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Huque R, Siddiqi K, Khokhar M, Jackson C, Kanaan M, Hewitt C, Kellar I, Welch C, Parrott S, Mishu MP, Sheikh A, Iqbal R. Children Learning About Secondhand Smoke (CLASS III): a protocol for a cluster randomised controlled trial of a school-based smoke-free intervention in Bangladesh and Pakistan. BMJ Open 2023; 13:e068620. [PMID: 37451725 PMCID: PMC10351234 DOI: 10.1136/bmjopen-2022-068620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Secondhand smoke (SHS) exposure is a major cause of premature death and disease, especially among children. Children in economically developing countries are particularly affected as smoke-free laws are typically only partially implemented and private homes and cars remain a key source of SHS exposure. Currently, firm conclusions cannot be drawn from the available evidence on the effectiveness of non-legislative interventions designed to protect children from SHS exposure. Following the success of two feasibility studies and a pilot trial, we plan to evaluate a school-based approach to protect children from SHS exposure in Bangladesh and Pakistan-countries with a strong commitment to smoke-free environments but with high levels of SHS exposure in children. We will conduct a two-arm cluster randomised controlled trial in Bangladesh and Pakistan to assess the effectiveness and cost effectiveness of a school-based smoke-free intervention (SFI) in reducing children's exposure to SHS and the frequency and severity of respiratory symptoms. METHODS AND ANALYSIS We plan to recruit 68 randomly selected schools from two cities-Dhaka in Bangladesh and Karachi in Pakistan. From each school, we will recruit approximately 40 students in a year (9-12 years old) with a total of 2720 children. Half of the schools will be randomly allocated to the intervention arm receiving SFI and the other half will receive usual education. Salivary cotinine concentration-a highly sensitive and specific biomarker of SHS exposure-is the primary outcome, which will be measured at month 3 post-randomisation. Secondary outcomes will include frequency and severity of respiratory symptoms, healthcare contacts, school absenteeism, smoking uptake and quality of life. Embedded economic and process evaluations will also be conducted. ETHICS AND DISSEMINATION The trial has received ethics approval from the Research Governance Committee at the University of York. Approvals have also been obtained from Bangladesh Medical Research Council and Pakistan Health Research Council. If SFI is found effective, we will use a variety of channels to share our findings with both academic and non-academic audiences. We will work with the education departments in Bangladesh and Pakistan and advocate for including SFI within the curriculum. TRIAL REGISTRATION NUMBER ISRCTN28878365.
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Affiliation(s)
- Rumana Huque
- Department of Economics, University of Dhaka, Dhaka, Bangladesh
- ARK Foundation, Dhaka, Bangladesh
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
| | - Mariam Khokhar
- Department of Health Sciences, University of York, York, UK
| | | | - Mona Kanaan
- Department of Health Sciences, University of York, York, UK
| | | | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, UK
| | - Charlie Welch
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | | | - Aziz Sheikh
- Division of Community Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Romaina Iqbal
- Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
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Robin RC, Noosorn N. A harm reduction model for environmental tobacco smoke exposure among Bangladeshi rural household children: A modified Delphi technique approach. PLoS One 2023; 18:e0276424. [PMID: 36795709 PMCID: PMC9934442 DOI: 10.1371/journal.pone.0276424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/13/2022] [Indexed: 02/17/2023] Open
Abstract
This paper aimed to develop a harm reduction model to reduce exposure to environmental tobacco smoke among children of rural households in Bangladesh. A mixed-methods exploratory sequential design has been applied, and data has been collated from six randomly selected villages of Munshigonj district, Bangladesh. The research was divided into three phases. In the first phase, the problem was identified through key informant interviews and a cross-sectional study. In the second phase, the model was developed by focus group discussion, and in the third phase, the model was evaluated through the modified Delphi technique. The data was analyzed by thematic analysis and multivariate logistic regression in phase one, qualitative content analysis for phase two, and descriptive statistics in phase three. The key informant interviews showed attitude toward environmental tobacco smoke, lack of awareness, inadequate knowledge as a reason and smoke-free rules, religious beliefs, social norms, and social awareness as preclusion of environmental tobacco smoke. The cross-sectional study detected that households with no smoker (OR 0.006, 95% CI 0.002-0.021), high implantation of smoke-free household rules (OR 0.005, 95% CI 0.001-0.058), moderate (OR 0.045, 95% CI 0.004-0.461) to strong (OR 0.023, 95% CI 0.002-0.224) influence of social norm and culture along with neutral (OR 0.024, 95% CI 0.001-0.510) and positive (OR 0.029, 95% CI 0.001-0.561) peer pressure had been significantly associated with environmental tobacco smoke exposure. The final components of the harm reduction model consist of a smoke-free household, social norms and culture, peer support, social awareness and religious practice identified by the FGDs and modified Delphi technique.
