1. Smoke Free Homes – From Leeds to Lahore Heather Thomson

2. Leeds Tobacco Control Strategy 3 key elements  Cessation  Prevention  Protection ….. Smoke Free Homes

3. How did we link with Pakistan The Tobacco Control work in Leeds was presented in Pakistan (Feb 2007). Interest to develop SFH in Lahore, following visit from Institute of Public Health to Leeds (July 2007). Value to Leeds Improve our engagement with the Pakistani Community - our largest ethnic minority NHS Leeds positively responding to ‘Global Health Partnerships’ and ‘Health is Global’

4. A partnership between: Prof. Shaheena Manzoor Dr. Rubina Sarmad Dr. Rabia Arshad Usmani Anila Kanwal Dr. Iram Manzoor Dr. Ian Cameron Dr. Kamran Siddiqi Dr. Nisreen Alwan Heather Thomson Joy Lane

5. Project Vision Project designed to draw together the expertise within public health, local healthcare providers and the local community. Careful monitoring of the process as well as the outputs and outcomes. Mutual sharing of the learning.

6. Smoke Free Homes Aim: To reduce the number of children exposed to second hand smoke in the home. Objectives: To increase the awareness of the impact of second hand smoke on children’s health. To encourage and support families implement smoking restrictions in their home.

7. Behaviour Change Process Knowledge – Harmful effect of second hand smoke Attitude – Reinforce benefits of a smoke free home Practice – Stepped approach to change Plus Reinforcement – Continuing support

8. Delivery of Smoke Free Homes 1 Project delivered by trained professionals e.g. teachers, health care workers, religious and community leaders. Based on a family sign up to a “contract” to keep their homes smoke free. Provision of knowledge: Harmful effects of second hand smoke. Clear, relevant, user friendly information.

9. Delivery of Smoke Free Homes 2 Change of attitude: Reinforce benefits of smoke free homes, creating positive attitude – supported by activities and trained professionals School based activities e.g. drama, artwork, learning through play – Toolkit provided for teachers Face to face interventions with family members using educational resources

10. Delivery of Smoke Free Homes 3 Change in practice: Stepped approach to change, supported by educational resources, reinforced by community events and professionals.

11. Vision for Smoke Free Homes Test Develop Demonstrate Scale up National Policy

12. Testing the project (Dec 07)

13. Development Phase Members of project team from Pakistan visited Leeds for experience and training (February 2008).

14. Developing the resources (Spring 08)

15. Selecting the Area for Project delivery

16. Jia Bagga Largest village in Lahore District 22,000 population 10 LHWs 5 schools (2 Govt. primary boys, I Govt. Primary girls, 2 private schools) Basic Health Unit

17. Smoke Free Homes in Jia Bagga Steering group formed: Principals, LHW supervisor, Imam, Nazim, Doctor of BHU, IPH, NHS Leeds. Tasks Baseline survey Training Delivery of interventions Post intervention evaluation.

18. Schools

19. Lady Health Workers

20. Community Events

21. Results Smoke Free Homes - Jia Bagga

22. Pre- and post-SFH survey 320 households( total population 2155) Average number of people/house 6.73 (SD+ 2.382) Females 47.7 % and males 52.3%. Average number of children/house 4.2 (SD+ 2.1). Mean age of children 8 years (SD+ 5.3) 58.4 % of the adult males and 84.7 % of the adult females - No formal education.

23. Smoking in front of children Households with at least one smoker where smoking takes place in front of children in %age Pre-SFH 90.8% 90.8% (167/184) 95%CI 86.6-94.9% Post-SFH 0% 0% (0/108) 95%CI

25. Smoking status in households Households with at least one regular smoker in %age Pre-SFH 57.5% 57.5% (184/320) 95%CI 52.1-62.9% Post-SFH 38.4% 38.4% (108/281) 95%CI 32.7-44.1%

28. What did the community say? (FGD with professionals, teachers, community leaders and children) “Choosing children to promote message was a wise decision….people try to fulfil the children wishes” (a school teacher) “Parents listened to us carefully and eagerly…….they took interest” (a 10 year old child) “Previously, at the Dera we used to offer huqqa and cigarettes and now we have stopped this tradition” (a community elder) By guiding them and talking to them, we were able to overcome people’s misconceptions” (a LHW)

29. What did the parents say? “We smoke away from children. Planning to discontinue” “Smoking is bad for other family members also” “I do not smoke in front of pregnant women and children” “Our home is free from smoke. We hate smoking”

30. Outputs Jia Bagga Evaluation report Imam guide SFH implementation tool kits Cohort follow up To promote the joint work as an example of best practice in Global Health Partnerships

31. Next steps Inclusion of the SFH toolkit as an element of the Pakistan national tobacco control programme. Demonstrate that the project can be delivered on a larger scale. Now scaling up the project to district level supported by WHO