Randomized Controlled Trial of Tailored Emails for Smoking Cessation

Background:  Telephone counseling has traditionally been an effective way to treat tobacco dependence.  However, this method has had relatively low rates of usage with smokers who are attempting to quit.  Computer, internet, and smartphone technological advances have created new opportunities for widespread dissemination of cessation assistance to smokers.  The low-cost and convenience of these technologies broaden the scope of possibilities for reaching millions of smokers with free or low-cost cessation treatments, but there is limited research investigating using emails to provide cessation assistance.      

Program background:  The Tailored Email Study was a randomized study that tested the efficacy of three email interventions: the first group (Deluxe/DEG) received up to 27 tailored emails over at least a 10-week period (pre- and post-quit date); the second group (Basic/BEG) received 3 to 4 tailored emails with links to downloadable booklets that contained cessation information; the third group (Web/Control/SEG) received 1 non-tailored email with resources for quitting.  Participants were asked to choose a quit date that was within 30 days from the time of enrollment.

Evaluation Methods and Results:  Upon completion of a baseline assessment, participants (n=1070) were randomly assigned to one of the 3 email groups.  Participants were emailed an online survey 4 weeks, 3 months, and 6 months after enrollment.  ANOVAs and pairwise comparisons were used to compare experimental groups on measures of engagement with and perceptions of the program.  65% of participants in the DEG opened 8 or more emails (M = 13.8, SD = 9.8).  In the BEG 74% opened at least 3 emails, while 99% of the SEG opened their email.  Participants in the DEG and BEG found that the emails contained helpful information, were appropriately timed, helped them try to quit, applied to them specifically, made them feel or think that someone cared if they quit, helped them to see that it was worthwhile to quit, provided them with the knowledge of the right steps to quit, and gave them confidence to quit.  A GEE model was used to examine the effect of experimental condition on 7-day point prevalence smoking abstinence at 4 weeks, 3 months, and 6 months.  The odds of abstinence for participants in the DEG were 47% greater than for those in the SEG (χ²=5.78, OR=1.47, CI=1.07-2.02, p<.02).  Cessation rates for participants in the DEG as compared to the SEG were, 32.7% vs. 23.7% (4 weeks), 35.1% vs. 28.9% (3 months), and 36.8% vs. 27% (6 months).

Conclusions:  This study examined the effectiveness of tailoring a computer-based intervention for smoking cessation.  The DEG and BEG who received tailored and/or personalized emails found the program to be helpful in their quit attempt, informative, appropriate, and a means by which their self-efficacy in their ability to quit improved.  The DEG also exhibited higher cessation rates than the SEG at each follow-up.

Implications for research and/or practice:  Multiple tailored and personalized emails providing support, motivation, and information before, during, and after a quit attempt are easy to disseminate, adaptable to specific populations, and a cost effective method to provide effective cessation support to large numbers of smokers planning to quit.