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Affiliation(s)
- Rishad Choudhury Robin
- Faculty of Public Health, Naresuan University, Phitsanulok, Thailand
- Shomman Foundation, Dhaka, Bangladesh
| | - Narongsak Noosorn
- Faculty of Public Health, Naresuan University, Phitsanulok, Thailand
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Jackson C, Huque R, Ahmed F, Nasreen S, Shah S, Ahluwalia JS, Kanaan M, Sheikh A, Siddiqi K. Children Learning About Second-hand Smoke (CLASS II): a mixed methods process evaluation of a school-based intervention. Pilot Feasibility Stud 2021; 7:112. [PMID: 34030729 PMCID: PMC8142478 DOI: 10.1186/s40814-021-00853-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/11/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Children are vulnerable to the effects of second-hand smoke exposure. Creating smoke-free homes is an effective strategy to limit exposure. We developed a smoke-free intervention (SFI) using children as a catalyst for change and teaching skills to negotiate a smoke-free home. In this paper, we present the process evaluation conducted within a pilot trial. METHODS This was a mixed-methods study comprising qualitative interviews and quantitative fidelity assessment of SFI delivery. Interviews in the six intervention schools were conducted with six headteachers and 12 teachers. These explored experiences of delivering the SFI, perceived impact, barriers and facilitators to success, and ideas for improvement and for scaling up. The data were analysed using framework analysis. Delivery of the SFI was observed and fidelity scores calculated. RESULTS The SFI was acceptable to headteachers and teachers. Fidelity scores ranged from 27/40 to 37/40. Didactic components were more fully implemented than interactive components. Time to complete the sessions, timing in the school day and school calendar were key challenges. Embedding the SFI into the curriculum was a potential solution. CONCLUSIONS These findings provide useful information to finalise the content and delivery and inform the scale-up of the SFI for our definitive trial, which is now underway. TRIAL REGISTRATION ISRCTN68690577.
