COUNTRY REPORT THE SLOVAK REPUBLIC

Transcription

1 COUNTRY REPORT THE SLOVAK REPUBLIC SUMMARY Tobacco use in Slovakia, similarly as in other European countries, represents a significant public health problem. 28% of adult population regularly smoke. Among schoolchildren, 24.3% of them are current smokers (one or more cigarette smoked during last month). Tobacco use in Slovakia contributes on 19.2% of all deaths and on 12.2% of total lost DALy (disability adjusted life years). According to the current legislation, smoking is regulated on workplaces and in many public places. In restaurants and bars, smoking is banned only partially. Legislation also regulates eligible information and warning placed on packs of tobacco products. Advertising of tobacco products, including electronic media, is banned with the exception of points of sale. Slovakia ratified Framework Convention on Tobacco Control in April Governmental body officially responsible for tobacco control activities is the Public Health Authority (PHA) of the Slovak Republic and 36 subordinated Regional Public Health Authorities (RPHA) providing, beside other activities, cognitive-behavioural cessation courses. These services are covered by governmental budget. Among non-governmental organisations the key role in tobacco control is played by Stop Smoking NGO and National Coalition for Tobacco Control. However, official guidelines for treatment of tobacco dependence have been published, smoking cessation still has not been included into standard health care system. 1. INTRODUCTION Slovakia belongs to the Central European Countries and is bordered by Poland to the north, Ukraine to the east; Hungary is to the south, and Austria and the Czech Republic border to the west. The Slovak territory covers 49,010 square kilometres. City of Bratislava (app. 443 thousands citizens), situated at the southwestern part of the country, is the official capitol. Slovakia is administratively divided into eight regions (from west to east): Bratislava, Trnava, Nitra, Trenčín, Žilina, Banská Bystrica, Prešov and Košice. The population includes 5.4 millions inhabitants, most of them of Slovak (86%) and Hungarian (10.7%) nationalities. Other national divisions include Roman, Czech and others minorities. The only official language is the Slovak (1). Slovak Republic has been established on 1 st of January 1993 after the peaceful split of the former Czechoslovakia. Slovakia is a country with multiparty parliamentary democracy. The official head of the state is a president, directly elected by universal suffrage. Legislative power belongs to the directly elected Slovak National Council having 150 members. Executive power belongs to the Prime Minister and Government accountable to the Slovak National Council. On 1 st of May 2004, Slovakia became the member of the European Union. A development of a Slovak economy as well as social relations has been affected by a communist totalitarian system ruling until The Slovak economy was also negatively influenced by the split of the Czechoslovakia as well as turbulent political situation during early 1990s. After the decisive economic reforms introduced in 2002, Slovakia evidenced a noteworthy economic growth. Currently, the Slovak economy is oriented beside traditional agriculture also to various industrial branches, particularly car industry. National currency is Slovak Crown (app. 38 SKK=1 EURO). The Slovak Government plans to introduce EURO in

