1. 1 Progress in the development, monitoring, and implementation of tobacco dependence treatment around the world 13 March, 2013 Boston, MA

2. 2 Disclosures Mayo Clinic receives funding from Pfizer that supports a portion of my effort Clinical trial research using varenicline Global Bridges (Pfizer Medical Education Group) No Pharma consultation or advisory panels No tobacco industry funds

3. 3 Martin Raw-- Conclusions  Relatively few countries have quitlines  Their provision also is strongly related to income level  Those that exist are run broadly in line with the evidence base  Provision of specialist treatment facilities strongly related to income level  As is the rated affordability of medications

4. 4 One sentence summary of our results? Offering support to tobacco users who wish to stop is not yet a priority for the majority of countries in the world “The reality is that in most of the world tobacco users cannot easily get help.”

5. 5 Martin Raw- Recommendations Record tobacco use in all clinical notes Address tobacco use among HCW’s Integrate brief advice into all healthcare systems Encourage the licensing of affordable medications

6. 6 Harry Lando- Implementation of Article 14 Growing burden of chronic disease for which tobacco use is a major risk factor There is a large gap between guideline acceptance and effective implementation HCW’s need to take a lead in tobacco control Model the behavior- quit smoking Provide brief intervention to there patients

7. 7 Tunisian Project Champion in the government with resources Intervene with HCW’s to help them quit Begin with broad implementation of brief behavioral support Then demonstrate the gap between treatment needs of those who can easily quit tobacco and those who will need more support Intervention resources to bridge the gap

8. 8 Ron Borland-- Some thoughts The cessation population may change over time Assistance only reaches a minority Those who need it may not want it early on Role of specialist clinics??? Roles for Quitlines Rx access patchy Access for poor??? Potential of internet Knowledgeable health professionals

9. 9 Treatobacco.net dissemination of information Total users during 2010: 34,588 (-8.26%) Total users during 2011: 35,109 (+1.51%) Total users during 2012: 53,653 (+52.82%) January 2012, +42% February 2012, +35% Progress in the development, monitoring, and implementation of tobacco dependence treatment around the world

10. 10 Treat tobacco.net Growing use by TTS and other professionals Powerful engine for dissemination of State-of-the-art evidence Best practices Treatment guidelines Can TTN become an impetus for the development of guidelines in all FCTC countries?

11. 11 What we heard today Tobacco users have limited access to evidence based treatment in most countries Prevalence of smoking among HCW’s remains alarmingly high There is a large gap between acceptance of tobacco control best practices and implementation/execution at a country level

12. 12 Global Bridges Leverage the broad reach and motivation of physicians to provide tobacco dependence treatment and advocacy for tobacco control Networking, training, supporting Important efforts in multiple regions after only two full years of work

13. 13 Policy/Legislation/TaxationP Population-level intervention (e.g., quit- line, mobile devices) Healthcare systems intervention (record smoking status, brief advice) Specialized clinics

14. 14 What Next? Make the case for the role of treatment in comprehensive tobacco control Government/legislature Health ministries Professional societies Funders Build capacity among HCW’s to provide effective treatment

15. 15 What Next? Provide treatment to HCW’s who use tobacco Is there “low-hanging fruit”? Implement uniform recording of smoking status Low cost treatment (brief intervention) and broader reach approaches (quit-lines, internet) Capacity building among HCW’s Innovatively introduce higher cost treatments Efficacious medications Specialized treatment

16. 16 Avoiding the potholes “Circular firing squad” Excluding stakeholders All health professionals All medical specialties Organizations not in health care Failure to recognize changing demographics and populations

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18. 18 THANK YOU!