Communities facilitating increasing smoke-free homes (CO-FRESH): co-developing an intervention with local stakeholders in Indonesia and Malaysia
Authors: O’Donnell Rachel , Bintoro Bagas Suryo , Rustandi Aliya Wardana , Padmawati Retna Siwi , Ahmad Aidil Ikhwan , Misban Nur Hanisah , Shu’ah Izzah Athirah Mohd , Safee Nur Shafiqa , Zamri Wan Taqiyyah , Kamni Siti Nurhasyimah Ayuni binti , Zulkifli Aziemah , Uny Isabelle , Abidin Emilia Zainal , Prabandari Yayi Suryo , Semple Sean 
Published: November 2024

ABSTRACTIntroductionExposure to second-hand tobacco smoke generates a considerable health burden globally. In south-east Asia, most of that burden falls on women and children who are exposed to second-hand smoke from male smoking in their home. Interventions to encourage smoke-free homes have tended to target smokers individually or within their family unit, although some evidence suggests a community-wide approach holds promise. This study co-developed an intervention toolkit that could be applied to small village/town communities in Indonesia and Malaysia.MethodsThe CO-FRESH study used four work packages to: (i) create online training materials to equip local health professionals to tackle smoking in the home; (ii) create a local public information campaign on the benefits of a smoke-free home; (iii) establish methods to provide household air quality feedback to highlight the impact of smoking in the home; and (iv) map local existing services to support families to create smoke-free homes.ResultsFour specific communities (two in each country) were involved in intervention development. Training materials for health professionals and a toolkit for use by communities to encourage smoke-free homes were co-created. Communities welcomed the concept of tackling smoking in the home, however there was a lack of knowledge about how second-hand smoke moved around the home and could enter indoor spaces from outdoor smoking. The concept of a ‘smoke-free’ home was often misunderstood, alongside what constitutes indoor versus outdoor space. In addition, findings of high background air pollution levels mean that household air quality measurement may not be suited to providing second-hand smoke information in these communities.ConclusionsCommunities in Malaysia and Indonesia recognised the importance of reducing smoking in the home, and welcomed the approach of co-developing community-wide methods of tackling the issue. The CO-FRESH toolkit requires evaluation to determine effectiveness and how it can be implemented at scale.What is already known on this topic?Exposure to second-hand smoke causes nearly 300,000 child deaths per year globally.As a result of high prevalences of adult male smoking, children in South-East Asia have a particularly high rates of exposure to SHS; 58% of children are exposed to SHS in Indonesia and 49% in Malaysia.What does this study add?Whilst participants showed some understanding of the health harms associated with second-hand smoke, many did not realise that smoke travels from one room to another, and can linger in the air for up to five hours.Although men often accepted smoking in the home as a social norm, and women spoke of challenges raising the issue with them, community members and health professionals welcomed the concept of creating a smoke-free home to better protect familial health.How this study might affect research, practice or policy?This study co-developed the CO-FRESH smoke-free homes intervention toolkit, which could be delivered in small village/town communities in Indonesia and Malaysia by healthcare professionals, community leaders and/or peers, to reduce exposure to second-hand smoke in both countries.