Tobacco cessation research in low- and middle-income countries : a commentary on challenges, innovations, and opportunities

Abstract

Tobacco use (predominantly smoking) is the leading cause of preventable disease, disability, and death worldwide. It increases the risk of cancer, heart disease, stroke, chronic lung disease, and tuberculosis, among others, costing healthcare systems billions in direct medical costs each year. Global tobacco use has declined from 22.7% in 2007 to 17% in 2021, but the total number of people who use tobacco remains high due to population growth, one leading to more than 8 million tobacco-related premature deaths yearly. Half of these deaths currently occur in high-income countries (HICs) due to the 50-year lag period between tobacco use initiation and death. More than 80% of the world’s 1.3 billion people who use tobacco now live in low- and middle-income countries (LMICs), where an exponential increase in tobacco-related deaths is anticipated to occur in the next 30–50 years. LMICs are not yet fully able to benefit from the global progress in tobacco control because they lag behind that in HICs, due to the disparity in access to comprehensive anti-tobacco programs, which will further exacerbate this extremely rapid increase in tobacco-related deaths in the future. Moreover, certain groups in LMICs (e.g., men, low income, and low education) report the highest tobacco use rates leading to a disproportionate burden of tobacco-related disease requiring targeted efforts.