Revolutionizing Quitting: Digital Solutions for Tobacco Addiction

Introduction:

Smoking is the most common cause of avoidable and premature death globally. It is a significant risk factor for serious health issues and fatal diseases.(1) Tobacco usage kills around 8 million people worldwide every year.(2) Furthermore, the overall worldwide economic cost of smoking exceeds $1.4 trillion each year.(3) Smoking is thus a huge global economic and public health risks.

The World Health Organization projects that unless worldwide tobacco control measures are implemented quickly, the number of tobacco-related fatalities would rise to one billion in the twenty-first century, up from 100 million in the twentieth century. However, a significant portion of the global population, approximately one-third, remains unprotected by the World Health Organization's six fundamental goals for tobacco control as mentioned in the (fig-1)

The World Health Organization (WHO) has established guidelines for healthcare practitioners regarding smoking cessation interventions. These guidelines are outlined in the WHO Framework Convention on Tobacco Control (FCTC) and the WHO MPOWER package, which offer evidence-based strategies for tobacco control.(4)

According to WHO recommendations, healthcare practitioners should:

Ask: Healthcare practitioners are encouraged to routinely ask patients about their tobacco use status, including frequency and type of tobacco product used.

Advise: Healthcare practitioners should advise tobacco users to quit in a clear, personalized, and non-judgmental manner, emphasizing the benefits of cessation for their health.

Assess: Healthcare practitioners should assess the willingness of tobacco users to quit and their level of nicotine dependence, as well as any barriers or challenges they may face in quitting.

Assist: Healthcare practitioners should assist tobacco users in quitting by providing brief counseling, evidence-based behavioral interventions, and pharmacotherapy (e.g., nicotine replacement therapy, prescription medications) as appropriate.

Arrange: Healthcare practitioners should arrange follow-up appointments or referrals to specialized smoking cessation services to provide ongoing support and monitoring for tobacco users attempting to quit.

Why is a newer approach needed?

Traditional smoking cessation programs are effective, but only about 15% of smokers achieve long-term abstinence.(5) Such initiatives have been demonstrated to have low usage rates due to schedule, time, and cost constraints.(6) Although telephone help can overcome these barriers, it only reaches approximately 1% of smokers annually. Given the difficulty of accessing support, there is an urgent need for cost-effective, easy, and scalable alternatives.(7)

Technological improvements have resulted in novel techniques aimed at overcoming the limitations of traditional smoking cessation programs. Digital health apps are one emerging strategy that has the potential to aid in habit change.(8) They have been used successfully in a variety of therapeutic settings, including chronic illnesses and to encourage healthy behaviors.(9)

So what are the examples of digital therapeutics platforms for smoking cessation?

The following are a few instances of digital therapeutics platforms designed with quitting smoking in mind:

Smartphone Apps: Smartphone apps have grown in popularity as smoking cessation tools due to their ease of use, convenience, and variety. These apps provide a variety of features, such as personalized stop programs, progress tracking, craving management techniques, daily advice and encouraging messages, and social support networks. Popular smoking cessation apps include QuitNow!, Smoke Free, and MyQuit Coach.(10)

Virtual Reality Programs: Virtual reality (VR) programs offer an immersive and interactive environment for practicing coping skills, managing cravings, and simulating real-life experiences without using cigarettes. VR-based smoking cessation programs frequently include exposure treatment, mindfulness exercises, and cognitive-behavioral therapies to help users develop healthy coping mechanisms and resist the impulse to smoke.(11)

Wearable Devices: Wearable gadgets, such smart watches and fitness trackers, can interact with smoking cessation apps to measure real-time smoking behaviour, physiological data (e.g., heart rate, activity levels), and progress towards quitting goals. These gadgets provide continual feedback and reminders to help users stick to their quitting goals and make informed health decisions.(12)

Text Message Programs: These therapies send supportive messages, reminders, and behavioral prompts straight to users' mobile phones, reinforcing their commitment to quit smoking. These programs may include personalized material, interactive features (such as quizzes and surveys), and access to extra resources for assistance. Text2Quit and SmokefreeTXT are two programs that use text messages to help people quit smoking.(13)

Advantages of Digital Therapeutics for Smoking Cessation

• Accessibility and scalability: reaching diverse populations regardless of geographical location or socioeconomic status

• Convenience and flexibility: providing anytime, anywhere access to smoking cessation support

• Cost-effectiveness compared to traditional face-to-face interventions

• Potential for continuous engagement and long-term behavior change through personalized feedback and reinforcement

