Usefulness of the smartphone app-based smoking cessation program for conventional cigarettes, heated tobacco products, and dual use: A retrospective study

BackgroundHeated tobacco products (HTPs) are widespread in Japan, and smoking cessation of such products have become an important issue owing to the dissemination of the harmful effects of HTPs. The efficacy of online digital therapy has been reported in smoking cessation treatment; however, we have limited evidence of online smoking cessation program for HTP users. In this study, we evaluate the usefulness of the "ascure" program for people using HTPs (exclusive HTP use or dual use of HTP and cigarettes) compared with exclusive cigarette users. MethodsThis was a retrospective study. We recruited adult smokers participating in the ascure online smoking cessation program in Japan from June 2019 to February 2021. The primary outcome was the chemically validated continuous abstinence rate (CAR) at weeks 21-24 using salivary cotinine testing. We also assessed CAR 9-12 and program adherence. FindingsWe analyzed data from 2952 participants (52% for cigarette group, 35% for HTP group, and 13% for dual-use group), the mean age was 43{middle dot}4 {+/-} 10{middle dot}8 years, 17% were women. Exclusive HTP user were more likely to stop tobacco use than exclusive cigarette smokers in CAR 21-24 (52.6% for cigarettes vs. 64.8% for HTP; OR: 1{middle dot}17; 95% CI: 1{middle dot}12-1{middle dot}22; p < .001). InterpretationExclusive HTP users had higher CARs and adherence compared with exclusive cigarette users, indicating a higher affinity for the ascure online smoking cessation program. This program might be a useful smoking cessation option for HTP users as well as cigarette smokers. FundingCureApp, Inc. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSHeated tobacco products have been widespread in Japan recently, and smoking cessation of these tobacco products became an important issue due to the gradual revealing of HTPs harmful effects on health. Besides, the efficacy of new online digital therapy has been reported in smoking cessation treatment. We searched PubMed on Dec 14, 2021, for publications on the effects of Heated tobacco on health and its relation to smoking cessation, using the terms "Heated tobacco products", "smoking cessation" and " digital therapy " with no restrictions on publication date. We excluded studies that reported specifically on electronic cigarettes. We found evidence about the harmful effect on the health of using HTPs, and the status and issues of smoking cessation, a moreover new attempt at smoking cessation using digital therapy. However, the efficacy of smoking cessation treatment was mostly limited to conventional cigarettes especially digital therapy we found little evidence regarding smoking cessation by tobacco products such as HTPs. Added value of this studyIn this study, we evaluated the usefulness of the ascure online smoking cessation program by tobacco products with a chemically validated index. The continuous abstinence rates (CARs) 21-24 was higher in the exclusive HTP group than the exclusive cigarettes group. Moreover, there was no significant difference between the exclusive cigarettes and the dual-use groups. Implications of all the available evidenceThe number of HTP users is currently increasing in Japan. In addition, online medical treatment is becoming more widespread and is expected to solve medical issues. The results of this study indicating a higher affinity for the ascure online smoking cessation program. This program might be a useful smoking cessation option for HTP users.