title: Tobacco Dependence Treatment Training Programs: An International Survey.
abstract: BACKGROUND
  In line with Article 14 guidelines for the WHO Framework Convention on Tobacco Control, we aimed to assess the progress in training individuals to deliver tobacco cessation treatment.
  
  
  METHODS
  Cross-sectional web-based survey in May-September 2013 among 122 experts in tobacco control and training from 84 countries (73% response rate among 115 countries surveyed). We measured training program prevalence, participants, and challenges faced.
  
  
  RESULTS
  Overall, 21% (n = 18/84) of countries, mostly low and middle-income countries (LMICs; P = .002), reported no training program. Among 66 countries reporting at least one training program, most (84%) trained healthcare professionals but 54% also trained other individuals including community health workers, teachers, and religious leaders. Most programs (54%) cited funding challenges, although stability of funding varied by income level. Government funding was more commonly reported in higher income countries (high 56%, upper middle 50%, lower middle 27%, low 25%; P = .03) while programs in LMICs relied more on nongovernmental organizations (high 11%, upper middle 37%, lower middle 27%, low 38%; P = .02).
  
  
  CONCLUSIONS
  One in five countries reported having no tobacco treatment training program representing little progress in terms of training individuals to deliver tobacco treatment in LMICs. Without more trained tobacco treatment providers, one of the tenets of Article 14 is not yet being met and health inequalities are likely to widen. More effort and resources are needed to ensure that healthcare worker educational programs include training to assess tobacco use and deliver brief advice and that training is available for individuals outside the healthcare system in areas with limited healthcare access.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA; Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA; gkruse@mgh.harvard.edu.
authors.forename: Gina R
authors.initials: GR
authors.lastname: Kruse
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA; Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA;
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Rigotti
authors.affiliation: UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom;
authors.forename: Martin
authors.initials: M
authors.lastname: Raw
authors.affiliation: Department of Addictions, UK Centre for Tobacco and Alcohol Studies, Institute of Psychiatry, Kings College London, London, United Kingdom;
authors.forename: Ann
authors.initials: A
authors.lastname: McNeill
authors.affiliation: UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom;
authors.forename: Rachael
authors.initials: R
authors.lastname: Murray
authors.affiliation: UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom;
authors.forename: Hembadoon
authors.initials: H
authors.lastname: Piné-Abata
authors.affiliation: Department of Medicine, Harvard Medical School, Boston, MA; Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA;
authors.forename: Asaf
authors.initials: A
authors.lastname: Bitton
authors.affiliation: National Centre for Smoking Cessation and Training, London, United Kingdom; Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, United Kingdom.
authors.forename: Andy
authors.initials: A
authors.lastname: McEwen
mesh_terms: D000488:Allied Health Personnel / Q000193:education; D003153:Community Health Services / Q000458:organization & administration*; D003150:Community Health Workers / Q000193:education; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D003906:Developing Countries; D006801:Humans; D016730:Program Development; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000517:prevention & control*