Faculty of Medicine

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Factors associated with previous quit attempts and motivation to quit, amongst primary care patients who are current smokers in Macedonia: a Breathe Well study
(Centar of Family Medicine, Faculty of Medicine, “Ss. Cyril and Methodius“ University in Skopje, 2021-05)
Stanoevski, Gjorgji
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Jordan, Rachel
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Adab, Peymanne
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Enocson, Alexandra
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Aim To explore the association between level of nicotine dependence and previous quit attempts and motivation to quit smoking amongst primary care patients. Method We analysed baseline questionnaire data from a randomized controlled trial of a smoking cessation intervention in 31 primary care practices in North Macedonia. Participants were aged ≥35 years and smoked >10 cigarettes/day. Regression models assessed associations between nicotine dependence (Fagerstrom) and intention to quit and previous attempts to quit, adjusting for sociodemographic variables. Results Data was available for 1328 patients. Participants had a mean age of 51,2 (SD 10,3) years, reported a mean smoking history of 39,3 (SD 22,7) pack years and 51% (n=679) were female. 83% (n=1100) of participants were of Macedonian ethnicity. 702 participants (52.9%) reported either moderate or high nicotine dependence. Approximately half of the participants (707/1328, 53.2%, reported previous serious quit attempts, with the majority of these (565/707, 79.9%) reporting 1-3 attempts. Regarding current motivation for quitting, the majority (69.2%) wanted to quit, and 78 (6%) intended to quit in the next 1-3 months. Participants with high nicotine dependence were less likely to have made previous quit attempts (OR=0.90; 95%CI 0.85 to 0.95). Nicotine dependency showed no significant association with current intention to quit (OR=1.00; 95% CI 0.90 to 1.12). Conclusion We found that the majority of smokers want to quit, but those with higher nicotine dependency were less likely to have made previous quit attempts. Declaration of Interest (including funding source and trial registration as appropriate) The authors declare no conflicts of interest. The NIHR Global Health Research (GHR) Programme is funded through UK Official Development Assistance (ODA) via the Department of Health and Social Care (DHSC). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. We gratefully acknowledge IPCRG for introducing us to the primary care networks involved in this study and for its continued facilitation of clinical engagement. The study is registered at http://www.isrctn.com(ISRCTN54228638)
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Tobacco dependence
(Macedonian Respiratory Society, 2025-04-13)
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Todevski, Dejan
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Tushevska Mitkovska, Monika
Tobacco is the leading cause of premature death and disability in Europe. Each year, more than 700,000 Europeans die from tobacco-related illness. In Macedonia, 46.6% of the male and 26.8% of the female population are active smokers. These numbers ascertain Macedonia to the high place in Europe by smoking rates. There is nothing more important we can do for patients who smoke than help them stop! Doctors and health professionals must take into account that tobacco dependence is a medical condition and not a habit, vice, pleasure, or life-style choice and it must be diagnosed and treated in the same way as other chronic diseases. Most smokers are not able to stop on their own (without help). Nicotine dependence is a chronic relapsing condition and has two components: physical dependence and psychological dependence. The tenacity of nicotine addiction means that many smokers who attempt to quit will relapse. Relapse is most common within the first few weeks of quitting. The ENSP Tobacco Treatment Guidelines recommend five strategies for addressing tobacco use in clinical settings. Known as the “5As” these strategies are: Ask all patients about smoking status and document in medical record; Advise patients who smoke to quit; Assess readiness to quit; Assist with making a quit attempt, including providing behavioral counselling and prescribing first-line smoking cessation medications; and Arrange follow-up. Behavioral support (Motivational interviewing) is the keystone of tobacco dependence treatment. It is generally matched to the patient’s motivation to quit smoking also known as the patients “stage of change”. There are five stages of change. Pre-contemplation, Contemplation. Preparation, Action and Maintenance. Tobacco dependence may need persistent and repeated therapeutic interventions, as well as long- term follow-up until it is cured. In order to give our contribution to the reduction of tobacco consumption in Macedonia, we are implementing a program for education of doctors and health workers for smoking cessation. The project represents partnership between the Medical faculty in Skopje and the Henry Ford Health System from Detroit, Michigan, USA.
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Continuous effect of migrant crisis on smoking status among migrants
(European Respiratory Society, 2020)
Monika Tushevska Mitkovska
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Nikola Chamurovski
Introduction: Acknowledging the specific problems of smoking prevalence and cessation in specific high risk populations in 2018, we have conducted a pilot research among migrants in the transitional refugee camps in Bosnia and Hercegovina, to evaluate their smoking habits, showing that migrants crisis has a negative impact on their smoking status. Objective and Method: We aimed to compare and follow the continuous effect of the crisis on the smoking habits, in order to provide data for developing a strategy that can be implemented as an continuous measure in the smoking cessation. From November untill December 2019 we interviewed a total of 368 randomly selected, migrants accommodated in the transitional camps, average length of stay of 70 days. We interwieved 333 men (90%), and 35 women (10%), age of 14-57 with the same questionnaire from the pilot study. Results: 60% were active smokers and 40% were nonsmokers.110 migrants(50%) responded that they have increased the amount of smoked cigarettes since they left they homeland, 65(20%) are smoking less cigarettes compared to the period before they left their homeland, 8(4%) have no difference in the number of smoked cigarettes, 36(16%) have started smoking since they left their homeland. None of the migrants had answered that they quit smoking since they left their homeland. Conclusion: Our data confirmed that the migration crisis has negative impact on the smoking habits of migrants. There was increase of the smoking prevalence and worsening of the smoking status true the migration crisis. We emphasize the need for organizing education and support in the process of quitting smoking for this vulnerable group.
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Strategy for Developing a Smoking Cessation Program in Macedonia
(E-Cronicon, 2020)
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Arben Rexhepi
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Macedonia has one of the highest smoking rates in Europe and ranks among the top ten globally. Although there is a moderately strict anti-smoking legislation, tobacco free policies are not financially supported and smoking cessation activities are not included in the regular educational process of health workers in the country. Smoking cessation is not considered a medical intervention, there is no consistent access to nicotine replacement therapy or other cessation medications, nor are they covered by health insurance. The goal of the partners from Henry Ford Health System and the University St Cyril and Method in Skopje was to develop and adapt a Certified Tobacco Treatment Specialists program (aCTTS). A team of physician champions was created to facilitate implementing the program and to educate respiratory and internal medicine specialists, as well as general practitioners who proceeded treating patients for tobacco dependence. During the first four months of the intervention 64,668 patients visits were registered, 25,710 (40%) of them for tobacco-related diseases. Of the latter, 18,558 (72%) included smoking cessation counseling, which by itself is a great progress to reaching a striving population of smokers.

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