This project runs in conjunction with Phase I of Project Quit. While Project Quit focuses on tailoring messages based on a variety of theoretical constructs, this study focuses on tailoring those messages on a deeper level. Depth of tailoring is another potentially active ingredient in tailoring and refers to the level of detail of tailoring and the extent of the connections made among theory-based constructs.

cancer prevention, tobacco, smoking cessation, depth of tailoring, Internet, web, email

1. Compare the effectiveness of low- versus high-depth tailored websites in achieving a 7-day abstinence measured at 6-month follow-up.
2. Compare the effectiveness of low- versus high-depth tailored websites on smoking cessation across baseline characteristics of self-efficacy, motivation, gender, age, income, and education.

The study includes 1,848 participants from the memberships of three HMOs participating in the National Cancer Institute's (NCI) Cancer Research Network (CRN): Group Health (GH) of Seattle, Washington, HealthPartners (HP) of Minneapolis, Minnesota, and the Henry Ford Health System's Health Alliance Plan (HFHS) of Detroit, Michigan. All three are not-for-profit health care delivery systems.

Participants are randomized into one of 16 study arms. All participants receive a web-based guide to help them quit smoking, along with a free 10-week supply of nicotine replacement therapy patches. Email messages are sent to participants about various aspects of the program, including patch use and step down process, and the availability of new web guide materials.

The 6 components for each web guide include:

• Source Letter: available immediately after baseline survey
• Action Plan: available immediately OR 7 days before Quit date
• Efficacy x 2: available immediately OR 1 day before and 7 days after Quit date
• Outcomes: available immediately OR 14 days after Quit date
• Testimonial: available immediately OR 21 days after Quit date

Additional factors:

• High vs. Low Depth: All components are tailored, using a high or low degree of depth.
• Single vs. Multiple Exposure: Participants receive web guide components either all at once (immediately after baseline survey), OR as listed above, over time.
• Gain vs. Loss Framed Messages: Outcomes messages are written either in terms of the benefits users stand to gain by quitting or the risks they stand to face by continuing to smoke.

• Abstinence was most influenced by high-tailored success stories (testimonials) and high-personalized message source (source letter).
• Cumulative assignment of the three tailoring depth factors (message source, testimonial, and efficacy) also resulted in increasing rates of six-month cessation, demonstrating an effect of tailoring depth.
• Greater engagement with a web-based smoking cessation program results in greater subsequent cessation.
• The depth of tailoring in smoking cessation messages results in greater perceptions of message relevance, which, in turn, results in greater engagement with a web-based smoking cessation program.
• A significant number of smokers can be recruited through Health Maintenance Organizations (HMOs) for web-based smoking cessation interventions.
• African Americans with a large number of people supporting their quit efforts were more than two times more likely to quit than those with few or no supporters, regardless of tailoring intensity.

The study identified relevant components of smoking cessation interventions that should be generalizable to other cessation interventions. The study also demonstrates the importance of higher-depth tailoring in smoking cessation programs. Finally, the fractional factorial design allowed efficient examination of the study aims. The rapidly changing interfaces, software, and capabilities of eHealth are likely to require such dynamic experimental approaches to intervention discovery.

Collins, L.M., Susan A. Murphy, V. Nair, and V. Strecher. "A Strategy for Optimizing and Evaluating Behavioral Interventions." Annals of Behavioral Medicine, 30 (1):66-73. 2005.<br><br>

Collins LM, Murphy SA, Strecher V. The multiphase optimization strategy (MOST) and the sequential multiple assignment randomized trial (SMART): new methods for more potent eHealth interventions. American Journal of Preventive Medicine. 2007 May;32(5 Suppl):S112-8.<br><br>

Strecher, VJ. McClure, J., Alexander, G., Nair, V., Konkel., Greene, S., Collins, L., Carlier, C., Wiese, C., Chakroborty, B., Little, R., Pomerleau, C., Pomerleau, O. Web-based Smoking Cessation Components and Tailoring Depth: Results of A Randomized Trial. American Journal of Preventive Medicine. May 2008, Vol 34(5). (In press).