- Tobacco causes over 7 million deaths annually; more than 80% of users live in low and middle income countries, prioritising cessation services.
- Implement cost effective population level interventions: quitlines, digital programmes, system screening with clinician advice, and Ask-Advise-Connect to expand reach.
- Provide universally accessible, cost covered behavioural support and WHO Model List pharmacotherapies to ensure equitable cessation care in low and middle income countries.
N Engl J Med. 2026 Aug 13;395(7):684-693. doi: 10.1056/NEJMra2507061.
ABSTRACT
Tobacco use is the leading cause of preventable death globally, claiming more than 7 million lives each year. The burden of disease is highest in low- and middle-income countries, where more than 80% of the world’s 1.3 billion tobacco users reside. 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. Many low- and middle-income countries provide tobacco-cessation services; however, only 31 meet the WHO best practice, defined as providing both cost-covered behavioral interventions and pharmacotherapy. In this article, case studies from India and Vietnam illustrate how cross-country differences in tobacco-related sociocultural norms, tobacco-use patterns (e.g., smokeless tobacco or water pipes), the tobacco-control regulatory environment, industry influence, and health care system financing shape treatment access and uptake. These cases further show that cost-effective population-level strategies, including quitlines, digital interventions, and systemwide screening for tobacco use paired with clinician advice to quit, are essential for expanding treatment reach. Combining these interventions with pharmacotherapy products that are included on the WHO Model List of Essential Medicines (e.g., cytisine and nicotine-replacement therapy) further improves cessation outcomes. System-level models, such as the Ask-Advise-Connect model (ask about tobacco use, advise to quit, connect to cessation help), offer a feasible, low-burden pathway for integrating cessation care into routine practice. 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.
PMID:42585647 | DOI:10.1056/NEJMra2507061
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