Effectiveness of an automated digital tool to aid smoking cessation: the Stamp randomized controlled trial (smoking cessation assisted by personalized emails)

Effectiveness of a fully automated internet-based smoking cessation program: a randomized controlled trial (STAMP)

Efficacité d’un outil numérique automatisé d’aide au sevrage tabagique : l'essai contrôlé randomisé Stamp (sevrage tabagique assisté par mailing personnalisé)

Tobacco control is one of the national public health priorities and a key focus area for Santé publique France. In 2016, more than one-third of people aged 15–75 in France reported smoking, and nearly 3 in 10 French people smoked daily. The Health Barometers have gradually become the benchmark for measuring reported trends in smoking. Santé publique France is also involved in tobacco control through its media campaigns targeting the general public or more specific audiences. This includes, in particular, the social marketing campaign “Moi(s) sans tabac” (Month Without Tobacco). Motivated individuals are encouraged to use Tabac-info-Service, a remote service dedicated to supporting smoking cessation.

The article, which has just been published in the journal *Nicotine & Tobacco Research* [1], describes the first study conducted in France on the effectiveness of a fully digital smoking cessation tool. The findings of this study—such as the fact that effectiveness depends on maintaining contact with the person trying to quit smoking after three months—have contributed to improving the current range of remote smoking cessation services, and were incorporated into the design of the Tabac info service app, developed by the French National Health Insurance and Santé publique France, and launched in 2016.

Viet Nguyen Thanh

Three Questions for Viet Nguyen Thanh, Director of Disease Prevention and Health Promotion

The aim of this study was to assess the effectiveness of email-based support (e-coaching) as an aid to smoking cessation. Once developed, this type of intervention is very cost-effective and complements more traditional interventions provided by healthcare professionals. The coaching program we evaluated was developed with the help of tobacco specialists, based on techniques proven effective in smoking cessation: motivational interviewing, and cognitive and behavioral therapies. The goal was to offer an attractive alternative to in-person counseling, so that those who cannot or do not wish to see a healthcare professional can still receive support for quitting. Participants in the coaching program received a series of approximately 45 emails, sent automatically over a period of two to three months. These messages contained information, advice, and exercises to prepare for quitting and then to stay on track afterward: messages of encouragement, relaxation exercises, a summary of savings since the quit date... Fourteen profiles were created to provide personalized support based on age, gender, level of nicotine dependence, and level of motivation to quit smoking…

Once the tool was developed, we wanted to measure its effectiveness. A randomized controlled trial was launched, in which we compared the quit rate achieved among a group of smokers receiving e-coaching to that achieved among a group of smokers who received a digital brochure to help them quit smoking. The group receiving this brochure served as the control group. 2,478 smokers were recruited via the Tabac info service website, agreed to participate in the study, and consented to be followed for 12 months.

We found that e-coaching was effective at the 3-month mark, which coincides with the duration of the online support provided. At 6 months, the effectiveness of e-coaching was demonstrated only among smokers who had used the provided resources diligently: systematic or frequent reading of emails in the e-coaching group, and at least partial reading of the brochure in the other group. No difference was detected at 12 months.

These results were consistent with those reported in the literature: digital tools to aid smoking cessation can be effective in the short term, particularly when they are personalized and highly interactive. One of the challenges remains improving adherence, that is, the optimal and consistent use of the offered support. Since smoking is deeply ingrained in society, another challenge is, of course, the accessibility of these tools, particularly for smokers from lower socioeconomic backgrounds. This challenge is not insurmountable: for example, we should commend the initiative by British researchers and public health professionals who developed and evaluated a website designed to help the most disadvantaged smokers quit (StopAdvisor).

This study, conducted using a robust methodology, demonstrated the effectiveness of online coaching, at least in the short term. These findings and the identified areas for improvement were used in the design of the Tabac info service app, in partnership with the French National Health Insurance. An evaluation of this app is currently underway through a randomized controlled trial(1). Developing tools based on available knowledge, evaluating them, optimizing them, and then evaluating them again: it is through this process of continuous improvement that Santé publique France strives to offer the public effective services that meet their needs. The various components of the Tabac info service (the 39 89 helpline, website, and app) benefit from this approach and serve as complementary resources whose quality and effectiveness are regularly verified.

For more information:

Pasquereau A, Smadja O, Andler R, Guignard R, Richard JB, Nguyen-Thanh V. Six-month efficacy of smoking cessation support provided by the Tabac Info Service helpline (39 89). Bull Epidémiol Hebd. 2016;(30-31):548-56.

Brown J, Michie S, Geraghty AW, Yardley L, Gardner B, Shahab L, Stapleton JA, West R. Internet-based intervention for smoking cessation (StopAdvisor) in people with low and high socioeconomic status: a randomized controlled trial. The Lancet Respiratory Medicine. 2014 Dec 1;2(12):997-1006.

(1) Viet Nguyen Thanh, Romain Guignard, Sylvie Lancrenon, Camille Bertrand, Catherine Delva, Ivan Berlin, Anne Pasquereau, Pierre Arwidson; Effectiveness of a Fully Automated Internet-Based Smoking Cessation Program: A Randomized Controlled Trial (STAMP), Nicotine & Tobacco Research, nty016.