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 providers. 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. Information on illness-specific harms of tobacco is not integrated into medical school curriculum and cessation skills are not taught to clinicians in training.
India and Indonesia are the second and fifth most populous countries in the world, and two nations where tobacco consumption is pervasive. At present, 67% of Indonesian and approximately 19% of Indian men smoke. In India, another 30% of men and 13% of women use smokeless tobacco.
Exposure to secondhand hand smoke in the households of both countries is very common (about 70%). Assisting these countries to accelerate the development of culturally appropriate smoking cessation interventions will have enormous public health impact. The lessons learned in these two countries may prove relevant for other countries.