Visual Narratives by FreshAir4Life: Exploring Youth Perspectives on Tobacco Use and Air Pollution in Pakistan

Introduction: Non communicable diseases (NCDs) present a global health concern, particularly in low- and middle-income countries (LMICs), where 86% of NCD-related deaths occur. Significantly exposed to risk factors like tobacco and air pollution, adolescents are overlooked but may have great potential to initiate positive community change. As part of the FreshAir4Life study, Photovoice, a participatory research method, was used to explore adolescents’ perspectives on tobacco use and air pollution (AP) in Karachi, Pakistan. Methods: This qualitative study included 18 adolescents aged 14-21, sampled purposefully from Karachi United and Indus University of Health Sciences. Two groups of nine adolescents, assigned topics of tobacco and AP, were trained in Photovoice methodology. They were to capture images over 7 days reflecting these risk factors, their impact on daily life, and air quality improvement. Of 30 images, they chose those that best answered this brief, providing titles and personal reflections. A 1.5-hour recorded discussion followed, exploring the stories behind the images, to enable adolescents’ identified themes. These were reviewed to perform a final thematic analysis. Results: Photovoice analysis revealed interconnected themes for both tobacco and air pollution. For tobacco use, the themes were (1) prevalent misconceptions and self-destructive behaviors, (2) personal health and environmental well-being, (3) manipulative marketing strategies, and (4) governmental accountability and policy enforcement. For air pollution, the themes were (1) air pollution from human activities, (2) struggles for better living condition. (3) Industrial and residential pollution overlap, and (4) value of green spaces and sustainable living. Conclusion: This study demonstrates the effectiveness of Photovoice in engaging adolescents in LMICs. It provides insights into social and environmental factors contributing to NCD risks, emphasizing the need for targeted actions and legislative changes. The findings highlight the importance of engaging communities and empowering youth to drive change addressing tobacco use and air pollution.