Evaluation of a targeted intervention to most at risk populations of tobacco users through a tea-shops community signage program

Background: The, “Leaving No One Behind” report to address the Sustainable Development Goals, recommends approaches to reduce long-term vulnerability and generate sustainable, meaningful change. Evidence from Bangladesh points to a higher burden of tobacco related morbidity and mortality in “most at risk populations” with vulnerability largely due to social and economic disparities. Challenges in addressing tobacco with most at risk populations are lower access to information, low risk perceptions toward tobacco related diseases, and poor self-efficacy perceptions toward quitting. Targeted interventions to vulnerable groups may provide cost effective approaches to address these inequalities. Methods: A tea-shop signage intervention was utilised in slum areas of Dhaka city. A street-intercept survey evaluation comprised a sample of 600 male and female tobacco users, aged 18 - 55-years randomly selected from 24 sites.. Measures included recall of the tea-shops signage and resultant knowledge, attitude, intention and cessation related indicators. Chi-square analyses and independent measures t-tests explored differences in predictor variables of vulnerability, income, education, gender and location. Results: Findings identified high recall of the tea-shops lung cancer message (83%) and strong agreement by campaign aware groups that the signs: Make tobacco users see the real harms of their tobacco use (96%); Discuss the message with others (62%); Know about serious illnesses caused by tobacco (75%); Try to persuade others to stop using tobacco (64%), and; Makes me more confident to try to quit (76%). Comparisons of cessation related behaviours by campaign awareness; Tried to stop smoking during the past 2 months (59% vs 40%); Tried to stop smokeless tobacco (49% vs 35%); identified significant improvements in quit attempts (< 95%) and a number of positive correlations according to vulnerability indicators. Conclusions: Targeted interventions in community settings to most at risk populations of tobacco users, can provide cost-effective approaches to support cessation related behaviors.