Measuring Armenia's progress on the Tobacco Control Scale: an evaluation of tobacco control in an economy in transition, 2005–2009

Objectives: This study aimed to measure the 5-year progress in the implementation of WHO Framework Convention on Tobacco Control (FCTC) in Armenia by applying the Tobacco Control Scale, a rapid assessment tool developed to assess the strength of tobacco control policies in Europe. Setting: Armenia, an economy in transition, has extreme smoking rates among men (62.5%) despite acceding to FCTC in 2004. However, little research has been carried out to evaluate Armenia's progress in tobacco control. Methods: The Tobacco Control Scale total score was estimated for Armenia using the original methodology; however, a different source of data was used in estimating the subscores on tobacco price and tobacco control spending. Results: Armenia's total score on Tobacco Control Scale has considerably improved from 2005 to 2009, mostly due to larger health warnings and advertising ban, and increased public spending on tobacco control. The scores for smoke-free public places, advertising ban, health warnings and treatment categories were below the European average in 2005 and 2007, while the price score was higher. Neither total tobacco control score nor any of its components showed a significant predictive value in a simple regression analysis using the total score and subscores as predictors for log-transformed per capita tobacco consumption. Conclusions: Higher than the European average price score for Armenia cannot be explained by the concept of affordability alone and may reflect a measurement error due to peculiarities of transition economies. The applicability of the Tobacco Control Scale could be limited to countries with mature economies, but not to transition countries such as Armenia with different social, political and economic environment. The scale modification, such as an adjustment for the policy enforcement and the effectiveness of public tobacco control spending along with alternative measures of affordability would be warranted to enhance its applicability in low-income and middle-income countries

Attitudes, practices and beliefs towards worksite smoking among administrators of private and public enterprises in Armenia

As one of the first studies to investigate smoking-related worksite practices, attitudes and beliefs in former Soviet countries, these findings provide insight into law enforcement processes for economies in transition. The study team conducted focus group discussions with worksite administrators to explore their beliefs, attitudes and practices related to worksite smoking. These findings guided development of a quantitative instrument to collect more representative data on the same issues. Research revealed widespread confusion between the concepts of worksite smoking restrictions and smoke-free workplaces. Public awareness campaigns that promote promulgation and enforcement of worksite smoking regulations could increase employee demand for smoke-free worksites

Prerequisites, components and barriers to the implementation of a smoking cessation training course for medical residents in Armenia

Introduction Studies suggest that trained physicians are about twice as likely to offer help to patients who smoke in contrast to non-trained physicians. Yet, inadequate training on tobacco dependence and its treatment is one of the major obstacles for consistent and effective treatment of tobacco dependence. The study aimed to explore the needed resources, prerequisites, components and barriers for implementing a pilot smoking cessation training course for medical residents in Armenia to provide practical skills and knowledge on smoking cessation counseling. Methods The research team utilized a qualitative research method by conducting four focus group discussions (overall 14 residents participated in the discussions) with medical residents from Yerevan State Medical University and four in-depth interviews with medical faculty members and administrators. The participants were recruited using convenience and snowball sampling techniques. Directed content analysis was utilized for data analysis. Results The main preconditions for teaching a smoking cessation training course were the residents’ exposure to tobacco related topics during the years of study, having some experience in advising smokers to quit and in managing patients, and negative attitude toward patient’s smoking. The duration of the training and use of active learning methods were likely to be the important components in planning and implementing the training course. Finally, the major barriers mentioned by participants included lack of time to attend the training due to clinical duties, underestimation of the physician’s role in patient’s decisions related to smoking cessation, low interest in the topic among residents who were smokers themselves, and shortage of time for counseling patients during hospitalization due to their short in-hospital stay. Conclusions Most of the participants were interested in the smoking cessation training course and helping their patients to quit. The study team will need to account for the identified barriers for the successful implementation of the program. Funding The study was a part of a larger collaborative project funded by the Swiss National Science Foundation and Swiss Agency for Development and Cooperation

Smoking behavior, attitudes, and cessation counseling among healthcare professionals in Armenia

