Customized, frequent emails show promise in tobacco cessation

Smokers who received frequent, tailored emails with quitting tips, motivational messages, and social support had cessation rates rivaling that of the most effective medication available for cessation, according to a new American Cancer Society study. The study appears in Tobacco Control.

New communication technologies have the potential to provide more cheaply the same kinds of social and other support that have previously proven effective in tobacco cessation. Telephone counselling has been shown to be effective for treating tobacco dependence, but its reach is low. Other modalities using internet and smartphone technologies to deliver evidence-based cessation treatment at the population level have begun to expand and have shown promise.

For the new research, authors studied the use of email, which has the advantage of being read daily or near-daily by most individuals. Email can also provide substantial content within the email, eliminating the need to access a specific website, and with the popularity of mobile phones and tablets, can be read on the go. Emails can also be tailored to address unique characteristics of the recipient.

To explore whether emails could be effective in cessation, researchers led by J. Lee Westmaas, Ph.D., strategic director of tobacco control research at the American Cancer Society, recruited 1,070 smokers who were planning to quit. They were randomly assigned to receive one of three email protocols: 27 tailored cessation emails; 3 to 4 tailored emails with links to downloadable booklets; or a single non-tailored email. All emails included links to quitting resources. To measure success, abstinence was assessed one, three, and six months post-enrollment by asking whether participants had smoked in the previous seven days.

Across all three follow-up times, the mean abstinence rate was highest for smokers getting the custom emails (34%), followed by receiving three or four emails (30.8%), and a single email (25.8%). Results were independent of baseline cigarettes per day, interest in quitting, whether there was a fellow smoker in household, and the use of nicotine replacement therapy (NRT) or varenicline, a drug also approved for smoking cessation.

"The overall quit rate for the main intervention group is about equivalent to the abstinence rates achieved by the most effective medication for cessation," said Dr. Westmaas. "It appears that the personalization in the emails and their frequency -initially every day then tapering off—gave people the assurance that someone cared about them, and wanted them to succeed. They were receiving daily or nearly-daily guidance about how to deal with issues that come up in their quit attempt, made possible by a relatively simple computer tailoring algorithm."

Dr. Westmaas believes the program can be adapted to target particular groups that show disparities in smoking and the health effects of smoking, and plan to conduct a pilot study to help guide an intervention aimed at low socioeconomic status smokers, a group with higher smoking rates.