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NCI seminar: Coalitions in Armenia and Georgia raised smoke‑free home adoption but community exposure unchanged, researcher says
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Summary
Dr. Carla Berg told an NCI seminar that a 2017–2023 Fogarty‑supported matched‑pair community trial showed coalitions increased smoke‑free home adoption and coalition awareness across 28 communities, but surveys found no overall reduction in measured secondhand smoke exposure; a new adapted RCT will enroll about 1,000 participants per country.
Dr. Carla Berg, a professor at George Washington University's Milken Institute School of Public Health, told a National Cancer Institute seminar she and partners used local coalitions in Armenia and Georgia to advance smoke‑free policies and build research capacity.
Berg described a Fogarty‑funded matched‑pair community randomized trial launched in 2018 that worked across 28 communities (14 per country). The study trained coalition members and implemented local actions—signage, school and clinic activities and outreach—despite interruptions from the COVID‑19 pandemic and regional conflict. "Over 50% of our coalitions created at least 1 smoke free policy, whether it was in factories or parks or etcetera," she said.
The evaluation used mixed methods including coalition leader interviews, member surveys and community surveys. Berg reported that intervention communities showed higher rates of smoke‑free home adoption and greater coalition awareness, but the team did not detect increases in receptivity to tobacco control policies or measurable reductions in secondhand smoke exposure at the community level. Berg cautioned those outcomes likely reflect multiple influences, including national policy timing and pandemic‑related changes in public behavior.
Building on that work, Berg outlined a follow‑on, individually randomized trial that adapts an evidence‑based smoke‑free homes intervention for Armenia and Georgia and uses national quit lines for delivery. The adapted program includes a mailed toolkit, a two‑week coaching call, follow‑up mailings with role‑modeling photo novellas and a challenges‑and‑solutions booklet. Materials were revised for cultural relevance (imagery, language and content on heated tobacco products and e‑cigarettes).
"We are enrolling, about 1000 participants per country," Berg said, noting the sample increase followed team consultation and is intended to detect differences related to country‑level adaptations. Coalitions in seven communities per country will identify potential participants and national agencies will screen and randomize enrollees to intervention or control.
Berg also described capacity‑building D43 grants in Georgia (2019) and Armenia (2023). She said the programs have mentored cohorts of master's and doctoral students—training researchers who can translate evidence into local policy and practice.
Recordings and slides from the NCI Center for Global Health seminar are available at cancer.gov/globalhealth, and the center posted related funding and event information.