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Affiliation(s)
- Cath Jackson
- Department of Health Sciences, University of York, ARRC Building, Heslington, York, Y010 5DD UK
| | - Rumana Huque
- Department of Economics, University of Dhaka and ARK Foundation, House No 6, Road NO 109, Gulshan 2, Dhaka, Bangladesh
| | - Farid Ahmed
- ARK Foundation, House No 6, Road NO 109, Gulshan 2, Dhaka, Bangladesh
| | - Shammi Nasreen
- ARK Foundation, House No 6, Road NO 109, Gulshan 2, Dhaka, Bangladesh
| | - Sarwat Shah
- Department of Health Sciences, University of York, ARRC Building, Heslington, York, Y010 5DD UK
| | - Jasjit S. Ahluwalia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St, Providence, RI 02912 USA
| | - Mona Kanaan
- Department of Health Sciences, University of York, ARRC Building, Heslington, York, Y010 5DD UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences, The University of Edinburgh, Edinburgh, EH8 9DX UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, ARRC Building, Heslington, York, Y010 5DD UK
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Robin RC, Noosorn N, Alif SM. Secondhand Smoking Among Children in Rural Households: A Community Based Cross-Sectional Study in Bangladesh. Osong Public Health Res Perspect 2020; 11:201-208. [PMID: 32864311 PMCID: PMC7442452 DOI: 10.24171/j.phrp.2020.11.4.09] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives This study aimed to determine the factors associated with reducing exposure to secondhand smoke among children in households of rural Bangladesh. Methods A cross-sectional study of 410 smokers and non-smokers, in 6 villages of Munshigonj district was conducted. Data were collected randomly using a self-administrative questionnaire. Differences between variables were assessed using Chi-square or Fisher's exact test (as appropriate). Univariate and multivariate logistic regression models were used to investigate associations. All results were presented as unadjusted and adjusted odds ratios with a 95% confidence interval. The level of statistical significance was reached when p < 0.05. Results A smoker in the household was determined to be a risk factor associated with exposure of other household members to secondhand smoke (p < 0.001). Higher education, strict implementation of household smoke-free rules, a higher influence of social norms and culture, as well as moderate knowledge on exposure to secondhand smoke were considered as preventive factors associated with exposure of others in the home to secondhand smoke. Conclusion Exposure to secondhand smoke is an extensive and preventable risk factor for children, and reducing exposure to secondhand smoke will have a largely positive effect in the community. An effective public health intervention model may reduce secondhand smoking.
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Affiliation(s)
- Rishad Choudhury Robin
- Department of Community Health, Faculty of Public Health, Naresuan University, Phitsanulok, Thailand
| | - Narongsak Noosorn
- Faculty of Public Health, Naresuan University, Phitsanulok, Thailand
| | - Sheikh Mohammad Alif
- epartment of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Siddiqi K, Huque R, Kanaan M, Ahmed F, Ferdous T, Shah S, Jackson C, Parrott S, Ahluwalia JS, Sheikh A. Children Learning About Secondhand Smoke (CLASS II): A Pilot Cluster Randomized Controlled Trial. Nicotine Tob Res 2020; 21:670-677. [PMID: 29771390 PMCID: PMC6468126 DOI: 10.1093/ntr/nty090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 05/15/2018] [Indexed: 02/02/2023]
Abstract
Introduction Children exposed to secondhand smoke (SHS) are at increased risk of respiratory illnesses. We piloted a Smoke Free Intervention (SFI) and trial methods before investigating its effectiveness and cost-effectiveness in primary school children. Methods In a pilot cluster randomized controlled trial in Bangladesh, primary schools were allocated to usual education (control) or SFI, using minimization. Year-5 children were recruited. Masking treatment allocation was not possible. Delivered by schoolteachers, SFI consisted of two 45-min and four 15-min educational sessions. Our primary outcome was SHS exposure at two months post randomization, verified by children’s salivary cotinine. The trial is registered at ISRCTN.com; ISRCTN68690577. Results Between April 1, 2015 and June 30, 2015, we recruited 12 schools. Of the 484 children present in Year-5, 481 consented. Six schools were allocated to both SFI (n = 245) and to usual education only (n = 236). Of them, 450 children (SFI = 229; control = 221) who had cotinine levels indicative of SHS exposure were followed-up. All schools were retained, 91% children (208/229) in SFI and 88% (194/221) in the control arm completed primary outcome assessment. Their mean cotinine at the cluster level was 0.53 ng/ml (SD 0.36) in SFI and 1.84 ng/ml (SD 1.49) in the control arm—a mean difference of −1.31 ng/ml (95% CI = −2.86 to 0.24). Conclusion It was feasible to recruit, randomize, and retain primary schools and children in our trial. Our study, though not powered to detect differences in mean cotinine between the two arms, provides estimates to inform the likely effect size for future trials. Implications In countries with high smoking prevalence, children remain at risk of many conditions due to secondhand smoke exposure. There is little empirical evidence on the effectiveness and cost-effectiveness of interventions that can reduce their exposure to secondhand smoke at homes. CLASS II trial found that a school-based intervention (SFI) has the potential to reduce children’s exposure to SHS—an approach that has been rarely used, but has considerable merit in school-based contexts. CLASS II trial provides key information to conduct a future definitive trial in this area of public health, which despite its importance has so far received little attention.
