Hiroki Tateno: Recommendation for Smoking Cessation Clinics — Quitting Smoking with a Smartphone App?!

Nowadays, no one thinks that smoking tobacco is not bad for the body. In the last few years, the market for heated tobacco products such as IQOS, glo, and Ploom TECH has also heated up, and the number of people switching from cigarettes is increasing. The number one reason, above all else, is "thinking about health."

For those who cannot quit smoking, smoking cessation treatment has been covered by health insurance in Japan since 2006. You can receive smoking cessation treatment using medication with a co-payment of about 30%, and the success rate is high. Treatment at so-called smoking cessation clinics is a program consisting of five visits over three months. For those who properly attend all five visits, the smoking cessation success rate after three months actually exceeds 80%. Quitting smoking at a smoking cessation clinic is currently considered the most scientifically supported and easiest way to succeed.

It is said that 70% of smokers think, "Tobacco doesn't seem good for my body, so I'll have to quit someday." Tobacco is sold as a luxury item, but unlike other luxury items such as tea or aromatherapy, why is tobacco alone so difficult to quit, and why does the government need to go to the trouble of using tax money to set up smoking cessation clinics?

The diagnosis for smoking cessation treatment covered by insurance is a chronic disease called "nicotine dependence." It is often called nicotine addiction, but nicotine has "dependency (= addictiveness)," and this is where all the keys lie.

Nicotine and tar. These are words often heard and displayed on cigarette boxes, but in fact, nicotine is a very rare substance that hardly exists in nature. It can only be produced by tobacco, a plant in the nightshade family, and is thought to be a toxic component to protect itself from pests. Columbus brought the custom of smoking this plant, native to South America, back to Europe from the American continent. Later, automatic rolling machines were made in North America, making mass production possible, and nicotine-dependent people spread throughout the world. If you were to dry weeds from the roadside, chop them up, wrap them in paper, light them, and try to smoke them, no one would continue smoking them. It is precisely because nicotine is in it that people continue to smoke.

The addictiveness of tobacco is said to be stronger than that of narcotics. The nicotine contained in tobacco smoke reaches the brain in a few seconds after one puff, giving the dependent person a sense of relief. It is a product that makes one feel, "I smoke because I want to," "It is indispensable for my life," and "If possible, I don't want to quit." However, it is also a product that people stock up on so they don't run out, or go out to buy even in a typhoon if they do run out. Is this really a luxury item that one smokes of their own free will? Wouldn't it be closer to say that one is "being made to smoke"?

Thus, the nicotine business is profitable, and once someone starts smoking, it becomes a lucrative product that they will continue to consume for decades. Furthermore, the government, which levies a 60% tax on it, also depends on tobacco revenue, making it a product whose sale cannot be easily banned.

However, the health damage from tobacco is serious. Smoking properly (?) every day shortens your lifespan by 10 years and doubles your mortality rate. If someone starts smoking at age 20 and dies at 75 when they could have lived to 85, they are calculated to be throwing away two months of their life every year. The fact that the mortality rate doubles for diseases that could have been avoided if one did not smoke is the same as playing a high-stakes game of Russian roulette with a bullet in every other chamber.

It is known that even with such tobacco, positive effects appear immediately if you quit. The risk of myocardial infarction decreases within 24 hours, and emphysema stops progressing. Lifespan is extended, and it becomes harder to develop dementia. In all cases, the earlier you quit, the greater the benefits, but it is effective no matter what age you quit, and it is never too late to stop smoking.

It's not just about health. How peaceful and comfortable a life without having to smoke is! You don't need to remember to carry a whole set of smoking gear when you go out, and you don't need to look for places where you can smoke at your destination beforehand. Worries about fire hazards disappear, and you don't need to pop a Frisk in your mouth out of concern for bad breath. Yes, when you quit smoking, everything is good for you; there is nothing to fear.

Recently, the number of places where you can smoke has decreased significantly. Japan's smoking population has fallen below 20%, and smoking in public is accompanied by a considerable sense of being unwelcome. Shops where you could smoke until now may become non-smoking from this April due to legal changes and ordinances, and non-smoking shops will likely increase further. This is to suppress health damage to others called "secondhand smoke." The damage from secondhand smoke is also serious, and it is estimated that 15,000 people die every year in Japan alone due to secondhand smoke.

