Community Health Worker-Led Smoking Cessation in Rural Primary Care: A Pragmatic Comparative Study: Twelve-Month Abstinence and Relapse Outcomes Across Six Rural Primary Health Centres

Tobacco use remains a leading preventable cause of premature death in rural South Asian populations, yet structured cessation programmes are uncommon outside tertiary centres. We conducted a pragmatic comparative study across six rural primary health centres, comparing a structured community health worker-led (CHW-led) cessation intervention with standard physician advice. Three centres delivered the CHW-led intervention (n=180 smokers) comprising motivational interviewing, nicotine replacement therapy where appropriate, and a structured 12-week follow-up schedule with home visits. Three centres delivered standard care (n=160) consisting of brief physician advice and self-help materials. Twelve-month biochemically-verified continuous abstinence was achieved by 28.9% of CHW-arm participants compared with 11.9% of standard-care participants (adjusted OR 3.12, 95% CI 1.78-5.47). Relapse rates among early quitters were also substantially lower in the CHW arm. Strongest modifiable predictors of sustained abstinence were attendance at four or more follow-up contacts, documented family support, NRT use, and establishment of a smoke-free household. The findings support broader deployment of CHW-led structured cessation as a scalable rural intervention with substantial absolute benefit over the conventional brief-advice approach.