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Smoking causes many diseases such as coronary artery disease, stroke, cancer, diabetes, COPD, and periodontal disease, and it is estimated that more than 130,000 people die from smoking annually in Japan. In comparison of the risk for developing cardiovascular disease, the risk of smoking is almost equal to that of metabolic syndrome, and smoking cessation in cardiovascular disease prevention is highly important even if weight gain was observed after smoking cessation. In the Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 edition, smoking is a risk factor for coronary artery disease, stroke, abdominal aortic aneurysm, and peripheral artery disease, and passive smoking is also a risk factor for coronary artery disease and stroke. For primary and secondary prevention of atherosclerotic cardiovascular diseases, it is strongly recommended to stop smoking and to avoid passive smoking. Metabolic syndrome is recognized as a condition prone to atherosclerotic cardiovascular diseases based on accumulation of visceral fat and increased insulin resistance. Focusing on the condition of accumulation of risk factors to prevent cardiovascular diseases, the Specific Health Checkups and Specific Health Guidance, the Japanese nationwide cardiovascular prevention system, started as metabolic health checkup in Japan . Although smoking was initially only added as an additional risk of stratification, it was obliged to make health guidance for smoking including the day of health checkup due to the revision of the 2013 version. However, health guidance for smoking cannot be done enough now. Health checkup is an opportunity for health consciousness to be raised for examinees, which is a great opportunity to provide individual health promoting information to many examinees. In the guidelines of WHO’s Tobacco Control Framework Convention Article 14 (Demand reduction measures concerning tobacco dependence and cessation) adopted in Uruguay in November 2010, smoking cessation advice is required to be offered at health care sites as a measure to promote smoking cessation in the healthcare system internationally. In this issue, Nakamura and colleagues examined whether specific health guidance promotes smoking cessation among targeted smokers using propensity score matching analysis. They found that in the Japanese cardiovascular prevention system, repeated counseling may promote smoking cessation for obese male smokers classified as active support. This manuscript contains important information on how to effectively use limited time and cost for smoking cessation guidance of many smokers in a routine program. It is important to select candidates who are more effective and to continuously support smoking cessation on an ongoing basis. However, it is reported that short time intervention for smoking cessation at medical examination will raise smoking cessation rate. Therefore, implementing short-term smoking cessation support (ABR: Ask, Brief advice, Refer) including information of smoking cessation treatment such as the effectiveness of smoking cessation aid for about 1 minute for all smokers will give rise to many quitters. Furthermore, it is also important to provide the information on the hazards of secondhand smoke to all examinees including non-smokers .

How Should We Effectively Support Smoking Cessation at Health Checkup Opportunity and Induce More Quitters