A framework for developing an evidence-based, comprehensive tobacco control program

BACKGROUND: Tobacco control is an area where the translation of evidence into policy would seem to be straightforward, given the wealth of epidemiological, behavioural and other types of research available. Yet, even here challenges exist. These include information overload, concealment of key (industry-funded) evidence, contextualization, assessment of population impact, and the changing nature of the threat. METHODS: In the context of Israel's health targeting initiative, Healthy Israel 2020, we describe the steps taken to develop a comprehensive tobacco control strategy. We elaborate on the following: a) scientific issues influencing the choice of tobacco control strategies; b) organization of existing evidence of effectiveness of interventions into a manageable form, and c) consideration of relevant philosophical and political issues. We propose a framework for developing a plan and illustrate this process with a case study in Israel. RESULTS: Broad consensus exists regarding the effectiveness of most interventions, but current recommendations differ in the emphasis they place on different strategies. Scientific challenges include integration of complex and sometimes conflicting information from authoritative sources, and lack of estimates of population impact of interventions. Philosophical and political challenges include the use of evidence-based versus innovative policymaking, the importance of individual versus governmental responsibility, and whether and how interventions should be prioritized.The proposed framework includes: 1) compilation of a list of potential interventions 2) modification of that list based on local needs and political constraints; 3) streamlining the list by categorizing interventions into broad groupings of related interventions; together these groupings form the basis of a comprehensive plan; and 4) refinement of the plan by comparing it to existing comprehensive plans. CONCLUSIONS: Development of a comprehensive tobacco control plan is a complex endeavour, involving crucial decisions regarding intervention components. "Off the shelf" plans, which need to be adapted to local settings, are available from a variety of sources, and a multitude of individual recommendations are available. The proposed framework for adapting existing approaches to the local social and political climate may assist others planning for smoke-free societies. Additionally, this experience has implications for development of evidence-based health plans addressing other risk factors

The effectiveness of the smoking cessation telephone quitline service in Clalit Health Services, Israel

Background and challenges to implementation Smoking cessation workshops were added to the Israel Basket of Health Services in 2010, however a quitline service wasn´t included. In 2013 Clalit Health Services established a pilot project testing a proactive counseling quitline. The service includes six individual counseling provided by cessation counselors, offered in five languages, tailored and cultural adapted. The service is free of charge, participants are given instructions about cessation medication and a tool kit is send by mail. Intervention or response Goals: To evaluate the effectiveness of the program, in terms of smoking cessation and maintenance; understand the barriers to smoking cessation and the reasons for dropping out before the end of the process; understand the factors that drive success for improvement and adaptation of the quitline, according to a needs assessment. Methods: Telephone interviews were conducted among 400 participants who received counseling, using a structured questionnaire, one year following counseling. Results and lessons learnt Counseling was provided mainly in Hebrew (75%), Russian and Arabic. Of the participants who completed the counseling- 77.7% quit smoking and with a one-year continuous abstinence rate of 39.2%. A significant correlation was found between the duration of participation in telephone counseling and the rate of smoking following one year (p< 0.001). Cessation was associated with education and income (p=0.02 and p=0.03, respectively). Among those who relapsed, 50% relapsed within 3 months, due to stress, tension and life/family problems (55%). Telephone consultation was noted as the leading factor for cessation and maintenance (74%). About 90% expressed "satisfaction" to "high-satisfaction" with the quitline. Conclusions and key recommendations This service provides an effective method for cessation and complements the workshops. The results suggest the need to examine reasons for dropout and relapse prevention, such as adding periodical support. In addition, special populations were identified as in need of more intensive support. It´s important to include quitline in the Israel basket of health services