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E-mail Referrals Help Smokers
February 7, 2014

By Nancy Volkers
InteliHealth News Service

INTELIHEALTH - E-mailed referrals to a quit-smoking website are more effective than paper referrals, a new study suggests.

The National Dental PBRN Collaborative Group did the study. It included 100 dental offices in 8 states. They were all general-dentistry offices with Internet access. To be included in the study, an office had to see at least 5 adult smokers per week.

Each office was randomly assigned to provide either paper or electronic referrals.

The paper-referral group filled out forms for smokers. The forms provided the web address of They advised people to visit the site and register.

The e-referral group obtained smokers' email addresses and permission to use them. Smokers were sent e-mails with direct links to They were encouraged to visit and register. The e-mails continued for 4 weeks or until the smoker logged on to the website. Dentists also could provide paper-based information to smokers in this group.

There were minor differences between the paper and e-referral groups:

  • The e-referral group had a higher percentage of African-American patients.
  • Dentists in the e-referral group saw more smokers, on average, per week (about 20) than the paper referral group (about 16).
  • The paper group had more existing procedures in place to help smokers quit than the e-referral group.

The study took place over 12 months. During that time, the paper group made 1,120 referrals. The e-referral group made 694. However, more smokers from the e-referral group registered on About 30% of e-referral smokers registered, compared with 8% of paper referral smokers.

In both groups, the patients who registered for the website were likely to be female and white and have at least some college education. Most smoked less than a pack a day. About 10% said they were not actually interested in quitting, even though they registered for the website.

Among the 258 people who registered on the website, 11.6% said they had quit smoking 6 months later. This is similar to rates reported by other web-assisted smoking cessation programs. People who were referred by e-mail were more likely to quit smoking. About 3% of e-referred smokers had quit 6 months later, compared with about 1% of paper-referred smokers.

The authors note the success of the e-referral program: There were 40% fewer e-referrals, but many more website registrations, as well as higher quit rates. They point out that e-referrals require slightly more effort on the part of the dental office. But the authors say that these referrals are effective and should be more fully explored.

The study appears in the February issue of the American Journal of Preventive Medicine.

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