Editor,—Starting in 1997, we introduced a new programme of smoking cessation, the “Quit-smoking marathon”, open to smokers wishing to quit and who have access to the internet.

The programme consists of three components.

• A home page on the world wide web <http://www.kin-en.com> provides facts on smoking and health, and information on how to take part.

• On the first day of each course, all participants stop smoking. Daily guidance emails are sent from the organiser to the participants throughout the 60-day programme.

• A mailing list offers a prompt contact forum between the participants and supporters. (Supporters, who are selected by the organiser, are doctors who are interested in the programme and volunteers who have succeeded in stopping smoking through the programme.)

In the first run in 1997, participants enrolled only through the internet. Since then, it has also been possible for people to enrol through newspapers and journals.

A questionnaire was used to evaluate the smoking status of the participants immediately after the programme, and at six and 12 months after finishing each course.

“Marathons” have now been held three times, starting on 9 June 1997, 9 October 1997, and 1 June 1998. In the first run, 12 months after having completed the programme, 52.0% of 102 smokers (daily consumption of cigarettes less than 30) and 43.4% of 122 heavy smokers (daily consumption more than 30) were judged to have successfully stopped smoking. Thirty per cent of the participants in the first run, who came to the authors’ clinics and confirmed that they had successfully stopped smoking, were interviewed face to face and their breath tested for carbon monoxide. All those tested were negative for smoking. Comparable results are expected from the two most recent courses as their quit rates immediately after completing the programme and after six months have been similar to those obtained in the first course.

The advantages of such a programme are clear.

• It is accessible 24 hours from any place in the world where internet access is available to Japanese speakers.

• There is no physical limitation to the number of participants.

• Continual support is available to participants day and night, provided by rostered supporters.

• Timely personal emails encourage participants in difficulty, and promote a feeling of solidarity.

Currently a shorter, 30-day trial is being tested with a view to making the programme compact and more efficacious; in the past, email communication spontaneously decreased in volume after the first three weeks.

Although improved methods for ascertaining the individual smoking status still need to be developed, this new approach is considered to be very promising and also adaptable to other areas of health promotion, particularly in view of increasing internet use throughout the world.