Implementation research on the tailored, multidisciplinary NCD prevention package FRESHAIR4LIFE: Targeting tobacco and air pollution exposure in mid- to late adolescents in disadvantaged populations

Project Information

FRESHAIR4LIFE

Grant agreement ID: 101095461

DOI

10.3030/101095461

EC signature date 1 November 2022

Start date 1 January 2023

End date 31 December 2026

Funded under

• Health

Total cost

€ 2 149 813,75

EU contribution

€ 2 149 813,75

Coordinated by

ACADEMISCH ZIEKENHUIS LEIDEN
Netherlands

Periodic Reporting for period 1 - FRESHAIR4LIFE (Implementation research on the tailored, multidisciplinary NCD prevention package FRESHAIR4LIFE: Targeting tobacco and air pollution exposure in mid- to late adolescents in disadvantaged populations)

Reporting period: 2023-01-01 to 2024-06-30

Summary of the context and overall objectives of the project

Non-communicable diseases (NCDs) are the leading cause of ill health and premature mortality, with tobacco and air pollution (AP) exposure accounting for 50% of the preventable burden. Disadvantaged populations are disproportionately affected. While the NCD prevention agenda has mostly focused on adults, adolescents also face a considerable part of the NCD burden. Early preventive intervention can substantially reduce NCD burden and premature mortality at acceptable costs. Despite mounting evidence for NCD-prevention, we have failed to translate knowledge into practice. We aim to bridge this translational gap and gain knowledge, resources and capacity to optimize implementation of prevention packages targeting adolescents in disadvantaged populations. We will work in five countries with a high NCD burden –Greece, the Kyrgyz Republic, Pakistan, Romania, and Uganda. In each site, the project will build dual capacity for NCD prevention, prioritizing youth advocacy and providers' leadership. As a result, informed and activated adolescents and families will work in equal partnership with providers to reduce tobacco and AP exposure. The FA4LIFE project will lead to improved knowledge, awareness, and behaviors towards tobacco and air pollution exposure, reduced risk factor prevalence and, ultimately, a reduction in morbidity and mortality. The project will establish local health policies and provide standardized implementation strategies that can be extrapolated to other contexts worldwide. Economically, prevention strategies targeting adolescents have a high return on investment, reducing healthcare costs and increasing quality of life years. Overall, the FA4LIFE project presents a promising approach to translating NCD prevention knowledge into practice and reducing transgenerational burden in disadvantaged populations.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

In each country, we will perform a two-step situational analysis. First, a risk stratification and population segmentation assessment will identify those adolescents most in need for prevention or at risk of tobacco and AP, mindful of age, gender and equity indicators. Next, a Rapid Youth Context Assessment will provide in-depth insight into the local burden, needs and perceptions of adolescents and other key stakeholders. Following stakeholder analysis, FA4LIFE teams will be established in each site, comprising adolescents, family members, providers, managers, policy makers, authorities and other key stakeholders.
The FA4LIFE teams, supported by local research teams, will select three core intervention strategies from the innovative prevention palette method, which build on the WHO 'best buys', WHO Framework Convention on Tobacco Control (WHO FCTC), and WHO NCD Global Action Plan. The strategies include a (mass) media campaign, Very Brief Advice, and the behavioral intervention 'implementation intentions’. The prevention package can be complemented with additional strategies based on local burden and context needs. Intervention strategies will be adapted following situational analysis results. The FA4LIFE prevention packages will then be implemented, evaluated, and refined through iterative cycles. Following audience segmentation, actionable messages will be co-created and delivered. Access to a digital FA4LIFE implementation toolbox, including infographics, advocacy podcasts, and scientific results (also in lay text), will promote upscaling.

In terms of outcomes, the FA4LIFE aims to create effective and context-specific NCD prevention packages for adolescents in disadvantaged populations. The expected results include making the FA4LIFE prevention packages and related methodology available to providers and stakeholders who serve those most in need or at risk, and the uptake of FA4LIFE tools and related implications on implementation and service outcomes in dedicated and sustainable guidelines, quality frameworks, and policies.

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

FA4LIFE will make impact on several indictors, such as improved knowledge, beliefs, and behaviors related to NCD prevention in adolescents and family members, establishment of (improved) local health policies on NCD prevention in adolescents, improved capacity of providers (including policy makers) to promote, implement, and lead NCD prevention, and integration of FA4LIFE results and tools in local guidelines and quality frameworks.
Overall, FA4LIFE aims to contribute to reducing the individual, societal, and economic NCD burden and reducing premature NCD mortality in those adolescents facing the highest burden, promoting global health equity.

To go beyond the state of the art, the project involves ground-breaking implementation research on a multi-level NCD prevention approach. This approach involves a comprehensive understanding of what is needed to establish globally transferable NCD prevention strategies targeting adolescents in disadvantaged populations. The project uses various research methods, including risk stratification assessment, rapid youth context assessment, cross-sectional cohort studies, audience segmentation, Photovoice and qualitative studies.

The FA4LIFE project also emphasizes youth advocacy by ensuring the equal engagement and participation of adolescents and their families. Additionally, the project utilizes a novel prevention palette method that combines insights from implementation research, health economics, medical anthropology, psychology, and sociology. This method enables the selection, adaptation, and evaluation of intervention and implementation strategies, leading to the development and iterative improvement of sustainable FA4LIFE prevention packages.

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