Dr. Rick Botelho, Co-Chair of the Wonca Task Force on Tobacco Cessation

1. Task Force Update on Tobacco CessationStrategy & Funding Issues

2. Objectives

3.  Use 30 seconds of silence to listen to your your internal reaction to an evocative image & a WHO fact sheet

5. 5 Tobacco Pandemic andDeath Rate   Tobacco causes 4 million deaths per year. In 20-30 years, it will cause one in eight deaths: 70% of these 10 million deaths per year will occur in developing countries. WHO Report

6. Propaganda Against Tobacco Imperalism

7. Marketing Impact of Anti-tobacco Propaganda 1. Stickiness What will stick with you? 2. Buzz Will you talk to others about it? 3. Action Will do you anything differently?

8. WORLD-NO-TOBACCO-DAY E-mailed by tn.PP.M.Z.Jeddy, Forwarded by Dr.G.M.Kullo, Lahore, Pakistan

9. Overcoming Imperialism I have only three enemies. My favorite enemy, the one most easily influenced for the better, is the British Empire. My second enemy, the Indian people, is far more difficult. But my most formidable opponent is a man named With him, I seem to have very little influence.

10. Gandhi quote

11.  What is the Purpose of the Wonca Online Survey on Tobacco for Member Organizations?Did your member organization respond?

12. Purpose of Online Tobacco Survey

13. Content of Survey Education and Training about Tobacco Cessation Examination/Certification/Accreditation Educational Tools and Curricula Programs for Practitioner Tobacco Users Guideline Dissemination, QI & Organizational issues Research Policy issues and collaborative relationships Funding Networking Organizational Plans for Improvement

14. Potential Outcomes of Survey Promote collaboration, networking and synergy among member organizations Encourage regional and international program committees to showcase �best practices� Organize workshops at the regional and international conferences to meet the needs of member organizations in working on their goals for improvement

15. Member Organizations Australia Greece Hong Kong Italy Lithuania Malta Netherlands Philippines Slovenia Trinidad USA

16. Case Examples:What are the learning lessons? 

17. The College of General Practitioners of Lithuania Disseminate information to general practitioners via monthly journals and conferences. In September 2000, the College organized a Conference on tobacco cessation and pharmacological treatments for nicotine addiction. Our challenge is to find funding for tobacco cessation training.

18. CGPL�s Organizational Needs Train trainers Prepare materials on motivational approaches Change the practice settings Provide online training Deliver prevention programs in community settings Publish self-help materials for patients Develop programs for practitioners who smoke

19. CGPL�s Organizational Needs Integrate tobacco cessation programs into: Counseling programs that address unhealthy behaviors in general. Quality improvement programs that change practice settings that promote healthy behaviors.

20. Association of Slovene Family Doctors Developed behavior change seminars on prevention and risk factor reduction (smoking, diet, alcohol, physical inactivity) that were also offered to school teachers and therapists Developed a national training program (supported by GSK) Develop prevention check-ups linked to intervention programs Worked with the Ministry for Health to sponsor workshops for GPs (2002)

21. Carribean College of Family Physicians Committed to the idealism and task of tobacco control Successfully advocated to the Ministries of Health for no-smoking in public areas and anti-tobacco campaigns for schools and workplaces

22. Philippine Academy of Family Physicians Ongoing teacher training workshops. Inclusion of family and community-based wellness programs in training undergraduates, residents and graduates in our department

23. American Association of Family Physicians A leader in the tobacco cessation/prevention with a reach of 94,000+ members. The Stop Smoking Kit was developed in the 1980s and updated in the 1990s. The "Patient Stop Smoking Guide" was one of the most popular items. The entire "kit" is not available now and needs to updating. Tobacco cessation training has been into the 476 FP residency programs. AAFP currently have no tobacco cessation committees

24. AAFP Resource Support AAFP staff members work on tobacco control. AAFP had funding from GSK Consumer Healthcare for the Stop Smoking Kit. Limited budget for tobacco cessation materials. Future plans include seeking funds to update tobacco cessation materials

25. AAFP Resources Tar Wars is a tobacco prevention program for 4th & 5th grade students. Visit www.tarwars.org for "Train-the Trainer" slide show For AAFP patient education materials, go to www.familydoctor.org and search for tobacco. 

