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To address the aforementioned challenges and improve the impact of national tobacco cessation services, the WHO recommends that countries prioritize integration, sustainability, innovation, and a systematic approach. Countries should leverage the unique opportunities presented by health systems and digital technology to establish an inclusive, resilient, and sustainable ecosystem for delivering tobacco cessation services. To create such an integrated and dynamic system, four strategic changes are recommended. These changes will allow tobacco users to access the interventions of their preference at a time that suits them best (8). The specifics of these strategic changes are discussed in detail below.
Implementing Tobacco Cessation Measures Synergistically with Other Tobacco Control Policies
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The optimal effectiveness of tobacco cessation support is achieved when it is implemented in conjunction with other demand-reduction tobacco control policies. These policies include raising tobacco taxes, establishing smoke-free environments, banning tobacco advertising, promotion, and sponsorship, printing pictorial health warnings on tobacco product packs, and developing anti-tobacco mass media campaigns. These measures promote tobacco cessation by encouraging quitting and creating a supportive environment. A compelling example of synergistic efforts is including the quitline number on cigarette packs and mass media anti-tobacco campaigns, resulting in a significant increase in demand for tobacco cessation services (9). This approach is especially important for China, as only 16.2% of smokers in China expressed a desire to quit, according to a 2018 survey of Chinese adults (5).
Using Existing Infrastructure to Develop Cessation Support
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Integrating brief advice into primary health care systems is a crucial measure for countries seeking to provide comprehensive cessation support. Given that en masse infrastructure, like primary health care, is available in almost all countries, this implementation is both practical and economical. The systematic distribution of brief advice across health care systems has the potential to touch base with over 80% of all tobacco users annually in a country if it is consistently delivered (10). Where feasible, cessation interventions should be incorporated into existing health programs like primary care, as well as those aimed towards specific populations and diseases like national tuberculosis programs, non-communicable disease programs, oral health programs, HIV/AIDS programs, mental health programs, and programs addressing the health requirements of women, children, and teenagers.
Countries should consider utilizing their pre-existing infrastructure to implement national toll-free quitline services. Several countries have well-established call centers, existing coronavirus disease 2019 (COVID-19), or other health-related hotlines with the potential to expand and offer tobacco quitline services.
Prioritizing Population-Level Tobacco Cessation Approaches
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Prioritizing population-based tobacco cessation interventions can help reach as many tobacco users as possible at the lowest possible cost and have the most impact on reducing the prevalence of tobacco use at the population level. Government should consider implementing the three “best-buy” interventions as recommended by WHO Global NCD Action Plan 2023–2030: integrating brief advice into primary care, national toll-free quitline services and cessation interventions delivered via mobile text messaging (mCessation) (11). The maximum impact of the three population-level tobacco cessation interventions occurs if they are part of a dynamic integrated tobacco cessation ecosystem.
In 2021, WHO developed the global investment case to explain why countries should invest in tobacco cessation from health and economic perspectives. A return-on-investment analysis of 124 LMICs shows that these population-level interventions cost little but have significant returns (12). On average, countries only need to spend 0.21 USD per person per year on these interventions to witness an estimated 88 million individuals quitting smoking by 2030, leading to 1.4 million lives saved. Over time, a total of 9.3 million lives can potentially be saved among those who quit smoking by the age of 65. It is evident that these three population-level interventions are exceedingly cost-effective.
Embracing More Innovative Approaches to Improve the reach of Tobacco Cessation Interventions
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Effective interventions to aid in tobacco cessation have been identified; however, not enough tobacco users are currently benefitting from them. To increase accessibility and outreach of these interventions, it is imperative to leverage emerging technologies. The popular digital platforms, in conjunction with mobile technology, can be effectively employed to deliver tobacco cessation services. For instance, WeChat, the most widely-used social media platform in China, has demonstrated to be a viable and efficient tool to administer cease-smoking interventions to a wide range of smokers through extensive research (13-14).
Research and development into other innovations such as artificial intelligence (AI) should also be encouraged. During the COVID-19 pandemic, WHO developed an AI-based digital health worker (Florence) to provide brief tobacco cessation advice (15). Florence is now available 24/7 in multi-languages. The next step is to get more people to use this tool.