Abstract
BACKGROUND: Smoking cessation plans under Japan's national health insurance system are hindered by low completion and success rates. A small-group intervention combining nicotine replacement therapy with digital peer support demonstrated improved smoking cessation success outcomes. However, the extent to which the type of tobacco products used affects the program's efficacy remains unclear. OBJECTIVE: This study aimed to evaluate the differences in smoking cessation success rates among cigarette-only smokers, heated tobacco product (HTP)-only users, and individuals who use both (dual smokers), following a group-based intervention combining nicotine replacement therapy and a digital peer-supported app. METHODS: A prospective study involved smokers from Japanese workplaces who owned smartphones. Participants received free nicotine replacement therapy (either patches or gum) and access to a digital peer support app. This app facilitated anonymous group chats (up to 5 participants) to encourage interactions and smoking cessation efforts by sharing activity reports, including photos and comments. Participants were classified into 3 groups: cigarette-only smokers, HTP-only users, and dual smokers. Logistic regression analysis was conducted to compare cessation success rates, with cigarette-only smokers being the reference group (odds ratios [ORs] and 95% CIs). RESULTS: A total of 435 participants were included in the final analysis, comprising 163 cigarette-only smokers (37.5%), 218 HTP-only users (50.1%), and 54 dual smokers (12.4%). The participants had a mean age of 46.6 (SD 10.1) years, with a predominant male representation (416/435, 95.6%) and a significant proportion (296/435, 68.1%) having more than 20 years of smoking history. The smoking cessation success rate was significantly higher among HTP-only users than among cigarette-only smokers (63.3% vs 52.8%; adjusted OR 1.84, 95% CI 1.57-2.16). Conversely, dual smokers exhibited a nonsignificantly lower success rate than cigarette-only smokers (48.1% vs 52.8%; adjusted OR 0.96, 95% CI 0.79-1.16). CONCLUSIONS: A group-based smoking cessation program using a digital peer support app yielded higher success rates among HTP-only users than among cigarette-only smokers. However, no significant differences were found in dual smokers. These findings highlight the importance of considering tobacco product type in workplace cessation programs.