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Kruse G, Zulu T, Ngubane H, Reddy K, Siedner M, Rigotti NA, Seeley J, Ngwenya N, Wong E. The ethics of conducting observational tobacco research without providing treatment to people who use tobacco: a case example from South Africa. BMJ Glob Health 2022; 7:e009732. [PMID: 35831036 PMCID: PMC9280873 DOI: 10.1136/bmjgh-2022-009732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/25/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Gina Kruse
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thando Zulu
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | | | - Krishna Reddy
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mark Siedner
- Harvard Medical School, Boston, Massachusetts, USA
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Janet Seeley
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Nothando Ngwenya
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | - Emily Wong
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
- Division of Infectious Diseases, University of Alabama Birmingham, Birmingham, Alabama, USA
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Balhara YPS, Sharma P, Chawla N. Education and training on addiction psychiatry in low and middle income countries: Observations from existing literature and recommendations going ahead. Asia Pac Psychiatry 2021; 13:e12492. [PMID: 34873858 DOI: 10.1111/appy.12492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Addictive disorders are a significant contributor to the global burden of disease. The burden of addictive disorders in LMIC is expected to grow further over the coming years. AIMS In this article we present the observations from the existing literature on the current status of education and training on addiction psychiatry in LMIC and provide recommendation on way forward for this specialized field of psychiatry. MATERIALS AND METHODS We searched electronic databases of PubMed to access the literature on the current status of education and training on addiction psychiatry. Additional searches were also conducted in other database of Google Scholar for potential 'grey' literature. RESULTS We were able to identify a total of 11 relevant articles. DISCUSSION Currently there is limited published literature on education and training on addiction psychiatry from the LMICs. CONCLUSIONS Strengthening of the training on addictive disorders shall not only help bridge the gap of the unmet need for the evidence-based interventions of addictive disorders across these countries it shall also help enhance the research capacity on addictive disorders in these countries.
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Affiliation(s)
- Yatan Pal Singh Balhara
- National Drug Dependence Treatment Center and Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi
| | - Pawan Sharma
- Department of Psychiatry, School of Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Nishtha Chawla
- NIHR-Global Research Group on Psychosis Outcomes-WIC Programme, All India Institute of Medical Sciences, New Delhi, India
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Shelley D, Cleland CM, Nguyen T, Van Devanter N, Siman N, Van M H, Nguyen NT. Effectiveness of a multicomponent strategy for implementing guidelines for treating tobacco use in Vietnam Commune Health Centers. Nicotine Tob Res 2021; 24:196-203. [PMID: 34543422 DOI: 10.1093/ntr/ntab189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/15/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Strategies are needed to increase implementation of evidence-based tobacco dependence treatment (TDT) in health care systems in low-and middle-income countries (LMICs). METHODS We conducted a two-arm cluster randomized controlled trial to compare the effectiveness of two strategies for implementing TDT guidelines in community health centers (n=26) in Vietnam. Arm 1 included training and a tool kit (e.g., reminder system) to promote and support delivery of the 4As (Ask about tobacco use, Advise to quit, Assess readiness, Assist with brief counseling) (Arm 1). Arm 2 included Arm 1 components plus a system to refer smokers to a community health worker (CHW) for more intensive counseling (4As+R). Provider surveys were conducted at baseline, six- and 12-months to assess the hypothesized effect of the strategies on provider and organizational-level factors. The primary outcome was provider adoption of the 4As. RESULTS Adoption of the 4As increased significantly across both study arms (all p<.001). Perceived organizational priority for TDT, compatibility with current workflow, and provider attitudes, norms and self-efficacy related to TDT also improved significantly across both arms. In Arm 2 sites, 41% of smokers were referred to a CHW for additional counseling. CONCLUSION The study demonstrated the effectiveness of a multicomponent and multilevel strategy (i.e., provider and system) for implementing evidence-based TDT in the Vietnam public health system. Combining provider-delivered brief counseling with opportunities for more in-depth counseling offered by a trained CHW may optimize outcomes and offers a potentially scalable model for increasing access to TDT in health care systems like Vietnam. IMPLICATIONS Improving implementation of evidence-based tobacco dependence treatment (TDT) guidelines is a necessary step towards reducing the growing burden of non-communicable disease (NCDs) and premature death in LMICs. The findings provide new evidence on the effectiveness of multilevel strategies for adapting and implementing TDT into routine care in Vietnam, and offers a potentially scalable model for meeting FCTC Article 14 goals in other LMICs with comparable public health systems. The study also demonstrates that combining provider-delivered brief counseling with referral to a community health worker for more in-depth counseling and support can optimize access to evidence-based treatment for tobacco use.
