title: Developing a smoke free homes initiative in Kerala, India.
abstract: BACKGROUND
  Results of the Global Adult Tobacco Survey in Kerala, India found that 42 % of adults were exposed to second hand smoke (SHS) inside the home. Formative research carried out in rural Kerala suggests that exposure may be much higher. Numerous studies have called for research and intervention on SHS exposure among women and children as an important component of maternal and child health activities.
  
  
  METHODS
  Community-based participatory research was carried out in Kerala. First, a survey was conducted to assess prevalence of SHS exposure in households. Next, a proof of concept study was conducted to develop and test the feasibility of a community-wide smoke free homes initiative. Educational materials were developed and pretested in focus groups. After feasibility was established, pilot studies were implemented in two other communities. Post intervention, surveys were conducted as a means of assessing changes in community support.
  
  
  RESULTS
  At baseline, between 70 and 80 % of male smokers regularly smoked inside the home. Over 80 % of women had asked their husband not to do so. Most women felt powerless to change their husband's behavior. When women were asked about supporting a smoke free homes intervention, 88 % expressed support for the idea, but many expressed doubt that their husbands would comply. Educational meetings were held to discuss the harms of second hand smoke. Community leaders signed a declaration that their community was part of the smoke free homes initiative. Six months post intervention a survey was conducted in these communities; between 34 and 59 % of men who smoked no longer smoked in their home.
  
  
  CONCLUSIONS
  The smoke free homes initiative is based on the principle of collective efficacy. Recognizing the difficulty for individual women to effect change in their household, the movement establishes a smoke free community mandate. Based on evaluation data from two pilot studies, we can project that between a 30 and 60 % reduction of smoking in the home may be achieved, the effect size determined by how well the smoke free home steps are implemented, the characteristics of the community, and the motivation of community level facilitators.
authors.affiliation: University of Arizona, School of Anthropology, Tucson, AZ, USA. mimi.nichter@gmail.com.
authors.forename: Mimi
authors.initials: M
authors.lastname: Nichter
authors.affiliation: Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India. sreedevip.amc@gmail.com.
authors.forename: Sreedevi
authors.initials: S
authors.lastname: Padmajam
authors.affiliation: University of Arizona, School of Anthropology, Tucson, AZ, USA. nichtermark@gmail.com.
authors.forename: Mark
authors.initials: M
authors.lastname: Nichter
authors.affiliation: Additional Professor, Department of Community Medicine, TD Medical College Alappuzha, Kerala, India. sairuphilip09@gmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Sairu
authors.affiliation: Professor, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India. aswathygopan@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Aswathy
authors.affiliation: Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India. minisureshkumar@yahoo.com.
authors.forename: G K
authors.initials: GK
authors.lastname: Mini
authors.affiliation: Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India. vcbindu@yahoo.com.
authors.forename: V C
authors.initials: VC
authors.lastname: Bindu
authors.affiliation: Additional Director of Health Services, Kerala State Health Services, Trivandrum, Kerala, India. aspkset@yahoo.com.
authors.forename: A S
authors.initials: AS
authors.lastname: Pradeepkumar
authors.affiliation: Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India. kavumpurathu@yahoo.com.
authors.forename: K R
authors.initials: KR
authors.lastname: Thankappan
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D055812:Community-Based Participatory Research; D005191:Family Characteristics; D005260:Female; D017144:Focus Groups; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D009042:Motivation; D010865:Pilot Projects; D015995:Prevalence; D016730:Program Development; D012111:Residence Characteristics; D012424:Rural Population / Q000706:statistics & numerical data; D012907:Smoking / Q000453:epidemiology; D000074606:Smoking Prevention; D014028:Tobacco Smoke Pollution / Q000517:prevention & control* / Q000706:statistics & numerical data
chemical_list: D014028:Tobacco Smoke Pollution