Doctors’ Outdated Training Hampers Quit Attempts in Central Asia and the Caucasus

Public smoking bans and taxes have trimmed use, but gaps in clinicians’ education leave patients without effective cessation support

A new survey of practicing physicians across Kazakhstan, Georgia and Ukraine suggests that clinic-level care is a weak link in regional efforts to reduce tobacco harm. Healthy Initiatives collected responses from 433 clinicians and found widespread gaps in formal training on how to help people stop using tobacco and nicotine. While governments have tightened rules on smoking in public places and raised taxes, many smokers still leave medical appointments without practical, evidence-based quitting options.

The most striking shortfall is in standardized cessation education. In Kazakhstan, roughly four in five doctors reported never receiving formal instruction in smoking-cessation counseling; in Georgia, about seven in ten said the same. That lack of training leaves clinicians to fall back on personal judgment, media narratives or outdated textbooks when advising patients — a problem local trainers say weakens the single most important touchpoint for people trying to quit.

Confusion about the causes of smoking-related disease emerged as a major consequence. The survey found that more than 94 out of 100 responding physicians in Kazakhstan and roughly 86 out of 100 in Georgia believe nicotine itself causes lung cancer. That misunderstanding blurs the important difference between the addictive substance and the deadly toxins produced when tobacco burns, and it alters how clinicians assess alternative nicotine products. International guidance in places such as the United Kingdom and New Zealand treats some non-combustible products as lower-risk options for smokers who cannot stop immediately, but those messages have not penetrated evenly into the region’s clinical practice.

National policy signals appear to reinforce clinicians’ skepticism. Kazakhstan enacted a ban on the sale and distribution of e-cigarettes in 2024 and had already outlawed oral nicotine pouches, and the survey shows that Kazakh doctors are markedly more suspicious of non-combustible products than their Georgian peers. About 62 out of 100 physicians in Kazakhstan judged nicotine pouches to be more harmful than smoking, while only about 11 out of 100 Georgian respondents said the same. Views on e-cigarettes showed a similar split: roughly 64 out of 100 Kazakh clinicians ranked them as more harmful than conventional cigarettes, compared with about one-quarter of Georgian doctors who rated them as no worse than smoking. Public health experts who reviewed the findings said regulatory prohibitions, without concurrent clinician education, can harden misconceptions.

The effect on patient care is practical and measurable. Across the survey, the strategies doctors most often advised were leaning on family or social networks and attempting to quit without formal help — recommended by roughly one-quarter and slightly less than one-quarter of Kazakh respondents, respectively. Over-the-counter nicotine replacement — patches or gum — was suggested by about one in five doctors in Kazakhstan, while fewer than three in every 100 clinicians recommended switching to non-combustible nicotine products. Evidence shows unassisted quitting produces low long-term success, on the order of three out of 100, and many smokers require dozens of attempts before they achieve lasting abstinence. The survey also noted that about 14 out of 100 Kazakh doctors themselves use tobacco or nicotine, underscoring how personal behavior can complicate professional practice.

If ministries of health want better results, they will need to move beyond prohibition and taxation and invest in clinician training that reflects current science. That means updating continuing medical education to teach practical counseling methods, clarifying the difference between addiction and combustion-related harm, and incorporating proven pharmacological and behavioral tools into routine care. Representatives of regional health groups who reviewed the survey urged health systems to make such training mandatory and practical, so patients who sit down with a clinician leave with a real plan rather than vague encouragement to “try harder.”