• Challenges and Limitations

• Digital divide: addressing disparities in access to technology and digital literacy

• Data privacy and security concerns in the collection and transmission of sensitive health information

• Limited regulatory oversight and standardization of digital therapeutics

• Potential for user disengagement and attrition over time

Discussion:

Our lives, jobs, and communication have all been altered by mobile technology. The goal of this rapidly developing field is to complement rather than replace traditional health care. The use of mobile technologies to support the achievement of goals has the potential to play a significant role in transforming health care to increase the quality and efficiency of care. Apps that directly or indirectly support or enhance people's healthy behaviours, quality of life, and well-being are the main category of health advances.(14)

Health care is evolving. Health care expenditures are rising as a result of the increasing demand for personalized and long-term care. Furthermore, it is projected that the usage of mobile apps could increase patient care efficiency and cut access and analysis time by up to 30%.(15) In fact, a recent study published in the Journal of Medical Economics found that patients who use digital health tools can save approximately 22% on their monthly medical costs(16).

Health apps are emerging as technical tools with significant potential to improve the management of chronic diseases. If they are carefully developed and focus on the requirements of patients, they may more effectively facilitate the administration of health care resources and communication between experts and patients, hence increasing the population's active engagement in their own treatment.(17)

Mobile apps offer enormous potential to assist patients in health treatment and promote good behavioral changes. However, it is the features of applications that impact patients' attitudes towards app use, and thus app success. To improve app usability, end users must be involved early in the design process.(18)

Research has demonstrated that demographics and personality traits are linked to mobile app uptake and use. Income and education level are positively correlated with mobile phone use, but age is inversely correlated.(19) Older people are less likely to purchase health apps, and nearly half (43%) of those over the age of 70 stop using them within the first 14 days, owing to the complexity of the tools, users' limited health knowledge (i.e., the knowledge required to fully understand the data), and the cost of the technology.(20) This emphasizes the necessity to build simple, end-user-oriented tools and involve end users in their creation to produce tools that fully meet.

Future Directions and Opportunities

Promising paths for developing the field of digital medicines for smoking cessation and optimizing their influence on public health include the integration of AI and ML algorithms, cooperative alliances, and research endeavor extension. We can move closer to creating tobacco-free communities and enhancing people's health outcomes all around the world by utilising technology, creativity, and teamwork.(21)

Conclusion:

Digital therapeutics platforms provide different and creative methods to smoking cessation, providing individuals with the tools and support they require to quit smoking and live better lives. Whether, through smartphone apps, virtual reality programs, gamified therapies, wearable devices, or text message programs, digital solutions show enormous potential for assisting individuals in overcoming tobacco addiction and achieving long-term success in their quit journey.

References:

1. Organization WH. World Health Organization Report on the Global Tobacco Epidemic, 2011: warning about the dangers of tobacco. 2011. World Health Organization: Geneva, Switzerland. 2011.

2. Organization WH. WHO report on the global tobacco epidemic 2019: Offer help to quit tobacco use. 2019. World Health Organization: Geneva, Switzerland. 2019.

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10. Regmi, K., Kassim, N., Ahmad, N., & Tuah, N. A. (2017). Effectiveness of Mobile Apps for Smoking Cessation: A Review. Tobacco prevention & cessation, 3, 12. https://doi.org/10.18332/tpc/70088.

11. Rajani, N. B., Bustamante, L., Weth, D., Romo, L., Mastellos, N., & Filippidis, F. T. (2023). Engagement With Gamification Elements in a Smoking Cessation App and Short-term Smoking Abstinence: Quantitative Assessment. JMIR serious games, 11, e39975. https://doi.org/10.2196/39975.

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13. Kong, G., Ells, D. M., Camenga, D. R., & Krishnan-Sarin, S. (2014). Text messaging-based smoking cessation intervention: a narrative review. Addictive behaviors, 39(5), 907–917. https://doi.org/10.1016/j.addbeh.2013.11.024.

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16. Whaley CM, Bollyky JB, Lu W, Painter S, Schneider J, Zhao Z, He X, Johnson J, Meadows ES. Reduced medical spending associated with increased use of a remote diabetes management program and lower mean blood glucose values. J Med Econ. 2019 Sep;22(9):869–877. doi: 10.1080/13696998.2019.1609483.

17. Iborra CR. Las aplicaciones móviles de salud como herramientas de apoyo a la autogestión de cuidados del paciente crónico. Universidad Autónoma de Madrid. 2019. May, [2022-07-05].

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