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Affiliation(s)
- Kamran Siddiqi
- Department of Health Sciences, University of York Seebohm Rowntree Building, Heslighton, York, UK
| | - Rumana Huque
- Department of Economics, University of Dhaka Social Science Building, Dhaka, Bangladesh
| | - Mona Kanaan
- Department of Health Sciences, University of York Seebohm Rowntree Building, Heslighton, York, UK
| | | | | | - Sarwat Shah
- Department of Health Sciences, University of York ARRC Building, University of York, Heslington, York, UK
| | - Cath Jackson
- Department of Health Sciences, University of York ARRC Building, University of York, Heslington, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York ARRC Building, University of York, Heslington, York, UK
| | | | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Teviot Place, Edinburgh, UK
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Shah S, Kanaan M, Huque R, Sheikh A, Dogar O, Thomson H, Parrott S, Siddiqi K. Secondhand Smoke Exposure in Primary School Children: A Survey in Dhaka, Bangladesh. Nicotine Tob Res 2020; 21:416-423. [PMID: 29228385 PMCID: PMC6472694 DOI: 10.1093/ntr/ntx248] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 11/04/2017] [Indexed: 12/02/2022]
Abstract
Introduction We report on second-hand smoke (SHS) exposure based on saliva cotinine levels among children in Bangladesh—a country with laws against smoking in public places. Methods A survey of primary school children from two areas of the Dhaka district was conducted in 2015. Participants completed a questionnaire and provided saliva samples for cotinine measurement to assess SHS exposure with a cut-off range of ≥0.1ng/mL. Results Four hundred and eighty-one children studying in year-5 were recruited from 12 primary schools. Of these, 479 saliva samples were found sufficient for cotinine testing, of which 95% (453/479) were positive for recent SHS exposure. Geometric mean cotinine was 0.36 (95% CI = 0.32 to 0.40); 43% (208/479) of children lived with at least one smoker in the household. Only 21% (100/479) reported complete smoking restrictions for residents and visitors; 87% (419/479) also reported being recently exposed to SHS in public spaces. Living with a smoker and number of tobacco selling shops in the neighborhood had positive associations with recent SHS exposure. Conclusions Despite having a ban on smoking in public places, recent SHS exposure among children in Bangladesh remains very high. There is an urgent need to reduce exposure to SHS in Bangladeshi children. Implications Children bear the biggest burden of disease due to SHS exposure than any other age group. However, children living in many high-income countries have had a sharp decline in their exposure to SHS in recent years. What remains unknown is if children living in low-income countries are still exposed to SHS. Our study suggests that despite having a ban on smoking in public places, most primary school children in Dhaka, Bangladesh are still likely to be exposed to SHS.
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Affiliation(s)
- Sarwat Shah
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Mona Kanaan
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Rumana Huque
- Department of Economics, University of Dhaka, Social Science Building, Nilkhet, Dhaka, Bangladesh
| | - Aziz Sheikh
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, UK
| | - Omara Dogar
- Department of Health Sciences, University of York, Heslington, York, UK
| | | | - Steve Parrott
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, Heslington, York, UK
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van Wijk EC, Overberg RI, Kunst AE, Harting J. Opportunities for Tailored Support to Implement Smoke-Free Homes: A Qualitative Study among Lower Socioeconomic Status Parents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010222. [PMID: 31892269 PMCID: PMC6981932 DOI: 10.3390/ijerph17010222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/15/2019] [Accepted: 12/23/2019] [Indexed: 11/24/2022]
Abstract
With the aim of preventing children from being exposed to secondhand smoke, we examined to which level lower socio-economic status (SES) households had implemented home smoking rules and the factors that hampered parents in their process of change toward a complete smoke-free home (SFH). We conducted a qualitative study including semi-structured in-depth interviews with 14 parents of young children living in a lower SES neighborhood of a provincial town in the Netherlands. Interview transcripts were subjected to a qualitative content analysis. Three distinct levels of SFH implementation emerged: complete SFH, flexible SFH, and partial SFH. Differences between parents at these three levels essentially concerned: (1) the role of child-related moral considerations in their motivation for an SFH; (2) whether they felt they had the agency to set and enforce home smoking rules; (3) the difficulties they experienced in changing their smoking habit from smoking indoors to smoking outdoors. Parents also had different opinions about the role their children could play in facilitating the parental process of change. We conclude that the current level of SFH implementation may serve as a starting point for developing tailored interventions. Such interventions should probably address other factors than the commonly used awareness–knowledge–commitment approach.