2 2. THE USE OF TOBACCO PRODUCTS Tobacco use in Slovakia, similarly as in other European countries, represents a significant public health problem. According to the latest survey carried out in 2004 by the Statistical Office 28% of adult population are regular and 13% are occasional smokers. Within last ten years ( ) no significant trends in smoking prevalence of adults has been shown (2). Smoking of males predominates, while according to a survey carried out in 2002 by Markant Agency, 31.1 % of males and 14.1 % of females are smokers (3). According to Global Youth Tobacco Survey (GYTS) data (from 2003), 24.3% of school children aged years currently smoked cigarettes (one or more cigarettes smoked during last month), with only slight gender differences. Smoking initiation before age 10 was reported by 35.9% of boys and only by 21.2% of girls. Besides cigarettes, also other tobacco products are of increasing importance, while 11.7% of children currently smoked cigars. According to GYTS findings 22.9% of never smokers aged years are likely to initiate smoking during the next year (4). Passive smoking is rather prevalent in Slovakia and represents another important issue of tobacco control in Slovakia. In GYTS, 79.0% schoolchildren were exposed to environmental tobacco smoke in their homes and 84.7% outside homes in public places (4). 3. THE HARM DONE BY TOBACCO According to latest estimations, tobacco use in Slovakia contributes on 19.2% of all deaths representing each year almost 4000 cases. The most of them are fatal results of ischaemic heart disease, cerebrovascular diseases, chronic obstructive pulmonary disease and several types of oncologic diseases, particularly lung cancer. Tobacco accounts considerably also on premature loss of health contributing on 12.2% of total lost DALy (disability adjusted life years) (5). Passive smoking represents also considerable public health problem and accounts in Slovakia almost 2000 deaths annually (6) 4. MEASURES TO REDUCE THE HARM DONE BY TOBACCO Tobacco use in Slovak Republic is regulated by several legislation norms. Among them, the most important are: In article 40, the Constitution of the Slovak Republic provides for the right of all people for health protection as one of the principal rights and freedoms recognised by the Constitution of the Slovak Republic. Act. 272/1994 Coll.LL. On Human Health Protection provides banning or restriction of smoking at institutions where persons gather, and banning of smoking from workplaces at which smoking may raise the risk of damage to health. The Act. 377/2004 Coll.LL. On Protection of n-smokers, with amendment. 533/2005 Coll.LL regulates the conditions of protection of people from the development of addiction to nicotine as an addictive and harmful component present in tobacco and tobacco products, from harmful effects of tobacco smoking and from other uses of tobacco products which harm the health of smokers and non-smokers directly exposed to the effects of smoking, conditions of packaging, rules of sales, labelling and marketing of tobacco products. Moreover, the Act defines some important concepts, and lists places where tobacco smoking is banned. According to this norm, tobacco products are forbidden to be sold in groceries beside shops owning special stands or counters, shops with goods determined to children and youth; in all types of health service facilities, school facilities, schools and social 2

3 care facilities for children and youth; in automatic machines and collected on delivery; and in a package of less than 10 pieces. The Act also prohibits selling grocery items or toys imitating tobacco products. Every package must show warning of the harmful effects of tobacco smoking (covering at least 30% of front side and 40% of back side of the package), contents of the harmful substances and the batch number or equivalent data, date and place of production. The contents of harmful substances (tar up to 1 mg, carbon dioxide up to 10 mg per one cigarette and the method of their determination) must correspond to international standards (ISO). The Act prohibits smoking in several public places such as health and social institutions, schools, colleges and bus stops. Although in bars, coffeehouses and pubs non-smoking area should be designated, the Act does not define how this area should be separated from smoking area. Another weak point of the Act is its ambiguousness and not properly determined executive policies. Act. 330/1996 Coll.LL. on safety and health protection at work, as amended by Act. 95/2000 Coll.LL. and Act. 158/2001 Coll.LL. provides for the responsibility of the employer to ban tobacco smoking at workplaces at which also non-smokers work, and to provide for the compliance with the ban, as well as with the ban of tobacco smoking at workplaces specified by separate regulations. In this respect, employer shall be liable to check, whether employees respect the ban of tobacco smoking within employer s premises. The Act. 147/2001 of April 2 on Advertising and on Amending and Supplementing prohibits the advertising of tobacco products on all types of information carriers; through free distribution of tobacco products samples to the public; and on advertising items, which are not related to smoking and are distributed to the public, with the exception of advertising issues, which are distributed at points of sale. The Act. 308/2000 on Broadcasting and Retransmission regulates the tobacco products advertisement in TV within the transmission under the Section 33, letter 1: The transmission of all forms of advertisement and teleshopping for tobacco products is forbidden. Evading this ban by means of the use of brand names, trademarks, emblems or other clear signs of such products in the broadcasting time selected for advertisement and teleshopping is forbidden. As for sponsoring, the Slovak legislation currently does not specifically regulate the issue of sponsoring directly by the law. Slovakia ratified Framework Convention on Tobacco Control in April 2004 and Governmental National Tobacco Control Action Plan for has been approved. 5. COMMUNITY ACTION AND MEDIA EDUCATION Governmental body officially responsible for tobacco control activities is the Public Health Authority (PHA) of the Slovak Republic and 36 subordinated Regional Public Health Authorities (RPHA) organising various community activities and campaigns (Quit&Win, municipal activities on the Tobacco Day etc.). Within this scheme, each RPHA institutes a Health Counselling Centre providing also cognitive-behavioural cessation courses. The courses are led by qualified workers and are fully covered from governmental budget, so these services are completely free. Another governmental body of an importance is the The Committee of Ministers for Drug Addiction and Drug Control working within the Governmental Office. The board is responsible for coordination of activities of individual Ministries as well as other institutions and organisations working in this field. 3

