Tobacco use is one of the world’s leading causes of preventable death, killing more than seven million people annually. Quitting smoking is objectively difficult, but is more so when resources and support are unavailable or lacking.
“The World Health Organization (WHO) defines six proven strategies to reduce tobacco use, referred to by the acronym MPOWER, with one of the strategies being to offer tobacco users help with quitting,” wrote the authors. The MPOWER framework includes monitoring tobacco use; protecting people from tobacco smoke; quitting tobacco; warning about the dangers of tobacco; enforcing tobacco advertising, promotion, and sponsorship bans; and raising taxes on tobacco.
Though more than 80% of tobacco users live in developing nations, a recent study published in the New England Journal of Medicine found that only 31 lower- and middle-income nations provide care that reaches the gold-standard of care recommended by the WHO with MPOWER. This lack of support leaves around 1.3 billion people globally without access to sufficient services or care for quitting tobacco use.
“Healthcare services have a fundamental responsibility to treat people with tobacco addiction. Evidence shows that such interventions are not only cost-effective and easy to integrate but also drive substantial health and economic improvements,” said co-author Kamran Siddiqi, MBBS, PhD, professor in public health at Hull York Medical School, at the University of York.
Siddiqi and his co-authors from the University of York, New York University, and Harvard University reviewed healthcare delivery in countries including India and Vietnam, and found that access to care for patients intending to quit smoking is heavily shaped by local factors, including cultural norms, government policy, healthcare funding models, and political interference from the tobacco industry.
The researchers determined that programs assisting patients must be tailored locally to the specific needs of each population rather than relying on a single standard model of support. They recommend several low-cost but high-impact strategies that can expand support even in resource-limited settings.
These strategies include national quit call lines and mobile health apps that deliver remote advice at scale, as well as access to community health workers to provide guidance in rural regions. They also recommend routine screening, such as the “Ask-Advise-Connect” system, which enables doctors to screen patients and link them directly to treatment during regular visits.
“Ensuring equitable access to comprehensive tobacco cessation support as standard care is a vital step toward preventing millions of tobacco-related deaths globally,” said Donna Shelly, MD, professor of public health policy and management at New York University.
The researchers pointed out that proven smoking-cessation medications, such as nicotine patches, cytisine, and varenicline, are cost-effective and should be licensed worldwide. They argue that full courses of these treatments must be covered by governments or insurers to eliminate financial barriers.
“Ultimately, curbing the rising global burden of tobacco-related disease requires establishing comprehensive cessation support as a universal standard of care, which would ensure equitable access for those most affected,” the authors concluded.