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Affiliation(s)
- Els C. van Wijk
- Amsterdam UMC, Department of Public Health, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (E.C.v.W.); (A.E.K.)
| | - Regina I. Overberg
- Department of Public Health, Public Health Service Kennemerland, Zijlweg 200, 2015 CK Haarlem, The Netherlands;
| | - Anton E. Kunst
- Amsterdam UMC, Department of Public Health, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (E.C.v.W.); (A.E.K.)
| | - Janneke Harting
- Amsterdam UMC, Department of Public Health, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (E.C.v.W.); (A.E.K.)
- Correspondence:
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Mdege N, Fairhurst C, Ferdous T, Hewitt C, Huque R, Jackson C, Kellar I, Parrott S, Semple S, Sheikh A, Swami S, Siddiqi K. Muslim Communities Learning About Second-hand Smoke in Bangladesh (MCLASS II): study protocol for a cluster randomised controlled trial of a community-based smoke-free homes intervention, with or without Indoor Air Quality feedback. Trials 2019; 20:11. [PMID: 30611292 PMCID: PMC6321715 DOI: 10.1186/s13063-018-3100-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 12/04/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Second-hand smoke (SHS) is a serious health hazard costing 890,000 lives a year globally. Women and children in many economically developing countries are worst affected as smoke-free laws are only partially implemented and homes remain a major source of SHS exposure. There is limited evidence on interventions designed to reduce SHS exposure in homes, especially in community settings. Following a successful pilot, a community-based approach to promote smoke-free homes in Bangladesh, a country with a strong commitment to smoke-free environments but with high levels of SHS exposure, will be evaluated. The study aims to assess the effectiveness and cost-effectiveness of a community-based intervention, Muslims for better Health (M4bH), with or without Indoor Air Quality (IAQ) feedback, in reducing non-smokers' exposure to SHS in the home. METHODS/DESIGN Based on behaviour-change theories, M4bH and IAQ feedback are designed to discourage people from smoking indoors. M4bH consists of a set of messages couched within mainstream Islamic discourse, delivered weekly by faith leaders (imams and khatibs) in mosques over 12 weeks (one message each week). The messages address key determinants of current smoking behaviours including lack of knowledge and misconceptions on specific harms associated with SHS exposure. IAQ feedback consists of personalised information on IAQ measured by a particulate matter (PM2.5) monitor within the home. Following adaptation of M4bH and IAQ feedback for the Bangladeshi context, a three-arm cluster randomised controlled trial will be conducted in Dhaka. Forty-five mosques and 1800 households, with at least one smoker and one non-smoker, will be recruited. Mosques will be randomised to: M4bH and IAQ feedback; M4bH alone; or usual services only. The primary outcome is 24-h mean household concentration of indoor fine particulate matter (PM2.5) at 12 months post randomisation. Secondary outcomes are 24-h mean household PM2.5 at 3 months post randomisation, frequency and severity of respiratory symptoms, health care service use and quality of life. A cost-effectiveness analysis and process evaluation will also be conducted. DISCUSSION The MCLASS II trial will test the potential of a community-based intervention to reduce second-hand smoke exposure at home and improve lung health among non-smokers in Bangladesh and beyond. TRIAL REGISTRATION ISRCTN, ISRCTN49975452 . Registered on 11 January 2018.
