Protecting Bangladeshi and Pakistani origin Muslim communities from second-hand smoke by delivering the "Smoke Free Homes" educational programme through faith leaders: Muslim Communities Learning About Second-hand Smoke (MCLASS)

Plain English summary of protocol

Background and study aims
In the UK, 40% of Bangladeshi and 29% of Pakistani men smoke cigarettes regularly compared to the national average of 24%. Second-hand smoking (SHS) is also common in their households, which is a serious health hazard to non-smokers, especially children. Smoking restrictions in households reduces children’s exposure to SHS. In adults, SHS is associated with heart disease, lung disease, and nose and lung cancer. Women’s exposure to SHS during pregnancy increases risk of miscarriage, stillbirth, under development and cot death. It has been suggested that 45% of children in England and Wales live with at least one smoker in their homes. Studies also suggest that teenagers are more likely to take up smoking if their parents are smokers.
SHS is also common in Bangladeshi and Pakistani households. For example, our study in a locality in which nearly 50% of the population is of South Asian origin found that smoking takes place regularly in front of children in 42% of all households with at least one smoker. Other studies also report higher levels of SHS exposure among Bangladeshi-origin children in households with smokers compared to children from other ethnic backgrounds. Moreover, smoking quit rates are lower than the UK average in these groups despite a high motivation to quit. There is a feeling of ‘isolation and marginalisation’ from the existing smoking cessation services and lack of benefit from smoke-free initiatives. There is limited evidence on the effectiveness of protecting non¬smoking adults and children from SHS, particularly in regards to interventions which are acceptable, feasible and sensitive to the needs of ethnic minorities (i.e., Bangladeshi¬ and Pakistani¬ origin communities). Therefore we plan to conduct a pilot trial of ”Smoke Free Homes“, which is an educational programme delivered by Muslim religious teachers in mosques in the UK to reduce second-hand smoke exposure among Bangladeshi- and Pakistani-origin ethnic communities. Our main aim is that the pilot trial will inform the design of a future definitive trial.

Who can participate?
The trial will be carried out in 14 mosques that either host communal prayers, convene study circles for women or have regular Qur’an classes for children. Around 50 households per mosque will be asked to participate.

What does the study involve?
We have developed a package titled “Smoke Free Homes: A resource for Muslim religious teachers”, which consists of a series of fact sheets detailing key information on smoking and SHS, and ”Smoke Free Homes”, a series of activities through which the key information can be circulated. We will randomly divide the 14 mosques into two equal groups. Mosques in one group will be trained and offered the Smoke Free Homes (SFH) programme and asked to carry out the SFH activities within their role and routine at the mosque. Mosques in the other group will not receive any intervention (i.e., training and/or the SFH programme) and therefore they will not carry out the SFH activities at their mosques.
From each of the 14 mosques, we will recruit at least 50 households where there is at least one adult resident who smokes cigarettes or other forms of tobacco, and at least one child or a non-smoking adult. Each of the households will participate in a survey and provide a saliva sample at two points in time (i.e., beginning and after the intervention has run for at least 3 months). The saliva sample will be used to test levels of cotinine, which is a substance found in cigarette smoke and is an indicator of SHS exposure. We will also conduct focus groups discussions and interviews with the mosque chairpersons, religious teachers and members who attend the SFH activities (i.e., adults and children). Using data from these sources, we will evaluate the feasibility and design issues relevant to conducting a definitive trial which aims to investigate whether “Smoke Free Homes” delivered through mosques is an effective way of protecting non¬smokers from second-hand smoke, and to reduce uptake of smoking and improve smoking quit rates in Bangladeshi-¬ and Pakistani-origin Muslim communities in the UK, as well as understanding the extent to which ‘Smoke Free Homes’ can be integrated into mosques’ routines.

What are the possible benefits and risks of participating?
Although the SFH programme has been highlighted in previous studies for reducing the levels of second-hand smoke, there are no particular benefits for the participants and mosques to take part in the trial. Participants in the intervention group will be offered the SFH package, and religious leaders/teachers will receive training as well, which can be perceived as potential benefits by the participants. Our preliminary work suggests that mosques are usually willing to take part in research projects that have the potential to directly benefit the communities they serve.
The SFH programme is an educational package, and the messages used are not harmful. Providing the saliva sample and completing the surveys presents very minimal risks, if any risk, to participants. The content of the SFH package was developed with the active participation of a number of Muslim faith leaders based in mosques in Leeds during our initial feasibility study and our work to ¬date suggests that it is acceptable to use and poses no harm to the participants.

When is the study starting and how long is it expected to run for?
This study will run for around 24 months, staring in April 2012. However, we predict that participants will be involved for considerably less time, since the recruitment of participants and the intervention stage (mosques implementing the SFH programme) will be staggered over a period of four months. We expect participants to be involved for around six to nine months.

Who is funding the study?
Medical Research Council (UK).

Who is the main contact?
Dr Kamran Siddiqi
kamran.siddiqi@york.ac.uk

Contact information

Study information

Eligibility

Locations

Countries of recruitment

• England
• United Kingdom

Study participating centre

Sponsor information

University of York (UK)
University/education

Heslington
York
YO10 5DD
England
United Kingdom

Phone	+44 (0)1904 72 5154
Email	sue.final@york.ac.uk
Website	http://www.york.ac.uk/
"ROR"	https://ror.org/04m01e293

Funders

Funder type

Research council

Results and Publications

Study outputs

Editorial Notes

18/12/2017: internal review.
16/03/2016: Publication reference added.