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Affiliation(s)
- D Shelley
- New York University School of Global Public Health, New York, NY
| | - C M Cleland
- New York University Grossman School of Medicine, Department of Population Health, NY
| | - T Nguyen
- Institute of Social and Medical Studies, My Dinh Ward, South Tu Liem District, Ha Noi, Vietnam
| | - N Van Devanter
- Rory Myers College of Nursing, New York University, New York, NY
| | - N Siman
- New York University Grossman School of Medicine, Department of Population Health, NY
| | - Hoang Van M
- Minh Hoang Van, MD, Hanoi University of Public Health, Duc Thang Ward, North Tu Liem district, Hanoi, Vietnam
| | - N T Nguyen
- Institute of Social and Medical Studies, My Dinh Ward, South Tu Liem District, Ha Noi, Vietnam
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Sheffer CE, Al-Zalabani A, Aubrey A, Bader R, Beltrez C, Bennett S, Carl E, Cranos C, Darville A, Greyber J, Karam-Hage M, Hawari F, Hutcheson T, Hynes V, Kotsen C, Leone F, McConaha J, McCary H, Meade C, Messick C, Morgan SK, Morris CW, Payne T, Retzlaff J, Santis W, Short E, Shumaker T, Steinberg M, Wendling A. The Emerging Global Tobacco Treatment Workforce: Characteristics of Tobacco Treatment Specialists Trained in Council-Accredited Training Programs from 2017 to 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2416. [PMID: 33801227 PMCID: PMC7967787 DOI: 10.3390/ijerph18052416] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 01/27/2023]
Abstract
Tobacco use is projected to kill 1 billion people in the 21st century. Tobacco Use Disorder (TUD) is one of the most common substance use disorders in the world. Evidence-based treatment of TUD is effective, but treatment accessibility remains very low. A dearth of specially trained clinicians is a significant barrier to treatment accessibility, even within systems of care that implement brief intervention models. The treatment of TUD is becoming more complex and tailoring treatment to address new and traditional tobacco products is needed. The Council for Tobacco Treatment Training Programs (Council) is the accrediting body for Tobacco Treatment Specialist (TTS) training programs. Between 2016 and 2019, n = 7761 trainees completed Council-accredited TTS training programs. Trainees were primarily from North America (92.6%) and the Eastern Mediterranean (6.1%) and were trained via in-person group workshops in medical and academic settings. From 2016 to 2019, the number of Council-accredited training programs increased from 14 to 22 and annual number of trainees increased by 28.5%. Trainees have diverse professional backgrounds and work in diverse settings but were primarily White (69.1%) and female (78.7%) located in North America. Nearly two-thirds intended to implement tobacco treatment services in their setting; two-thirds had been providing tobacco treatment for 1 year or less; and 20% were sent to training by their employers. These findings suggest that the training programs are contributing to the development of a new workforce of TTSs as well as the development of new programmatic tobacco treatment services in diverse settings. Developing strategies to support attendance from demographically and geographically diverse professionals might increase the proportion of trainees from marginalized groups and regions of the world with significant tobacco-related inequities.
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Affiliation(s)
- Christine E. Sheffer
- Tobacco Treatment Specialist Training Program, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Abdulmohsen Al-Zalabani
- Tobacco Treatment Specialist Training and Certification Program at College of Medicine, Taibah University, Madinah 42353, Saudi Arabia;
| | - Andrée Aubrey
- Tobacco Treatment Specialist Course, College of Medicine, Florida State University, Tallahassee, FL 32306, USA;
| | - Rasha Bader
- Tobacco Dependence Treatment Training, King Hussein Cancer Center, Amman 11941, Jordan; (R.B.); (F.H.)
| | - Claribel Beltrez
- Rutgers Tobacco Dependence Program, New Brunswick, NJ 08903, USA; (C.B.); (M.S.)
| | - Susan Bennett
- Tobacco Treatment Specialist Training Program, Mayo Clinic Nicotine Dependence Center, Rochester, MN 55905, USA; (S.B.); (T.S.)
