A survey of tobacco dependence treatment services in 121 countries

AIMS This paper reports the results of a survey of national tobacco dependence treatment services in 36 countries. The objective was to describe the services and discuss the results in the context of Article 14 of the Framework Convention on Tobacco Control, which asks countries to promote adequate treatment for tobacco dependence. DESIGN, SETTING AND PARTICIPANTS A questionnaire on tobacco dependence treatment services was e-mailed to a convenience sample of contacts in 2007. Completed questionnaires were received from contacts in 36 countries. MEASUREMENTS The survey instrument was a 10-item questionnaire asking about treatment policy and practice, including medications. FINDINGS According to our informants, fewer than half the countries in our survey had an official written policy on (44%), or a government official responsible for (49%), treatment. Only 19% had a specialized national treatment system and only 24% said help was easily available in general practice. Most countries (94%) allowed the sale of nicotine replacement therapy (NRT), bupropion (75%) and varenicline (69%) but only 40% permitted NRT on 'general sale'. Very few countries responding to the question fully reimbursed any of the medications. Fewer than half (45%) fully reimbursed brief advice and only 29% fully reimbursed intensive specialist support. Only 31% of countries said that their official treatment policy included the mandatory recording of patients' smoking status in medical notes. CONCLUSION Taken together, our findings show that few countries have well-developed tobacco dependence treatment services and that, at a national level, treatment is not yet a priority in most countries.