Presentation by Martin Raw, UK Centre for Tobacco Control Studies and National Institute of Alcohol and Drug Policies, Brazil, at the Global Bridges Preconference at the 15th World Conference on Tobacco OR Health in Singapore.

1. Overview of treatment provision at
national level
Martin Raw
UK Centre for Tobacco Control Studies
&
National Institute of Alcohol and Drug Policies,
Brazil
Global Bridges workshop, WCTOH, Singapore
March 2012

2. Survey of Article 14 implementation
This presentation is based on the preliminary results of a
survey conducted with colleagues from Nottingham and
Harvard Universities, funded by the Society for the Study of
Addiction and the FCA, to whom we are extremely grateful.
We are:
Asaf Bitton, Ann McNeill, Rachael Murray, Hemba Piné-Abata,
Martin Raw, Nancy Rigotti
Our posters reporting this work are presented at this
conference, and the survey will be published in a peer review
scientific journal, and will also serve officially as FCA Article
14 monitoring in a report presented at COP5

3. Interests statement
I do not accept funding from the manufacturers of stop
smoking medications
My funding since 2008 is from:
Bloomberg Philanthropies, FCA, Global Bridges, Roswell
Park Transdisciplinary Tobacco Use Research Centre,
Society for the Study of Addiction, SRNT

4. Sample
All Parties to the FCTC for which we have contacts so far
Parties 174
Countries* 176
No contacts yet 22
Total sample so far 154
Responses 69 (45%)
* Parties minus EU and UK plus England, N Ireland, Scotland, Wales

5. Sample by region and income level
Americas 41%
Europe 56%
Africa 29%
Eastern Mediterranean
32%
South East Asia 20%
Western Pacific 37%
High income 33%
Upper middle 33%
Lower middle 23%
Low 10%

6. Some key policy elements

7. Do you have specialised treatment
services?

8. Quitlines
(n=30)

9. Can tobacco users get help in the
following settings?
(%)

10. How medications are licensed
(%)

11. Three key policies
Mandatory recording of tobacco use in 27%
medical notes
Promote brief advice in existing services like 59%
tuberculosis, HIV/AIDS, etc
Offer help to healthcare workers to stop 48%

12. Reducing tobacco use in health
professionals
Table 3.1: Selected studies of GP smoking prevalence
Country Method and sample details Published % who smoke
Bulgaria3 National survey (n=1194) in 8 of 28 regions 2005 44
Denmark6 Postal questionnaire with 313 GPs 1993 33
National questionnaire of 1,284 physicians including 370
Greece10
GPs
2007 39
Italy11 Regional phone interview 2003 28
Netherlands12 Postal survey with GPs and other physicians. 1990/93 38
Romania14 Survey, details not given, n=1136, p=0.05 2000 43
Slovakia4 European postal survey of GPs 2005 49
Sweden4 European postal survey of GPs 2005 4

13. Guidelines
(n=39)
Have national guidelines 57%
For whole healthcare system 77%
Dissemination strategy 51%
Published in peer review journal 26%
Government/public support 69%
Clear description of writing process 69%
COI statements for all authors 41%
Pharma industry support 18%

14. Are the guidelines for all healthcare
professionals?

15. Some key guideline characteristics

16. Year of guideline publication

17. Do guidelines recommend

18. Percent of guidelines that recommend
these medications

19. More key guideline characteristics
Stress that HCPs should not use tobacco 69%
Formally endorsed by national professional 77%
Associations (ten or more 18%)
Peer reviewed 74%
Formally supported by government 64%
Professional associations involved in writing 74%
or reviewing
Include cost effectiveness data 41%
Reference other countries’ guidelines 69%
Based on another countries 46%

20. Other countries’ guidelines referenced

21. Based on other countries’ guidelines

22. Key findings / messages
2. All regions in world represented
4. Largest sample ever for civil society monitoring
(currently 88 countries or 50%)
6. These findings will under-estimate provision
(because low income regions under-represented in our reponses so far)

23. Key findings / messages
1. Under half of the countries in our sample run mass
media campaigns promoting cessation
3. Only 44% have quitlines
5. Only 25% have treatment systems with national
coverage
7. Another 25% have virtually no treatment provision at all

24. Key findings / messages
1. Recording of tobacco use in notes still not mandatory
3. Smoking health professionals still an issue
5. Few tobacco users can easily get help in any settings

25. Key findings / messages
• 57% of countries have national guidelines
• Only half have a dissemination strategy
• Few have COI statements
• A surge in publishing guidelines in 2009/2010

26. In one sentence
Cessation support / treatment
is not yet a priority in most countries