Examining local smoke-free coalitions in Armenia and Georgia: context and outcomes of a matched-pairs community-randomised controlled trial.

Publication date: Feb 07, 2024

Local coalitions can advance public health initiatives such as smoke-free air but have not been widely used or well-studied in low-income and middle-income countries. We conducted a matched-pairs community-randomised controlled trial in 28 communities in Armenia and Georgia (N=14/country) in which we helped establish local coalitions in 2019 and provided training and technical assistance for coalition activity promoting smoke-free policy development and enforcement (2019-2021). Surveys of ~1450 households (Fall 2018, May-June 2022) were conducted to evaluate coalition impact on smoke-free policy support, smoke-free home adoption, secondhand smoke exposure (SHSe), and coalition awareness and activity exposure, using multivariable mixed modelling. Bivariate analyses indicated that, at follow-up versus baseline, both conditions reported greater smoke-free home rates (53. 6% vs 38. 5%) and fewer days of SHSe on average (~11 vs ~12 days), and that intervention versus control condition communities reported greater coalition awareness (24. 3% vs 12. 2%) and activity exposure (71. 2% vs 64. 5%). Multivariable modelling indicated that intervention (vs control) communities reported greater rates of complete smoke-free homes (adjusted Odds Ratio [aOR] 1. 55, 95% confiedence interval [CI] 1. 11 to 2. 18, p=0. 011) and coalition awareness (aOR 2. 89, 95% CI 1. 44 to 8. 05, p=0. 043) at follow-up. However, there were no intervention effects on policy support, SHSe or community-based activity exposure. Findings must be considered alongside several sociopolitical factors during the study, including national smoke-free policies implementation (Georgia, 2018; Armenia, 2022), these countries’ participation in an international tobacco legislation initiative, the COVID-19 pandemic and regional/local war). The intervention effect on smoke-free homes is critical, as smoke-free policy implementation provides opportunities to accelerate smoke-free home adoption via local coalitions. NCT03447912.

Concepts Keywords
Armenia Cluster randomized trial
June Health policy
Pandemic Public Health


Type Source Name
drug DRUGBANK Medical air
disease IDO country
disease IDO intervention
disease MESH COVID-19 pandemic

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