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Automated E-mail Messaging as a Tool for Improving Quit Rates in an Internet Smoking Cessation Intervention

Affiliations of the authors: Department of Medicine, University of California, La Jolla, CA (LL); Veterans Affairs San Diego Healthcare System, San Diego, CA (LL, AB); Department of Psychiatry, University of California, San Francisco, CA (RFM, JEP); San Francisco General Hospital, San Francisco, CA (RFM).

Correspondence and reprints: Leslie A. Lenert, MD, HSRD Section, MC 111N1, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161; e-mail: <llenert{at}ucsd.edu>.

Received for publication: 09/23/03; accepted for publication: 03/03/04.

Objective: The aim of this study was to determine whether an automated e-mail messaging system that sent individually timed educational messages (ITEMs) increased the effectiveness of an Internet smoking cessation intervention.

Design: Using two consecutive series of participants, the authors compared two Web-based self-help style smoking cessation interventions: a single-point-in-time educational intervention and an enhanced intervention that also sent ITEMs timed to participants' quit efforts. Outcomes were compared in 199 participants receiving the one-time intervention and 286 receiving ITEMs.

Measurements: Demographic factors, number of cigarettes smoked, nicotine addiction, depressive symptoms, and confidence in ability to quit were measured at entry. Twenty-four–hour quit attempts and seven-day point-prevalence of abstinence (nonrespondents assumed to smoke) were measured 30 days after each subject's self-selected quit date.

Results: The one-time and ITEMs groups differed in some demographics and some relapse risk factors but not in factors associated with 30-day quit rates. ITEMs appeared to increase the rate at which individuals set quit dates (97% vs. 91%, p = 0.005) and, among the respondents to follow-up questionnaires (n = 145), the rate of reported 24-hour quit efforts (83% vs. 54%, p = 0.001). The 30-day intent-to-treat quit rates were higher in the ITEMs group: 7.5% vs. 13.6%, p = 0.035. In multivariate analyses controlling for differences between groups, receiving ITEMs was associated with an increase in the odds ratio for quitting of 2.6 (95% confidence interval = 1.3–5.3).

Conclusion: ITEMs sent on strategic days in smokers' quit efforts enhanced early success with smoking cessation relative to a single-point-in-time Web intervention. The effect appears to be mediated by ITEMs' causing smokers to plan and undertake quit efforts more frequently.