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Kellar I, Al Azdi Z, Jackson C, Huque R, Mdege ND, Siddiqi K. Muslim Communities Learning About Second-hand Smoke in Bangladesh (MCLASS II): a combined evidence and theory-based plus partnership intervention development approach. Pilot Feasibility Stud 2022; 8:136. [PMID: 35780245 PMCID: PMC9250240 DOI: 10.1186/s40814-022-01100-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 04/14/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Deaths from second-hand smoke (SHS) exposure are increasing, but there is not sufficient evidence to recommend a particular SHS intervention or intervention development approach. Despite the available guidance on intervention reporting, and on the role and nature of pilot and feasibility studies, partial reporting of SHS interventions is common. The decision-making whilst developing such interventions is often under-reported. This paper describes the processes and decisions employed during transitioning from the aim of adapting an existing mosque-based intervention focused on public health messages, to the development of the content of novel community-based Smoke-Free Home (SFH) intervention. The intervention aims to promote smoke-free homes to reduce non-smokers’ exposure to SHS in the home via faith-based messages. Methods The development of the SFH intervention had four sequential phases: in-depth interviews with adults in households in Dhaka, identification of an intervention programme theory and content with Islamic scholars from the Bangladesh Islamic Foundation (BIF), user testing of candidate intervention content with adults, and iterative intervention development workshops with Imams and khatibs who trained at the BIF. Results It was judged inappropriately to take an intervention adaptation approach. Following the identification of an intervention programme theory and collaborating with stakeholders in an iterative and collaborative process to identify barriers, six potentially modifiable constructs were identified. These were targeted with a series of behaviour change techniques operationalised as Quranic verses with associated health messages to be used as the basis for Khutbahs. Following iterative user testing, acceptable intervention content was generated. Conclusion The potential of this community-based intervention to reduce SHS exposure at home and improve lung health among non-smokers in Bangladesh is the result of an iterative and collaborative process. It is the result of the integration of behaviour change evidence and theory and community stakeholder contributions to the production of the intervention content. This novel combination of intervention development frameworks demonstrates a flexible approach that could provide insights for intervention development in related contexts. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01100-5.
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Affiliation(s)
- Ian Kellar
- School of Psychology, Faculty of Medicine & Health, University of Leeds, Leeds, LS2 9JT, UK.
| | - Zunayed Al Azdi
- ARK Foundation, Suite C-3, C-4, House number 06, Road 109, Dhaka, 1212, Bangladesh
| | - Cath Jackson
- Valid Research Ltd., Sandown House, Sandbeck Way, Wetherby, LS22 7DN, UK.,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
| | - Noreen Dadirai Mdege
- 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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Arciero E, Dogra SA, Malawsky DS, Mezzavilla M, Tsismentzoglou T, Huang QQ, Hunt KA, Mason D, Sharif SM, van Heel DA, Sheridan E, Wright J, Small N, Carmi S, Iles MM, Martin HC. Fine-scale population structure and demographic history of British Pakistanis. Nat Commun 2021; 12:7189. [PMID: 34893604 PMCID: PMC8664933 DOI: 10.1038/s41467-021-27394-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 11/09/2021] [Indexed: 02/08/2023] Open
Abstract
Previous genetic and public health research in the Pakistani population has focused on the role of consanguinity in increasing recessive disease risk, but little is known about its recent population history or the effects of endogamy. Here, we investigate fine-scale population structure, history and consanguinity patterns using genotype chip data from 2,200 British Pakistanis. We reveal strong recent population structure driven by the biraderi social stratification system. We find that all subgroups have had low recent effective population sizes (Ne), with some showing a decrease 15‒20 generations ago that has resulted in extensive identity-by-descent sharing and homozygosity, increasing the risk of recessive disorders. Our results from two orthogonal methods (one using machine learning and the other coalescent-based) suggest that the detailed reporting of parental relatedness for mothers in the cohort under-represents the true levels of consanguinity. These results demonstrate the impact of cultural practices on population structure and genomic diversity in Pakistanis, and have important implications for medical genetic studies.