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Affiliation(s)
- Noreen Mdege
- Department of Health Sciences, Faculty of Sciences, University of York, York, YO10 5DD UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, Faculty of Sciences, University of York, York, YO10 5DD UK
| | - Tarana Ferdous
- ARK Foundation, Suite C-3, C-4, House number 06, Road 109, Dhaka, 1212 Bangladesh
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, Faculty of Sciences, University of York, York, YO10 5DD UK
| | - Rumana Huque
- ARK Foundation, Suite C-3, C-4, House number 06, Road 109, Dhaka, 1212 Bangladesh
- Department of Economics, Dhaka University, Dhaka, Bangladesh
| | - Cath Jackson
- Valid Research Ltd, Sandown House, Sandbeck Way, Wetherby, LS22 7DN UK
| | - Ian Kellar
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT UK
| | - Steve Parrott
- Department of Health Sciences, Faculty of Sciences, University of York, York, YO10 5DD UK
| | - Sean Semple
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, EH8 9AG UK
| | - Shilpi Swami
- Department of Health Sciences, Faculty of Sciences, University of York, York, YO10 5DD UK
| | - Kamran Siddiqi
- Department of Health Sciences, Faculty of Sciences, University of York, York, YO10 5DD UK
- Hull York Medical School, University of York, Heslington, York, YO10 5DD UK
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Allen LN, Pullar J, Wickramasinghe KK, Williams J, Roberts N, Mikkelsen B, Varghese C, Townsend N. Evaluation of research on interventions aligned to WHO 'Best Buys' for NCDs in low-income and lower-middle-income countries: a systematic review from 1990 to 2015. BMJ Glob Health 2018. [PMID: 29527342 PMCID: PMC5841523 DOI: 10.1136/bmjgh-2017-000535] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Non-communicable diseases (NCDs) are the leading cause of death and disability worldwide, with low-income and middle-income countries experiencing a disproportionately high burden. Since 2010 WHO has promoted 24 highly cost-effective interventions for NCDs, dubbed ‘best buys’. It is unclear whether these interventions have been evaluated in low-income and lower-middle-income countries (LLMICs). Aim To systematically review research on interventions aligned to WHO ‘best buys’ for NCDs in LLMICs. Methods We searched 13 major databases and included papers conducted in the 83 World Bank-defined LLMICs, published between 1 January 1990 and 5 February 2015. Two reviewers independently screened papers and assessed risk of bias. We adopted a narrative approach to data synthesis. The primary outcomes were NCD-related mortality and morbidity, and risk factor prevalence. Results We identified 2672 records, of which 36 were included (608 940 participants). No studies on ‘best buys’ were found in 89% of LLMICs. Nineteen of the 36 studies reported on the effectiveness of tobacco-related ‘best buys’, presenting good evidence for group interventions in reducing tobacco use but weaker evidence for interventions targeting individuals. There were fewer studies on smoking bans, warning labels and mass media campaigns, and no studies on taxes or marketing restrictions. There was supportive evidence that cervical screening and hepatitis B immunisation prevent cancer in LLMICs. A single randomised controlled trial supported polypharmacy for cardiovascular disease. Fourteen of the ‘best buy’ interventions did not have any good evidence for effectiveness in LLMICs. Conclusions We found studies on only 11 of the 24 interventions aligned with the WHO ‘best buys’ from LLMIC settings. Most LLMICs have not conducted research on these interventions in their populations. LLMICs should take action to implement and evaluate ‘best buys’ in their national context, based on national priorities, and starting with interventions with the strongest evidence base.
