BACKGROUND-AIM:
The WHO First Clinical Guidelines on Tobacco Cessation for Adults emphasize that brief advice delivered by health care providers is among the most effective interventions to support smoking cessation. We examined the current practices, barriers, and opportunities faced by primary care physicians in Ukraine in providing smoking cessation counseling.

METHODS:
In 2022, PHC conducted 45 in-depth telephone interviews with primary care physicians across three regions of Ukraine (Vinnytsia, Ternopil, Chernivtsi) to analyze different aspects of smoking cessation counseling.

RESULTS:
A total of 96% of doctors recognize smoking as a significant risk factor for the development of non-communicable diseases (NCDs). The same portion (96%) reported providing smoking cessation counseling to patients, with the frequency of consultations varying depending specific diseases (cardiovascular, diabetes, chronic obstructive pulmonary disease, hypertension etc.), conditions (shortness of breath, cough, high blood pressure, pregnancy etc.), patient age and smoking history. All surveyed doctors indicated that they are able to identify smokes with observable indicators - smell, hoarse voice, cough, yellowing of fingers. 89% of doctors emphasize to patients that smoking is a major risk factor for NCD. Most doctors reported conducting counseling in the conventional, question-answer format and tailoring anti-smoking messages by using examples and relevant statistical data. Many physicians highlighted the lack of sufficient, evidence- based information on health effects of newer tobacco and nicotine products. 71% of doctors consistently documented patient’s smoking in medical records and 70% of doctors reported taking this information into account in clinical decision making - such as adjusting treatment strategies, selecting medications, and monitoring changes in smoking behavior. Half of the surveyed physicians reported that in their practice, they had never had patients who proactively sought smoking cessation counseling on their own initiative. Instances of self-referral were rare and typically occurred when patients experienced deteriorating health, the onset of illness, or recognized that smoking was contributing to a more severe progression of their disease.

CONCLUSIONS:
Since heavy smokers are primary recognized by doctors, they are more likely to receive counseling than light smokers, highlighting inequalities in access to care.The limited evidence on the health risks of newer tobacco and nicotine products limit physicians’ ability to make strong arguments in smoking cessation counseling. Our study underscores the need for regular training of health care professionals in simple, effective, and evidence-based interventions to enhance awareness of the impact of smoking and strengthen tobacco control measures. Our findings may inform the development of strategies for smoking cessation and the prevention of smoking-related diseases in other countries.