How confident are health care professionals in helping patients quit smoking? And how often does that confidence translate into practical assistance? Our recent research suggests these questions can produce very different answers.
In October, we reported findings from a survey of 1,538 Ukrainian health care professionals in Healthcare Business Today. The results revealed a striking contrast: Most respondents felt confident advising patients to quit smoking, despite limited formal training and familiarity with clinical guidelines. Advising patients was considerably more common than assisting with quit attempts or arranging follow-up.
We have now observed a similar pattern in Kyrgyzstan. The new findings come from a separate survey conducted as part of Healthy Initiatives’ regional research on smoking cessation, tobacco and nicotine products, and health care professionals’ clinical practices.
Smoking remains a major public health challenge in Kyrgyzstan, particularly among men. According to the latest nationally representative survey, 30.3 percent of men aged 18-69 currently smoked tobacco, compared with just 2.7 percent of women. When smokeless tobacco products were included, tobacco use reached 38.5 percent among men. In a country where every third man smokes, health care professionals have an important role not only in encouraging cessation but also in helping patients successfully quit.
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A first look at Kyrgyzstan
Our Kyrgyzstan dataset contains responses from 141 health care personnel. Women accounted for 94 percent of respondents. The sample included 71 nurses, 45 physicians, and personnel in other clinical roles. This was a convenience sample, not a nationally representative survey.
The initial results reveal three striking contrasts. First, confidence was widespread, but formal preparation was not. Although 83 percent felt very or somewhat confident advising patients about smoking cessation, 84 percent reported no previous cessation training, and 73 percent said they were unfamiliar with clinical cessation guidelines. Among the 117 participants who reported confidence in advising patients, 97 had received no cessation training, while 81 were unfamiliar with clinical guidelines.
Confidence is not necessarily misplaced. Experienced clinicians can develop useful counseling skills through daily practice. But confidence alone does not demonstrate familiarity with recommended treatments or the ability to deliver structured support. Encouragingly, 67 percent of respondents expressed interest in receiving cessation training. This suggests an opportunity to strengthen clinical preparation.
Where does cessation support become less consistent?
The second contrast concerns what health care personnel reported doing during the previous month. The survey asked about five familiar components of smoking-cessation care: asking about smoking, advising patients to quit, assessing readiness, assisting with cessation, and arranging follow-up. The proportion reporting that they performed each activity frequently or always was:
- 57 percent asked patients about smoking.
- 56 percent advised patients to quit.
- 39 percent assessed readiness to quit.
- 28 percent provided cessation assistance.
- 30 percent arranged follow-up.
The pattern is important. Asking and advising were substantially more common than assisting patients or arranging subsequent support. The individual responses make this distinction clearer. Among the 117 confident participants, 80 did not report frequently assisting patients with cessation, and 81 did not report frequently arranging follow-up.
These findings should not be interpreted as evidence that these respondents never provided assistance. The survey measured self-reported frequency, not the quality of care delivered during individual consultations. Respondents also had different professional responsibilities and potentially different opportunities to encounter patients who smoke. Nevertheless, the results identify a practical question worth investigating: Are health care personnel sufficiently equipped to move beyond recommending cessation and help patients act on that advice?
Encouragement is common. Structured support is less so.
The third contrast concerns the methods respondents usually recommended. Unaided quitting, or relying on willpower, was selected by 67 percent. Family or social support was recommended by 53 percent. In comparison, 28 percent selected nonprescription nicotine-replacement therapy, 18 percent selected referral to a cessation clinic, and just 4 percent selected prescription cessation medicines.
A similar pattern appeared in the topics discussed with patients. Sixty percent reported discussing the benefits of quitting, and the same proportion discussed the risks of continued smoking. Yet only 28 percent selected explaining cessation methods, and 21 percent selected helping patients develop a quit plan. Discussing why smoking is harmful is important. Helping a patient understand how to quit requires additional skills and resources.
Why clinical training matters
The World Health Organization’s 2024 clinical treatment guideline recommends routine brief cessation advice, more intensive behavioral support for people interested in quitting, and access to evidence-based pharmacological treatments.
The evidence also supports investing in professional training. A 2026 Cochrane review covering 29 studies found that training health care professionals in smoking cessation improved patient quit outcomes compared with no training. The pooled analysis of 16 studies showed a 34 percent relative increase in cessation.
Our Kyrgyzstan findings are consistent with the importance of clinical preparation, although they cannot demonstrate that training caused better practice. Among respondents familiar with cessation guidelines, 45 percent reported frequently assisting patients, compared with 21 percent among those unfamiliar with guidelines. Prior training was also associated with greater reported guideline familiarity.
A regional question worth investigating
Our Ukrainian and Kyrgyzstan surveys cannot establish how widespread these gaps are nationally, identify their underlying causes, or measure their effects on patient quitting outcomes. They do, however, raise a recurring question for clinical education and health service delivery: Are health care professionals being prepared only to recommend smoking cessation, or also to help patients achieve it?
As Healthy Initiatives continues its regional research, examining these patterns across settings may help identify where clinician education, practical guidance, and access to cessation services could be strengthened.
The goal is not to undermine professional confidence. It is to ensure that confidence is supported by knowledge, practical skills, and systems that make effective care possible.
Patients need health care professionals (and systems) who are confident enough to raise smoking cessation, and prepared enough to help them succeed.
This study was funded through a grant from Global Action to End Smoking (formerly known as the Foundation for a Smoke-Free World), an independent U.S. nonprofit 501(c)(3) grantmaking organization. The funder had no role in the conception, design, implementation, data analysis, interpretation of the study results, or preparation of this article. At the time this research was conducted, the authors had a service agreement with the Ukraine-based nonprofit organization Healthy Initiatives. In parallel, Giorgi Mzhavanadze has a service agreement with Knowledge-Action-Change (KAC), a U.K.-based organization focused on harm reduction as a public-health strategy.
Giorgi Mzhavanadze is a health economist, public health researcher, and PhD candidate in economics at Tbilisi State University in Georgia. His research focuses on health economics, tobacco control, tobacco harm reduction, and the economic and behavioral determinants of health.
His work combines applied econometrics, discrete choice experiments, and quantitative policy analysis to examine tobacco and nicotine use, risk perceptions, smoking cessation, taxation, and regulatory interventions. He has contributed to peer-reviewed scientific research and international policy reports, with a particular focus on Eastern Europe and Central Asia.
His research is listed on ORCID, and he has written about the implementation gap in smoking cessation for Healthcare Business Today.
Anastasiya Kalashnikova is a public health researcher.