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Affiliation(s)
- Luke N Allen
- Centre on Population Approaches for NCD Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jessica Pullar
- Centre on Population Approaches for NCD Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kremlin Khamarj Wickramasinghe
- Centre on Population Approaches for NCD Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Julianne Williams
- Centre on Population Approaches for NCD Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nia Roberts
- Health Library, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Bente Mikkelsen
- Global Coordination Mechanism for Noncommunicable Diseases, WHO, Geneva, Switzerland
| | - Cherian Varghese
- Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, WHO, Geneva, Switzerland
| | - Nick Townsend
- Centre on Population Approaches for NCD Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Bay JL, Hipkins R, Siddiqi K, Huque R, Dixon R, Shirley D, Tairea K, Yaqona D, Mason-Jones A, Vickers MH. School-based primary NCD risk reduction: education and public health perspectives. Health Promot Int 2017; 32:369-379. [PMID: 28011654 DOI: 10.1093/heapro/daw096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The rising global burden of noncommunicable diseases (NCDs) has heightened awareness of the necessity for primary risk prevention programmes. These aim to facilitate long-term behaviour changes in children and adolescents that can reduce NCD risk factors and disease onset in later-life. School-based programmes designed to improve childhood and adolescent health behaviours and wellbeing contribute to this; however, design and impact assessment of these is complex. These programmes should be multidisciplinary, utilizing both educational and health expertise. Health outcomes may not be evident in the short term, but may occur with learning-related behaviour modifications, highly effective when sustained over a lifetime. Thus assessment must analyse short-term learning and behaviour impacts as well as long-term capability, behaviour and health outcomes.The focus of assessment measures in the health and education sectors differs and often lacks depth in one or other area. Educators generally focus on identifying evidence of learning related to capability, attitude and/or behaviour changes, while public health practitioners typically focus on health measures (e.g. body mass index (BMI), mental health, or risk behaviours).We argue that multidisciplinary approaches incorporating education and health viewpoints clarify issues relating to the potential value of schools as a setting to facilitate primary NCD risk reduction. To demonstrate this, we need to: 1) build stronger understandings of the features of effective learning for behavioural change and the best way to evaluate these, and 2) convincingly correlate these measures with long-term metabolic health indicators by tracking learner behaviour and health over time.
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Affiliation(s)
- Jacquie L Bay
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Gravida: National Centre for Growth and Development, New Zealand
| | - Rosemary Hipkins
- New Zealand Council for Educational Research, Wellington, New Zealand
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
| | - Rumana Huque
- Department of Economics, University of Dhaka, Dhaka, Bangladesh
| | - Robyn Dixon
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Debra Shirley
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Karen Tairea
- Cook Islands Ministry of Health, Te Marae Ora, Rarotonga, Cook Islands
| | | | - Amanda Mason-Jones
- Department of Health Sciences, University of York, York, UK.,Adolescent Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Mark H Vickers
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Gravida: National Centre for Growth and Development, New Zealand
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Brown N, Luckett T, Davidson PM, DiGiacomo M. Family-focussed interventions to reduce harm from smoking in primary school-aged children: A systematic review of evaluative studies. Prev Med 2017; 101:117-125. [PMID: 28601619 DOI: 10.1016/j.ypmed.2017.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 06/04/2017] [Accepted: 06/05/2017] [Indexed: 01/15/2023]
Abstract
Children living in families where adults smoke are exposed to harmful effects of tobacco smoke and risk a predisposition to smoking initiation. Interventions to support families to reduce risk of harm from smoking have been developed and tested. The purpose of this review is to identify effective family-based interventions used to promote smoke-free home environments in families with primary school age children (aged 5-12years). A systematic search of MEDLINE, Cochrane and CINAHL electronic databases was conducted. Narrative synthesis of included articles was completed. Guidelines for reporting behaviour change interventions were used to summarise and compare intervention timing, content, intensity and delivery. Quality of included studies was critiqued using United States Preventative Services Taskforce (USPST) procedures for internal and external validity. Narrative synthesis was based on methods described by Popay and colleagues. Nineteen articles that evaluated 14 intervention studies focussed on child smoking prevention (n=5), parent smoking cessation (n=4) and environmental tobacco smoke reduction (n=6). Interventions and outcomes were heterogeneous, and were rarely informed by theoretical frameworks relating to family, parenting or child development. Family based interventions may be an important strategy to reduce the effects of smoking for children. There is a need for interventions to be informed by theory relevant to children, parenting and families.
