Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Sep 25, 2025
Date Accepted: Apr 14, 2026
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Associations Between Nicotine Dependence, Self-confidence of Quitting, and Smoking Cessation Success Rate Among Users of a Group-Based Digital Peer-Supported Application and Nicotine Aids: A Retrospective Study
ABSTRACT
Background:
The completion rate of smoking cessation treatments under Japan’s national health insurance system remains low. Our smoking cessation program, which integrates the use of nicotine gums or patches into a group-based digital peer-supported application (app), has achieved higher cessation success rates. Nicotine dependence is negatively associated with smoking cessation, whereas self-confidence for quitting is positively associated. Nonetheless, little is known about how these factors interact across different tobacco product types, and no study has explored these associations in the context of app-based interventions.
Objective:
This study aimed to investigate the independent and combined associations of nicotine dependence and self-confidence for quitting with smoking cessation success among cigarette-only smokers, heated tobacco product-only users, and dual users.
Methods:
This retrospective study included 2,144 smokers who were employed at Japanese workplaces, owned smartphones, and received free nicotine patches or gum and a group-based peer-supported app. This app facilitated anonymous group chats (up to five participants) to encourage interactions and smoking cessation efforts by sharing activity reports, including photos and comments. Nicotine dependence was assessed according to the time to the first cigarette smoking after waking (high: ≤30 min; low: >30 min). Self-confidence for quitting was rated on a 0–10 scale and dichotomized at the median. A composite four-level variable combined nicotine dependence (low or high) and self-confidence for quitting (low or high). Overall cessation success according to tobacco product types was evaluated using logistic regression analyses.
Results:
Self-confidence for quitting consistently predicted cessation success across all tobacco product types, whereas nicotine dependence showed product-specific associations, significant only for cigarette-only smokers. Even with high nicotine dependence, greater self-confidence for quitting was linked to higher success rates. Digital cessation interventions should assess both nicotine dependence and self-confidence for quitting while considering tobacco product types to tailor support strategies.
Conclusions:
Self-confidence for quitting consistently predicted cessation success across all tobacco product types, whereas nicotine dependence showed product-specific associations, significant only for cigarette-only smokers. Even with high nicotine dependence, greater self-confidence for quitting was linked to higher success rates. Digital cessation interventions should assess both nicotine dependence and self-confidence for quitting while considering tobacco product types to tailor support strategies.
Citation
