BMJ 2001;322:1396 ( 9 June )

Primary care

Cost effectiveness of computer tailored and non-tailored smoking cessation letters in general practice: randomised controlled trial

A Scott Lennox, clinical research fellow, a Liesl M Osman, senior research fellow, b Ehud Reiter, lecturer, c Roma Robertson, research assistant, c James Friend, professor of respiratory medicine, b Ian McCann, research assistant, a Diane Skatun, research fellow, d Peter T Donnan, medical statistician. e

a Department of General Practice and Primary Care, University of Aberdeen, Aberdeen AB25 2AY, b Department of Medicine and Therapeutics, University of Aberdeen, c Department of Computing Science, University of Aberdeen, d Health Economics Research Unit, University of Aberdeen, e Medicines Monitoring Unit, Department of Clinical Pharmacology, University of Dundee, Dundee DD1 9SY

Correspondence to: A Scott Lennox s.lennox{at}abdn.ac.uk

Objectives: To develop and evaluate, in a primary care setting, a computerised system for generating tailored letters about smoking cessation.
Design: Randomised controlled trial.
Setting: Six general practices in Aberdeen, Scotland.
Participants: 2553 smokers aged 17 to 65.
Interventions: All participants received a questionnaire asking about their smoking. Participants subsequently received either a computer tailored or a non-tailored, standard letter on smoking cessation, or no letter.
Main outcome measures: Prevalence of validated abstinence at six months; change in intention to stop smoking in the next six months.
Results: The validated cessation rate at six months was 3.5% (30/857) (95% confidence interval 2.3% to 4.7%) for the tailored letter group, 4.4% (37/846) (3.0% to 5.8%) for the non-tailored letter group, and 2.6% (22/850) (1.5% to 3.7%) for the control (no letter) group. After adjustment for significant covariates, the cessation rate was 66% greater (-4% to 186%; P=0.07) in the non-tailored letter group than that in the no letter group. Among participants who smoked <20 cigarettes per day, the cessation rate in the non-tailored letter group was 87% greater (0% to 246%; P=0.05) than that in the no letter group. Among heavy smokers who did not quit, a 76% higher rate of positive shift in "stage of change" (intention to quit within a particular period of time) was seen compared with those who received no letter (11% to 180%; P=0.02). The increase in cost for each additional quitter in the non-tailored letter group compared with the no letter group was £89.
Conclusions: In a large general practice, a brief non-tailored letter effectively increased cessation rates among smokers. A tailored letter was not effective in increasing cessation rates but promoted shift in movement towards cessation ("stage of change") in heavy smokers. As a pragmatic tool to encourage cessation of smoking, a mass mailing of non-tailored letters from general practices is more cost effective than computer tailored letters or no letters.


What is already known on this topic
Brief opportunistic advice on stopping smoking that is given face to face by health professionals increases rates of cessation by 2-3%

Intensive, expert-led interventions increase cessation rates by up to 20% or more but are expensive and reach only a small proportion of smokers

Written advice tailored to an individual's "stage of change" (intention to stop in a particular period of time) has been claimed to be as effective as intensive interventions, but previous studies of tailored written advice did not biochemically validate cessation

What this paper adds
A simple standard letter sent to patients of general practices that gave brief advice on stopping smoking increased the biochemically validated rate of cessation by 2%

A letter tailored to the individual's "stage of change" was not more effective than the non-tailored standard letter

Although the increase in cessation resulting from the non-tailored standard letter was small, this intervention was highly cost effective



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This article has been cited by other articles:

  • Gilbert, H., Nazareth, I., Sutton, S. (2007). Assessing the feasibility of proactive recruitment of smokers to an intervention in general practice for smoking cessation using computer-tailored feedback reports. Fam Pract 24: 395-400 [Abstract] [Full text]  
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  • Strecher, V. J, Velicer, W. F (2003). Tailoring smoking cessation programs to the specific needs and interests of the patient. BMJ 327: E57-58 [Full text]  
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  • Ramsey, S.D., Sullivan, S.D. (2003). The burden of illness and economic evaluation for COPD. Eur Respir J 21: 29S-35s [Abstract] [Full text]  
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  • Bronson, D. (2001). Written, personalised feedback in addition to a standard intervention increased smoking cessation. Evid. Based Ment. Health 4: 107-107 [Full text]  
  • (2001). Sending a Letter May Help Patients to Stop Smoking. JWatch Psychiatry 2001: 14-14 [Full text]  
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Rapid Responses:

Read all Rapid Responses

Putting evidence into practice
Ruth Livingstone
bmj.com, 10 Jun 2001 [Full text]
Non-tailored smoking cessation letter is available to download
Scott Lennox
bmj.com, 12 Jun 2001 [Full text]
Is simple written advice on stopping smoking really so effective and cheap?
Robert Bunney
bmj.com, 25 Jun 2001 [Full text]
Yes, it really is
Scott Lennox
bmj.com, 6 Jul 2001 [Full text]
Comments on Lennox et al.
Victor J Strecher, et al.
bmj.com, 9 Aug 2001 [Full text]
Presentation of results is inappropriate
Guido Wendland
bmj.com, 14 Aug 2001 [Full text]
Reply to Strecher et al.
Scott Lennox, et al.
bmj.com, 31 Aug 2001 [Full text]
General Comment on Tailoring
Ehud Reiter
bmj.com, 31 Aug 2001 [Full text]
Re: Presentation of results is inappropriate
Scott Lennox, et al.
bmj.com, 7 Sep 2001 [Full text]
New correspondence email
Ehud R Reiter
bmj.com, 15 Oct 2002 [Full text]
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