A community led tobacco free city

Abstract

Background and challenges to implementation: Framework Convention for Tobacco Control advocates for smoke free cities as an effective strategy. A 'tobacco-free city' advocated by this project is not only a city that protects exposure to tobacco smoke, but has reduced demand and availability of cigarettes as well. Aim was to evaluate the effectiveness and challenges of reducing availability of cigarettes in a semi-urban area in Sri Lanka by a community led process. Intervention or response: A community group led the process. Collective actions such as discussions at different community settings, informal campaigns in public transport, poster campaigns and protests against industrial influence were implemented to improve awareness on effects on health and economy and change norms and attitudes. Evaluation was conducted using participatory mechanisms. Pre and post assessments and the comparison with a control area to assess long term outcomes used mixed methods. Results and lessons learnt: In the pre-test, 91% of shops were selling cigarettes. In one year, daily cigarette sales reduced by 10,415 sticks (86%). Percentage of shops selling cigarettes reduced from 91% to 25% in one year. Among the community, a majority showed a good level of knowledge on health effects and legislations and negative attitudes related to smoking after a one year. Of the participants 63.0%: 95% CI (57.2, 68.8) stated they perceived smoking as a “stupid and a meaningless habit”. The prevalence of smoking (9.09% & 28.0%) and exposure to tobacco smoke (11.7% &65.0%) was low compared to the control area in 18 months (p<0.001). Conclusions and key recommendations: Community led initiatives based on Health Promotion approach are effective in establishing 'Tobacco-free' cities. The community empowerment processes linked with such approaches can reduce the exposure to passive smoking, generating “smoke free cities” as well. Continuous vigilance at ground level and supportive actions from the national level are needed to sustain the results and enhance long term outcomes.