Evidence-Based Tobacco-Cessation Strategies for Low- and Middle-Income Countries
Donna Shelley1, Nancy A Rigotti2, Pratima Murthy3
1School of Global Public Health, New York University, New York.
The New England Journal of Medicine
|August 12, 2026
Summary
Globally, tobacco use causes millions of preventable deaths, with low-income nations bearing the highest burden. Offering accessible tobacco cessation services, including pharmacotherapy and behavioral support, is crucial for reducing tobacco-related disease.
Area of Science:
- Public Health
- Global Health
- Health Policy
Background:
- Tobacco use is the leading cause of preventable death worldwide, responsible for over 7 million deaths annually.
- Low- and middle-income countries disproportionately bear the burden, housing over 80% of the world's 1.3 billion tobacco users.
- While the World Health Organization (WHO) promotes six MPOWER strategies to reduce tobacco use, only 31 countries meet best practices for cessation support.
Purpose of the Study:
- To examine how cross-country differences in sociocultural norms, tobacco use patterns, regulatory environments, industry influence, and healthcare financing affect tobacco cessation treatment access and uptake.
- To illustrate these challenges and potential solutions using case studies from India and Vietnam.
- To highlight the importance of integrating comprehensive cessation support into routine healthcare.
Main Methods:
- Analysis of case studies from India and Vietnam focusing on tobacco-related sociocultural norms, use patterns, regulatory environments, industry influence, and healthcare financing.
- Evaluation of the effectiveness of population-level strategies like quitlines, digital interventions, and systemwide screening.
- Assessment of pharmacotherapy options listed on the WHO Model List of Essential Medicines.
Main Results:
- Cross-country variations significantly shape the accessibility and utilization of tobacco cessation services.
- Cost-effective population-level strategies are essential for expanding treatment reach.
- Combining interventions with WHO-listed pharmacotherapy improves cessation outcomes.
- The Ask-Advise-Connect model offers a feasible pathway for integrating cessation care into practice.
Conclusions:
- Comprehensive tobacco cessation support must become a universal standard of care to ensure equitable access, particularly for vulnerable populations.
- Tailoring interventions to local contexts, including sociocultural norms and specific tobacco use patterns, is vital.
- Integrating evidence-based cessation strategies into routine healthcare delivery is key to curbing the global tobacco epidemic.
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