From Schools to Sports: Adapting Implementation Intentions in FreshAir4Life to Prevent Tobacco Use in Pakistani Youth

Background: Tobacco use among youth is a growing public health concern in Pakistan, yet prevention efforts remain limited. Within the FreshAir4Life project, we are adapting a tobacco prevention intervention originally developed and found effective in the UK in high school settings. The intervention integrates engagement with anti-smoking messages and the repeated formation of ‘If-Then’ plans to resist cigarette offers, delivered in eight sessions over four years. We present the method used in adapting the intervention and discuss its implementation strategies within a sports-based setting in Karachi, Pakistan. Methods: The adaptation involved two steps: a stakeholder workshop with adolescents (14-21yrs), football coaches, managers from Karachi United (KU), and policy makers (n=19) to gather diverse views on intervention’s importance, target population, potential benefits, reach, feasible implementation strategies, and adaptation requirements. This was followed by an iterative, collaborative process to adapt strategies for implementation in a sports club setting and intervention content to socio-cultural context of Pakistan. Results: The adapted intervention targets adolescents aged 13-16 years enrolled in KU’s sports programs. Adaptation involved: (a) a streamlined schedule of four sessions, 30-45 minutes each, delivered bi-monthly over eight months, (b) Training of coaches to deliver the sessions within the football coaching context, (c) Coaches will then implement the sessions in the field, (d) enhancing cultural relevance of the content through translation into Urdu, storytelling methods, inclusion of emerging tobacco products, and (e) relating the intervention content to sports and fitness context. Conclusion: By engaging adolescents and coaches in a collaborative adaptation process, the intervention ensures contextual relevance and effective implementation. Next steps involve training master trainers and KU coaches to deliver the adapted sessions to adolescents from Karachi United. This will be accompanied by a mixed-methods evaluation assessing the reach, effectiveness, adoption, implementation, maintenance and scalability of the intervention.