Introduction:
The CTTS program has been shown to decrease smoking in populations within the United States. The program was adapted into a 1 ½ day training for Macedonian physicians. The overall program aim was to train 100 medical providers in the aCTTS curriculum. The objectives were to: 1) increase provider knowledge and self-efficacy for patient counseling; and, 2) counsel at least 500 patients to quit tobacco use over a one-year period.

Methods:
A longitudinal survey was conducted at baseline, immediate post-intervention (knowledge only), and 6- and 12-months post-intervention. Data were analyzed in SPSS (version 25). Data are analyzed through 6-months post-intervention. Analysis included descriptive data, bivariate analysis to determine significant changes across time, and multivariate analysis to further refine associations between physician demographic characteristics, physician personal smoking history, and changes in knowledge and self-efficacy for counseling between baseline and 6-months post-intervention. In addition, weekly data has been collected from physicians regarding their engagement in tobacco counseling with patients.

Results:
On a 30-item knowledge scale, scores increased between baseline and immediate post-intervention from 10.9 to 17.4 (t=-10.04, p<0.001). Post-intervention, physicians report counseling over 70% of patients who use tobacco. Additional data presented will include impact of the training on physicians’ knowledge about tobacco use, addiction, and health risks, physician-patient communication, physician perceptions and attitudes regarding tobacco use, perceived peer and systemic support for tobacco counseling, and perceived self-efficacy for patient counseling.

Conclusions:
The adapted CTTS program has been well-received by physicians in Macedonia and is contributing to increased counseling for patients of trained providers. Future efforts include expanding the training across Macedonia with potential for use in the broader region.

Funding:
Authors gratefully acknowledge funding through Pfizer Grants for Learning and Change (European Division) and the Global Bridges Healthcare Alliance for Tobacco Dependence Treatment, Mayo Clinic.