4 Among non-governmental organisations the key role in tobacco control is played by Stop Smoking NGO established in the year 2000 and National Coalition for Tobacco Control (NCTC) in Slovak Republic. Stop smoking NGO organises numerous community campaigns focused on smoking prevention, operates the most comprehensive website in Slovakia in this field and participates in several international projects in close cooperation with organizations ENSP and ENYPAT. Among its most important achievements belongs translation and editing of the textbook Curbing with Epidemic: governments and the economics of tobacco control (originally published by World Bank). NCTC until 2005 worked within the activities of Stop Smoking NGO. Since January 2005 it started its independent existence. One of the most important current objectives of NCTC was to establish a QUITLINE in cooperation with Regional Public Health Authority in Martin and Insitute of Public Health, Jessenius Faculty of Medicine, Comenius University. The QUITLINE was launched on 3 rd of January 2006 and currently provides reactive services on a regular base. 6. THE EFFECTIVENESS AND COST EFFECTIVENESS OF SMOKING CESSATION INTERVENTIONS Currently, no financial analysis dealing with smoking cessation in the conditions of the Slovak Republic, does not exist. 7. HEALTH CARE INFRASTRUCTURE 7.1 Integrated health care system Smoking cessation is included into work of the RPHA as a part of the activities of Health Counselling Centres. However, these services include only cognitive-behavioural therapy. Nicotine replacement therapy (NRT), as an over-the-counter drug, can be recommended for clients to be bought in pharmacies. Bupropion cannot be prescribed in such centres, and interested clients could be referred to physician. General practitioners and other physicians do not provide cessation therapy on regular basis. Although, a short intervention is reimbursed partially by health insurance as a preventive activity, the current reimbursement is not financially motivating. Neither NRT nor bupropion are reimbursed by health insurance and should be fully paid by a client. One pack of NRT costs app EURO depending on type and manufacturer. One pack of bupropion (Zyban) costs app. 48 EURO. 7.2 Structures for quality of care Quality of health care is monitored by the Slovak Medical Chamber as well as special Office for Supervising of Health Care founded under the Ministry of Health. Although guidelines for treatment of tobacco dependence are available, at the time no eligible standards for smoking cessation have been defined. 7.3 Research and knowledge for health Neither special governmental funds for research in the fields of tobacco control nor earmarked taxes are available at the time, however, such specific grant system is under preparation. Resources for a research in the field of tobacco control are available through standard scientific grant schemes. 7.4 Health care policies and strategies for smoking cessation The government approved the National Action Plan for Tobacco Control in This Plan assumes greater support of tobacco control from governmental resources. 4

