The WHO Framework Convention on Tobacco Control (WHO FCTC), through its evidence-based MPOWER strategies, provides the cornerstone for global tobacco control.1 Among these, the “O” component—Offering help to quit tobacco use—is operationalized through Article 14, which obligates parties to promote tobacco cessation and ensure access to effective treatment for tobacco dependence.1 While population-level prevention strategies remain essential, global evidence consistently demonstrates that cessation-focused interventions deliver the most immediate and substantial reductions in tobacco-attributable morbidity and mortality. India ratified the WHO FCTC in 2004. Yet, with an estimated 267 million adult tobacco users (GATS-2, 2016–17), tobacco use continues to pose a significant public health challenge.2 At the same time, India has recorded measurable progress: Overall tobacco use declined by 6% in absolute terms and 17% in relative terms between GATS-1 (2009–10) and GATS-2.2 However, quit attempts have not increased overall between the two surveys—the proportion of smokers who tried to quit remained virtually unchanged, and quit attempts among smokeless tobacco users slightly declined—suggesting that higher motivation to quit has not translated into more frequent or successful cessation.2 With an established National Tobacco Control Programme (NTCP), expanding digital health platforms, and a large primary healthcare workforce, India stands at a critical inflexion point. While India’s tobacco control narrative has focused on taxation and regulation, the next frontier must be systematic integration of cessation across care levels, framed not as an optional service, but as a core element of universal health coverage. THE STATUS QUO: PROGRESS AMID PERSISTENT GAPS Tobacco cessation interventions are among the most cost-effective public health strategies, yielding long-term economic and health gains by preventing chronic tobacco-related diseases. In India, cessation services under the NTCP are delivered primarily through Tobacco Cessation Centres (TCCs) located at district hospitals and select medical and dental colleges. The National Tobacco Control Cell has also developed multiple operational guidelines and training modules aimed at healthcare providers.3-5 At the population level, services such as the National Tobacco Quitline Service (NTQLS)6 and m-Cessation7 provide telephonic and SMS-based behavioral support. Integration efforts—including TB–tobacco collaborative activities and brief advice within National Health Mission (NHM) programs—have expanded the potential reach of cessation services. Despite this infrastructure, substantial service delivery gaps remain. GATS-2 data indicate that while 55% of smokers and 50% of smokeless tobacco users were considering quitting, only 50% of smokers and 32% of smokeless tobacco users reported being advised to quit by a healthcare provider.2 This intention–action gap reflects missed opportunities within routine care and highlights the limited institutionalization of cessation within clinical practice. The presence of services alone has not ensured consistent delivery, coverage, or continuity of cessation support. CHARTING THE NEXT CHAPTER: PUTTING CESSATION AT THE CORE To achieve meaningful reductions in tobacco use over the next decade, India must move beyond fragmented interventions and adopt a comprehensive, system-oriented cessation strategy. Evidence-based communication strategies National and state-level IEC/BCC campaigns must shift from solely highlighting harms to actively promoting quitting and available cessation support. Behavioral science evidence suggests that gain-framed, action-oriented messages—reinforced through repeated exposure—are more effective in motivating quit attempts. Social media platforms offer an opportunity to counter misinformation surrounding emerging nicotine products and to normalize quitting, particularly among younger populations. Expanding access through brief advice at primary healthcare levels Brief advice (30 seconds to 3 minutes) delivered opportunistically at primary healthcare facilities is one of the most scalable and cost-effective cessation interventions. Integrating brief advice across national programs (e.g. NTEP, NOHP, RKSK, NMHP, NPNCD) can significantly increase reach without overburdening the system. Experiences from other LMICs, such as Thailand8 and the Philippines,9 demonstrate that systematically integrating brief advice into primary care substantially increases cessation rates. India’s extensive frontline workforce positions it well to replicate and scale such models. Leveraging technology-based interventions With over 27 crore tobacco users, digital interventions are indispensable for scale. Evidence indicates that SMS-based cessation programs increase quit rates, particularly when messages are tailored and interactive. Integrating NTQLS with m-Cessation can ensure continuity of care for callers who miss calls. Further, national telemedicine platforms such as e-Sanjeevani can be leveraged to deliver counseling to underserved and remote populations. Emerging evidence on AI-assisted chatbots suggests potential to improve engagement and adherence, warranting carefully designed pilots within the public health system. Capacity building of health and allied health workforce Although training initiatives have been undertaken, inconsistent delivery of cessation advice indicates the need for structured, role-specific capacity building. Evidence shows that trained providers are significantly more likely to offer cessation support consistently. Cascade-based training models, supported by supervision and monitoring, can help embed cessation into routine clinical workflows. Affordable and accessible pharmacological support Pharmacotherapy—including Nicotine Replacement Therapy (NRT) and non-nicotine medications—is a cornerstone of evidence-based cessation but remains underutilized in India. While NRTs are available free of cost in selected public facilities in some states, access is largely restricted. Inclusion of NRTs in State Essential Drug Lists, aligned with the National List, would enable availability at the primary healthcare level. Economic evaluations from India and other LMICs indicate that NRT provision is cost-effective. State-level NTCP experiences in Tamil Nadu suggest that NRTs are cost-effective when compared with existing practices.10 Cessation for adolescents and youth The rising use of novel nicotine and tobacco products among adolescents poses a serious challenge to long-term tobacco control. Youth-specific cessation strategies—such as age-appropriate counseling, peer-led interventions, and confidential digital support—are essential. Integrating cessation into school health programs and RKSK, complemented by digital interventions, can address early nicotine dependence and prevent lifelong addiction. Preventing misrepresentation of newer products as cessation tools Despite the Prohibition of Electronic Cigarettes Act (PECA), 2019,11 newer nicotine products continue to circulate through informal and online channels, often marketed as “harm reduction” or cessation aids. Such narratives risk undermining evidence-based cessation and renormalizing nicotine use. Stronger enforcement of PECA, regulatory amendments under the Drugs and Cosmetics Act, and clear public health messaging distinguishing proven cessation therapies from unvalidated alternatives are urgently required. Workplace-based cessation Workplaces represent a critical yet underutilized platform for cessation support. Evidence shows that workplace cessation programs increase quit attempts and cessation-related outcomes. Integrating cessation into workplace wellness and occupational health initiatives can substantially expand reach, particularly among working-age adults in both formal and informal sectors. Strengthening research and surveillance While India has generated substantial tobacco research, gaps remain in implementation science, equity-focused cessation strategies, and real-world effectiveness evaluations. Strengthening surveillance of cessation outcomes and prioritizing India-specific implementation research will support the development of adaptive, scalable, and contextually relevant solutions. CONCLUSION India has made demonstrable strides in tobacco control and cessation, reflected in declining prevalence, increased quit attempts, and expanding cessation infrastructure.2 However, the persistence of a large tobacco-using population, low rates of provider-delivered cessation advice, and limited access to pharmacotherapy indicate that these gains remain uneven and fragile.2,12 The next decade demands a decisive shift—from fragmented, reactive efforts to a proactive, people-centred cessation strategy embedded within the health system. This moment represents an inflexion point: Sustained investment in cessation can translate intention into successful quitting and avert millions of premature deaths. Financial support and sponsorship None. Conflicts of interest There are no conflicts of interest.
Singh et al. (Sun,) studied this question.