A situational analysis as groundwork for the FRESHAIR4Life study: Targeting tobacco use and air pollution for the prevention of non-communicable diseases in adolescents worldwide

Introduction: Addressing the urgent need for non-communicable diseases prevention, the FRESHAIR4Life study targets two major modifiable risk factors: tobacco use and air pollution exposure. Interventions on community- and individual level can be effective, but are rarely implemented successfully. Although adolescents represent an ideal target group for early prevention and could drive positive community change, they are often overlooked in prevention efforts. FRESHAIR4Life focuses on implementing evidence-based interventions in adolescents in disadvantaged populations in five countries, pursuing to establish an implementation toolbox with strategies that can be extrapolated to other settings worldwide. Methods: The first project phase involves a situational analysis (SA), serving as the foundation for subsequent intervention selection and implementation. Data collection is ongoing, but has been completed in two countries. A team of (non-)local researchers received training and conducted the Rapid Youth Context Assessment, including interviews, focus group discussions (FGD), and Photovoice (PV) sessions with relevant stakeholders. Daily debriefings ensured timely adaptation of data-collection instruments and procedures. Quantitative data collected through questionnaires and air quality measurements triangulate the qualitative results. Pragmatic data analyses were performed during the debriefing sessions and evaluation exercises. Results: In the Kyrgyz Republic and Pakistan, 57 interviews, 27 FGD, and 6 PV sessions were conducted, including 88 adolescents, 75 providers (i.e., healthcare workers and teachers), and 52 other stakeholders (e.g. family members). Participants with diverse backgrounds were included (e.g., urban and rural settings, socioeconomic levels, education). Preliminary analyses reveal limited access to smoking cessation services and similar reasons between countries for tobacco initiation. A sense of helplessness regarding air pollution exposure is observed in both countries. Identified providers, collaborative parties and suitable implementation sites contribute to shaping future interventions. Conclusion: The situational analysis proves invaluable in selecting and adapting interventions and establishing connections before implementation, and lays the essential groundwork the for FRESHAIR4Life study.