Introduction:
A Certified Tobacco Treatment Specialist (CTTS) program was adapted to address socio-cultural contexts of tobacco use in FYROM. The training objectives were to increase provider knowledge regarding tobacco use and risks; increase provider self-efficacy for patient counseling; decrease tobacco use among providers; and document provider counseling during post-intervention clinic appointments.

Methods:
A survey was conducted at baseline, and 6- and 12-months post-intervention. Bivariate and multivariate analyses were conducted to determine significant changes across time and refine associations between independent and dependent variables. Weekly logbook data documented numbers of patients counseled and time spent counseling.

Results:
Of 97 participants who completed baseline, 72 (74.2%) completed the 12-month survey. Scores on a 30-item knowledge scale increased between baseline (10.5), 6-month (18.9) and 12-month (20.7) post-intervention (p<0.001). Between baseline and 12 months, perceived barriers to engaging with patients regarding tobacco use decreased (p=0.001) and confidence in providing tobacco treatment counseling increased (p=0.046). At baseline and 12-month post-intervention respectively, 29% and 20% of respondents reported current smoking (p<.001). Providers’ interest or engagement in quitting tobacco increased significantly between baseline and 6-month (p=0.026) and 12-month (p=0.019) post-intervention. Logbook data indicate that 39% of patient visits were tobacco related with 78% of those patients receiving counseling.

Conclusion:
There is an urgent need for tobacco-focused education among health providers in FYROM. The adapted CTTS program was well-received. Data indicate physicians are engaging in tobacco counseling, with increased knowledge and greater confidence. Future efforts include expanding training in FYROM and possibly elsewhere in the Balkan region.