Promoting Tobacco Cessation in Low- and Middle-Income Countries

Abstract

The tobacco epidemic is increasingly concentrated in low- and middle-income countries (LMICs) (WHO, 2008). These countries often have very limited resources and infrastructure to confront this epidemic. Public knowledge of tobacco health harms may be quite limited and, unfortunately, this is often true for health professionals as well (Nichter, 2006). Clinical practice guidelines have identified effective tobacco cessation interventions (Clinical Practice Guideline, 2008), but these have been focused primarily upon high-income countries. Approaches that have been successful in high-income countries may not be directly applicable in low-resource settings. Thus, for example, medications may not be readily accessible and infrastructure to support quit line programs may be minimal or non-existent.

Tobacco cessation in low‐ and middle‐income countries: some challenges and opportunities

“…Additionally, enlisting community leaders such as teachers and religious leaders to discourage tobacco use and promote cessation is likely to yield success [8].…”

“…Tobacco cessation medications are not cheap or affordable for the majority residing in LMICs [17]. Even if medication such as cytisine is relatively inexpensive [8], this may still be beyond the reach of the poor and require subsidization.…”

Tobacco intervention research in low- and middle-income countries: lessons learned and future directions

“…In his commentary for this theme issue, Professor Harry Lando reminds us that “providing tobacco cessation treatment is feasible even in countries with the fewest resources”, and he does a laudable job of recommending a path forward to accomplish this (Lando, 2016). He places strong emphasis on building capacity for research and treatment, and disseminating low cost cessation strategies.…”

“…The problem is multi-layered: many LMICs have high rates of tobacco use by physicians and other healthcare providers (Abdullah, Qiming, Pun, Stillman, & Samet, 2013, Abdullah et al, 2014; Asfar, Al-Ali, Ward, Vander Weg, & Maziak, 2011), which make them reluctant to champion their patients’ quit attempts. Beyond this motivational issue, many physicians are skeptical that patients want their advice to quit smoking (Ossip et al, 2016; Prucha et al, 2015), do not view cessation as part of their jobs (Dozier et al, 2009; Tee, & Hairi, & Hairi, 2012), and misunderstand the harms of tobacco (Abdullah & Husten, 2004; Asfar et al, 2011; Dogar, Elsey, Khanal, & Siddiqi, 2016; Lando, 2016). …”

“…As Professor Lando reminds us (Lando, 2016), tobacco intervention does not occur in a vacuum. Efforts to help smokers quit are more successful when linked to other tobacco control strategies, such as product labelling (Baskerville et al, 2016; Li et al, 2016) and community engagement (Ossip et al, 2016).…”