Department of Biomedical Informatics, CureApp Institute, Karuizawa, Japan.
Department of Transdisciplinary Sciences for Innovation, Kanazawa University, Kanazawa, Japan.
J Med Internet Res. 2023 Mar 17;25:e42776. doi: 10.2196/42776.
Heated tobacco products (HTPs) are widespread in Japan, and smoking cessation of such products has become an important issue owing to the spread of harmful effects from HTPs. The efficacy of online digital therapy has been reported in smoking cessation treatment; however, we have limited evidence of online smoking cessation programs for HTP users.
In this study, we evaluate the usefulness of the Ascure program for HTP users (defined as exclusive HTP use or dual use of HTP and cigarettes) compared with exclusive cigarette users.
This 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 Ascure smartphone app provided four elements: (1) educational video tutorials to enhance the understanding of nicotine dependence, (2) a personalized to-do list for behavior change, (3) a digital diary for record keeping, and (4) interactive chat sessions for relief from cravings or withdrawal symptoms. The primary outcome was the continuous abstinence rate (CAR) at weeks 21 to 24, biochemically validated using salivary cotinine testing. We considered those who dropped out of the program as smoking cessation failures. We analyzed the primary outcome using inverse probability weighting against tobacco product type estimated by multinomial propensity scores. We also assessed CAR at weeks 9 to 12 and program adherence.
We analyzed data from 2952 participants, including 52% (1524/3478) in the cigarette group, 35% (1038/3478) in the HTP group, and 13% (390/3478) in the dual-use group, who had a mean age of 43.4 (SD 10.8) years and included 17% (513/2952) women. CAR at weeks 21 to 24 showed that exclusive HTP users were more likely to stop tobacco use than exclusive cigarette smokers (CAR 52.6% for cigarette users vs CAR 64.8% for HTP users; odds ratio [OR] 1.17, 95% CI 1.12-1.22; P<.001). There was no significant difference between the exclusive cigarette users and the dual users (CAR 52.6% for cigarette users vs CAR 48.7% for dual users; OR 0.99, 95% CI 0.93-1.05; P=.77). CAR at weeks 9 to 12 was 56.7% (95% CI 54.2%-59.2%) for the exclusive cigarette users, 68.3% (95% CI 65.5%-71.1%) for the exclusive HTP users, and 58.2% (95% CI 53.3%-63.1%) for the dual users. The program adherence rate at week 24 was 70.7% overall (68.4% for cigarette users, 75% for HTP users, and 67.9% for dual users).
Exclusive 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 for cigarette smokers.
加热烟草制品（HTP）在日本广泛使用，由于 HTP 有害影响的传播，此类产品的戒烟已成为一个重要问题。在线数字疗法在戒烟治疗中的疗效已有报道；然而，我们对于 HTP 用户的在线戒烟计划证据有限。
本研究旨在评估 Ascure 计划对 HTP 用户（定义为仅使用 HTP 或 HTP 和香烟双重使用）的有效性，与仅使用香烟的用户进行比较。
这是一项回顾性研究。我们招募了 2019 年 6 月至 2021 年 2 月期间参加日本 Ascure 在线戒烟计划的成年吸烟者。Ascure 智能手机应用程序提供了四个元素：（1）增强对尼古丁依赖理解的教育视频教程，（2）个性化的待办事项列表以促进行为改变，（3）数字日记用于记录，以及（4）互动聊天会话以缓解渴望或戒断症状。主要结局是使用唾液可替宁测试进行生物化学验证的 21 至 24 周连续戒烟率（CAR）。我们将那些退出计划的人视为戒烟失败。我们使用基于多项概率倾向评分估计的烟草产品类型的逆概率加权来分析主要结局。我们还评估了第 9 至 12 周的 CAR 和计划依从性。
我们分析了 2952 名参与者的数据，其中 52%（1524/3478）在香烟组，35%（1038/3478）在 HTP 组，13%（390/3478）在双重使用组，他们的平均年龄为 43.4（SD 10.8）岁，包括 17%（513/2952）的女性。21 至 24 周的 CAR 显示，仅使用 HTP 的用户比仅使用香烟的吸烟者更有可能停止吸烟（香烟使用者的 CAR 为 52.6%，HTP 使用者的 CAR 为 64.8%；优势比[OR]1.17，95%CI 1.12-1.22；P<.001）。仅使用香烟的用户和双重使用者之间没有显著差异（香烟使用者的 CAR 为 52.6%，双重使用者的 CAR 为 48.7%；OR 0.99，95%CI 0.93-1.05；P=.77）。第 9 至 12 周的 CAR 分别为 56.7%（95%CI 54.2%-59.2%）的仅使用香烟的用户、68.3%（95%CI 65.5%-71.1%）的仅使用 HTP 的用户和 58.2%（95%CI 53.3%-63.1%）的双重使用者。第 24 周的计划依从率总体为 70.7%（香烟使用者为 68.4%，HTP 使用者为 75%，双重使用者为 67.9%）。
与仅使用香烟的用户相比，仅使用 HTP 的用户具有更高的 CAR 和依从性，表明他们对 Ascure 在线戒烟计划的亲和力更高。该计划可能是 HTP 用户以及香烟吸烟者的一种有用的戒烟选择。
