Strengthening tobacco cessation across the primary health sector in the Americas: progress, gaps, and opportunities since 2007

Objective: Tobacco use is a major modifiable risk factor for the four main noncommunicable diseases (NCDs) globally-cardiovascular diseases, chronic respiratory conditions, cancer, and diabetes. Addressing tobacco use through cessation interventions is therefore a cornerstone of comprehensive NCD prevention and control efforts. In this context, strengthening cessation support within primary health care has emerged as a high-impact and cost-effective strategy to accelerate progress toward NCD targets. Methods: Despite advances in tobacco control, cessation support remains insufficiently implemented across much of the Region of the Americas. This article examines progress made between 2007 and 2024 in implementing the World Health Organization (WHO)-recommended tobacco cessation measures, with a focus on the availability, cost coverage, and integration of services within health systems. Results: Only 7 of the 35 countries in the Americas achieved the highest level of cessation support, which combines national free quit lines, the availability of nicotine replacement therapy (NRT), and the provision of cessation services with partial or full cost coverage. Although these countries represent over 70% of the population, disparities persist-particularly in the Caribbean and in lower-middle-income countries. Findings show that NRT and other pharmacological treatments are inconsistently available, treatment costs are often not covered, and quit lines operate in only 40% of countries. These gaps underscore the urgent need for stronger policies, sustainable financing, and improved health system coordination. Conclusion: Tobacco cessation must be prioritized as an essential health service, integrated into national NCD strategies, and supported by legal and institutional frameworks guaranteeing equitable access. Strengthening cessation is essential to reducing tobacco use and its health and economic burden across the Americas.