Personalized risk information to increase enrollment in smoling cessation programs

One of the hardest habits to kick is smoking. There are a variety of aids to help you quit including nicotine patches and gum, various drugs such as antidepressants, counseling and support groups, etc.

In the U.K. the National Health Services (NHS) have established effective Stop Smoking Services (SSSs) that are available to all members. The program has achieved an impressive rate of success for those who have enrolled (Lancet):

"Government-funded specialist smoking cessation services, now known as NHS Stop Smoking Services (SSSs), were established by primary care trusts throughout England in 2000, to help and support smokers to quit. These services are effective, with quit rates of around 35% at 4 weeks. This quit rate is higher than if the smokers attending SSSs had received only a prescription for a stop smoking medication. However, despite the increased probability of success, fewer than 5% of smokers attend the SSS each year and, since 2012, figures have shown a continuing downward trend. Anecdotal evidence suggests that the increasing use of e-cigarettes as a stop smoking aid could account for this trend."

The 35% cessation rate at 4 weeks is impressive. As expected there was some decay in the quit rate over time, and after 1 year the number who had successfully quit had dropped to 8%. Nevertheless, 8% of all smokers in the U.K. quitting for a year would represent roughly 700,000 people.

The SSS program offers "intensive behavioural support (in groups or one to one) plus pharmacotherapy for smoking cessation", which includes providing access to Nicotine Replacment Therapy (NRT) and bupropion (i.e. the antidepressant Zyban). The program lasts 6 weeks.

The problem is that so few people join the program in the first place. As mentioned above, traditional outreach methods result in fewer than 5% of smokers attending the programs.

This very low enrollment rate was the motivation for a new study that explored non-traditional outreach methods. The idea was to provide more personalized risk information to motivate smokers to attend:

"Participants allocated to the control group were sent a standard generic letter from the GP practice, which advertised the local SSS and asked the smoker to contact the service to make an appointment to see an adviser. Participants allocated to the intervention group received a brief personalised and tailored letter sent from the GP that included information specific to the patient, obtained via the screening questionnaire and from their medical records; a personal invitation and appointment to attend a “come and try it” taster session to find out more about the services, run by advisers from the local SSS; and a repeated personal letter with a further invitation 3 months after the original for participants who did not attend a taster session after the first letter and invitation.

The goal of the more personalized letter was "to communicate personal risk level of serious illness if the individual continued to smoke."

So the control group received the standard generic outreach letter. The intervention group received up to three letters: 1) a personalized letter with individual risk information, 2) an invitation to join a "come and try it" introductory session, 3) a follow-up letter if the person did not participate in the introductory session.

The researchers then measured the effect of the intervention strategy:

"Attendance at the first session of an SSS course was significantly higher in the intervention group than in the control group (458 [17·4%] vs 158 [9·0%] participants; unadjusted odds ratio 2·12 [95% CI 1·75–2·57]"<0 br="">

The more personalized (and persistent) approach approximately doubled the chance of enrolling in the SSS program from 9% in the control group to 17.4% in the intervention group. The authors concluded that "[d]elivery of personalised risk information alongside an invitation to an introductory session more than doubled the odds of attending the SSS compared with a standard generic invitation to contact the service. This result suggests that a more proactive approach, combined with an opportunity to experience local services, can reduce patient barriers to receiving treatment and has high potential to increase uptake."
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Developing more effective programs to help smokers quit smoking while also being more proactive and clever about encouraging smokers to enroll in these programs is a potent combination in the ongoing battle against smoking, which continues to decline in both the U.K. and U.S.

<0 br=""> Figure 1. More personalized and persistent notifications informing of individual risk can increase the probability of a smoker enrolling in a quit-smoking program.