Progress in implementation of WHO FCTC Article 14 and its guidelines: a survey of tobacco dependence treatment provision in 142 countries

Abstract

Aims: To (1) estimate the number of Parties to the Framework Convention on Tobacco Control (FCTC) providing tobacco dependence treatment in accordance with the recommendations of Article 14 and its guidelines; (2) assess association between provision and countries' income level; and (3) assess progress over time.

Design: Cross-sectional study.

Setting: Online survey from December 2014 to July 2015.

Participants: Contacts in 172 countries were surveyed, representing 169 of the 180 FCTC Parties at the time of the survey.

Measurements: A 26-item questionnaire based on the Article 14 recommendations including tobacco treatment infrastructure and cessation support systems. Progress over time was assessed for those countries that also participated in our 2012 survey and did not change country income level classification.

Findings: We received responses from contacts in 142 countries, an 83% response rate. Overall, 54% of respondents reported that their country had an officially identified person responsible for tobacco dependence treatment, 32% an official national treatment strategy, 40% official national treatment guidelines, 25% a clearly identified budget for treatment, 17% text messaging, 23% free national quitlines and 26% specialized treatment services. Most measures were associated positively and significantly with countries' income level (P < 0.001). Measures not associated significantly with income level included mandatory recording of tobacco use (30% of countries), offering help to health-care workers (HCW) to stop using tobacco (44%), brief advice integrated into existing services (44%), and training HCW to give brief advice (81%). Reporting having an officially identified person responsible for tobacco cessation was the only measure with a statistically significant improvement over time (P = 0.0351).

Conclusion: Fewer than half of countries that are Parties to the Framework Convention on Tobacco Control have implemented the recommendations of Article 14 and its guidelines, and for most measures, provision was greater the higher the country's income. There was little improvement in treatment provision between 2012 and 2015 in all countries.

Keywords: Article 14 guidelines; FCTC Article 14; middle- and low-income countries; tobacco cessation; tobacco control; tobacco dependence treatment.

Figure 1

Access to cessation support in different settings. ‘Can tobacco users get help to stop smoking in the following settings?’. The bars show ‘Yes’ responses overall (black) then by income‐level in the order high‐income countries (HIC); upper middle‐income countries (UMIC); lower middle‐income countries (LMIC); low‐income countries (LIC). P‐values are for difference across income level