5 7.5 Structures to manage the implementation of treatment within health services Currently, the PHA of the Slovak Republic is responsible for tobacco control activities, namely the Section for Prevention and Health Monitoring. However, PHA undergoes currently personal and structural changes. 7.6 Funding health services and allocating resources Tobacco control activities done at the RPHAs are fully paid from the governmental budget. Also short intervention in smoking cessation provided mainly by general practitioners and psychiatrists is partially reimbursed by health insurances. Also small grant scheme provided by the Governmental Office is available and its resources can cover selected activities, particularly provided by non-governmental organisations. 8. SUPPORT FOR TREATMENT PROVISION 8.1 Screening, quality assessment, referral and follow-up systems Up to the time, in Slovakia no screening, quality assessment, referral and follow-up systems have been established. 8.2 Protocols and guidelines Official guidelines for treatment of tobacco dependence are available currently approved by the Slovak Medical Chamber, PHA as well as Slovak Medical Association (7). However, their use is fully under the initiative of physicians. 9. INTERVENTION AND TREATMENT 9.1 Availability and accessibility Advises regarding cessation are available free in Health Counselling Centres working within RPHAs, which are available almost in each district (36 RPHAs). Patient can ask for a help in each general practitioner. In several hospitals Smoking Cessation Centres have been founded. Many pieces of information are available also through internet. 9.2 Affordability Services including only cognitive-behavioural therapy provided within RPHAs and most of phyisicians are free. Phramcotherapy, i.e. NRT and bupropion is fully covered by a patient. 10. HEALTH CARE PROVIDERS 10.1 Clinical accountability There is no official system of clinical accountability regarding cessation services. Any activities provided by clinicians are fully on their own initiative. Generally, pneumologists, internal disease specialists and oncologists consider these issues as important and mayn of them are able to provide qualified information and intervention Treatment provision There are no data from Slovakia regarding treatment provision. 11. HEALTH CARE USERS 11.1 Knowledge 5

6 Health effects of tobacco and smoking have been discussed many times in media and other information resources intended for lay public. These issues are also included into preschool and school education. In GYTS 69.4% of years old schoolchildren thought that smoke from others is harmful to them and 76.8% of respondents expressed positive approach towards legislative restrictive measures to control environmental tobacco smoke (4) Treatment seeking behaviour Currently, no relevant data on treatment seeking behaviour from adult population are available. Among years old schoolchildren, 71.9% of current smokers (smoking one or more cigarettes during last month) reported to receive help or advice to stop smoking Smoking behaviour and intentions to quit According to data from the Statistical Office of the Slovak Republic from 2004, 26% of daily smokers tried to quit and spent abstinence for longer time. 48% tried to quit unsuccessfully. apparent trend in this field can be seen since 1998 while the data are balanced and have been remained almost the same. 12. REFERENCES 1. Statistical Office of the Slovak Republic. Available at: 2. Using of addictive drugs in Slovakia and opinions of citizens related to drug addiction [in Slovak] (2004). Statistical Office of the Slovak Republic, Bratislava 3. Survey on opinions of the Slovak population regarding passive smoking carried out by Markant Agency [in Slovak] (2002). Markant, Bratislava 4. Baška T et GYTS Slovakia Collaborative Group: Report on the Results of the Global Youth Tobacco Survey in Slovakia 2003 (2003). Centers for Disease Control and Prevention, Atlanta, Georgia. available at: 5. The European Health Report Public health action for healthier children and populations (2005). World Health Organisation Europe, Copenhagen. 6. Lifting the smokescreen. 10 reasons for a smoke free Europe (2006). European Respiratory Society, Brussels. 7. Kavcová E., Rozborilová E., Krištúfek P. et al.: Manual and Guidelines for smoking cessation and treatment of nicotine dependence [in Slovak] 1 st Edition (2005), Jessenius Faculty of Medicine, Comenius University, Martin 6

7 THE ASSESSMENT TOOL A tool to assess the available services for smoking cessation at the country or regional level Please cross the box, place a cross in the table or ring the option corresponding to your answer or write your answer where indicated. PART I Personal details of contact person for completion of tool Name: Organization and position: Address (name and number of street, postal code, town): Telephone: Fax: Website: Country: If you are answering for a jurisdictional 1 region rather than a country as a whole, which jurisdictional region is it? Please note: unless you state otherwise in the tool, it will be assumed, if you are completing the questionnaire for a jurisdictional region other than a country, that all your answers are for this jurisdictional region. Population size of the country/region: Date of completing the tool (dd-mm-yy): 1 Such a jurisdictional region could be a region within a country or a municipality 7