| | - Ellen Carl
- Tobacco Treatment Specialist Training Program, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Caroline Cranos
- Tobacco Treatment Specialist Training Program, Center for Tobacco Treatment Research and Training, University of Massachusetts Medical School, Worcester, MA 01655, USA;
| | - Audrey Darville
- BREATHE Online Tobacco Treatment Specialist Training Program, College of Nursing, University of Kentucky, Lexington, KY 40504, USA;
| | - Jennifer Greyber
- Duke-UNC Tobacco Treatment Specialist Training Program, Duke Smoking Cessation Program, Duke Cancer Center, Durham, NC 27705, USA;
| | - Maher Karam-Hage
- Tobacco Treatment Training Program, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Feras Hawari
- Tobacco Dependence Treatment Training, King Hussein Cancer Center, Amman 11941, Jordan; (R.B.); (F.H.)
| | - Tresza Hutcheson
- Tobacco Treatment Specialist Training Program, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Victoria Hynes
- Tobacco Treatment Education & Training Program, MaineHealth Center for Tobacco Independence, Portland, ME 04101, USA;
| | - Chris Kotsen
- Tobacco Treatment Specialist Training Program, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA;
| | - Frank Leone
- Comprehensive Smoking Treatment Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Jamie McConaha
- Tobacco Treatment Specialist Training and Certificate Program, School of Pharmacy, Duquesne University, Pittsburg, PA 15282, USA;
| | - Heather McCary
- Tobacco Treatment Specialist Certification Program, The Breathing Association, Columbus, OH 43203, USA;
| | - Crystal Meade
- Tobacco Prevention and Control Program, Wellness and Prevention Department, Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA;
| | | | - Susan K. Morgan
- Tobacco Treatment Training Program, School of Dentistry, West Virginia University, Morgantown, WV 26506, USA;
| | - Cindy W. Morris
- Rocky Mountain Tobacco Treatment Specialist Training Program, Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Thomas Payne
- ACT Center for Tobacco Treatment, Education and Research, University of Mississippi Medical Center Cancer Institute, Jackson, MS 39213, USA;
| | - Jessica Retzlaff
- Council for Tobacco Treatment Training Programs, Inc., Madison, WI 53704, USA; (J.R.); (W.S.)
| | - Wendy Santis
- Council for Tobacco Treatment Training Programs, Inc., Madison, WI 53704, USA; (J.R.); (W.S.)
| | - Etta Short
- Optum’s Quit for Life Program, Eden Prairie, MN 55344, USA;
| | - Therese Shumaker
- Tobacco Treatment Specialist Training Program, Mayo Clinic Nicotine Dependence Center, Rochester, MN 55905, USA; (S.B.); (T.S.)
| | - Michael Steinberg
- Rutgers Tobacco Dependence Program, New Brunswick, NJ 08903, USA; (C.B.); (M.S.)
| | - Ann Wendling
- Tobacco Cessation Program, Healthways, A Sharecare Company, Franklin, TN 37067, USA;
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Hasan SI, Mohd Hairi F, Ahmad Tajuddin NA, Amer Nordin AS. Empowering healthcare providers through smoking cessation training in Malaysia: a preintervention and postintervention evaluation on the improvement of knowledge, attitude and self-efficacy. BMJ Open 2019; 9:e030670. [PMID: 31562154 PMCID: PMC6773327 DOI: 10.1136/bmjopen-2019-030670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/15/2019] [Accepted: 09/03/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Healthcare providers are ideally positioned to advise their patients to quit smoking by providing effective smoking cessation intervention. Thus, we evaluate the effectiveness of a 1-day training programme in changing the knowledge, attitude and self-efficacy of healthcare providers in smoking cessation intervention. METHODS A prepost study design was conducted in 2017. The 8-hour Smoking Cessation Organising, Planning and Execution (SCOPE) training comprised lectures, practical sessions and role-play sessions to 218 healthcare providers. A validated evaluation tool, Providers' Smoking Cessation Training Evaluation, was administered to assess the impact of training on knowledge, attitude and self-efficacy on smoking cessation intervention. RESULTS After SCOPE training, the knowledge score increased significantly from 7.96±2.34 to 10.35±1.57 (p<0.001). Attitude and self-efficacy in smoking cessation intervention also increased significantly from 34.32±4.12 to 37.04±3.92 (p<0.001) and 40.31±8.61 to 54.67±7.45 (p<0.001) respectively. Pretraining and post-training scores improved significantly for all professions, and each measure, particularly self-efficacy. CONCLUSION This study demonstrates that SCOPE training could improve healthcare providers' knowledge, attitude and self-efficacy on smoking cessation intervention. Future training is recommended to equip healthcare providers with current knowledge, positive attitude and high self-efficacy to integrate what they have learned into practice successfully.