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Affiliation(s)
- Elena Arciero
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK.
| | - Sufyan A. Dogra
- grid.418449.40000 0004 0379 5398Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Daniel S. Malawsky
- grid.10306.340000 0004 0606 5382Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Massimo Mezzavilla
- grid.5133.40000 0001 1941 4308Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Theofanis Tsismentzoglou
- grid.9909.90000 0004 1936 8403Leeds Institute for Data Analytics, University of Leeds, Leeds, UK ,grid.9909.90000 0004 1936 8403Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Qin Qin Huang
- grid.10306.340000 0004 0606 5382Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Karen A. Hunt
- grid.4868.20000 0001 2171 1133Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Dan Mason
- grid.418449.40000 0004 0379 5398Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Saghira Malik Sharif
- grid.415967.80000 0000 9965 1030Yorkshire Regional Genetics Service, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - David A. van Heel
- grid.4868.20000 0001 2171 1133Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Eamonn Sheridan
- grid.9909.90000 0004 1936 8403Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - John Wright
- grid.418449.40000 0004 0379 5398Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Neil Small
- grid.6268.a0000 0004 0379 5283Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, UK
| | - Shai Carmi
- grid.9619.70000 0004 1937 0538Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mark M. Iles
- grid.9909.90000 0004 1936 8403Leeds Institute for Data Analytics, University of Leeds, Leeds, UK ,grid.9909.90000 0004 1936 8403Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Hilary C. Martin
- grid.10306.340000 0004 0606 5382Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
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Delivering a childhood obesity prevention intervention using Islamic religious settings in the UK: What is most important to the stakeholders? Prev Med Rep 2021; 22:101387. [PMID: 34012766 PMCID: PMC8113716 DOI: 10.1016/j.pmedr.2021.101387] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/28/2021] [Accepted: 04/15/2021] [Indexed: 11/30/2022] Open
Abstract
Obesity prevention interventions could be delivered through Islamic religious settings. Co-production with target communities is essential to ensure cultural sensitivity and relevance. Integrating Islamic narrative on healthy behaviours could enhance uptake and adherence. Interventions should be adequately resourced, considering the cost of staff, space and materials. Collaborating with external organisations can support scalability.
Ten per cent of the childhood population in the UK are of South Asian (SA) origin. Within this population, over 40% are living with overweight or obesity. The majority of SA children are Muslim and attend Islamic religious settings (IRS) daily after school. Because of their reach and influence, IRS may be an appropriate channel for obesity prevention initiatives. We conducted 20 in-depth interviews with parents of children attending IRS, 20 with Islamic leaders, and 3 focus group discussions with 26 managers and workers of IRS in Bradford and Birmingham. Topic guides were developed, interviews and focus group discussions were audio-recorded, transcribed, and analysed thematically. Muslim parents, Islamic leaders and IRS staff were supportive of the delivery of obesity prevention interventions for children using IRS. Participants identified important components of an intervention including: Prophet Muhammad (PBUH) as a role model for healthy lifestyle; healthy diet, physical activity, and organisational behaviour change within IRS. Participants suggested that Islamic narrative on healthy diet and physical fitness could increase delivery uptake. Staff showed willingness to conduct physical activity sessions for boys and girls. Barriers for the intervention delivery were poor funding systems and time constraints for staff. All participant groups thought that it would be possible to deliver a childhood obesity prevention intervention. Interventions should be co-designed, culturally and religiously sensitive and combine the scientific guidelines on healthy living with Islamic narrative on importance of healthy diet consumption and physical activity.