Recently, the term "thirdhand smoke" has also emerged. This refers to the health effects received from tobacco smoke substances remaining in rooms even if no one is smoking in front of you. Nicotine released from tobacco sticks and remains on furniture and carpets in the room. When it reacts with substances in the atmosphere, carcinogens are also produced. For infants in particular, by putting hands that have touched these surfaces into their mouths while crawling, they ingest these harmful substances at higher concentrations than adults.

Furthermore, harmful substances continue to be emitted from exhaled breath for 45 minutes after smoking. It is obvious that taking a few deep breaths will not make them disappear, as you can tell immediately by the smell when a colleague returning from a smoking area sits in the next seat. For this reason, some places have begun to prohibit entry to the premises or elevators for 45 minutes after smoking.

While such a restricted life will only become stricter in the future, the prospect of it being relaxed is slim. Yes, if you quit smoking, these social awareness problems will be solved all at once.

As mentioned at the beginning, sales competition for heated tobacco products from various companies has intensified in recent years. The sales pitch is "reduction of harmful substances," and pamphlets show graphs suggesting that toxic substances have been cut by 90%. Manufacturers hope you will think, "If this is the case, it might not be that bad for my health, and I might not have to quit tobacco itself."

Since they have only been on the market for a few years, no one knows how much heated tobacco affects lung cancer or emphysema, which take 20 or 30 years to develop after starting to smoke. However, medical professionals are unanimous in saying that you should also quit heated tobacco. In fact, IQOS pamphlets state in fine print, "The expression 'approximately 90% reduction in the amount of harmful components' does not mean that the adverse health effects of this product are smaller compared to other products," and "The best way to reduce tobacco-related health risks is to quit both cigarettes and IQOS."

What is known at this point is that the same amount of nicotine can be ingested from heated tobacco (this is natural in a sense, as the purpose of the new product is to maintain nicotine dependence and keep people buying tobacco products), there are many substances that have increased compared to cigarettes, many people cannot switch completely to only heated tobacco and end up smoking cigarettes as well, even if harmful components could be cut by 90%, health effects would not decrease by even 50%, and in experiments conducted on Japanese people, even if they switched completely to heated tobacco for three months, although the toxic substances detected in the body decreased, the biological response to toxic substances did not improve.

E-cigarettes containing nicotine are not sold in Japan due to legal regulations, but in the United States, they have become a problem after it was found that lung damage comparable to severe coronavirus pneumonia occurs.

The aldehydes (one of the harmful substances) detected from these new types of tobacco are indeed about one-tenth of those in cigarettes, but if you quit smoking and breathe only the atmosphere, the aldehydes entering your body decrease to one-hundred-thousandth. Yes, the order of magnitude is different. If you're going to think about your body, stopping at heated tobacco is a waste; now is the chance to quit smoking!

The success rate of quitting smoking at smoking cessation clinics is high. However, the aforementioned data of over 80% is limited to those who completed five visits in three months. If we include those who stopped visiting midway and track them for up to one year, the smoking cessation rate drops to about 30%.

Smoking cessation medications suppress the "nicotine withdrawal symptoms" that appear as soon as you start quitting. This is also effective for heated tobacco. Thus, one can quit smoking easily, but another important element in the clinic—receiving counseling from doctors and nurses—only happens once every two to four weeks. While not visiting, you continue to handle things in your own way while using medication and remembering the content of the counseling.

Also, smoking cessation treatment ends in three months, but there are cases where people start smoking again after that.

The Department of Respiratory Medicine at the Keio University School of Medicine supervised the joint development of a smartphone app for smoking cessation treatment with CureApp, Inc., which can be used by patients at smoking cessation clinics. When we conducted clinical trials with nearly 600 smokers who visited about 30 smoking cessation clinics in Japan, we obtained high effects comparable to smoking cessation medications.

The app has an automatic response function and is equipped with powerful tools: you can chat with a nurse icon daily for advice, animated videos that can be watched in a few minutes are delivered to help you master smoking cessation strategies, a portable exhaled carbon monoxide measuring device is included for daily measurement at home so you can feel the values getting better as you quit, and if you record a smoking cessation diary, you can have a doctor look at it during your next visit. When this was used together with smoking cessation medication and continued until the sixth month even after the medication ended, the smoking cessation rate remained high even after one year. We are currently applying to be able to "prescribe the app" under health insurance and aim to realize this within this year.

The success rate of quitting smoking at smoking cessation clinics will likely become even higher in the future. If you visit, you can say goodbye to a high-risk life much more cheaply and easily than continuing to smoke. I would like to end this article by once again conveying the peace and comfort of a life where you don't have to worry about tobacco, including my own self-reflection as a former smoker.