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Introduction: Armenia's and Georgia's high rates of smoking and secondhand smoke and recent implementation of smoke-free laws provide a timely opportunity to examine factors that increase compliance, like social enforcement and support for governmental enforcement. Methods: Using 2022 data from 1,468 Armenian and Georgian adults (Mage=42.92, 48.6% male, 31.6% past-month smoking), multilevel linear regression examined tobacco-related media exposures, social exposures, and perceptions/attitudes in relation to: 1) likelihood of asking someone to extinguish cigarettes where a) prohibited and b) allowed; and 2) support of fines for smoke-free violations (1=not at all to 4=very). Results: There was low average likelihood of asking someone to extinguish cigarettes where allowed (M=1.01, SD=1.12) or prohibited (M=1.57, SD=1.21) and "little" agreement with fines for smoke-free violations (M=2.13, SD=1.06). Having fewer friends who smoked, greater support for indoor smoke-free laws, and no past-month cigarette use were positively associated with all 3 outcomes. Greater exposure to media and community-based action supporting smoke-free policies, and witnessing more requests to stop smoking where prohibited were associated with higher likelihood of asking someone to extinguish cigarettes where allowed or prohibited. Less exposure to news stories opposing smoke-free policies and cigarette ads and higher perceived harm of cigarettes were also related to higher likelihood of asking someone to stop smoking where prohibited. Higher perceived harm of cigarettes was also associated with greater agreement with fines for smoke-free violations. Conclusions: Comprehensive strategies targeting social norms, media exposure, and risk perceptions are needed to effectively facilitate strategies to enhance smoke-free law enforcement. [ABSTRACT FROM AUTHOR]

Local coalitions can advance public health initiative but have not been widely used or well-studied in low- and middle-income countries. This paper provides (i) an overview of an ongoing matched-pairs community-randomized controlled trial in 28 communities in Armenia and Georgia (N = 14/country) testing local coalitions to promote smoke-free policies/enforcement and (ii) characteristics of the communities involved. In July-August 2018, key informants (e.g. local public health center directors) were surveyed to compare their non-communicable disease (NCD) and tobacco-related activities across countries and across condition (intervention/control). More than half of the informants (50.0-57.1%) reported their communities had programs addressing hypertension, diabetes, cancer and human papilloma virus, with 85.7% involving community education and 32.1% patient education programs. Eleven communities (39.3%) addressed tobacco control, all of which were in Georgia. Of those, all included public/community education and the majority (72.7-81.8%) provided cessation counseling/classes, school/youth prevention programs, healthcare provider training or activities addressing smoke-free environments. Informants in Georgia versus Armenia perceived greater support for tobacco control from various sectors (e.g. government, community). No differences were found by condition assignment. This paper provides a foundation for presenting subsequent analyses of this ongoing trial. These analyses indicate wide variability regarding NCD-related activities and support across communities and countries.

Community coalitions depend on their members to synergistically pool diverse resources, including knowledge and expertise, community connections and varied perspectives, to identify and implement strategies and make progress toward community health improvement. Several coalition theories suggest synergy is the key mechanism driving coalition effectiveness. The Community Coalition Action Theory (CCAT) asserts that synergy depends on how well coalitions engage their members and leverage their resources, which is influenced by coalition processes, member participation and satisfaction and benefits outweighing costs. The current study used mixed methods, including coalition member surveys (n  = 83) and semi-structured interviews with leaders and members (n  = 42), to examine the process of creating collaborative synergy in 14 community coalitions for smoke-free environments in Armenia and Georgia. Members, typically seven per coalition representing education, public health, health care and municipal administration sectors, spent an average of 16 hr/month on coalition-related work. Common benefits included making the community a better place to live and learning more about tobacco control. The greatest cost was attending meetings or events at inconvenient times. Members contributed various resources, including their connections and influence, skills and expertise and access to population groups and settings. Strong coalition processes, greater benefits and fewer costs of participation and satisfaction were correlated with leveraging of member resources, which in turn, was highly correlated with collaborative synergy. Consistent with CCAT, effective coalition processes created a positive climate where membership benefits outweighed costs, and members contributed their resources in a way that created collaborative synergy. [ABSTRACT FROM AUTHOR]

The collapse of the Soviet Union in 1991 left many ex-republics in a financial and administrative crisis for the ensuing two decades. Previously centralised processes like recertification of doctors and healthcare workers and continuing medical education fell by the wayside. Continuing medical education and continuing professional development in Armenia have evolved through multiple phases from Soviet, to immediate, mid and late-transitional post-Soviet periods, to current modernising efforts. This manuscript describes the phases of evolution of continuing medical education chronologically and details the legislative and regulatory framework surrounding each stage of development. Armenia is currently implementing a credit system of continuing medical education with the aim to introduce and adopt new and efficient approaches in this field. Continuing education credits fall into three categories: didactic or theoretical knowledge, practical skills and self-education/self-development. To recertify, professionals must collect credits from all three groups with specified minimum amounts according to their degrees. Armenia's guiding principle is to harmonise the continuing medical education and professional development model with internationally accepted criteria in order to contribute to the international mobility of healthcare workers and to provide for true on-going professional development and knowledge that will benefit our doctors, nurses and above all our patients. [ABSTRACT FROM AUTHOR]