Smoke-free Air Coalitions in Georgia and Armenia: A Community Randomized Trial

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SUMMARY/ABSTRACT Public health efforts in low- and middle-income countries (LMICs) could be catalyzed by bolstering ways to optimally leverage local talents and resources, such as civil society. Developing effective models for aligning civil society and governmental public health at the local level in LMICs has the potential to impact a range of chronic diseases and risk factors, including tobacco. Local coalitions have been a dominant strategy in tobacco control in the US, with well-documented success in establishing smoke-free policies specifically. However, this approach has not been widely leveraged or well-studied in LMICs or those with less democratic traditions than the US. Instead, in many LMICs, smoke-free policy progress is largely initiated at the national level. Parallel civil society movements at the local level may be needed to build support for and compliance with policies. Given their sociopolitical histories and high tobacco use and secondhand smoke exposure (SHSe) rates, Georgia (GE) and Armenia (AM) are two strategic settings for the proposed work. The smoking prevalence is 57.7% and 52.3% in men (6th and 11th highest in the world) and 5.7% and 1.5% in women, respectively. Moreover, our findings indicate extremely high rates of SHSe. However, we also documented high receptivity to public smoke-free policies despite high use rates, particularly in worksites and restaurants. This proposal is a well-justified extension of the literature and our prior work. We will build the capacity of GE and AM researchers to conduct high-quality mixed methods tobacco research and test the Community Coalition Action Theory as a framework for impacting local community-driven policy change. Researchers from the GE National Center for Disease Control (NCDC) and AM National Institute of Health (NIH) will collaborate with Emory to execute the proposed research, train tobacco control researchers within their organizations and partnering universities, and train practitioners within local communities to build local coalitions for tobacco control policy. We aim to: 1) conduct a matched-pair community randomized controlled trial in 28 municipalities in GE and AM to examine the impact of local coalitions promoting the adoption of smoke-free policies in worksites and restaurants, with the primary outcome of changes in SHSe over time; 2) assess how community context and coalition factors influence adoption of organizational and municipal smoke-free policies to provide an evidence- base for public health practice; 3) disseminate research findings regarding both the effectiveness and the process of establishing and maintaining coalitions, and consequently increasing smoke-free policies and reducing SHSe, to key stakeholders in GE and AM; and 4) capitalize on the proposed research and dissemination opportunities to build tobacco control research capacity within the GE NCDC, AM NIH, and partnering universities, as well as practice capacity within local public health centers and their civil society partners. Ultimately, the activities outlined in this proposal will serve as a catalyst for future action-oriented science and evidence-based practice to support tobacco control progress in this region more broadly.