A survey of tobacco dependence treatment guidelines content in 61 countries.

Kapka Nilan,Tricia M Mckeever,Martin Raw,Rachael L Murray,Ann Mcneill

doi:10.1111/add.14204

Abstract

AimsTo assess tobacco dependence treatment guidelines content in accordance with Article 14 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) and its guidelines, and association between content and country income level.DesignCross‐sectional study.SettingOn‐line survey from March to July 2016.ParticipantsContacts in 77 countries, including 68 FCTC Parties, six Signatories and three non‐Parties which had indicated having guidelines in previous surveys, or had not been surveyed before.MeasurementsA nine‐item questionnaire on guidelines content, key recommendations, writing and dissemination.FindingsWe received responses from contacts in 63 countries (82%); 61 had guidelines. The majority are for doctors (93%), primary care (92%) and nurses (75%). All recommend brief advice, 82% recording tobacco use in medical notes, 98% nicotine replacement therapy (NRT), 61% quitlines, 31% text messaging and 87% intensive specialist support, and 54% stress the importance of health‐care workers not using tobacco. Only 57% have a dissemination strategy, and 62% have not been updated for 5 or more years. Compared with high‐income countries, quitlines are less likely to be recommended in upper middle‐income countries guidelines [odds ratio (OR) = 0.15, 95% confidence interval (CI) = 0.04–0.61] and intensive specialist support in lower middle‐income countries guidelines (OR = 0.01, 95% CI = 0.00–0.20). Guidelines updating is associated positively with country income level (P = 0.027).ConclusionsAlthough most tobacco dependence treatment guidelines in the 61 countries assessed in 2016 follow the World Health Organization's Framework Convention on Tobacco Control Article 14 recommendations and do not differ significantly by income level, improvements are needed in keeping guidelines up‐to‐date, applying good writing practices and developing a dissemination strategy.

Highlights

Article 14 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) requires Parties to develop and disseminate comprehensive guidelines based on scientific evidence, and to take effective measures to promote cessation of tobacco use and adequate treatment for tobacco dependence [1]
In this paper we report the results of a survey of the content of the guidelines, with the aims of (1) assessing how well they follow the recommendations of the 2010 FCTC Article 14 guidelines; and (2) assessing the association between guideline content and country income-level
By WHO region, 56% were in Europe, 18% in the Americas, 13% in the Western Pacific, 10% in the Eastern Mediterranean, 3% in South East Asia and none in (OR = 14.8, 95% confidence interval (CI) = 2.13–102.71) (Supporting information, Table S3)

Summary

Introduction

Article 14 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) requires Parties to develop and disseminate comprehensive guidelines based on scientific evidence, and to take effective measures to promote cessation of tobacco use and adequate treatment for tobacco dependence [1].Guidelines for the implementation of Article 14, adopted at the fourth Conference of the Parties to the FCTC in 2010, provide more detailed recommendations and outline the key characteristics of national tobacco treatment guidelines [2] which should:• be evidence-based; • be comprehensive, and include a broad range of interventions; for example, brief advice, quitlines, behavioural support and cessation medications; • cover all settings and providers, both within and outside the health-care systems; • include a dissemination and implementation plan; • stress the importance of all service providers setting an example by not using tobacco, and that they be offered help to stop; • be developed in active collaboration with key stakeholders, including health professional organizations; • be endorsed widely at national level by health professional organizations and/or associations; AddictionThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.• be protected from all actual and potential conflicts of interest; and• be reviewed periodically and updated in light of new scientific evidence. Previous surveys identified 31 guidelines in 2007 and 53 in 2012 [3,4]. In our most recent (2015) global survey of tobacco treatment provision, in 142 countries, we identified 57 guidelines [5]. The treatment survey also found that more than half of high-income countries had guidelines (63%), while fewer than half of middle-income and only one low-income country (LIC) did [5], showing a strong association between having guidelines and country income-level. It is not known if this income gradient is reflected in the content of the guidelines and the way countries with different income levels follow the recommendations of Article 14 and its guidelines.

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