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Tobacco use is in decline in most high-income countries (HICs); however, the number of tobacco users are rising in many low/middle-income countries (LMICs).1 Consequently, by 2030 tobacco-attributable deaths are projected to rise to 8.3 million per year with more than 80% occurring in LMICs.1 Furthermore, the tobacco-attributable burden is not evenly distributed within these nations; being highest in socioeconomically disadvantaged and marginalised sections of society.2 The urban poor—the participants of the trial published by Sarkar et al3 in Thorax—are particularly vulnerable. For example, 55% of the poorest 20th centile of urban male residents in South Asia use tobacco in contrast to 40% of the richest.4 Quitting tobacco leads to immediate benefits and if stopped before the age of 40, the associated risk of death is reduced by 90%.5 However, tobacco being an addictive substance, most users struggle to quit and many only do so with behavioural and/or pharmacological support.6 According to Global Adult Tobacco Survey, more than 30% of smokers in LMICs attempted to quit in the previous year (15% in China).7 However, in most countries in particular LMICs, cessation advice or services are not available.8 Even where they are, the urban poor are least likely to receive cessation advice …
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Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.