8 Is there a country-wide or region-wide formal or informal smoking cessation coalition or partnership? Do not know If yes: What is the name of the coalition? When was it established? Please describe the aim of the coalition in one sentence: Please provide a separate word document listing the members of the coalition or partnership, including the following information: Name of member organization or individual: One sentence description of organization or individual: (e.g. national scientific body representing general practitioners, or recognized expert ) 8

9 PART II A. LEGISLATIVE MEASURES This section will provide the completed country specific WHO European profiles of tobacco control, and the completed country specific profiles of the ENSP project on tobacco control policies as attachments. The files will be sent separately and at a later date. Respondents will be asked to check and update the data, and provide an assessment of implementation and enforcement. There is no need to do anything at present. 9

10 B. COMMUNITY ACTION AND MEDIA EDUCATION 1. What is the percentage of health professionals in your country or region who smoke? 1.1. Doctors overall 1.2. Nurses overall 1.3. General practitioners 1.4. Nurses in general practice 1.5. Nurses in general hospitals 1.6. Pharmacists 1.7. Midwives 1.8. Dentists 1.9. Oncologists Cardiologists Lung physicians Surgeons Gynaecologists % who are daily smokers Date of survey Please provide filename for document reference (and complete document reference template) 2. Have there been public education campaigns implemented in your country or region in the past 24 months in the listed media that provide information about why smokers should quit smoking, or provide information on how to quit? If so, were they publicly funded? Television Radio Newspapers and magazines Billboards Other (please state) Provide information about why smokers should quit smoking Provide information on how to quit Were the campaigns publicly funded Fully Partial 1

11 C. HEALTH CARE INFRASTRUCTURE Integrated health care system 3. Would you say that smoking cessation is integrated in the health care system, including co-operation or relationships between primary health care and secondary health care, similar to that for other chronic diseases such as asthma?, widely, partially Do not know Structures for quality of care 4. For each topic in the table, is there a formal governmental organization, or organization appointed or contracted by the government that: 4.1. Licenses drugs for smoking cessation? If yes, please provide filename for organizational reference (and complete organization reference template) 4.2. Has the responsibility of preparing clinical guidelines for smoking cessation? 4.3. Monitors health outcomes at the population level from smoking cessation? 4.4. Monitors the quality of care provided for smoking cessation? 4.5. Reviews the cost effectiveness of smoking cessation interventions? 4.6. Deals with cases of clinical negligence in smoking cessation? 4.7. Reviews the safety of pharmacological treatments for smoking cessation? 4.8. Provides information on smoking cessation to health care providers? 2

12 Research and knowledge for health 5. Is there a formal research programme for smoking cessation with specifically allocated funding from governmental, government appointed or non-governmental organizations (excluding the pharmaceutical companies and the tobacco industry)? 6. Is education on smoking cessation formally part of the curriculum of undergraduate/basic professional training of the following health care providers? Medical students Nursing students Pharmacy students Dentistry students Undergraduate/ basic professional training Postgraduate professional training Continuing medical education Health care policies and strategies for smoking cessation 7. Are there official written policies on smoking cessation from the Government or Ministry of Health in your country or region? Please mark all that apply:, a governmental written stand alone policy on smoking cessation, a governmental written policy on smoking cessation which is part of an overall tobacco control policy, but there is a governmental policy on smoking cessation in preparation, there are no governmental policies on smoking cessation Do not know If yes, Please give filename for document reference: (and complete document reference template) 3

13 8. If available, the governmental policy on smoking cessation includes: A strategy on training for health professionals A national funded research strategy for smoking cessation A strategy for support of interventions by primary care professionals Intensive support for smoking cessation in specialised treatment facilities Position promoting the use of pharmaceutical products Structures to manage the implementation of treatment within health services 9. Is there an identified person within the Department of Health or Government, or who is contracted by the Department of Health or Government, who oversees or manages smoking cessation services? Do not know Please provide his/her contact details: Name: Organization and position: Address: Telephone: Website: 4

