Background and challenges to implementation:
Passive smoking affects fetal and childhood lung growth and development. It is also responsible for aggravation of symptoms in many childhood respiratory disorders. High levels of adult smoking and associated passive smoking among pregnant women, fetuses and children persist in the Western Cape province in South Africa. Efforts to reduce the prevalence of smoking have had limited effect.

Intervention or response:
Empowering children to be advocates for their own lung health, especially in relation to reducing exposure to tobacco smoke was seen as a novel approach to altering society's attitude to active and passive smoking. This led us to conceptualise the 'Leaders for Little Lungs' programme with the slogan 'Look after Little Lungs'.

Results and lessons learnt:
The programme is to have three elements: a booklet of facts for children on lungs and the deleterious effects of smoking; educational group work at community and health service levels for children to become knowledgeable advocates; and campaign materials such as T-shirts, pamphlets and stickers. The development of T-shirt for health workers and children has produced positive responses from health workers, students, parents and children. The booklet is in the development and testing phase. Roll out of the programme is due to occur in the first winter on 2018, coinciding with the annual surge in pneumonia in the Western Cape.

Conclusions and key recommendations:
This novel programme has the potential to change attitudes to passive and active smoking in high-prevalence communities, and to reduce smoking-associated lung diseases among children and adults in the Western Cape province.