26. AAFP Advocacy The AAFP Government Relations office (Washington DC) advocates for policy change (reimbursement for physicians doing tobacco cessation counselling) and liaison with Campaign for Tobacco-Free Kids, American Cancer Society and AMA.

27.  What is the Code of Practice on Tobacco Control for Health Professionals' Organizations?

28. 28 Code of Practice on Tobacco Control for Health Professionals' Organizations  In order to contribute actively on tobacco control and include tobacco control in the public health agenda at national, regional and global levels, it is hereby agreed that health professional organizations will: WHO Report

29. 29 Code of Practice on Tobacco Control for Health Professionals' Organizations  1. Encourage and support their members to be role models by not using tobacco and by promoting a tobacco-free culture. 2. Assess and address the tobacco consumption patterns and tobacco-control attitudes of their members. 3. Make their own organizations� (and their members') premises and events tobacco-free. 4. Include tobacco control in the agenda of all health-related congresses and conferences.

30. 30 Code of Practice on Tobacco Control for Health Professionals' Organizations  7. Actively participate in World No Tobacco Day every 31 May. 8. Refrain from accepting any kind of tobacco industry support � financial or otherwise �, and from investing in the tobacco industry or any other type of interaction, and encourage their members to do the same. 9. Ensure that your organization does not maintain any commercial or other kind of relationship with partners who interact with or have interests in the tobacco industry through a declaration of interest.

31. 31 Code of Practice on Tobacco Control for Health Professionals' Organizations  11. Actively support governments in the process leading to signature, ratification and implementation of the WHO Framework Convention on Tobacco Control. 12. Dedicate financial and/or other resources to tobacco control � including dedicating resources to the implementation of this code of practice. 13. Participate in the tobacco-control activities of health professional networks. 14. Support campaigns for tobacco-free public places.

32. Does Europe have a Guideline on Tobacco Cessation?

33. 33  WHO Europe evidence based recommendations on the treatment of tobacco dependence   M Raw, P Anderson, A Batra, G Dubois, P Harrington, A Hirsch, J Le Houezec, A McNeill, D Milner, M Poetschke Langer, W Zatonski � Tobacco Control 2002;11:44�46

34. 34  WHO Europe evidence based recommendations on the treatment of tobacco dependence   Recommendations panel a three year project, funded largely by three pharmaceutical companies that manufacture treatment products for tobacco dependence, but managed by WHO Europe and a steering group which included government representatives and many public sector organisations.

35. 35 Endorsements  ASH (England and Scotland) Alliance pour la sant� (France), British Medical Association, Comit� Nacional de Prevenci�n del Tabaquismo (Spain) Czech Medical Association, Danish Medical Association, Dentistry against Tobacco (Sweden), European Medical Association on Smoking or Health European Nurses and Midwives Against Tobacco,

36. 36 Endorsements  European Review Group on Prevention and Health Promotion in Family Medicine and General Practice (EUROPREV), Europharm Forum, Georgian Medical Association, German Coalition against Smoking, German Medical Association, Norwegian Medical Association Slovenian Medical Association, Society for Research on Nicotine and Tobacco Swedish Medical Association

37. What do you think about an unrestricted grant from Pharma to support this proposal?

38. Global Guidelines on Tobacco Dependence Treatment Goals To develop authoritative, evidence based global guidelines for the treatment of tobacco dependence, endorsed by international professional organizations, and regional and national organizations To encourage international professional organizations and individual countries to adapt, translate and implement these guidelines for their own needs. Martin Raw

39. www.treatobacco.net Resource center created by the Society for Research on Nicotine and Tobacco (SRNT) and WHO. Supported by CDC, World Bank, Cochrane Collaboration, ACS, and others.