Abstract Background Smoking cessation counseling by health professionals has been effective in increasing cessation rates. However, little is known about smoking cessation training and practices in transition countries with high smoking prevalence such as Armenia. This study identified smoking-related attitudes and behavior of physicians and nurses in a 500-bed hospital in Yerevan, Armenia, the largest cancer hospital in the country, and explored barriers to their effective participation in smoking cessation interventions. Methods This study used mixed quantitative and qualitative methods. Trained interviewers conducted a survey with physicians and nurses using a 42-item self-administered questionnaire that assessed their smoking-related attitudes and behavior and smoking cessation counseling training. Four focus group discussions with hospital physicians and nurses explored barriers to effective smoking cessation interventions. The focus group sessions were audio-taped, transcribed, and analyzed. Results The survey response rate was 58.5% (93/159) for physicians and 72.2% (122/169) for nurses. Smoking prevalence was almost five times higher in physicians compared to nurses (31.2% vs. 6.6%, p  Conclusions This study was the first to explore differences in smoking-related attitudes and behavior among hospital physicians and nurses in Yerevan, Armenia. The study found substantial behavioral and attitudinal differences in these two groups. The study revealed a critical need for integrating cessation counseling training into Armenia’s medical education. As nurses had more positive attitudes toward cessation counseling compared to physicians, and more often reported having cessation training, they are an untapped resource that could be more actively engaged in smoking cessation interventions in healthcare settings.</p

Learning to assist smokers through encounters with standardized patients: An innovative training for physicians in an Eastern European country

Objectives: A lack of physician training is a major obstacle for effective tobacco dependence treatment. This study assessed the feasibility of an active learning training program and its effects on smoking cessation counselling skills of medical residents in Armenia, an Eastern European country with high smoking prevalence. Study design: The study used a pre-post assessment of smoking cessation counselling activities and a course evaluation survey to assess the feasibility of the intervention in a different environment. Methods: We adapted an active learning training model developed in Switzerland. Residents were trained in Yerevan, Armenia, using video-taped counselling sessions, role plays, standardized patients (actors), group discussions and immediate feedback. The training evaluation was done using a semi-structured anonymous questionnaire. The study assessed the physicians' self-reported smoking cessation counselling activities before and 6 months after the training. A non-parametric Mann-Whitney test was used to assess pre-post differences in physicians' counselling skills measured on ordinal scale. Results: Of the 37 residents trained, 75% were female, 89% aged 20-29 years and 83% were never-smokers. Twenty-eight trainees (76%) returned the course evaluation survey and 32 (86%) answered a questionnaire on skills self-assessment at 6 months follow-up. The majority agreed the course was successful in achieving its learning objectives (64%-96%) and increased their confidence in assisting their patients to quit (74%). After 6 months, the physicians were more likely than at baseline to adhere to evidence-based counselling strategies, including assessing the smoking status and dependence and matching the advice to the patient motivation. The training did not, however, improve the prescription of tobacco dependence medications. Conclusions: Six months after the training, several self-reported smoking cessation counselling activities had significantly improved compared to baseline. This training model is acceptable for medical residents in Yerevan, Armenia and offers a promising approach in addressing the lack of physician counselling skills in similar settings and populations

Current and past smoking patterns in a Central European urban population: a cross-sectional study in a high-burden country

Abstract Background Many studies have examined the socioeconomic variations in smoking and quitting rates across the European region; however, data from Central and East European countries, where the tobacco burden is especially high, are sparse. This study aimed to assess the patterns in current and past smoking prevalence based on cross-sectional data from a Central European urban population sample. Methods Data from 2160 respondents aged 25–64 years in Brno, Czech Republic were collected in 2013–2014 using the Czech post-MONICA survey questionnaire to assess the prevalence of cardiovascular risk factors, including smoking status. The age- and sex-stratified randomized sample was drawn using health insurance registries. Descriptive statistics and quit ratios were calculated, and chi-square and multivariate logistic analyses conducted to examine relationships between current and past smoking and demographic (age, gender, marital status) and socioeconomic variables (education, income, occupation). Results The prevalence of current and past smoking was 23.6 and 31.3 % among men and 20.5 and 23.2 % among women, respectively. Education reliably predicted smoking and quitting rates in both genders. Among men, being unemployed was associated with greater odds of smoking (OR 3.6; 1.6–8.1) and lower likelihood of quitting (OR 0.2: 0.1–0.6); the likelihood of quitting also increased with age (OR 1.8; 1.2–2.8). Among women, marital status (being married) decreased the odds of current smoking (OR 0.6; 0.4–0.9) and increased the odds of quitting (OR 2.2; 1.2–3.9). Quit ratios were the lowest in the youngest age group (25–34 years) where quitting was more strongly associated with middle income (OR 2.7; 95 % CI 1.2–5.9) than with higher education (OR 2.9; 95 % CI 0.9–8.2). Conclusions Interventions to increase cessation rates and reduce smoking prevalence need to be gender-specific and carefully tailored to the needs of the disadvantaged groups of the population, especially the less well-off young adults. Future studies should examine the equity impact of the tobacco control policies and be inclusive of the Central and East European countries