1. Time to take treatment seriously
Martin Raw
Director, International Centre for Tobacco Cessation
Visiting Professor, New York University Medical School
Madrid
June 2018 1

2. Interests statement
Kapka Nilan was funded by UK Centre for Tobacco and Alcohol Studies
The ICTC was funded by Pfizer & the InterAmerican Heart Foundation 2

3. Survey team
Martin Raw, Ann McNeill, Rachael Murray, Tricia McKeever, Kapka Nilan
University of Nottingham & Kings College London
Sample
172 FCTC Parties
142 replies
83% response rate 3

4. Basic infrastructure e Does your country % Yes
Have an officially identified person responsible for treatment? 54
Have an official national treatment strategy? 32
Have national treatment guidelines? 40
Have a clearly identified budget for treatment? 25
Offer to help healthcare workers to stop using tobacco? 44
Mandate recording tobacco use in medical notes 30 e
Check n 4

5. Components of national treatment system
Does your country
% Yes
Run mass media campaigns promoting cessation? 13
Integrate brief advice in existing services? 44
Have a national telephone quitline? 23
Have nationwide specialised treatment facilities? 26
Have specialised treatment facilities but only in selected areas? 37
Have cessation support via text messaging? 17
Check n 5

6. Availability of medications by income level
% Yes
All
High UM LM
Low
NRT gum 72 96 60 61 53
Bupropion 90 58 39 18
Varenicline 54 88 48 36 6
Cytisine 14 10 13 19 12
High=High income countries; UM=Upper middle income countries; LM=Lower middle income countries;
Low=Low income countries 6

7. Affordability of medications by income level
% Yes
All
High UM LM
Low
NRT gum 66 88 58 45 33
Bupropion 57 73 43 36
Varenicline 54 77 32 15
Cytisine 68 80 50
High=High income countries; UM=Upper middle income countries; LM=Lower middle income countries;
Low=Low income countries 7

8. Specialised treatment provision by income level
% Yes
High UM LM
Low
Has nationwide treatment services
55 (36)
20 (19)
6 (0)
0 (0)
High=High income countries; UM=Upper middle income countries; LM=Lower middle income countries; Low=Low income countries 8

9. Changes in provision from 2012 to 2015
Question
2012 n
2015
Government official responsible for cessation? 40 53
Treatment budget? 22 23
Treatment guidelines? 46 55
Mandatory recording tobacco use in patients’ notes? 21 26
Healthcare workers offered help to stop smoking? 42
Mass media campaigns promoting cessation? 54
National free quitline? 29 30
Specialised cessation services covering the whole country or in selected areas? 68 9

10. 10

11. 11

12. Availability of ecigarettes by income level
% Yes
All
High UM LM
Low
Overall 79 90 80 47
Internet 67 82 69 66 24
Shops 53 65 46 57 29
Pharmacies 21 33 15 17 6
High=High income countries; UM=Upper middle income countries; LM=Lower middle income countries;
Low=Low income countries; these data are being written up for publication by John Wang, whom we thank sincerely 12

13. Availability of medications by income level
% Yes
All
High UM LM
Low
NRT gum 72 96 60 61 53
Bupropion 90 58 39 18
Varenicline 54 88 48 36 6
Cytisine 14 10 13 19 12
Ecigs 79 80 24
High=High income countries; UM=Upper middle income countries; LM=Lower middle income countries;
Low=Low income countries 13

14. Some issues for discussion
Treatment is not taken seriously
(including by tobacco control funders)
Implementation is slow and cost / perceived cost is an issue
All countries could be doing some of the basics
Is it ethical to increase price and ban smoking in public spaces but not offer help to those that need it?
Is it time to consider the potential of reduced risk products? 14

15. Thank you martin@martinraw.com15