EC Pulmonology and Respiratory Medicine

An estimated at 47% of adult men and 27% of women use tobacco in the Republic of N. Macedonia. Few policies and programs exist within the country to support tobacco dependence treatment. An adapted Certified Tobacco Treatment Specialist (aCTTS) program for physicians was implemented and evaluated to determine if participation increased knowledge and positive perceptions of clinic-based tobacco dependence treatment and counselling. In 2017, 97 physicians participated in the two-day aCTTS training. Program evaluation included a longitudinal survey at baseline and 6- and 12-months post-intervention, weekly logbooks on tobacco counselling activities, and qualitative interviews on program implementation. Outcomes data demonstrate sustained increases in knowledge at 6- (p < 0.001) and 12 months (p < 0.001) post-intervention and confidence to engage in counselling and treatment practices at 6- (p < 0.009) and 12-months (p < 0.001). Participants also decreased personal tobacco use. Logbook data indicate that participating physicians counselled 74.8% of patients with tobacco-related conditions over the 12-month evaluation period. Qualitative interview data support evaluation and logbook data on program outcomes and implementation. The aCTTS program evaluation demonstrates the potential for clinical physicians and other health care providers as mediators and supporters of tobacco cessation in the Republic of N Macedonia.

 Keywords: Certified Tobacco Treatment Specialist (CTTS); Physicians; Republic of North Macedonia

1. World Health Organization. “Tobacco” (2018).
2. World Health Organization. “WHO Report on the Global Tobacco Epidemic: Monitoring Tobacco Use and Prevention Policies” (2017).
3. Clear Locations Institute for Health Metrics and Evaluation. “Tobacco Viz” (2017).
4. “FYR Macedonia”. The Tobacco Atlas. (no date).
5. S. Center for Disease Control and Prevention. Health Effects of Cigarette Smoking (2018).
6. Sung H., et al. “Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries”. CA: A Cancer Journal for Clinicians 3 (2021): 209-249.
7. World Health Organization. International Agency for Research on Cancer. Cancer Today (2021).
8. Jacobs M., et al. “Policies to restrict secondhand smoke exposure: American College of Preventive Medicine Position Statement”. American Journal of Preventive Medicine 3 (2013): 360-367.
9. Vlaski E., et al. “Do household tobacco smoking habits influence asthma, rhinitis and eczema among 13-14 year-old adolescents”. Allergologia et Immunopathologia (Madr)1 (2011): 39-44.
10. com. “Cost of Living in Macedonia” (2019).
11. Marusic SJ. “Macedonia Moves to Make Smokers’ Lives Easier”. BalkanInsight (2017).
12. Mayo Clinic. Nicotine Dependence Center. V5 (2019).
13. Council for Tobacco Treatment Training Programs (CTTTP). (no date).
14. Walsh JM and McPhee SJ. “A systems model of clinical preventive care: an analysis of factors influencing patient and physician”. Health Education Quarterly 2 (1992): 157-175.
15. Spasovski M and Lazarevik V. “Study on use of tobacco and tobacco products among medical doctors in the Republic of Macedonia”. Ministry of Health, Skopje (2014).