COmmunities Facilitating incREasing Smoke-free Homes (CO-FRESH)

Breathing second-hand tobacco smoke is directly harmful to health, while seeing parents smoke can also encourage children to start smoking. Second-hand smoke exposure causes an estimated 1.2 million premature deaths each year together with considerable health burden from a wide range of illness from ear infections through to life-limiting chronic obstructive pulmonary disease (COPD). Some of the highest global rates of children breathing second-hand smoke are found in low and middle income countries particularly in south and south-east Asia.

The COFRESH study will look at developing a new approach to encouraging smokers to make their home a tobacco smoke-free environment to protect the health of their family. Previous methods have focussed on targeting individuals but this work will be about helping communities tackle the problem together. It will be aimed at small towns and villages and will seek to involve all aspects of community life including healthcare professionals, schools, service providers, local employers and community leaders to work together to increase the proportion of homes where smoke-free becomes the 'new normal'.

COFRESH will involve a team from the University of Stirling, Universiti Putra Malaysia and Universitas Gadjah Mada working with communities in Malaysia and Indonesia to develop a community intervention to protect non-smokers from the harms of second-hand smoke within the home. The project will involve five key parts. 1. Development of training on the benefits of smoke-free homes for health professionals so they can provide brief advice at every contact with smokers and their families within the community. 2. Generation of a local information campaign to include a series of poster, word of mouth, social media and media engagement work that would be delivered through workplaces, schools and leisure settings. 3. Application of low-cost methods to engage local families in citizen science air quality measurement work that will provide personalised data showing how smoking at home produces high indoor pollution levels. 4. Methods to support smokers and their families through visible declarations or pledges to a smoke-free home, and in signposting to local smoking cessation services. 5. Development of ways in which we can assess the success of the scheme in any future trial.

The project will develop this community-led approach to smoke-free homes with the aim of a future trial that will implement the scheme in four villages/towns and compare the results with four comparable communities that do not receive the intervention.

Breathing the second-hand tobacco smoke (SHS) is estimated to cause over 880,000 premature deaths each year globally. SHS exposure is more common in disadvantaged households and poses particular long-term health burdens for children as they have smaller, and developing, respiratory systems. Deaths in childhood account for 28% of SHS-related deaths and 61% of the estimated 11 million disability-adjusted life-years lost per annum. Early life exposure to SHS is associated with impaired intra-uterine growth, smaller lungs, more respiratory infections, and exacerbations of asthma and illnesses such as glue ear. A child exposed to SHS in the home is also more likely to grow up to become a teenage and adult smoker.

The 'COmmunities Facilitating incREasing Smoke-free Homes' (CO-FRESH) project will develop a co-created, community-level intervention to increase the proportion of smoke-free households within small towns and villages in low- and middle-income countries (LMICs). It will build on and combine previous work carried out by the University of Stirling and Universiti Putra Malaysia, aimed at encouraging individual behaviour change to prevent smoking in the home, with community-level intervention experience from the Universitas Gadjah Mada in Indonesia. The project will: (i) educate health and allied-health professionals about the benefits of a smoke-free home; (ii) inform the local population about the harms of second-hand tobacco smoke through targeted campaigns at smokers, non-smokers and children, and engagement with community influencers; (iii) provide personalised information to families about the impact of smoking on their household air quality; (iv) enable individual behaviour change through advice and support; and (v) establish mechanisms to measure and audit smoke-free homes (SFH) compliance.

The work will also aim to lead to a full proposal to implement and evaluate a trial of the developed COFRESH intervention.