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Affiliation(s)
- Siti Idayu Hasan
- Social & Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Nicotine Addiction Research & Collaboration, UMCAS, University of Malaya, Kuala Lumpur, Malaysia
| | - Farizah Mohd Hairi
- Social & Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Nicotine Addiction Research & Collaboration, UMCAS, University of Malaya, Kuala Lumpur, Malaysia
| | - Nur Amani Ahmad Tajuddin
- Nicotine Addiction Research & Collaboration, UMCAS, University of Malaya, Kuala Lumpur, Malaysia
- Primary Care Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Amer Siddiq Amer Nordin
- Nicotine Addiction Research & Collaboration, UMCAS, University of Malaya, Kuala Lumpur, Malaysia
- Psychological Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Nguyen N, Nguyen T, Truong V, Dang K, Siman N, Shelley D. Impact of a tobacco cessation intervention on adherence to tobacco use treatment guidelines among village health workers in Vietnam. Glob Health Promot 2019; 27:24-33. [PMID: 31319786 DOI: 10.1177/1757975919854032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Community health workers (in Vietnam referred to as village health workers) have the potential to play a key role in expanding access to evidence-based tobacco use treatment. We conducted a cluster randomized controlled trial in community health centers in Vietnam that compared the effect of provider advice and cessation assistance (i.e. brief counseling and patient education materials) (BC) vs. BC + three sessions of in-person counseling delivered by a village health worker (BC+R) on providers' and village health workers' adherence to tobacco use treatment guidelines. All village health workers and health care providers received training. This paper presents data on the effect of the intervention on village health workers' adherence to tobacco use treatment guidelines, including asking about tobacco use, advising smokers to quit, offering assistance and their attitude, norms, and self-efficacy related to tobacco use treatment. We examined changes in adherence to tobacco use treatment guidelines before and 12 months after the intervention among 89 village health workers working in the 13 community health centers enrolled in the BC+R study condition. Village health workers' adherence to tobacco use treatment guidelines increased significantly. Village health workers were more likely to ask about tobacco use (3.4% at baseline, 32.6% at 12 months), offer advice to quit (4.5% to 48.3%) and offer assistance (1.1% to 38.2%). Perceived barriers to treating tobacco use decreased significantly. Self-efficacy and attitudes towards treating tobacco use improved significantly. Increased adherence to tobacco use treatment guidelines was associated with positive attitudes towards their role in delivering tobacco use treatment and increasing awareness of the community health center smoke-free policy. The findings suggest that, with training and support systems, village health workers can extend their role to include smoking cessation services. This workforce could represent a sustainable resource for supporting smokers who wish to quit.
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Affiliation(s)
- Nam Nguyen
- Institute of Social Medical Studies, Hanoi, Vietnam
| | - Trang Nguyen
- Institute of Social Medical Studies, Hanoi, Vietnam
| | - Van Truong
- Institute of Social Medical Studies, Hanoi, Vietnam
| | - Kim Dang
- Institute of Social Medical Studies, Hanoi, Vietnam
| | - Nina Siman
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Donna Shelley
- Department of Population Health, New York University School of Medicine, New York, NY, USA
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Warsi S, Elsey H, Boeckmann M, Noor M, Khan A, Barua D, Nasreen S, Huque S, Huque R, Khanal S, Shrestha P, Newell J, Dogar O, Siddiqi K. Using behaviour change theory to train health workers on tobacco cessation support for tuberculosis patients: a mixed-methods study in Bangladesh, Nepal and Pakistan. BMC Health Serv Res 2019; 19:71. [PMID: 30683087 PMCID: PMC6347762 DOI: 10.1186/s12913-019-3909-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 01/15/2019] [Indexed: 12/25/2022] Open
Abstract
Background Low- and middle-income countries (LMICs) are disproportionately impacted by interacting epidemics of tuberculosis (TB) and tobacco consumption. Research indicates behavioural support delivered by health workers effectively promotes tobacco cessation. There is, however, a paucity of training to support LMIC health workers deliver effective tobacco cessation behavioural support. The TB and Tobacco Consortium undertook research in South Asia to understand factors affecting TB health workers’ delivery of tobacco cessation behavioural support, and subsequently developed a training package for LMICs. Methods Using the “capability, opportunity, and motivation as determinants of behaviour” (COM-B) framework to understand any issues facing health worker delivery of behaviour support, we analysed 25 semi-structured interviews and one focus group discussion with TB health workers, facility in-charges, and national tuberculosis control programme (NTP) staff members in each country. Results were integrated with findings of an adapted COM-B questionnaire on health worker confidence in tobacco cessation support delivery, administered to 36 TB health workers. Based on findings, we designed a guide and training programme on tobacco cessation support for health workers. Results Qualitative results highlighted gaps in the majority of health workers’ knowledge on tobacco cessation and TB and tobacco interaction, inadequate training on patient communication, insufficient resources and staff support, and NTPs’ non-prioritization of tobacco cessation in all three countries. Questionnaire results reiterated the knowledge deficits and low confidence in patient communication. Participants suggested strengthening knowledge, skills, and competence through training and professional incentives. Based on findings, we developed an interactive two-day training and TB health worker guide adaptable for LMICs, focusing on evidence of best practice on TB and tobacco cessation support, communication, and rapport building with patients. Conclusions TB health workers are essential in addressing the dual burden of TB and tobacco faced by many LMICs. Factors affecting their delivery of tobacco cessation support can be identified using the COM-B framework, and include issues such as individuals’ knowledge and skills, as well as structural barriers like professional support through monitoring and supervision. While structural changes are needed to tackle the latter, we have developed an adaptable and engaging health worker training package to address the former that can be delivered in routine TB care. Trial registration ISRCTN43811467. Electronic supplementary material The online version of this article (10.1186/s12913-019-3909-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sahil Warsi
- Leeds Institute of Health Sciences, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Helen Elsey
- Leeds Institute of Health Sciences, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK.
| | - Melanie Boeckmann
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany
| | - Maryam Noor
- The Initiative, Orange Grove Farm, Banigala, Islamabad, Pakistan
| | - Amina Khan
- The Initiative, Orange Grove Farm, Banigala, Islamabad, Pakistan
| | - Deepa Barua
- ARK Foundation, House B130, Road 21, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - Shammi Nasreen
- ARK Foundation, House B130, Road 21, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - Samina Huque
- ARK Foundation, House B130, Road 21, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - Rumana Huque
- ARK Foundation, House B130, Road 21, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - Sudeepa Khanal
- HERD International, P O Box Number: 24144, Thapathali 11, Kathmandu, Nepal
| | - Prabin Shrestha
- HERD International, P O Box Number: 24144, Thapathali 11, Kathmandu, Nepal
| | - James Newell
- Leeds Institute of Health Sciences, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Omara Dogar
- The Hull York Medical School, University of York, York, YO10 5DD, UK
| | - Kamran Siddiqi
- The Hull York Medical School, University of York, York, YO10 5DD, UK
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Sreeramareddy CT, Hon J, Abdulla AM, Harper S. Hardcore smoking among daily smokers in male and female adults in 27 countries: a secondary data analysis of Global Adult Tobacco Surveys (2008-2014). JOURNAL OF GLOBAL HEALTH REPORTS 2018. [DOI: 10.29392/joghr.2.e2018019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Andreano A, Peake MD, Janes SM, Valsecchi MG, Pritchard-Jones K, Hoag JR, Gross CP. The Care and Outcomes of Older Persons with Lung Cancer in England and the United States, 2008–2012. J Thorac Oncol 2018; 13:904-914. [DOI: 10.1016/j.jtho.2018.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/11/2018] [Accepted: 04/13/2018] [Indexed: 11/16/2022]
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Building Capacity for Global Tobacco Treatment: International Frontline Provider Perspectives. J Smok Cessat 2018. [DOI: 10.1017/jsc.2018.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: Many countries are enacting tobacco treatment training, guidelines and policies in order to fulfil Framework Convention on Tobacco Control (FCTC) treaty agreements. This study tapped the perspectives of international treatment providers to identify challenges and recommendations for improvement.Methods: The cross-sectional survey included closed- and open-ended items. Distribution included professional listservs (ATTUD; Global Bridges; ENSH Global) and word-of-mouth. The survey collected data using an open-source platform (Enketo Smart Paper/Ona). We used R for quantitative analysis and Google Sheets to categorize open-ended responses.Results: There were 155 respondents from 49 countries. Most (78.6%) provided direct services. Almost half (48.1%) reported receiving less than 6 hours of tobacco treatment training; respondents from low and lower-middle income countries (LMICs) received significantly less training (Fisher's p < 0.014). Likewise, among all respondents, 43% rated poor access to treatment; this rose to 100% among LMICs (Fisher's p < 0.001). To improve treatment and training, respondents suggested increasing government funding for pharmacotherapy and behavioural services; providing training in local languages and in the treatment of smokeless tobacco forms; trainee certification and access to online support for providers.Conclusions: Globally, half of front-line treatment providers reported having poor access to training; this was true for all providers in LMICs and most in upper middle-income countries. Existing online trainings, available mainly in English, could be migrated to open-access formats to permit countries to tailor them to their local needs and languages. Countries in geographical proximity or historical linguistic/political alliances could forge cross-country mentoring relationships and mutual support for training.
