Evidence-Based Tobacco Cessation Strategies for LMICs

Tobacco use remains the leading cause of preventable mortality worldwide, claiming over 7 million lives annually. Furthermore, over 80% of the world’s 1.3 billion tobacco users live in low- and middle-income countries (LMICs). Consequently, implementing evidence-based tobacco cessation strategies is crucial for healthcare providers across clinical settings. However, only 31 LMICs currently meet World Health Organization (WHO) best practices by offering both cost-covered behavioral interventions and essential pharmacotherapy. In countries like India, unique cultural norms, smokeless tobacco prevalence, and system barriers require adapted approaches.

WHO MPOWER Framework and Population-Level Approaches

The WHO MPOWER framework outlines essential policies to curb global tobacco use. Specifically, offering cessation assistance to tobacco users serves as a pivotal cornerstone of this global strategy. In addition, population-level interventions provide highly scalable support for patients who want to quit. For instance, national quitlines and digital health platforms deliver tailored behavioral support at low costs. Moreover, systemwide screening in routine clinical encounters allows providers to identify tobacco users early. Therefore, healthcare facilities can reach millions of individuals through structured population interventions.

Integrating Tobacco Cessation Strategies in Routine Practice

Clinicians can seamlessly adopt the Ask-Advise-Connect model during routine patient visits. First, clinicians ask every patient about their tobacco habits, including smokeless tobacco use. Second, clinicians advise every tobacco user to quit with clear, personalized messaging. Third, clinicians connect willing patients directly to quitlines, counselors, or digital tools. Additionally, combining behavioral counseling with essential medicines significantly improves long-term quit rates. Pharmacotherapies such as nicotine replacement therapy (NRT) and cytisine offer cost-effective options on the WHO Model List of Essential Medicines. Consequently, clinical teams in LMICs like India can deliver comprehensive cessation support without overwhelming health system resources.

Frequently Asked Questions

Q1: What is the Ask-Advise-Connect model in tobacco cessation?

The Ask-Advise-Connect model is a streamlined clinical workflow. Healthcare providers ask patients about tobacco use, advise them to quit, and directly connect them to cessation resources like quitlines.

Q2: Which pharmacotherapies are included in the WHO essential medicines list for tobacco cessation?

The WHO Model List of Essential Medicines includes nicotine replacement therapy (NRT) and cytisine as effective, cost-covered options for tobacco cessation.

Q3: Why must LMICs tailor tobacco cessation strategies locally?

LMICs face distinct challenges, including high rates of smokeless tobacco use, limited healthcare financing, and unique cultural norms that require customized cessation approaches.

References

1. Shelley D et al. Evidence-Based Tobacco-Cessation Strategies for Low- and Middle-Income Countries. N Engl J Med. 2026 Aug 13. doi: 10.1056/NEJMra2507061. PMID: 42585647.
2. World Health Organization. WHO report on the global tobacco epidemic 2023: Protect people from tobacco smoke. Geneva: World Health Organization; 2023.
3. van Zyl-Smit RN et al. The efficacy of smoking cessation interventions in low- and middle-income countries: a systematic review and meta-analysis. Addiction. 2019;114(4):620-635.