face (F2F) treatments, where web-based components replace 50% of the F2F components in blended treatment.Objective:The primary objective of this 2-arm noninferiority randomized controlled trial was to determine whether a BSCT is noninferior to an F2F treatment with identical ingredients in achieving abstinence rates.Methods:This study included 344 individuals who smoke (at least 1 cigarette per day) attending an outpatient smoking cessation clinic in the Netherlands. The participants received either a blended 50% F2F and 50% web-based BSCT or only F2F treatment with similar content and intensity. The primary outcome measure was cotinine-validated abstinence rates from all smoking products at 3 and 15 months after treatment initiation. Additional measures included carbon monoxide–validated point prevalence abstinence; self-reported point prevalence abstinence; and self-reported continuous abstinence rates at 3, 6, 9, and 15 months after treatment initiation.Results:None of the 13 outcomes showed statistically confirmed noninferiority of the BSCT, whereas 4 outcomes showed significantly (P<.001) inferior abstinence rates of the BSCT: cotinine-validated point prevalence abstinence rate at 3 months (difference 12.7, 95% CI 6.2-19.4), self-reported point prevalence abstinence rate at 6 months (difference 19.3, 95% CI 11.5-27.0) and at 15 months (difference 11.7, 95% CI 5.8-17.9), and self-reported continuous abstinence rate at 6 months (difference 13.8, 95% CI 6.8-20.8). The remaining 9 outcomes, including the cotinine-validated point prevalence abstinence rate at 15 months, were inconclusive.Conclusions:In this high-intensity outpatient smoking cessation trial, the blended mode was predominantly less effective than the traditional F2F mode. The results contradict the widely assumed potential benefits of blended treatment and suggest that further research is needed to identify the critical factors in the design of blended interventions.Trial Registration:Netherlands Trial Register 27150; https://onderzoekmetmensen.nl/nl/trial/27150
DOCUMENT
Polycotton textiles are fabrics made from cotton and polyester. It is used in many textile applications such as sporting cloths, nursery uniforms and bed sheets. As cotton and polyester are quite different in their polymer nature, polycotton textiles are hard to recycle and therefore mostly incinerated. Incineration of discarded polycotton, and substitution by virgin polycotton, create a significant environmental impact. However, textile manufacturers and brand owners will become obliged to apply recycled content in clothing from 2023 onwards. Therefore, the development of more sustainable recycling alternatives for the separation and purification of polycotton into its monomers and cellulose is vital. In a recently approved GoChem project, it has been shown that cotton can be separated from polyester successfully, using a chemical recycling process. The generated solution is a mixture of suspended and partially decolorized cotton (cellulose) and a liquid fraction produced from the depolymerization of the polyester (monomers). A necessary further step of this work is the investigation of possible separation methods to recover the cotton and purify the obtained polyester monomers into polymer-grade pure products suitable for repolymerization. Repolymerize is a new consortium, composed of the first project members, plus a separation and purification process group, to investigate efficient and high yield purification steps to recover these products. The project will focus on possible steps to separate the suspended fraction (cotton) and further recover of high purity ethylene glycol from the rest fraction (polyester depolymerization solution). The main objective is to create essential knowledge so the private partners can evaluate whether such process is technologically and economically feasible.
