Want to quit tobacco? A simple 3-Step approach can help more Indians kick the habit

There, she was counselled on setting a quit date, managing withdrawal symptoms and identifying triggers. She was also offered nicotine gum.

About two weeks later, Priya learnt that the ulcer was not cancer and was expected to resolve it if she stopped using khaini.

For Dr Pratima Murthy, former director of the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, and a co-author of a new review published in the New England Journal of Medicine, Priya’s experience illustrates a larger challenge: how to make tobacco-cessation support part of routine healthcare rather than something patients must actively seek out.

Ask. Advise. Connect.

“India has a huge burden from both tobacco smoking and smokeless tobacco use. Cost-effective population-level interventions — including quit lines, digital interventions and system-wide screening paired with clinician advice to quit — are essential to expand treatment reach,” Murthy told The Indian Express.

The review, co-authored by Murthy and researchers from the US, Vietnam and the UK, examines evidence-based tobacco-cessation strategies for low- and middle-income countries.

One approach it highlights is the Ask–Advise–Connect model: ask patients about tobacco use, advise those who use it to quit, and connect them with appropriate cessation support. Its appeal lies in its simplicity. A doctor, nurse, dentist or other trained healthcare professional does not necessarily need to provide a lengthy counselling session at every visit. A brief conversation can identify tobacco use and create a pathway to counselling, behavioural support, medication or a quit line.

The model also emphasises connecting patients directly to help rather than simply telling them to find it themselves. Research evaluating the approach found that direct connection to a quit line resulted in substantially higher enrolment in cessation treatment than referral alone.

India’s burden and the infrastructure

India has more than 250 million adult tobacco users, according to national survey data. Tobacco use includes smoking as well as smokeless products such as khaini and gutka.

The health consequences extend beyond lung disease. Tobacco use increases the risk of cardiovascular disease, stroke, several cancers and respiratory illness, while smokeless tobacco is associated with oral cancers and other diseases of the mouth.

India has implemented a broad range of tobacco-control measures, including restrictions on advertising and promotion, smoke-free policies, health warnings, mass-media campaigns and cessation services. The National Tobacco Quitline Services were established in 2016, while mobile-based interventions such as mCessation offer another route to support. India also has a network of tobacco-cessation centres under the National Tobacco Control Programme.

But availability of a service does not necessarily mean people know about it or use it. According to Murthy, one in five people, who used the SMS-based cessation programme, has successfully quit tobacco, but awareness of the service remains low.

Quitting is not simply about willpower

Nicotine dependence can make quitting difficult. Cravings, withdrawal symptoms, established routines and social triggers can all contribute to relapse. That is why evidence-based cessation care can combine behavioural support with pharmacological treatment, including nicotine-replacement therapy when appropriate.

Priya’s experience shows how an ordinary healthcare encounter can become an opportunity to address tobacco dependence. Her concern about a mouth ulcer brought her into contact with healthcare professionals; the consultation then opened a conversation about quitting.

Taking cessation beyond specialist clinics

The need is particularly important in communities where tobacco products are cheap, easily available and socially accepted. People living in rural areas, and women in particular, may face additional barriers to accessing specialised cessation services. Community-based interventions and trained frontline health workers can help bring support closer to where people live.

India’s experience may also offer lessons for other low- and middle-income countries, particularly in South Asia. The review also examines Vietnam, highlighting how tobacco-use patterns, social norms, regulation and healthcare systems can shape access to treatment.

The details differ between countries, but the basic principle is transferable: identify tobacco use, advise quitting and make evidence-based help accessible.

• Tobacco quitline: 1800112356
• TeleManas: 14416
• mCessation: 011-22901701