Innovative digital health solution nudges tobacco users to quit

Bambi Francisco Roizen · January 4, 2022 · Short URL:

Pivot solves the tobacco addiction crisis that has been overlooked and underserved for decades

Millions of adults are seeking healthier lifestyles through better sleep, diet and exercise, and breaking addictive habits like tobacco use. It may come as a shock, but yes, people still smoke. In fact, more than 50 million U.S. adults use one or more types of tobacco like cigarettes, vaporized nicotine (e-cigs) or smokeless tobacco. Three out of four tobacco users want to kick the habit and half make a quit attempt every year. Most efforts are self-guided and abruptly initiated. As such, most attempts fail within six months. Fortunately, we know there’s a better way to help a tobacco user quit: using proven behavioral change interventions charged with motivation and positive reinforcement. 

That’s why one company has made its mission to help save millions of lives with a modern approach to tobacco cessation. Pivot is a clinically-proven program that welcomes all tobacco users, regardless of their readiness to quit. “We’ve built the first FDA-cleared device that measures a biomarker in exhaled breath (carbon monoxide) linked to tobacco use and combined it with dedicated coaching, a virtual community, and proven behavior change content,” said David S. Utley, M.D., founder and CEO of Pivot. “Pivot encompasses a holistic approach that is proven to raise motivation to quit and builds the skills to help a user stay quit.”

Dr. Utley was an academic surgeon at Stanford University Medical Center focused on treating head and neck tumors related to tobacco use. During his career, he saw how such addictive behavior inevitably led to head and neck cancers as well as numerous other chronic and often fatal conditions.  

“Pivot delivers evidence-based strategies in a unique way that helps users reduce or quit tobacco consumption,” he said. “Real-time breath sensor feedback, 24/7 access to community and behavior change content, and a dedicated, trained coach help Pivot users build the skills they need to successfully reduce or quit tobacco.” 

​​Smoking is the new smoking

Conventional wisdom suggests that anxiety, depression, obesity, and diabetes are all “the new smoking”.  But actually, smoking is the new smoking.  Tobacco is the proverbial elephant in the room causing more preventable illnesses and deaths than any other behavior or chronic condition. Sadly, tobacco is making a big comeback. COVID resulted in an increase in tobacco use in the US. Vaporized nicotine, aka vape or electronic cigarettes, is accelerating the comeback. A recent CDC study found more than 2 million middle and high school students are using e-cigarettes.  Vape use is often an on-ramp to future cigarette usage.   

While vape has been touted as potentially safer than cigarettes, mostly by vape manufacturers, the jury is still out.  Remember, in the 1950s physicians recommended cigarettes for their patients to calm their nerves.  Vape is the new cigarette folks. Simply saying that it’s safer than cigarettes is naive.  First, such a statement suggests that vape is safe for a never-smoker to try.  Second, such a statement suggests that it’s safe to switch from cigarettes to vape rather than embarking on a proper tobacco cessation program to stop ALL forms of tobacco use. 

Subtracting vaping from the equation, cigarettes kill half a million people a year in the United States and eight million globally, according to the CDC and The World Health Organization. Tobacco causes one-third of all cancer deaths and tobacco users live 10 years less than never-smokers. Additionally, tobacco users are 80% more likely to be admitted to the hospital with COVID-19, according to an Oxford University-led study. 

“Tobacco is a nightmare that no one is addressing with the focus and fervor it deserves,” said Dr. Utley. “It’s the only industry on the planet that can sell $1 of cigarettes which then generates $4 in healthcare costs borne by the general population.”

Traditional approaches are underpowered, underutilized

The Affordable Care Act requires that most health plans and employers offer tobacco cessation twice per year to their members and employees, but engagement and outcomes tend to be very low. Employers may point to an employee assistance helpline responsible for managing a myriad of services, including behavior change, group counseling, telephonic coaching, and employee ethics issues. Tobacco addiction costs employers about $9,000 per year per tobacco user in the form of excess health care claims and lost productivity.

In a recent study of primary care physicians, 100% confirmed that they ask their patients about tobacco use.  More than 90% went on to advise those patients who smoke to quit and then set up a treatment plan consisting of pharmacotherapy or telephonic coaching.  Physicians are not trained or don’t have the time to deliver tobacco cessation beyond this first step, so study participants reported very low satisfaction with the actual outcomes of their referral recommendations. Some 87% then said they are seeking better, easier, digital solutions to supplant traditional cessation programs and would refer their patients to Pivot at the point of care.

How Pivot works

While most tobacco users want to quit, the actual act of quitting is terrifying. Because of this fear, many tobacco users never try to quit in the first place. "Tobacco users need a solution that is easy to weave into their existing lifestyle, and is positive, reinforcing, and fun. We celebrate every interaction as a success, rather than focusing solely on quitting," noted Dr. Utley. 

The Pivot journey is personalized and constantly updated based on the user’s needs and progress. Pivot's mobile app provides users with a dedicated quit coach, peer community, easy ordering of pharmacotherapy, and on-demand educational resources and challenges. Pivot users are also provided a first of its kind FDA-cleared breath sensor to measure toxins inhaled from cigarette smoke. Pivot users are empowered to practice small steps, build skills, and make progress one brick at a time.  The experience is highly customized and includes goal setting, daily recommendations, peer community support, and a dedicated coach.

The Pivot breath sensor measures carbon monoxide in exhaled breath, providing visual numeric values related to a user's tobacco consumption.  Think Fitbit for activity monitoring.  In FDA clinical trials, the sensor increased motivation to quit in 75% of users. "The [breath] sensor gave me affirmation that there is proof in the palm of my hand that smoking affects every breath I take...I use the [breath] sensor everyday as it helps keep me focused when I feel an urge to smoke." noted Pivot user Linda from New Brighton, PA who smoked for over 40 years. 


It’s hard to quit smoking without the appropriate support or resources. It often takes years and multiple attempts for tobacco users to quit, and many times the quitting process starts with the decline in the user’s health. But it doesn’t have to be that way thanks to behavioral-based innovative tobacco cessation programs like Pivot, which are the best way to truly move the needle toward a brighter future and better health.

Pivot is transforming tobacco cessation by moving away from a one-size-fits all pamphlet and quitline option and instead fostering a personalized, progressive, and positive approach to quitting. If we embraced programs like this as much as we pushed vaccines for Covid, we'd not only reduce the number of people with chronic conditions but we'd cut the number of severe Covid cases.  

(Image source: Mount Elizabeth)

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Bambi Francisco Roizen

Founder and CEO of Vator, a media and research firm for entrepreneurs and investors; Managing Director of Vator Health Fund; Co-Founder of Invent Health; Author and award-winning journalist.

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