Global Bridges Work in the Eastern Mediterranean Region

1. Global Bridges Work in the Eastern Mediterranean Region Feras I Hawari, MD Chief of Pulmonary and Critical Care Service Director of Cancer Control Office King Hussein Cancer Center Regional Director, EMR Global Bridges

2. Regional Host in EMR King Hussein Cancer Center (KHCC) • Dedicated to comprehensive cancer care • Disease-specific accreditation by JCAHO • Campus 100% smoke-free Cancer Control Office at KHCC • Established in 2010 • Undertakes evidence-based interventions to lower cancer incidence, and related morbidity and mortality Tobacco Dependence Treatment Clinic at KHCC • Established in 2008 • Enrolled a total of 890 patients • One-year continuous abstinence rate of 21%

3. The environment in the eastern Mediterranean Region

4. A region plagued with tobacco use Percent of males who smoke cigarettes (2010 or latest available) The Tobacco Atlas, 4th edition

5. Young populations with substantial per capita cigarette consumption Annual Cigarette Consumption (per capita, 2009, total population) The Tobacco Atlas, 4th edition

6. Health professionals in need of help Smoking prevalence among health professions students (2010 or latest available) The Tobacco Atlas, 4th edition

7. Cigarettes highly affordable ... Cigarette Affordability (relative income price, 2009) The Tobacco Atlas, 4th edition

8. ...where treatment is lacking or not covered Quitting Resources Available by Country (2010) The Tobacco Atlas, 4th edition

9. Strategy in the eastern Mediterranean

10. Article 14: Demand reduction measures concerning tobacco dependence and cessation • Short-term strategy: build a network of professionals to treat and advocate • Focus  training on TDT • Mid-term strategy: mobilize network to address requirements of Article 14 • Focus  regional guidelines • integration into PHC • extending reach through workplaces

11. Execution of strategy

12. Built the Infrastructure • Scanned status of tobacco control and tobacco dependence treatment in selected countries • Recruited “Regional Consultants”; in-country counterparts • Looking at some training programs world-wide • Defined profile of candidate trainee

13. Established Multi-disciplinary Core Team • Experience in establishing TDT clinics • Experience in offering TDT services • Experience in strategizing, and M&E • Experience in design and delivery of training • Peer-reviewed publications in field • Comprehensive tobacco control experience • Qualifications on the team include: medicine, pharmacy, nursing, engineering, public health, health services management, business administration, health services research

14. Designed the Training Program • Two- to three-day training workshops • Twelve to 16 hours of training time • Didactic, interactive exercises, case studies • Objectives: • Enhance understanding of tobacco control and TDT • Build capacity to handle various cases of TDT • Advance TDT in country through preparing participants to practice and train

15. Designed the Training Program (2) • Topics covered: • Tobacco control strategies • Tobacco control in country • Tobacco and disease • Tobacco and addiction • Evidence on treatment • Assessing individual cases • Counseling and motivational interviewing • Pharmacotherapy • Designing a plan • Case studies • Ethical considerations

16. Set the Evaluation Mechanism • Of trainee: • Pre-workshop test • Post-workshop test and case study • Of workshop (qualitative and quantitative): • Alignment with expectations, practicability of content, and relevance to practice • Knowledge and style of trainers

17. Completed work

18. Reach - stats • Trained 500 healthcare professionals and advocates • Conducted 11 events • Engaged 17 countries • Recruited 21 Regional Consultants • Engaged 36 speakers in different events • CME accreditation through Dubai Health Authority and Abu Dhabi Health Authority

19. Reach - specialties • General medicine • Community medicine • Family medicine • Public health specialists • University professors • Physiotherapists • Pharmacists • Occupational health specialists • Tobacco control practitioners • School teachers • Cardiologists • Oncologists • Pulmonologists • Internists • Registered nurses • Nutritionists • Dentists • Respirologists • Counselors • Psychiatrists • Health educators • Environmental health specialists • Occupational health specialists

20. Presenting in Global Forums • World Conference on Tobacco or Health – Singapore - March 2012 • UICC World Cancer Congress - Montreal - August 2012 • The Second Middle East Asthma and COPD Conference – Kuwait - November 2012

21. Reach – geographic Workshops Participants

22. Completed Work - EMR • “Tobacco Dependence Treatment” • Two –day Training Workshop • January 2012 • Dubai - UAE

23. Completed Work - EMR • “Tobacco Dependence Treatment” • Three –day Training Workshop • December 2012 • Fes - Morocco

24. Completed Work - EMR • “Tobacco Dependence Treatment” • Three -day Training Workshop • October 2012 • Abu Dhabi - UAE

25. Completed Work - EMR • “NCD Prevention through Health Lifestyles” • One-day Training Workshop • October 2012 • Amman – Jordan

26. Completed Work - EMR • “Tobacco Dependence Treatment” • Two -day Training Workshop • July 2012 • Amman - Jordan

27. Completed Work - EMR • “Tobacco Dependence Treatment” Three -day Training Workshop June 2012 Tunis - Tunisia

28. Completed Work - EMR • “Tobacco Dependence Treatment” • Three -day Training Workshop • April 2012 • Abu Dhabi - UAE

29. Completed Work - EMR • “Tobacco Dependence Treatment” • Three -day Training Workshop • March 2012 • Cairo - Egypt

30. Completed Work - EMR • “Tobacco Dependence Treatment” • Three -day Training Workshop • December 2011 • Tunis - Tunisia

31. Completed Work - EMR • “Tobacco Dependence Treatment Training” • Two-day Training Workshop • April 2011 • Amman-Jordan

32. Completed Work - EMR • “Tobacco Dependence Treatment: Global Experience and Regional Perspective” • Four-day Regional Conference • June 2011 • Amman-Jordan

33. Next steps

34. Fulfilling Article 14 • Developing regional guidelines • Expanding reach for patient recruitment (PHC and workplaces) • Availing supporting tools (quitlines, smokefree policies)

35. Thank you