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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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Livingstone‐Banks J, Ordóñez‐Mena JM, Hartmann‐Boyce J. Print-based self-help interventions for smoking cessation. Cochrane Database Syst Rev 2019; 1:CD001118. [PMID: 30623970 PMCID: PMC7112723 DOI: 10.1002/14651858.cd001118.pub4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Many smokers give up smoking on their own, but materials that provide a structured programme for smokers to follow may increase the number who quit successfully. OBJECTIVES The aims of this review were to determine the effectiveness of different forms of print-based self-help materials that provide a structured programme for smokers to follow, compared with no treatment and with other minimal contact strategies, and to determine the comparative effectiveness of different components and characteristics of print-based self-help, such as computer-generated feedback, additional materials, tailoring of materials to individuals, and targeting of materials at specific groups. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Trials Register, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP). The date of the most recent search was March 2018. SELECTION CRITERIA We included randomised trials of smoking cessation with follow-up of at least six months, where at least one arm tested print-based materials providing self-help compared with minimal print-based self-help (such as a short leaflet) or a lower-intensity control. We defined 'self-help' as structured programming for smokers trying to quit without intensive contact with a therapist. DATA COLLECTION AND ANALYSIS We extracted data in accordance with standard methodological procedures set out by Cochrane. The main outcome measure was abstinence from smoking after at least six months' follow-up in people smoking at baseline. We used the most rigorous definition of abstinence in each study and biochemically validated rates when available. Where appropriate, we performed meta-analysis using a random-effects model. MAIN RESULTS We identified 75 studies that met our inclusion criteria. Many study reports did not include sufficient detail to allow judgement of risk of bias for some domains. We judged 30 studies (40%) to be at high risk of bias for one or more domains.Thirty-five studies evaluated the effects of standard, non-tailored self-help materials. Eleven studies compared self-help materials alone with no intervention and found a small effect in favour of the intervention (n = 13,241; risk ratio (RR) 1.19, 95% confidence interval (CI) 1.03 to 1.37; I² = 0%). We judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for indirect relevance to populations in low- and middle-income countries because evidence for this comparison came from studies conducted solely in high-income countries and there is reason to believe the intervention might work differently in low- and middle-income countries. This analysis excluded two studies by the same author team with strongly positive outcomes that were clear outliers and introduced significant heterogeneity. Six further studies of structured self-help compared with brief leaflets did not show evidence of an effect of self-help materials on smoking cessation (n = 7023; RR 0.87, 95% CI 0.71 to 1.07; I² = 21%). We found evidence of benefit from standard self-help materials when there was brief contact that did not include smoking cessation advice (4 studies; n = 2822; RR 1.39, 95% CI 1.03 to 1.88; I² = 0%), but not when self-help was provided as an adjunct to face-to-face smoking cessation advice for all participants (11 studies; n = 5365; RR 0.99, 95% CI 0.76 to 1.28; I² = 32%).Thirty-two studies tested materials tailored for the characteristics of individual smokers, with controls receiving no materials, or stage-matched or non-tailored materials. Most of these studies used more than one mailing. Pooling studies that compared tailored self-help with no self-help, either on its own or compared with advice, or as an adjunct to advice, showed a benefit of providing tailored self-help interventions (12 studies; n = 19,190; RR 1.34, 95% CI 1.20 to 1.49; I² = 0%) with little evidence of difference between subgroups (10 studies compared tailored with no materials, n = 14,359; RR 1.34, 95% CI 1.19 to 1.51; I² = 0%; two studies compared tailored materials with brief advice, n = 2992; RR 1.13, 95% CI 0.86 to 1.49; I² = 0%; and two studies evaluated tailored materials as an adjunct to brief advice, n = 1839; RR 1.72, 95% CI 1.17 to 2.53; I² = 10%). When studies compared tailored self-help with non-tailored self-help, results favoured tailored interventions when the tailored interventions involved more mailings than the non-tailored interventions (9 studies; n = 14,166; RR 1.42, 95% CI 1.20 to 1.68; I² = 0%), but not when the two conditions were contact-matched (10 studies; n = 11,024; RR 1.07, 95% CI 0.89 to 1.30; I² = 50%). We judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for risk of bias.Five studies evaluated self-help materials as an adjunct to nicotine replacement therapy; pooling three of these provided no evidence of additional benefit (n = 1769; RR 1.05, 95% CI 0.86 to 1.30; I² = 0%). Four studies evaluating additional written materials favoured the intervention, but the lower confidence interval crossed the line of no effect (RR 1.20, 95% CI 0.91 to 1.58; I² = 73%). A small number of other studies did not detect benefit from using targeted materials, or find differences between different self-help programmes. AUTHORS' CONCLUSIONS Moderate-certainty evidence shows that when no other support is available, written self-help materials help more people to stop smoking than no intervention. When people receive advice from a health professional or are using nicotine replacement therapy, there is no evidence that self-help materials add to their effect. However, small benefits cannot be excluded. Moderate-certainty evidence shows that self-help materials that use data from participants to tailor the nature of the advice or support given are more effective than no intervention. However, when tailored self-help materials, which typically involve repeated assessment and mailing, were compared with untailored materials delivered similarly, there was no evidence of benefit.Available evidence tested self-help interventions in high-income countries, where more intensive support is often available. Further research is needed to investigate effects of these interventions in low- and middle-income countries, where more intensive support may not be available.
