Why did we choose medical colleges to work with as partners, and India and Indonesia as initial Project QTI sites?
A primary recommendation of the World Health Organization’s Tobacco Free Initiative is the promotion of cessation among health care providers.1 It is reasoned that in order for a downward shift in tobacco use to occur, health care providers must be at the forefront of tobacco cessation efforts. To do so, they need to both quit using tobacco themselves and ask patients about tobacco use and encourage them to quit as a routine part of medical assessment. If tobacco is a priority of the healthcare community in a nation, it may be difficult for a government to ignore the need for a progressive tobacco policy. Unfortunately, physicians and other health care professionals have had little involvement in tobacco cessation efforts in most LMIC, including India and Indonesia. Information on illness-specific harms of tobacco is not integrated into medical school curriculum and cessation skills are not taught to clinicians in training.
India and Indonesia are the second and fifth most populous countries in the world, and two nations where tobacco consumption is pervasive.2 At present, 67% of Indonesian and approximately 19% of Indian men smoke. In India, another 30% of men and 13% of women use smokeless tobacco.
Exposure to secondhand hand smoke in the households of both countries is very common (about 70%). Assisting these countries to accelerate the development of culturally appropriate smoking cessation interventions will have enormous public health impact. The lessons learned in these two countries may prove relevant for other countries.
Turkey has made impressive strides in tobacco control policy, but this has not been accompanied by integration of tobacco cessation in routine medical and nursing practice or training. Smoking prevalence among men is 44% and unlike India and Indonesia, a significant number of women smoke (18%). Smoking prevalence among both genders appears to be on the rise.3 While smoking in public places is strictly banned, secondhand smoke within households is common (74%).
The role of nurses and midwives in tobacco cessation in Turkey is being explored through QTI-inspired research and training with the overall goal of extending the reach of smoking cessation within the Turkish healthcare system. More specifically, nurses and midwives are being trained to introduce illness-specific as well as general cessation within the practice of their sub-specialties. Based on the ongoing experience of nurses, culturally sensitive cessation training is in the process of being tailored to the needs of the Turkish population. QTI Turkey is attempting to involve nurses and midwives in tobacco cessation in order to extend the reach of the modest number of cessation clinics in Turkey and physicians who have been trained largely in pharmacotherapy approaches to tobacco cessation. QTI-inspired nurse training activities in Turkey have been funded by Global Bridges Healthcare Alliance for Tobacco Dependence Treatment. QTI Turkey is now expanding its reach to the training of a new cohort of psychologists who will be working in the Turkish health care system.