Foundation for a Smoke-Free World Grant Supports Healthy Initiatives’ Anti-Smoking Efforts in Former Soviet Union

In 2022, the organization Healthy Initiatives advanced its mission to promote and strengthen public health by implementing research and education projects that address the risk of noncommunicable diseases, targeting the contributing risk factors like combustible cigarettes in the former Soviet Union region. Global public health advocate Nataliia Toropova, who is the head of Healthy Initiatives international, recently said, “Smoking cessation programs in our region of the former Soviet Union are nonexistent.”

In 2021 and 2022, with a Foundation for a Smoke-Free World (FSFW) grant, Ukraine-based Healthy Initiatives International conducted a pair of significant and unprecedented research studies focused on tracking patterns of combustible tobacco use and working toward solutions to help smokers quit. Healthy Initiatives provides multidimensional public health policy and advocacy programs to the Russian Federation, Ukraine, Kazakhstan, Georgia, and Uzbekistan.

Smoking-Related Fatalities and Insights into Healthier Tobacco Alternatives

As reported by the Ukrainian Independent News Agency (UINA), the FSFW grant supported Healthy Initiatives research that focused on the behaviors of individuals who were looking to give up unhealthy habits, including excessive tobacco consumption. The innovative research was aimed at identifying public awareness and perceptions of combustible tobacco harm reduction strategies and related harm reduction products.

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“We tried to identify the potential impact of electronic cigarettes on [the] death toll [due to] cigarette smoking,” Toropova explained. “That was the research that we did in Ukraine, in Georgia, in Russia, and actually now we are expanding it to four more countries of the region. The team of experts built a dynamic population simulation model … Their findings were very impressive and very inspiring.”

Survey figures, which were compiled by Healthy Initiatives before the start of the war in Ukraine, indicate an estimated 4,000 premature deaths in Georgia and 62,000 in Ukraine could be linked back to smoking combustible tobacco products. However, on a more hopeful note, Toropova said, “Our findings [also] suggest that electronic cigarettes have a great potential in reducing smoking prevalence and smoking death toll.”

But even with the possibility of overall better health outcomes as less-detrimental alternatives to traditional tobacco consumption methods are introduced, for those already locked into an addictive smoking cycle, the news was less promising. In the portion of the survey focusing on the availability of assistance for chain-smokers who wished to kick the habit, Toropova conceded the data was appalling. “None of the smokers willing to quit could get help from a doctor,” she said. “All of them tried to use their willpower in their attempts … the so-called [cold turkey method], which, needless to say, was ineffective.”

In fact, according to the 2017 Global Adult Tobacco Survey conducted by the Kyiv International Institute of Sociology in conjunction with the Ministry of Health of Ukraine, the National Academy of Medical Sciences of Ukraine, and the World Health Organization, 31% of smokers didn’t seek help when attempting to give up smoking, while a meager 0.9% got assistance from a medical professional. The result? Only 3% to 4% of the cold-turkey crowd were able to give up smoking at all, and as many as 96% of them eventually fell back into the habit.

“According to statistics, in countries where doctors are involved in helping smokers get rid of bad habits, the fight against smoking is much more effective,” Toropova told UINA.

The Impact of Regional Conflict on the Illicit Cigarette Trade

Unfortunately, Healthy Initiatives’ promising research into smoking tobacco cessation has been hampered by the escalating hostilities in the region. In addition to its other devastating consequences, Russia’s armed incursion into Ukraine has put the population under increasing tension, which, not surprisingly, has led to an uptick in traditional combustible tobacco use.

“The overall trend is disappointing,” Toropova told UINA. “Ukrainians have begun to smoke more. This is expected. This is a reaction to the stress associated with the war and an absolute change in the priorities of life. But where will this lead us? Smoking remains the main cause of preventable death and disability.”

This setback for smoking cessation efforts in the former Soviet Union is exacerbated by the laws of supply and demand. Simply put, war and black-market economies go hand in hand. Toropova reports the issue of illicit cigarette trade has skyrocketed since the fighting began.

But amid the conflict, Toropova asserts there’s also been an unprecedented cooperative response to growing concerns over the long-term and far-reaching financial and health implications of contraband combustible tobacco trade. “Healthy Initiatives managed to build a wonderful team of stakeholders who drew … public attention to the issue of smuggling [and] cigarette illicit trade and actually worked on developing a draft road map on combating illicit trade in Ukraine,” she said.

“And that was done for the first time in the history of the country,” Toropova added. “All the stakeholders were involved: government, scientists, doctors, economists — even the custom officials — and that was a big deal. We were very proud of that.”

In addition to its studies in Ukraine, Healthy Initiatives conducted research in Georgia, estimating the size of the illicit trade there and collating the data in order to determine whether black-market cigarettes and other traditional combustible tobacco products directly influenced subsequent death-toll figures. They also sought to ascertain whether pirated tobacco accounted for fluctuations in smoking rates and to what extent illegal activities had an impact on state revenues and taxation.

“It turned out that illicit trade is not a key driver in smoking prevalence,” Toropova conceded. With a ready supply of cheap, legal combustible products such as handmade, roll-your-own cigarette materials available in Georgia (“The lower the economy, the wider [the] market,” Toropova noted), illicit trade becomes less of a factor.

The Combustible Tobacco Bottom Line: Quit, Switch, or Just Don’t Start

Whether the supply is government regulated or bootlegged, when it comes to combustible tobacco, the devastating, deadly consequences for habitual long-term smokers are the same. In May 2022, the World Health Organization stated that tobacco kills up to half of its users and that tobacco accounts for more than 8 million fatalities each year. “More than 7 million of those deaths are the result of direct tobacco use,” they reported, “while around 1.2 million are the result of nonsmokers being exposed to second-hand smoke.”

“The bottom line and the goal of our organization is to make sure that as many adult chain-smokers as possible can quit or make healthier choices and switch if they cannot quit,” Toropova affirmed.