Smoking cessation medications and cigarettes in Guatemala pharmacies Ernesto Viteri M.D.1, Joaquín Barnoya M.D. M.P.H.1, Pedro Solórzano M.D.1, José Carlos Monzón1 1Chronic Disease Control Research Fellowship Program, Cardiovascular Unit of Guatemala. Abstract # 216502 BACKGROUND RESULTS Table 3. Smoking cessation medications availability and cost (US$). Availability (%) Median Cost (IQR)   (n=115) Nicotine patch (7 patch package) 93 (80.9) 16.50 (14.44 - 20.63) Nicotine gum (30 gum package) 91 (79.1) 13.00 (12.24 - 15.75) Varenicline (1mg x 28) 63 (54.8) 69.26 (68.06 - 70.51) Bupropion (150mg x 30) 13 (11.3) 59.00 (56.60 - 59.00) Least expensive SCM available 15.27 (12.25 - 20.00) 20 cigarettes pack (US$) 1.70 (1.63 - 1.77) Minimum wage in Guatemala (US$): 7.00/day 2,555.00/year IQR = Interquartile Range / SCM = Smoking Cessation Medication Guatemala, as a party of the Framework Convention on Tobacco Control (FCTC) is obliged to: “facilitate accessibility and affordability for treatment of tobacco dependence” and “undertake a comprehensive ban of all tobacco advertising.” Currently, no comprehensive advertising ban. No government program to facilitate accessibility to cessation treatment. . Pharmacies are fundamental to increase accessibility to smoking cessation medications (SCM), but can also increase cigarette availability. US: 78 to 95% of pharmacies sell SCM while 47 to 61% sell cigarettes. Cigarette advertising observed in 84% of those that sell cigarettes. Developing countries: 5.3% of Thailand pharmacies sell tobacco products. No additional data. PHARMACIES EVALUATED Of 857 pharmacies selected in Guatemala City, after exclusion, - 463 (54.0%) were included in the analysis - 394 (46.0%) were not included because of incomplete survey, safety reasons, were in another city, not found, permanently closed or repeated in the list. In Antigua, 42 pharmacies were evaluated. Table 1. Pharmacy type. Guatemala City Antigua   (n=463) (n=42) p Non-profit (n, %) 98 (21.2) 5 (11.9) 0.2 Chain 160 (34.6) 13 (31.0) Independent 205 (44.3) 24 (57.1) ADVERTISING SCM advertising was found in 2 (0.4%) pharmacies and information brochures in 5 (1.0%), all printed by the pharmaceutical company. Cigarette advertising was found in 21 (4.2%) pharmacies (72.4% of those that sell cigarettes) always as part of the cigarette display. Chain pharmacies were significantly more likely to advertise cigarettes. Cigarette brands advertised: Marlboro (PM), After Hours (BAT), Rubios (PM), Pall Mall (BAT). Most SCM (57.4%) was not visible to the client while most cigarettes (86.2%) were. OBJECTIVES In Guatemala pharmacies: Assess SCM and cigarette availability and compare by pharmacy type. Assess SCM and cigarette advertising and compare by pharmacy type. Estimate SCM cost. AVAILABILITY AND COST Table 2. Availability of smoking cessation medications and cigarettes by pharmacy type and city. Cessation Medication Cigarettes   n (%) p Total (n=505) 115 (22.8) 29 (5.7) Type Chain (n=173) 81 (46.8) <0.001 20 (11.6) 0.003 Independent (n=229) 34 (14.9) 9 (3.9) City Guatemala City (n=463) 97 (21.0) 0.001 27 (5.8) 0.8 Antigua (n=42) 18 (42.9) 2 (4.8) METHODS Sample selection: In Guatemala City registered pharmacies were classified into chain, independent, and non-profit. We randomly selected chain and independent pharmacies (n=300 of each). All non-profit pharmacies were included (n=257). Those that were closed or non-existent were replaced by the closest one available within a one-block radius. In addition, all pharmacies in a neighboring town (Antigua) were included for comparison. Checklist: To evaluate availability of SCM, sale of cigarettes, and their corresponding advertising, a previously utilized checklist developed in the U.S. by Eule et al. was translated and adapted with permission. In addition, the retail price of the least expensive SCM available and the availability of other tobacco products, e-cigarettes and cigarette filters were also noted. Data Analysis: Percentages and medians (inter-quartile ranges) were used to describe the data. Chi-square was used for data analysis with STATA 11.0. LIMITATIONS Several pharmacies not evaluated due to outdated list provided by the Ministry of Health. Some neighborhoods not included for security reasons. Pharmacy type may not accurately reflect actual pharmacy ownership and management. Price analyzed refers to the least expensive SCM available. This represents an underestimate of all SCM available. No data on rural Guatemala. Chain pharmacies were significantly more likely to sell SCM and cigarettes than independent and non-profit pharmacies. Non-profit pharmacies did not stock SCM or cigarettes. Antigua pharmacies were significantly more likely to sell SCM than Guatemala City pharmacies. Besides cigarettes, no other tobacco product was observed. E-cigarettes and cigarette filters were available in 0.8% and 3.8% of pharmacies, respectively. CONCLUSIONS AND RECOMMENDATIONS Most pharmacies in Guatemala lack SCM and some sell cigarettes. SCM is rarely advertised. Most stores selling cigarettes also advertise them. SCM price is prohibitive compared to the minimum wage. To comply with FCTC a government-sponsored tobacco cessation program should be initiated and a comprehensive tobacco advertising ban implemented. Corresponding author EV: netovy@hotmail.com Work funded by Research for International Tobacco Control (RITC) of the International Development Research Center (IDRC), Ottawa, Canada.