14 Funding health services and allocating resources 10. Is there government funding for services for smoking cessation? Do not know If no, Funding is being prepared 11. Is the funding reviewed? Do not know If yes, Annually reviewed Reviewed every 2 to 5 years Reviewed every 5 years or longer Other (please specify): 12. Is a proportion of tobacco taxes specifically earmarked (hypothecated) to fund the costs of smoking cessation services? Do not know 13. If yes, please state the proportion: 14. Is yes, is the money raised from the tax actually spent on the costs of smoking cessation services? Do not know 5

15 15. Is the hypothecated tax reviewed? Do not know If yes, Annually reviewed Reviewed every 2 to 5 years Reviewed every 5 years or longer Other (please specify): 6

16 D. SUPPORT FOR TREATMENT PROVISION Screening, quality assessment, referral and follow-up systems 16. Are the following screening and support systems available for health care providers in smoking cessation? Standardized screening instruments to identify smoking status Standardized case notes or computer records to record smoking status Protocol charts or diagrams as an aid for smoking cessation Support by facilitators or advisors for smoking cessation Systems to follow-up patients for monitoring and treatment Available in general practice,, widely partially Available in hospitals,, widely partially Protocols and guidelines 17. Are there multidisciplinary clinical guidelines for smoking cessation in your country/region that have been approved or endorsed by at least one health care professional body? If yes: Do not know Stand alone guidelines for smoking cessation Part of other clinical care guidelines (e.g. asthma guidelines) If yes, please provide filename for document reference(s): (and complete document reference template(s)) If no: Guidelines are being prepared 7

17 18. If there are endorsed clinical guidelines for smoking cessation, have there been any studies in your country on their implementation or adherence? Do not know If yes, please provide filename for document reference(s): (and complete document reference template(s)) If no: Studies are being prepared 19. Are the following health care providers reimbursed for smoking cessation, or is smoking cessation within their terms of service (contract) and part of their normal salary? General practitioners Nurses working in general practice Doctors in hospital Nurses in hospitals Pharmacists Dentists Addiction specialists Reimbursed for providing smoking cessation Smoking cessation within terms of service and part of normal salary 8

18 20. For the following professional groups, are there specialized guidelines or protocols, a written policy on smoking cessation by the professional association, smoking cessation training within professional vocational education and smoking cessation training within accredited continuing medical education? For the following professional groups, are there the following for smoking cessation: General practitioners Nurses in general practice Nurses in general hospitals Specialist nurses Pharmacists Midwives Dentists Oncologists Cardiologists Lung physicians Ear, nose and throat specialists Internal medicine specialists Surgeons Psychiatrists Counsellors in specialist services Telephone quit line counsellors Counsellors in community clinics Obstetricians Paediatricians Addiction specialists Specialized guidelines or protocols Written policy on smoking cessation by professional association Smoking cessation training within professional vocational training Smoking cessation training within accredited continuing medical education 9

19 E. INTERVENTION AND TREATMENT Availability and accessibility 21. Is patient help for smoking cessation available and obtainable (e.g., patients have good access) in the following settings? Smoking cessation is Available in: Obtainable from: available and obtainable: Do not know Do not know General/family practice Hospital clinics Work places Pharmacists Specialist clinics Addiction services Community based clinics Dentists Schools Prisons Telephone quit-lines Country or regional internet sites 22. Are the following products licensed for use? In what way are they available and, can they be advertised on the television? Are these products licensed and available from: Licensed for use? General sale (e.g. in supermarkets) From pharmacies (over the counter) Doctors prescription Can be advertised on television Do not know Do not know Do not know Do not know Do not know NRT 2 mg gum NRT 4 mg gum NRT Patch NRT Sub-lingual tablet NRT Lozenge NRT Inhaler NRT Nasal spray Bupropion Other pharmaceuticals (please specify) Affordability 10

