Case studies: creative and community-led THR communication in LMICs

This section presents three case studies from the THRSP that illustrate how THR communication is being advanced in LMICs through locally led, creative, and community-based approaches. Rather than relying on government campaigns or formal health messaging, these examples show how advocates, researchers, and creatives have used storytelling, media, and grassroots engagement to reach people who smoke, families, and decision-makers in ways that resonate with local realities.

The case studies highlight different communication pathways, including sideways communication to people who smoke and communities, upward engagement with policymakers, and the use of creative media to address misinformation, resistance, and economic concerns linked to smoking and harm reduction. Together, they demonstrate that effective THR communication in LMICs often depends on cultural relevance, local ownership, and innovative use of non-traditional platforms.

Case Study 1: Film-Based THR Communication in Zambia – Saving Chalo

Saving Chalo (2021) is a 23-minute drama film by Emmanuel Mwape, a THRSP scholar. The film follows Justina, a woman who introduces safer e-cigarettes to her community after losing her husband to cancer, and her conflict with Nyunde, a local cigarette seller whose livelihood is threatened by the shift away from combustible tobacco. Through this narrative, the film explores harm reduction, community resistance, misinformation, and economic disruption in a way that mirrors real-world challenges in many LMIC settings.

This case demonstrates how film and storytelling can communicate THR concepts to audiences who may not engage with policy documents or clinical guidance. By presenting harm reduction through lived experience rather than technical argument, the film opens space for dialogue, empathy, and reflection, making it a powerful tool for community-level THR education.

Case Study 2: Gender-Focused THR Advocacy and Communication in LMICs

This case study draws on the work of Nafisat Dasola Jimoh, a graduate of the THRSP, whose writing and advocacy highlight how THR communication can be adapted to address the gendered realities of smoking in LMICs. Her work demonstrates how reframing THR through a gender lens can reach audiences that are often overlooked by mainstream tobacco control and harm reduction messaging.

Through policy commentary, public-facing articles, and advocacy, Nafisat draws attention to the fact that while women smoke at lower rates globally, they experience disproportionate harm from tobacco use and second-hand smoke, particularly in LMIC settings. Cultural stigma, hidden smoking, limited access to cessation services, and gendered social norms often prevent women from engaging with conventional tobacco control programmes. Her communication work reframes THR as a tool for empowerment, choice, and harm reduction, rather than moral judgement or lifestyle preference.

A key strength of this case is the strategic use of narrative framing. Instead of relying solely on epidemiological data, the communication focuses on lived experience, caregiving roles, economic vulnerability, and autonomy. Messages are tailored to different audiences: women who smoke, families affected by second-hand smoke, health workers, donors, and policymakers. This illustrates how THR messaging can be shaped to specific purposes, rather than relying on a single equity or public health frame.

Here is the link to the piece: https://filtermag.org/tobacco-harm-reduction-women/

Case Study 3: Consumer-Led Research on Safer Nicotine Alternatives in India

This case study draws on research led by Samrat Chowdhery, a THRSP scholar, whose work explored whether safer nicotine products could provide realistic alternatives for India’s large populations of people who smoke bidi and smokeless tobacco users. India accounts for around 10% of the world’s people who smoke, with nearly one million tobacco-attributable deaths each year, and an additional heavy burden from smokeless tobacco use. Despite this, access to cessation support remains limited, particularly for low-income and rural populations.

Samrat’s first study focused on people who smoke bidi, who represent more than 80% of tobacco-related deaths in India and are predominantly from disadvantaged groups. Working with manufacturers, he helped develop a bidi-flavoured vaping liquid tailored to local preferences, addressing a key barrier to switching. He also tested affordability, demonstrating that after the initial cost of a device, vaping was cheaper than continued bidi smoking. Among 130 people who smoke bidi recruited near Mumbai, over 90% successfully switched away from bidi use. Notably, some participants used vaping intermittently to manage cravings and ultimately reduced or stopped both products, an unexpected outcome in a population with little prior access to cessation tools.

This case highlights several important lessons for THR in LMICs. First, consumer-led and locally informed research can generate practical solutions even in restrictive policy environments. Second, adapting products to cultural preferences and cost realities is critical for uptake among low-income users. Third, harm reduction strategies must remain flexible, shifting focus when regulatory conditions change. Finally, the case illustrates how THR research does not only inform policy debates but can directly improve health outcomes for populations otherwise excluded from conventional cessation services.