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Chung-Hall J, Craig L, Gravely S, Sansone N, Fong GT. Impact of the WHO FCTC over the first decade: a global evidence review prepared for the Impact Assessment Expert Group. Tob Control 2018; 28:s119-s128. [PMID: 29880598 PMCID: PMC6589489 DOI: 10.1136/tobaccocontrol-2018-054389] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/09/2018] [Accepted: 05/13/2018] [Indexed: 11/16/2022]
Abstract
Objective To present findings of a narrative review on the implementation and effectiveness of 17 Articles of the WHO Framework Convention on Tobacco Control (FCTC) during the Treaty’s first decade. Data sources Published reports on global FCTC implementation; searches of four databases through June 2016; hand-search of publications/online resources; tobacco control experts. Study selection WHO Convention Secretariat global progress reports (2010, 2012, 2014); 2015 WHO report on the global tobacco epidemic; studies of social, behavioural, health, economic and/or environmental impacts of FCTC policies. Data extraction Progress in the implementation of 17 FCTC Articles was categorised (higher/intermediate/lower) by consensus. 128 studies were independently selected by multiple authors in consultation with experts. Data synthesis Implementation was highest for smoke-free laws, health warnings and education campaigns, youth access laws, and reporting/information exchange, and lowest for measures to counter industry interference, regulate tobacco product contents, promote alternative livelihoods and protect health/environment. Price/tax increases, comprehensive smoking and marketing bans, health warnings, and cessation treatment are associated with decreased tobacco consumption/health risks and increased quitting. Mass media campaigns and youth access laws prevent smoking initiation, decrease prevalence and promote cessation. There were few studies on the effectiveness of policies in several domains, including measures to prevent industry interference and regulate tobacco product contents. Conclusions The FCTC has increased the implementation of measures across several policy domains, and these implementations have resulted in measurable impacts on tobacco consumption, prevalence and other outcomes. However, FCTC implementation must be accelerated, and Parties need to meet all their Treaty obligations and consider measures that exceed minimum requirements.
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Affiliation(s)
- Janet Chung-Hall
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Lorraine Craig
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Natalie Sansone
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.,School of Public Health and Health Systems, Waterloo, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Nolan MB, Kemper KE, Glynn TJ, Hurt RD, Hays JT. Tobacco Dependence Treatment Grants: A Collaborative Approach to the Implementation of WHO Tobacco Control Initiatives. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2018; 2018:8429738. [PMID: 29765430 PMCID: PMC5885333 DOI: 10.1155/2018/8429738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 02/19/2018] [Indexed: 11/17/2022]
Abstract
The number of global tobacco-related deaths is projected to increase from about 6 million to 8 million annually by 2030, with more than 80% of these occurring in low- and middle-income countries (LMICs). The World Health Organization Framework Convention on Tobacco Control (FCTC) came into force in 2005 and Article 14 relates specifically to the treatment of tobacco dependence. However, LMICs, in particular, face several barriers to implementing tobacco dependence treatment. This paper is a descriptive evaluation of a novel grant funding mechanism that was initiated in 2014 to address these barriers. Global Bridges. Healthcare Alliance for Tobacco Dependence Treatment aims to create and mobilize a global network of healthcare professionals and organizations dedicated to advancing evidence-based tobacco dependence treatment and advocating for effective tobacco control policy. A 2014 request for proposals (RFP) focused on these goals, particularly in LMICs, where funding for this work had been previously unavailable. 19 grants were awarded by Global Bridges to organizations in low- and middle-income countries across all six WHO regions. Virtually all focused on developing a tobacco dependence treatment curriculum for healthcare providers, while also influencing the political environment for Article 14 implementation. As a direct result of these projects, close to 9,000 healthcare providers have been trained in tobacco dependence treatment and an estimated 150,000 patients have been offered treatment. Because most of these projects are designed with a "train-the-trainer" component, two years of grant funding has been a tremendous catalyst for accelerating change in tobacco dependence treatment practices throughout the world. In order to foster such exponential growth and continue to maintain the impact of these projects, ongoing financial, educational, and professional commitments are required.