20 23. Are the costs of smoking cessation or the following pharmacological products available free of charge or fully reimbursed to users by the health care system or other third party payers (insurance companies)? Smoking cessation advice and treatment is free of charge or fully reimbursed, totally, partially (indicate the proportion covered) Only by paying the full cost Do not know NRT 2 mg gum NRT 4 mg gum NRT patch NRT sub-lingual tablet NRT lozenge NRT inhaler NRT nasal spray Bupropion Other pharmaceuticals (please specify) Brief counselling interventions Intensive counselling interventions 24. What is the unit cost (please state currency) for one 4mg piece of gum and one tablet of bupropion, and, if the information is available, what are the quantities sold (either in volume or in the costs of total sales) in your country/region Unit cost Number of units sold (please state year) Cost of total sales (please state year) NRT 4 mg gum Bupropion 11

21 25. Is there a specialist service (i.e., specialist or specialist clinic) for smoking cessation available in the country/region? Do not know If yes, Only by referral Only by self-referral By both referral and self-referral If yes, is it reimbursed for the patient? Do not know 12

22 F. HEALTH CARE PROVIDERS Clinical accountability 26. To what extent do you estimate on a ten-point scale that treatment providers consider smoking cessation advice as a part of their routine clinical practice? Advice is routine in clinical practice: t at all Fully General practitioners/ Family doctors Nurses working in general practice Pharmacists Midwives Dentists Oncologists Cardiologists Lung physicians ENT (ear, nose and throat) specialists Paediatricians If there are any publications on this topic, please provide the filenames for the document reference(s) and complete the document reference template(s): 13

23 Treatment provision 27. Have there been any studies, surveys or publications on the following or similar outcomes in primary health care (general practice/family practice), and if so, what are the main findings of the most recent results? Patients are asked or screened about their smoking status Smoking patients are given advice to quit Smoking patients are assessed their willingness to quit Smoking patients are assisted with quitting Treatment meets quality criteria Practice protocols are followed Pharmacological products are recommended Pharmacological products are prescribed Abstinence is assessed at the end of treatment Patients making a quit attempt are followed- up Smoking patients stopped in the last year Date of information Please write NO, if no information Main findings Please provide filename for document reference (and complete document reference template, one for each document) 14

24 G. HEALTH CARE USERS Knowledge 28. Have there been any studies, surveys or publications that provide answers for the following or similar information concerning smoking and if so, what are the main findings of the most recent results? People know that smoking is dangerous to their health People know that living with someone who smokes increases their own risk for health problems People think that cigarette dependence is a behaviour that you can simply choose to stop (a habit) People think that cigarette dependence is a behaviour that is difficult to stop even when you want to (an addiction) People know about effective treatment methods Date of information Please write NO, if no information Main findings Please provide filename for document reference (and complete document reference template, one for each document) 15

25 Treatment seeking behaviour 29. Have there been any surveys, studies, or publications which provide information on the proportion of smokers who have ever used one of the following methods to stop smoking and if so, what are the main findings of the most recent results? Help from a doctor Help from a nurse Help from a pharmacist Help from a dentist Help from friends or family NRT products overall Nicotine gum Nicotine patches Other nicotine products, such as lozenges, tablets, Inhaler or nasal spray Bupropion tablets Herbal remedies Hypnotherapy or acupuncture Leaflets, books, articles or videos on how to stop smoking Advice from the Internet Stop smoking competitions Stop smoking clinic or group Smoking help line telephone service Willpower alone Date of information Please write NO, if no information Main findings Please provide filename for document reference (and complete document reference template, one for each document) 16

26 Smoking behaviour and intentions to quit 30. Have there been any surveys, studies, or publications which provide information on smoking status or intentions to quit, and if so, what are the main findings of the most recent results? Date of information Please write NO, if no information Definition of adult Proportion of adults (%) who are Please provide filename for document reference (and complete document reference template, one for each document) Current smokers: Males Females Total Tobacco dependent smokers according to Fagerström score: Males Females Total Ex-smokers: Males Females Total Attempted to quit over a 1 year period Males Females Total Considering to quit in next 6 months Males Females Total 17

27 Date of information Please write NO, if no information Definition of adult Proportion of adults (%) who are Please provide filename for document reference (and complete document reference template, one for each document) Successfully quit for at least 1 year during last 2 years Males Females Total If there is data breaking down the above information in more detail by age or socioeconomic group, please provide the data. 18