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

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

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

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

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

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

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

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

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

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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

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

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

Thank you martin@martinraw.com 15