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Affiliation(s)
- Margaret B. Nolan
- Department of Anesthesia, Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA
| | | | - Thomas J. Glynn
- Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
| | | | - J. Taylor Hays
- Department of General Internal Medicine, Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA
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Nguyen N, Nguyen T, Chapman J, Nguyen L, Kumar P, VanDevanter N, Shelley D. Tobacco cessation in Vietnam: Exploring the role of village health workers. Glob Public Health 2017; 13:1265-1275. [PMID: 28776481 DOI: 10.1080/17441692.2017.1360376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to explore current tobacco use treatment (TUT) practice patterns, and attitudes and beliefs among Village Health Workers (VHWs) about expanding their role to include delivering smoking cessation interventions and the perceived barriers. We conducted a survey of 449 VHWs from 26 communes in Thai Nguyen province, Vietnam. We assessed TUT practice patterns including asking about tobacco use, advising smokers to quit, offering assistance (3As) and attitudes, self-efficacy, and norms related to TUT. Seventy two per cent of VHWs reported asking patients if they use tobacco, 78.6% offered advice to quit, and 41.4% offered cessation assistance to few or more patients in the past month. Self-efficacy was low, with 53.2% agreeing that they did not have the skills to counsel patients about smoking cessation. The most commonly reported barriers to offering TUT were a lack of training and perceived lack of patient interest. Greater awareness of their commune health centre's smoke-free policy and higher levels of self-efficacy were associated with screening and offering cessation assistance. VHWs support an expanded role in tobacco cessation, but require additional resources and training to increase their self-efficacy and skills to provide effective treatment.
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Affiliation(s)
- Nam Nguyen
- a Institute of Social and Medical Studies , Ha Noi , Vietnam
| | - Trang Nguyen
- a Institute of Social and Medical Studies , Ha Noi , Vietnam
| | - Jessica Chapman
- a Institute of Social and Medical Studies , Ha Noi , Vietnam
| | - Linh Nguyen
- a Institute of Social and Medical Studies , Ha Noi , Vietnam
| | - Pritika Kumar
- b Department of Population Health , New York University School of Medicine , New York , NY , USA
| | - Nancy VanDevanter
- c New York University Rory Meyers College of Nursing , New York , NY , USA
| | - Donna Shelley
- b Department of Population Health , New York University School of Medicine , New York , NY , USA
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Application of the Consolidated Framework for Implementation Research to assess factors that may influence implementation of tobacco use treatment guidelines in the Viet Nam public health care delivery system. Implement Sci 2017; 12:27. [PMID: 28241770 PMCID: PMC5330005 DOI: 10.1186/s13012-017-0558-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 02/14/2017] [Indexed: 11/10/2022] Open
Abstract
Background Services to treat tobacco dependence are not readily available to smokers in low-middle income countries (LMICs) where smoking prevalence remains high. We are conducting a cluster randomized controlled trial comparing the effectiveness of two strategies for implementing tobacco use treatment guidelines in 26 community health centers (CHCs) in Viet Nam. Guided by the Consolidated Framework for Implementation Research (CFIR), prior to implementing the trial, we conducted formative research to (1) identify factors that may influence guideline implementation and (2) inform further modifications to the intervention that may be necessary to translate a model of care delivery from a high-income country (HIC) to the local context of a LMIC. Methods We conducted semi-structured qualitative interviews with CHC medical directors, health care providers, and village health workers (VHWs) in eight CHCs (n = 40). Interviews were transcribed verbatim and translated into English. Two qualitative researchers used both deductive (CFIR theory driven) and inductive (open coding) approaches to analysis developed codes and themes relevant to the aims of this study. Results The interviews explored four out of five CFIR domains (i.e., intervention characteristics, outer setting, inner setting, and individual characteristics) that were relevant to the analysis. Potential facilitators of the intervention included the relative advantage of the intervention compared with current practice (intervention characteristics), awareness of the burden of tobacco use in the population (outer setting), tension for change due to a lack of training and need for skill building and leadership engagement (inner setting), and a strong sense of collective efficacy to provide tobacco cessation services (individual characteristics). Potential barriers included the perception that the intervention was more complex (intervention characteristic) and not necessarily compatible (inner setting) with current workflows and staffing historically designed to address infectious disease prevention and control rather than chronic disease prevention and competing priorities that are determined by the MOH (outer setting). Conclusions In this study, CFIR provided a valuable framework for evaluating factors that may influence implementation of a systems-level intervention for tobacco control in a LMIC and understand what adaptations may be needed to translate a model of care delivery from a HIC to a LMIC. Trial registration NCT02564653. Registered September 2015
