Introduction:
Aims and objectives: Ascertain a basic understanding of the prevalence of tobacco use and policies in representative municipalities in Macedonia.

Methods:
We conducted a windshield survey of six predefined regions in Macedonia with diverse socio-economic, geographic, and environmental characteristics. Windshield surveys are a qualitative research tool for rapid systematic collection of observational data. A project-specific community-based formative research toolkit was created with a dedicated observation form encompassing demographic, organizational data, community identity, economic elements, and use of tobacco in various socio-cultural settings, and personal perception of researchers. Observations were conducted by teams of two researchers by site: one detecting micro focus data (i.e. looking at particular individual’s actions and characteristics) while the other focused on a broader macro perspective (i.e. larger focus on environment and total big-picture numbers).

Results:
The research has shown that in 6/6 (100%) regions, outdoor smoking was present around public places, immediately outside and surrounding the health and educational facilities, in open balconies of restaurants and cafés, public transportation, and in private vehicles. In 2/6 regions (33.4%), researchers detected smoking indoors (shops and restaurants). No significant differences in smoking habits were observed based on site type (urban/rural) or demographics characteristics (e.g., gender, age, socio-economic status). Tobacco products were readily available in all regions in local markets, grocery shops and newsstands. Although tobacco advertising is forbidden, in one site there was an advertisement in front of a shop. Tobacco products were easily visible in the retail locations. In 5/6 (83.3%) regions, people stated it is very difficult to fight tobacco abuse efficiently.

Conclusions:
In Macedonia, tobacco is cheap, easily accessible, and a part of local cultures. These observations were combined with qualitative interview data to adapt the Certified Tobacco Treatment Specialist program for Macedonian physicians and the associated evaluation tools.

Funding:
This project receiving funding from Global Bridges/Pfizer Independent Grant for Learning and Change European Grant Program.