Muslim communities learning about second-hand smoke: a pilot cluster randomised controlled trial and cost-effectiveness analysis

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.

Fathers’ Views and Experiences of Creating a Smoke-Free Home: A Scoping Review

“…A second approach that has shown initial promise is currently being trialled in Bangladesh to evaluate the effectiveness of a community-based intervention to reduce SHS exposure at home, primarily targeting men via mosques [48]. This cluster RCT is based on the findings of a pilot trial that concluded that a smoke-free home intervention was acceptable to Muslim communities, and feasible to deliver in mosques [49,50]. If found to be effective in changing smoking behaviour in the home, this approach could be generalizable to other communities with similar male smoking norms where faith-based settings (i.e., churches, mosques, synagogues) play an integral part in their lives [48].…”

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

“…The interventions have been co-produced with Muslim religious leaders and public health experts in Bangladesh, through an iterative process of adaptation of the SFH intervention developed as part of the MCLASS pilot trial (MR/J000248/1) [19] to the Bangladesh context. IAQ feedback, piloted in Scotland [24] and currently undergoing method development as part of a Medical Research Foundation (MRC) Public Health Intervention Development grant (MR/M026159/1) has also been adapted.…”

“…They will be asked to sign a written agreement to participate for their mosque and themselves. This approach is considered to be reasonable given the organisational structures within mosques based on the MCLASS pilot trial findings [19].…”

“…This research focusses on community-based approaches to protect non-smoking adults and children from the harms of SHS in their homes. The proposal builds on the findings of a pilot trial conducted in England [19], which concluded that a Smoke-Free Homes (SFH) intervention was acceptable to Muslim communities and feasible to deliver in mosques [20]. It was also possible to recruit, randomise and retain mosques and participant households.…”

Involving mosques in health promotion programmes: a qualitative exploration of the MCLASS intervention on smoking in the home

“…Mosques in the control arm did not receive the SFH intervention, but on completion of the trial they were offered the SFH educational package and a detailed guide on training RTs on its use. The detail on findings of the pilot trial in relation to recruitment, effect size, response rates and costs are reported elsewhere [ 31 ]. We present the summary of findings of the pilot trial in Box 1 .…”