Developing a smoke free homes initiative in Kerala, India

BMC Public Health

Research Article

G.K. Mini¹  Sreedevi Padmajam¹  V.C. Bindu¹  K.R. Thankappan¹  A.S. Pradeepkumar²  P. Sairu³  S. Aswathy⁴  Mimi Nichter⁵  Mark Nichter⁵ 

[1] Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India;Additional Director of Health Services, Kerala State Health Services, Trivandrum, Kerala, India;Additional Professor, Department of Community Medicine, TD Medical College Alappuzha, Kerala, India;Professor, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India;University of Arizona, School of Anthropology, Tucson, AZ, USA;

关键词: Smoke free homes;    Secondhand smoke exposure;    India;    Community-based participatory research;   

DOI  :  10.1186/s12889-015-1815-1

 received in 2014-07-29, accepted in 2015-05-01,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundResults of the Global Adult Tobacco Survey in Kerala, India found that 42 % of adults were exposed to second hand smoke (SHS) inside the home. Formative research carried out in rural Kerala suggests that exposure may be much higher. Numerous studies have called for research and intervention on SHS exposure among women and children as an important component of maternal and child health activities.MethodsCommunity-based participatory research was carried out in Kerala. First, a survey was conducted to assess prevalence of SHS exposure in households. Next, a proof of concept study was conducted to develop and test the feasibility of a community-wide smoke free homes initiative. Educational materials were developed and pretested in focus groups. After feasibility was established, pilot studies were implemented in two other communities. Post intervention, surveys were conducted as a means of assessing changes in community support.ResultsAt baseline, between 70 and 80 % of male smokers regularly smoked inside the home. Over 80 % of women had asked their husband not to do so. Most women felt powerless to change their husband’s behavior. When women were asked about supporting a smoke free homes intervention, 88 % expressed support for the idea, but many expressed doubt that their husbands would comply. Educational meetings were held to discuss the harms of second hand smoke. Community leaders signed a declaration that their community was part of the smoke free homes initiative. Six months post intervention a survey was conducted in these communities; between 34 and 59 % of men who smoked no longer smoked in their home.ConclusionsThe smoke free homes initiative is based on the principle of collective efficacy. Recognizing the difficulty for individual women to effect change in their household, the movement establishes a smoke free community mandate. Based on evaluation data from two pilot studies, we can project that between a 30 and 60 % reduction of smoking in the home may be achieved, the effect size determined by how well the smoke free home steps are implemented, the characteristics of the community, and the motivation of community level facilitators.

【 授权许可】

CC BY   
© Nichter et al.; licensee BioMed Central. 2015