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Randomised controlled trial of stand-alone tailored emails for smoking cessation
  1. J Lee Westmaas1,
  2. Jeuneviette Bontemps-Jones1,
  3. Peter S Hendricks2,
  4. Jihye Kim3,
  5. Lorien C Abroms4
  1. 1 Behavioral Research Center, American Cancer Society, Atlanta, Georgia, USA
  2. 2 University of Alabama at Birmingham, Birmingham, Alabama, USA
  3. 3 Kennesaw State University, Kennesaw, Georgia, USA
  4. 4 Department of Prevention & Community Health, George Washington University, Washington, USA
  1. Correspondence to Dr J Lee Westmaas, Behavioral Research Center, American Cancer Society, 250 Williams St. NW, Atlanta, GA 30312, USA; lee.westmaas{at}


Introduction Digital technology has created opportunities for delivering smoking cessation assistance at the population level. However, the efficacy of sending multiple, automated, tailored emails providing motivation, support and information for quitting is unknown.

Methods Smokers planning to quit (n=1070) were randomly assigned to (1) 27 tailored cessation emails (deluxe email group (DEG)), (2) 3 to 4 tailored emails with links to downloadable booklets (basic email group (BEG)) or (3) a single non-tailored email (single email group (SEG)). All emails included links to quitting resources. Self-reported 7-day point-prevalence abstinence was assessed at 1 month, 3 months and 6 months postenrolment.

Results Across follow-ups, abstinence was significantly greater for smokers in the DEG (34%) compared with the SEG (25.8%; OR=1.47, 95% CI 1.07 to 2.02, p=0.02) but there was no difference between the BEG (30.8%) and the SEG (p=0.13). Results were independent of baseline cigarettes per day, interest in quitting, smoker in household, use of nicotine replacement therapy (NRT) or varenicline and gender, themselves associated with abstinence (ps<0.05). Missing=smoking and multiple imputation analyses based on 25 data sets corroborated results. Participants in the DEG were also more likely to use non-medication aids (eg, quit smoking website, cessation class/clinic) compared with the SEG (OR=1.34, p=0.02, CI 1.06 to 1.71), but use of these or NRT by the 4-week follow-up (vs no use) increased abstinence across follow-ups primarily for those in the SEG.

Conclusions Stand-alone tailored, multiple emails providing support, motivation and information during a quit attempt are an easily deployable, inexpensive mode of providing effective cessation assistance to large numbers of smokers planning to quit.


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  • Contributors JLW, LA and JB-J planned the study. JB-J conducted recruitment, online survey data collection and follow-up reminders. JLW conducted analyses, assisted by PH and JK. JLW and JB-J wrote the manuscript, and all authors contributed to editing an original draft of the manuscript. JLW submitted the study, and is responsible for the overall content as guarantor.

  • Funding American Cancer Society.

  • Competing interests None declared.

  • Ethics approval IRB of George Washington University.

  • Provenance and peer review Not commissioned; externally peer reviewed.