Tobacco Free Cities: implementation research with city governments in Pakistan, Bangladesh and Vietnam

Background

In 2021, tobacco killed more than 8 million people worldwide; of these 1.3 million were due to second-hand smoke (SHS). Two-thirds of these SHS deaths were among women and children in low- and middle-income countries (LMICs). Exposure to SHS increases risk of respiratory infections, asthma, cardiovascular diseases, cancers and poor birth outcomes. Protecting people from SHS offers major population health benefits. LMICs are urbanising rapidly; conditions in cities fuel uptake of smoking, particularly among those vulnerable to non-communicable diseases. Despite high smoking prevalence, existence of smoke free laws and potential health and liveability gains, implementation of smoke-free public places in Asian cities is inadequate.

Aims

To enable city actors in Bangladesh, Pakistan, and Vietnam to implement evidence-based, context-specific strategies to ensure smoke-free public places. Objectives:

1. Explore strategies that promote smoke-free cities

2. Evaluate implementation of smoke-free laws and understand their economic value

3. Generate insights on adaptation of evidence-based strategies to promote smoke-free cities

4. Build capacities among researchers and implementers to conduct implementation research in urban contexts.

Project plan

To understand implementation in a range of contexts, we will work in one mega and one smaller city in each country (6 cities). We take an action research approach, guided by the RE-AIM framework.

• Phase 1 – Reconnaissance (month 1-12): Baseline observation of compliance in public places, questionnaires, qualitative interviews with public space users, stakeholder mapping, rapid reviews, and analysis of existing datasets.

• Phase 2 – Co-design (month 12-18): taskforces of city actors and public panels will agree public places to target and select implementation strategies from an evidence-based toolbox.

• Phase 3 – Action-research (month 18-45): Each taskforce will work through cycles of plan, act, observe, reflect, working with our team to monitor compliance. Six-monthly observations and surveys in public spaces will provide data to reshape strategies. Cost data and qualitative interviews with diverse public space users and city authorities on implementation experiences will be collected. The journey of each taskforce, as they optimise implementation strategies through the cycles, will be documented as ‘learning histories’ to inform case-studies and guidelines.

• Phase 4 – Learning and sharing (to month 48): Longitudinal analysis of the closed-cohort (5 time points) of observations to identify changes in compliance and provide insights on economic value and across RE-AIM domains.

The study will provide city leaders with evidence to support implementation of smoke-free laws. Economic analysis will show the value of smoke free public places across sectors. As SHS exposure disproportionately affects the poor and those vulnerable to NCDs, effective implementation will help reduce population health inequities.

Publications and output

For more information about Tobacco Free Cities, you can listen to Professor Huque’s podcast about the project. To access publications and other outputs relating to this project, see our publications webpage.

Funding organisations

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