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Affiliation(s)
- Nicola Brown
- University of Technology Sydney, Faculty of Health, Centre for Cardiovascular and Chronic Care, P.O. Box 123, Broadway, New South Wales 2007, Australia.
| | - Tim Luckett
- University of Technology Sydney, Faculty of Health, Centre for Cardiovascular and Chronic Care, P.O. Box 123, Broadway, New South Wales 2007, Australia.
| | - Patricia M Davidson
- University of Technology Sydney, Faculty of Health, Centre for Cardiovascular and Chronic Care, P.O. Box 123, Broadway, New South Wales 2007, Australia; Johns Hopkins University, School of Nursing, Baltimore, MD 20215, USA.
| | - Michelle DiGiacomo
- University of Technology Sydney, Faculty of Health, Centre for Cardiovascular and Chronic Care, P.O. Box 123, Broadway, New South Wales 2007, Australia.
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12
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Siddiqi K, Huque R, Jackson C, Parrott S, Dogar O, Shah S, Thomson H, Sheikh A. Children Learning About Secondhand Smoke (CLASS II): protocol of a pilot cluster randomised controlled trial. BMJ Open 2015; 5:e008749. [PMID: 26307620 PMCID: PMC4550726 DOI: 10.1136/bmjopen-2015-008749] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Exposure to secondhand smoke (SHS) increases children's risk of acquiring chest and ear infections, tuberculosis, meningitis and asthma. Smoking bans in public places (where implemented) have significantly reduced adults' exposure to SHS. However, for children, homes remain the most likely place for them to be exposed to SHS. Additional measures are therefore required to protect children from SHS. In a feasibility study in Dhaka, Bangladesh, we have shown that a school-based smoke-free intervention (SFI) was successful in encouraging children to negotiate and implement smoking restrictions in homes. We will now conduct a pilot trial to inform plans to undertake a cluster randomised controlled trial (RCT) investigating the effectiveness and cost-effectiveness of SFI in reducing children's exposure to SHS. METHODS AND ANALYSIS We plan to recruit 12 primary schools in Dhaka, Bangladesh. From these schools, we will recruit approximately 360 schoolchildren in year 5 (10-12 years old), that is, 30 per school. SFI consists of six interactive educational activities aimed at increasing pupils' knowledge about SHS and related harms, motivating them to act, providing skills to negotiate with adults to persuade them not to smoke inside homes and helping families to 'sign-up' to a voluntary contract to make their homes smoke-free. Children in the control arm will receive the usual education. We will estimate: recruitment and attrition rates, acceptability, fidelity to SFI, effect size, intracluster correlation coefficient, cost of intervention and adverse events. Our primary outcome will consist of SHS exposure in children measured by salivary cotinine. Secondary outcomes will include respiratory symptoms, lung function tests, healthcare contacts, school attendance, smoking uptake, quality of life and academic performance. ETHICS AND DISSEMINATION The trial has received ethics approval from the Research Governance Committee at the University of York. Findings will help us plan for the definitive trial. TRIAL REGISTRATION NUMBER ISRCTN68690577.
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Affiliation(s)
- Kamran Siddiqi
- Department of Health Sciences, The University of York, York, UK
| | | | - Cath Jackson
- Department of Health Sciences, The University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, The University of York, York, UK
| | - Omara Dogar
- Department of Health Sciences, The University of York, York, UK
| | - Sarwat Shah
- Department of Health Sciences, The University of York, York, UK
| | | | - Aziz Sheikh
- Centre for Medical Informatics, Usher Institute of Population Heath Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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