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Carroll AJ, Labarthe DR, Huffman MD, Hitsman B. Global tobacco prevention and control in relation to a cardiovascular health promotion and disease prevention framework: A narrative review. Prev Med 2016; 93:189-197. [PMID: 27717667 PMCID: PMC5125629 DOI: 10.1016/j.ypmed.2016.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/18/2016] [Accepted: 10/03/2016] [Indexed: 11/21/2022]
Abstract
The purpose of this review is to emphasize the role of tobacco prevention and control in cardiovascular health (CVH) promotion and cardiovascular disease (CVD) prevention, including the importance of these endpoints for measuring the full impact of tobacco-related policies, programs, and practices. In this review, we describe an overview of tobacco control interventions that have led to substantial declines in tobacco use and the relationship between these declines with CVH and CVD. We review interventions that have had success in high-income countries (HICs) as well as those that are gaining traction in low- and middle-income countries (LMICs). We emphasize the challenges to comprehensive tobacco prevention and control strategies faced by LMICs, and highlight the special role of cardiovascular health professionals in achieving CVH promotion and CVD prevention endpoints through tobacco control. Tobacco prevention and control strategies have a strong scientific basis, yet a distinct gap remains between this evidence and implementation of tobacco control policies, particularly in LMICs. Health professionals can contribute to tobacco control efforts, especially through patient-level clinical interventions, when supported by a health care system and government that recognize and support tobacco control as a critical strategy for CVH promotion and CVD prevention. Understanding, supporting, and applying current and evolving policies, programs, and practices in tobacco prevention and control is the province of all health professionals, especially those concerned with CVH promotion and CVD prevention. A new tobacco control roadmap from the World Heart Federation provides a strong impetus to the needed interdisciplinary collaboration.
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Affiliation(s)
- Allison J Carroll
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, United States
| | - Darwin R Labarthe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, United States
| | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, United States
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, United States.
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Content and Methods used to Train Tobacco Cessation Treatment Providers: An International Survey. J Smok Cessat 2016; 12:213-220. [PMID: 29861787 DOI: 10.1017/jsc.2016.22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction There are limited existing data describing the training methods used to educate tobacco cessation treatment providers around the world. Aims To measure the prevalence of tobacco cessation treatment content, skills training and teaching methods reported by tobacco treatment training programs across the world. Methods Web-based survey in May-September 2013 among tobacco cessation training experts across six geographic regions and four World Bank income levels. Response rate was 73% (84 of 115 countries contacted). Results Of 104 individual programs from 84 countries, most reported teaching brief advice (78%) and one-to-one counseling (74%); telephone counseling was uncommon (33%). Overall, teaching of knowledge topics was more commonly reported than skills training. Programs in lower income countries less often reported teaching about medications, behavioral treatments and biomarkers and less often reported skills-based training about interviewing clients, medication management, biomarker measurement, assessing client outcomes, and assisting clients with co-morbidities. Programs reported a median 15 hours of training. Face-to-face training was common (85%); online programs were rare (19%). Almost half (47%) included no learner assessment. Only 35% offered continuing education. Conclusion Nearly all programs reported teaching evidence-based treatment modalities in a face-to-face format. Few programs delivered training online or offered continuing education. Skills-based training was less common among low- and middle-income countries (LMICs). There is a large unmet need for tobacco treatment training protocols which emphasize practical skills, and which are more rapidly scalable than face-to-face training in LMICs.
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