Tobacco use is a well-documented risk factor for lung cancer, respiratory infections, and TB, often worsening disease and increasing complications. Smoking is also significantly more common among patients with TB, occurring at rates roughly three times higher than in healthy individuals.1 However, smoking cessation support is often absent from TB treatment programs, leaving a critical gap in care.
In a multicenter, cluster randomized clinical trial involving 27 TB clinics across Bangladesh and Pakistan, investigators found that a text message-based mobile health (mHealth) intervention was effective in achieving continuous tobacco abstinence at six months compared with usual care among patients with TB.2
“In low- and middle-income countries with a high TB burden—such as Pakistan and Bangladesh—smoking cessation support is not routinely integrated into TB care, despite strong evidence linking smoking with poor TB outcomes,” said Maham Zahid, PhD, the study’s lead author. “Our findings highlight the potential of mHealth-based interventions as a feasible and scalable solution to address this gap.”
The trial randomized 27 TB clinics across Bangladesh and Pakistan to either the mHealth intervention or usual care. Patients were eligible if they smoked daily, expressed a willingness to quit, had been diagnosed with drug-sensitive pulmonary TB within the previous four weeks, had access to a mobile phone, and were at least 15 years old.2 Of the 9,232 patients assessed for eligibility, 1,080 were randomized in a 2-to-1 ratio, with 720 assigned to the mHealth intervention and 360 to usual care.2
The mHealth intervention involved daily text messages encouraging tobacco cessation during the first two months of the study and then a monthly message for the next four months of TB treatment. Usual care consisted of written information on tobacco cessation.2
“While digital health interventions are increasingly recognized as the future of health care delivery, evidence from populations with lower literacy levels and constrained health systems remains limited,” Dr. Zahid said. “By addressing tobacco use within TB care, this research contributes to improving both individual patient outcomes and broader public health goals.”
Continuous tobacco abstinence at six months, verified biochemically via carbon monoxide breath testing and by self-report, served as the primary outcome.
At six months, biochemically verified continuous tobacco abstinence was significantly higher in the mHealth group than in the usual care group. Abstinence was confirmed in 41.7% of participants (300 of 720) receiving the mHealth intervention, compared with 15.3% of participants (55 of 360) receiving usual care (RR, 3.0; 95% CI, 2.0-4.9).2
Dr. Zahid noted limitations including a predominantly male study population, limited assessment of participants’ understanding of the text messages, and the use of a breath test that could confirm only recent cessation rather than long-term abstinence.
Dr. Zahid emphasized the importance of implementation beyond the research setting.
“The greatest impact is likely to be achieved through widespread implementation and long-term sustainability within routine health systems,” she said. “To realize this potential, it is essential to translate these research findings into policy-relevant evidence. Engagement with policymakers and program managers will be critical to support adoption, integration, and scale-up, ultimately advancing patient-centered TB care that systematically addresses tobacco use.”
References
1. Alavi-Naini R, Sharifi-Mood B, Metanat M. Association between tuberculosis and smoking. Int J High Risk Behav Addict. 2012;1(2):71-74. doi:10.5812/ijhrba.5215
2. Zahid M, Rahman F, Danaee M, et al. An mHealth (mobile health) intervention for smoking cessation in people with tuberculosis: a cluster randomized clinical trial. JAMA. 2026;335(4):336-344. doi:10.1001/jama.2025.20765
