Tobacco dependence treatment around the world
During 2012 our team, based at the universities of Nottingham, King’s College London and Harvard, conducted a survey of tobacco dependence treatment services and treatment guidelines in Parties to the FCTC. We received responses from 121 of the 166 countries surveyed, a response rate of 73%. The response rate was high in all WHO regions and all World Bank income groups, the lowest being 65% and the highest 83%.
The key findings on basic infrastructure were that fewer than half of the countries surveyed had national treatment guidelines (44%), a government official responsible for tobacco dependence treatment (41%), an official national treatment strategy (44%), a clearly identified treatment budget (22%), mandated the recording of tobacco use in medical notes, or provided tobacco cessation support for health workers (46%); 56% encouraged brief advice in existing health care services.
The key findings on the provision of cessation support were that 36% of countries had quitlines, 17% had a network of specialised treatment support covering the whole country (32% had no specialised treatment facilities at all), the most readily available medications (according to manufacturer data) were available in just over half of countries – varenicline in 52%, NRT in 51%, bupropion in 17% and cytisine in 10%.
Perhaps not surprisingly there were large differences in rated affordability of medications according to World Bank income levels, with affordability being highest in high income countries. The only medication rated as being easily affordable everywhere it was available, was cytisine (in eastern Europe a one month course costs approximately US$15).
Respondents in almost one third (30%) of countries indicated that tobacco users could easily get help in a general/family practice setting, while 17% said the same for pharmacists, 7% for dentists, 18% for hospitals and 23% from the internet; in no other setting did the figure exceed 25%.
In the case of almost all aspects of provision of cessation support, there was a steep gradient by income level, with much lower levels of provision in lower income countries.
We also conducted a similar survey in 2007 and although the results cannot be directly compared because the samples were so different, it does not look as if there has been significant improvement in the provision of cessation support over these five years.
The (not very surprising) finding that countries with higher income provide more support, should remind us that the FCTC Article 14 guidelines strongly stress prioritising the development of broad reach low cost interventions.
The relatively poor integration of brief advice throughout the healthcare system is disappointing, as is the very low proportion of countries that mandate the recording of tobacco use in medical notes. Low cost measures like these last two should be standard in all countries.
About the Author: Martin Raw, Ph.D., is the deputy manager of treatobacco.net; a special lecturer at the UK Centre for Tobacco Control Studies, University of Nottingham, England, and a visiting professor at the National Institute of Alcohol and Drug Policies, Brazil
The research team was: Hemba Pine-Abata, Ann McNeill, Martin Raw, Rachael Murray, Nancy Rigotti, Asaf Bitton; the papers are now available online to Addiction subscribers: (1) Piné-Abata H, McNeill A, Raw M, Bitton A, Rigotti N, Murray R. A survey of tobacco dependence treatment guidelines in 121 countries. Addiction 2013, in press; (2) Piné-Abata H, McNeill A, Murray R, Bitton A, Rigotti N, Raw M. A survey of tobacco dependence treatment services in 121 countries. Addiction 2013, in press.