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King R, Warsi S, Amos A, Shah S, Mir G, Sheikh A, Siddiqi K. Involving mosques in health promotion programmes: a qualitative exploration of the MCLASS intervention on smoking in the home. HEALTH EDUCATION RESEARCH 2017; 32:293-305. [PMID: 28854570 PMCID: PMC5914388 DOI: 10.1093/her/cyx051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 06/26/2017] [Indexed: 06/07/2023]
Abstract
Second-hand smoke (SHS) exposure is high among UK Bangladeshi and Pakistani populations, reflecting higher male smoking prevalence and fewer home smoking restrictions than the general population. The Muslim Communities Learning About Second-hand Smoke (MCLASS) study explored the feasibility and acceptability of implementing SHS education in 14 UK mosques. Religious teachers (RTs) in seven intervention mosques were trained and provided with a culturally appropriate educational package. After the intervention, mosque leaders, RTs and congregants' experiences and perceptions of the intervention were explored through interviews and focus group discussions. Delivery of the intervention varied across mosques. Facilitators and barriers included: mosque diversity (congregation size, organizational structure, educational activities, women's role and involvement); degree of trust between researchers and personnel; and views on SHS. Most participants thought mosques' involvement in SHS health promotion was appropriate, but the perceived importance of SHS differed. We found that a health promotion programme delivered within Islamic religious settings that engages RTs in the process of facilitation, can be acceptable and feasible, but care must be taken to explore the culture and ethos of the institution, including its organizational structure, management committee, RTs and congregation.
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Affiliation(s)
- R. King
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - S. Warsi
- Department of Health Sciences, University of York, York, UK
| | - A. Amos
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Edinburgh, UK
| | - S. Shah
- Department of Health Sciences, University of York, York, UK
| | - G. Mir
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - A. Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Edinburgh, UK
| | - K. Siddiqi
- Department of Health Sciences, University of York, York, UK
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Shah S, Ainsworth H, Fairhurst C, Tilbrook H, Sheikh A, Amos A, Parrott S, Torgerson D, Thompson H, King R, Mir G, Siddiqi K. Muslim communities learning about second-hand smoke: a pilot cluster randomised controlled trial and cost-effectiveness analysis. NPJ Prim Care Respir Med 2015; 25:15052. [PMID: 26313312 PMCID: PMC4551097 DOI: 10.1038/npjpcrm.2015.52] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/04/2015] [Accepted: 06/22/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In the United Kingdom, men of Bangladeshi and Pakistani origin have higher smoking rates than the general population. This makes non-smokers in their households more vulnerable to second-hand smoke (SHS) exposure than the general population. AIMS The aim of this study was to investigate the feasibility of implementing and pilot testing the effectiveness and cost-effectiveness of a 'Smoke-free Homes' (SFH) intervention in Islamic religious settings to encourage families of Bangladeshi and Pakistani origin to apply smoking restrictions in their homes. METHODS We allocated Islamic religious settings (clusters) to either receive SFH-an educational intervention-or to a control arm. Within each cluster, we recruited households with at least one smoker and one non-smoker. SHS exposure among non-smokers was measured using salivary cotinine. RESULTS Seven (50%) clusters were randomised to each trial arm. A total of 468 households were assessed for eligibility and 62% (n=289) were eligible, of which 74% (n=213) agreed to participate in the trial. Six of the seven intervention clusters delivered the intervention, and all clusters were retained throughout the trial. In all, 81% (n=172) of households provided data at follow-up. No evidence of a difference in log cotinine level was observed (adjusted mean difference -0.02, 95% confidence interval (CI) -1.28-1.23, P=0.97) between the two trial arms. The direct mean cost of delivering the intervention was £18.18 per household (range £3.55-42.20). CONCLUSIONS It was possible to recruit, randomise and retain Islamic religious settings and participant households. However, some of the original assumptions, in particular our ability to collect primary outcome data, need to be revisited before a definitive trial.
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Affiliation(s)
- Sarwat Shah
- Department of Health Sciences, University of York, York, UK
| | - Hannah Ainsworth
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Helen Tilbrook
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Aziz Sheikh
- Centre for Population Health Sciences, The University of Edinburgh, Medical School, Edinburgh, UK
| | - Amanda Amos
- Centre for Population Health Sciences, The University of Edinburgh, Medical School, Edinburgh, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Heather Thompson
- The Office of The Director of Public Health, Leeds City Council, Leeds, UK
| | - Rebecca King
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ghazala Mir
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
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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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