Across Central Asia and the Caucasus, public health systems are challenged by the Soviet-era legacy of high smoking rates.Governments have increasingly used taxation and public smoking bans to reduce tobacco use, but state-led efforts to get smokers to quit are hampered by a lack of training of doctors and medical professionals in counseling patients.
A recent survey conducted by Healthy Initiatives, a Ukraine-based non-governmental organization, gathered data from 433 practicing doctors across three countries, with a primary focus on Kazakhstan, Georgia and Ukraine.
The findings suggest that continuing medical education in these countries has not kept pace with global developments in smoking cessation, risk communication, and tobacco harm reduction.One of the clearest weaknesses is the lack of standardized cessation training.
Among surveyed practitioners in Kazakhstan, over four out of five respondents said they had never received formal training on smoking cessation support.In Georgia, the figure was somewhat lower, but still high, at 69 percent.
In practice, this means many doctors are left to rely on intuition, general media narratives, or older clinical frameworks when advising patients.A large body of clinical and epidemiological evidence shows that the toxins and carcinogens released through the combustion of tobacco (and not nicotine) are the primary drivers of smoking-related diseases.
Yet many doctors in the region do not appear to make this distinction.In Kazakhstan, over 94 percent of surveyed doctors said they believe nicotine directly causes lung cancer.
In Georgia, nearly 86 percent said the same.When doctors confuse the mechanism of addiction (nicotine) with the primary cause of smoking-related mortality (combustion), it influences how they communicate risk to patients.
That becomes especially visible in attitudes toward alternative, non-combustible nicotine products.Public health agencies in countries such as the United Kingdom and New Zealand include e-cigarettes in clinical guidance as less harmful transitional tools for smokers who are unable or unwilling to quit nicotine immediately.
In Central Asia and the Caucasus, however, doctors appear to view these products with much greater suspicion.That skepticism is likely reinforced by the local policy environment.Kazakhstan, for example, introduced a ban on the sale and distribution of e-cigarettes in 2024; a similar ban was introduced earlier on oral nicotine pouches.
The survey shows that this skepticism is far more pronounced in Kazakhstan than in Georgia.The difference is especially striking for non-combustible oral products: about 62 percent of Kazakh practitioners consider nicotine pouches more harmful than smoking, compared with only 11 percent of Georgian doctors.
A similar divide appears for e-cigarettes, which 64 percent of doctors in Kazakhstan regard as more harmful than traditional smoking, versus 25 percent in Georgia, where doctors are more likely to rate them as equally harmful.
The data points to a particularly pronounced knowledge gap within Central Asia’s largest economy.The findings suggest that Kazakh medical professionals may be more insulated from, or less persuaded by, international evidence on the continuum of risk in tobacco harm reduction.
Without confidence in pharmacological interventions or harm reduction tools, many doctors simply tell smokers wanting to quit to rely on various forms of willpower.Across the survey, the most frequently recommended strategies for patients trying to quit were “social or family support” and “self-cessation without support.” In Kazakhstan, these were recommended by 25 percent and 23 percent of surveyed doctors, respectively.
By comparison, standard over-the-counter nicotine replacement therapies such as patches or gums were recommended by only 20 percent of surveyed doctors in Kazakhstan.Switching to non-combustible alternative nicotine products (nicotine pouches, e-cigarettes, or heated tobacco products) was recommended by fewer than 3 percent.
If doctors rely mostly on the “cold turkey” approach, they are leaning on a method that has historically produced very low long-term cessation success rates, with effectiveness estimated at around 3 percent, and smokers needing 30 or more quit attempts to achieve lasting abstinence.
The survey also found that about 14 percent of doctors in Kazakhstan themselves use tobacco or nicotine products.That is a useful reminder that medical professionals are not outside the behavioral realities they are asked to address in clinical practice.
If countries in Central Asia and the Caucasus want better public health outcomes, policy responses will need to go beyond bans and restrictions and reach into medical education itself.
Practicing doctors require updated, evidence-based clinical guidance that clearly distinguishes between the risks of nicotine and the much greater harms associated with tobacco combustion.Closing this institutional knowledge gap by integrating modern cessation science into mandatory continuing medical education is a necessary step if the region’s healthcare workforce is to be better equipped to tackle one of its most persistent public health problems.