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

众所周知，吸烟有害健康，但吸入别人的烟也很危险。事实上，据估计，仅在2021年，全球就有800多万人死于烟草，其中130万人死于二手烟。这些死亡大多发生在低收入和中等收入国家。在拥挤的城市，接触烟草烟雾的比例特别高，香烟的供应和广告也是如此。然而，城市可以通过制定章程、跨部门合作和利用大众媒体，走在变革的前沿。禁止在公共场所吸烟的法律已被证明是减少接触二手烟的有效方法。然而，挑战在于如何执行这些法律。这在快速发展的城市尤其具有挑战性。例如，在我们计划研究的三个国家，孟加拉国，巴基斯坦和越南，虽然有法律禁止在公共场所吸烟，但遵守率很低。在孟加拉国，42.7%在室内工作的成年人和44%使用公共交通工具的成年人暴露于烟草烟雾；在越南，餐馆的合规率仅为30.9%，酒吧为36.2%，咖啡馆为42%。在巴基斯坦的卡拉奇，只有57%的公共场所遵守了禁烟法。在这项为期4年的研究中，我们的目标是使用行动研究方法来产生知识，使孟加拉国、巴基斯坦和越南的城市管理部门能够实施基于证据的、针对具体情况的战略，以确保遵守公共场所无烟法律：1)探索促进无烟城市的战略；2)评估无烟法律的实施及其经济价值。3)了解适应循证战略促进无烟城市。4)加强研究人员和实施者在城市环境下开展实施研究的能力建设。为了了解不同背景下的实施情况，我们将在每个国家的一个大城市和一个小城市开展工作。行动研究方法涉及“计划-行动-反思-观察”的连续循环，涉及那些在日常工作和生活中沉浸在问题中的人。我们将与城市当局密切合作，建立或加强现有的工作组，将负责确保这些法律实施的城市部门和部门的行动者聚集在一起。每个城市的工作组将通过行动研究周期来优化实施策略——我们的研究人员将分享6个月的合规观察数据，并在选定的公共场所进行定期调查，以帮助他们在整个过程中反思和重塑策略。定性观察和访谈将有助于理解这一过程。在整个过程中，我们将广泛分享知识，并通过每个城市的“学习历史”记录经验教训。这些建议将作为指导，支持在研究国家及其他地区的其他城市可持续实施和推广。

It is well known that smoking tobacco is bad for your health, but breathing in other people's smoke is also dangerous. In fact, it estimated that in 2021 alone, tobacco killed more than 8 million people worldwide, and of these 1.3 million were due to second-hand smoke. Most of these deaths were in low- and middle-income countries. In crowded cities, exposure to tobacco smoke is particularly high, as is the supply and advertising of cigarettes. Yet, cities can be at the forefront of change by passing by-laws, working across sectors and using mass media. Laws that forbid smoking in public places have been shown to be an effective way to reduce exposure to second-hand smoke. The challenge, however, is in enforcing these laws. This is particularly challenging in rapidly growing cities. For instance, in the three countries we plan to study i.e., Bangladesh, Pakistan and Vietnam, while there are laws that forbid smoking in public places, the compliance is very low. In Bangladesh 42.7% of adults who worked indoors and 44% of those who used public transport were exposed to tobacco smoke; in Vietnam compliance in restaurants is just 30.9%, in bars 36.2%, and 42% in cafes. In Karachi, Pakistan only 57% of public places complied with smoke-free laws.In this 4-year study our aim is to use an action research approach to generate knowledge to enable city administrations in Bangladesh, Pakistan, and Vietnam to implement evidence-based, context-specific strategies to ensure compliance with laws on smoke free public places by 1) exploring strategies that promote smoke-free cities 2) Evaluating implementation of smoke-free laws and their economic value. 3) Understanding adaptation of evidence-based strategies to promote smoke-free cities. 4) Building capacities among researchers and implementers to conduct implementation research in urban contexts. To understand implementation in a range of contexts, we will work in one mega and one smaller city in each country. The action research approach involves continuous cycles of 'plan-act-reflect-observe' involving those who are immersed in the issue in their everyday work and lives. We will work closely with city authorities to establish or strengthen existing taskforces that will bring together actors across city departments and sectors who are responsible for ensuring the implementation of these laws. The taskforce in each city will work through the action research cycles to optimise implementation strategies - our researchers will share data from 6 monthly observations of compliance and regular surveys in their selected public places to help them reflect and reshape strategies throughout the process. Qualitative observations and interviews will help understand the process.Throughout we will share knowledge widely, and document lessons learnt through 'learning histories' for each city. These will serve as guidance to support sustainable implementation and scale up in other cities in study countries and beyond.