40. Applications of Global Guidelines  A valuable starting point for countries Developing new guidelines Updating existing guidelines Introducing treatment into their national programs Stimulating and encouraging action on treatment.

41. Global Guidelines on Tobacco Dependence Treatment  Project Structure and Strategy A Management Group (UICC, WHO) Scientific Group (SNRT) Practitioner Groups (Wonca, WMA, ICN)

42. Guideline Challenges A framework for healthcare systems at different stages of development Generalizable to all relevant healthcare professionals Reviewers from different countries and professional groups can provide feedback to address these challenges.

43. Timetable  Complete project proposal Oct 2005 Establish core groups of organisations by Oct 2005 First draft of core global guidelines by March 2006 Endorsement April to June 2005 Presentation at 13WCTOH July 2006 Revision and final sign-off July to Sept 2006 Submit for publication 01 October 2006 Keep Tobacco Control informed

44. Going Beyond the Limits ofEvidence-based Guidelines: Fostering Experience-basedLearning

45. Vision for the Future Motivational interventions that promote healthful behaviors must become more individualized than the 21st century advances in the drug treatment of diseases.

48. Limitations of 5 A�s Model Giving quit-smoking advice is equivalent to the placebo impact of nineteenth-century drugs. The use of this �drug� over and over again, when it is clearly not working, should be regarded as a

49. Need for Behavioral Innovations

50. Limitations of 5 A�s Model Provides no or little guidance for Smokers in PC & Contemplation Children and youth Patients who fail to respond to the 5A�s model The 5 R�s are not evidence-based but they represent an attempt to address the limitations of the guidelines.

51. Move Beyond Superficial Scientific Evidence Outside-in Approaches

52. to Personal Evidence What works for the individual patient. In other words, what does it mean to change. .

53. Personal Evidence Means Moving Beyond Superficial Change Gaining knowledge

54. Doing emotional work to Deep Change

55. Resistant Smokers Evidence-based guidelines only work with a minority of smokers. Knowledge does not change behavior. Patient resistance to change and lack of motivation are pandemic.

56. Experience-based learning can help you and your patients move beyond the limits of: Scientific evidence and surface change to develop Personal evidence about deep change Experience-based Learning 

57. 57 The reflective and emotional process of developing personal evidence involves patients exploring deep change, making sense of their learning experiences and creating new meaning about the need for change. Personal Evidence

58. 58 Invite patients to participate in ongoing learning opportunities to develop personal evidence. Such reflection can enhance patients� readiness to quit and to make quit attempts. Innovative Tobacco Cessation Programs

59. Perceptions about risks, benefits and harms Cognitive and emotional resistance Cognitive and emotional motivation Energy level and competing priorities Confidence and ability Motives and values Motivational Practice

60. Future Directions: What Strategies can Wonca deploy with thegreatest impact?

61. Purpose of Wonca Online Tobacco Survey Member organizations can: Benchmark their capabilities in helping family doctors address tobacco cessation (policy, organizational and clinical levels) Identify their strengths and needs Set priorities and goals for improvement Foster organizational synergy to accelerate progress in meeting their improvement goals www.GlobalFamilyDoctor.com/tobacco

62. 62 Advocacy role of member organizations within their countries Endorsement of WHO Code of Practice by member organizations Implement Global Guidelines Foster intersectoral approaches Create inter-organizational approaches Research and training projects Work with research centers associated with member organizations Future Directions of Member Organizations 

63. 63 Identify Tobacco-free champions from each member organization Online survey results-bench marking reports Establish international and regional steering committees Present at international/regional conferences showing �best practices� Wonca Tobacco Summit 2007 Online learning resources WHO liaison and GLOBALink Funding issues Future Directionsfor Wonca