Tobacco use is one of the greatest causes of preventable deaths and disease in human history. As a global health issue, smoking kills more people worldwide than malaria, maternal and major childhood conditions, and tuberculosis combined1. Currently, tobacco kills nearly 6 million people per year. Given current trends, by 2030, the number of deaths caused by tobacco will rise to more than 8 million per year, with a substantial number of these deaths occurring among the 35 to 69 year old age group2. More than 80 percent of these deaths will occur in low and middle-income countries (LMICs), especially India, China, and Indonesia, where tobacco use is pervasive and is on the increase. Beyond mortality statistics, morbidity caused and exacerbated by tobacco use is the source of immense suffering for both the afflicted and their family members. The direct and opportunity costs of caring for those rendered chronically ill by tobacco use is a huge drain on household resources as well as national health budgets struggling to deal with the challenges of health transition.

The only way of reducing tobacco-related mortality and morbidity in the short term is through proactive tobacco cessation efforts. The potential to save lives globally through aggressive cessation initiatives has been well documented3-5. By the year 2020, if adult consumption were to decrease by 50%, approximately 180 million tobacco-related deaths could be avoided6. Not only is tobacco cessation important in its own right, but it also contributes to tobacco prevention in countries where tobacco use is normative7. Cessation initiatives draw attention to the ill effects and addictive nature of tobacco use, as well as to users’ desirability and struggles to quit.

The wealth of research knowledge and lessons learned about tobacco cessation from high income countries cannot simply be transferred to LMICs given vast differences in social norms and cultural values, tobacco products and tobacco use patterns, the logistics of health care and medical training, and public health outreach. Tobacco cessation research attentive to these differences, which at the same time builds on lessons learned elsewhere, is clearly needed.

Project Quit Tobacco International (QTI) is a transnational and transdisciplinary research and training collaboration dedicated to developing clinic and community- based tobacco cessation research capacity in India and Indonesia. Now in its tenth year, and completing its second cycle of funding from the National Institutes of Health, Fogarty International Center (FIC), Project QTI has developed innovative tobacco cessation training programs in medical colleges, introduced cessation programs in clinic and community settings, promoted a community-based smoke free home movement, and helped establish a tobacco cessation community of practice.

QTI India & Indonesia

Why did we choose medical colleges to work with as partners, and India and Indonesia as initial Project QTI sites?

A primary recommendation of the World Health Organization’s Tobacco Free Initiative is the promotion of cessation among health care providers8. It is reasoned that in order for a downward shift in tobacco use to occur, health care providers must be at the forefront of tobacco cessation efforts. To do so, they need to both quit using tobacco themselves and ask patients about tobacco use and encourage them to quit as a routine part of medical assessment. If tobacco is a priority of the healthcare community in a nation, it may be difficult for a government to ignore the need for a progressive tobacco policy. Unfortunately, physicians and other health care professionals have had little involvement in tobacco cessation efforts in most LMIC, including India and Indonesia.

India and Indonesia are the second and fifth most populous countries in the world, and two nations where cigarette consumption is increasing9. At present, almost 70% of Indonesian males smoke and approximately 50% of Indian males are tobacco users. Assisting these countries to accelerate the development of culturally appropriate cessation interventions will have enormous public health impact. The lessons learned in these two countries may prove relevant for other countries.

What do we have to share?

All of the training and research resources developed, pretested, and piloted by Project QTI are freely available on this website. We ask that you register on the site to provide us with information on who is accessing these resources. Those who register are also able to access cutting edge articles that we post on tobacco-related research. We invite feedback and encourage you to visit the site periodically as we continue to post new resources.

QTI Turkey - Project Overview

The overall goal of the project is to extend the reach and depth of smoking cessation training within the Turkish healthcare system. In order to achieve this goal, we aim to create a cadre of nurses and psychologists trained in tobacco cessation who are able to introduce illness-specific as well as general cessation training within their own practice-based communities and sub-specialties. Our team is dedicated to the development and implementation of culturally sensitive cessation training tailored to the needs of the Turkish population. QTI Turkey builds on lessons learned during QTI India and Indonesia to increase capacity for tobacco cessation in the country, facilitating the mainstreaming of cessation as routine practice within the health care system. The project will extend the reach of the recently opened cessation clinics in Turkey which have trained a cohort of physicians in tobacco cessation.

QTI Turkey - Project Objectives

  1. To adapt evidence-based cessation training materials to Turkey’s cultural context through a process of formative research;
  2. To conduct Training of Trainers (TOT) programs in illness-specific and general cessation skills for nurses and psychologists;
  3. To produce illness-specific cessation videos modeling tobacco cessation skills for use in trainings and quit guides for laypersons to be used in clinic-based cessation counseling;
  4. In Year Two, to provide assistance to health professionals trained in Year One to train other professionals in both their own hospitals and in their professional organizations as a means of promoting cessation as a normative part of clinical practice in Turkey;
  5. To provide leadership in the fields of nursing and psychology in smoking cessation as a foundation for a larger smoking cessation movement within Turkey’s healthcare sector.

QTI Turkey is funded by Global Bridges Healthcare Alliance for Tobacco Dependence Treatment.

Reference List

  1. The World Bank. Curbing the Epidemic: Governments and the Economics of Tobacco Control. Washington, DC: The World Bank; 1999.
  2. World Health Organization. Tobacco fact sheet, 2013. Geneva: WHO 2013
  3. Ezzati M, Lopez AD. Estimates of global mortality attributable to smoking in 2000. Lancet 2003;362:847-852.
  4. Abdullah ASM, Husten CG. Promotion of smoking cessation in developing countries: a framework for urgent public health interventions. Thorax 2004;59:623-630.
  5. Teo KK, Ounpuu S, Hawken S et al. Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case-control study. The Lancet;368:647-658.
  6. Mackay J, Eriksen MP. The Tobacco Atlas. Brighton: Myriad Editions Limited; 2002.
  7. Slama K. Current challenges in tobacco control. Int.J Tuberc.Lung Dis. 2004;8:1160-1172.
  8. World Health Organization. Code of practice on tobacco control for health professional organizations. World Health Organization Web-site 2004. 11-9-2007.
  9. Murray CJL, Lopez AD. Assessing the burden of disease that can be attributed to specific risk factors. World Health Organization; 1996.

Click here to view a slideshow that further explains this project

Also available as a PDF: here