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Preventing uptake of smoking by young people; proposing a school based peer intervention - opinions of pupils (age14/15) and their teachers

First published: 10 May 2019 | Last updated: 20 May 2019

Aims:

To understand the views of young people and teachers on smoking prevention and current practice in schools in a UK rural county (Norfolk).

Design:

An online survey followed by discussion groups explored school policies, smoking prevention teaching, experience/acceptability of interventions, optimal age for delivering smoking prevention interventions.

Setting:

More than 200,000 (5.5%) UK children aged 11 – 15 years start smoking each year.  Whilst rates of smoking uptake have decreased significantly, the social gradient in young people taking up smoking remains marked.

The evidence based ASSIST approach of peer-led school-based intervention for preventing smoking uptake involves training influential children to encourage their peers not to smoke.

Findings and conclusion:

22 teachers and 249 pupils completed the surveys, 37 pupils from three schools participated in discussion groups.

Staff and Pupils reported current teaching practice in Science or PSHE. Information about the health threats of smoking was perceived as the most effective means of preventing smoking uptake.  The use of peers to discourage smoking initiation was rarely reported.

Discussion:

The ASSIST intervention is the ‘gold standard’ evidence based approach. However, many Norfolk schools are not implementing this intervention.  There is a need to reassess the most appropriate form of intervention for smoking prevention in a changing landscape of reduced smoking prevalence at a population level, but where pockets of inequality suggest sustained high levels of smoking amongst some young people. Locally, we found opportunity and willingness to implement effective interventions. A targeted approach to intervention in high risk settings may be appropriate.

Co-Authors

Ms Brioney Gee, Ms Vivienne Maskrey, Ms Annie Blythe; Prof Richard Holland, Dr Caitlin Notley Norwich Medical School, University of East AngliMs

Conflicts of interest:

Funding Sources: Primary and Community Care Research Capability Funding, Norfolk and Suffolk Primary and Community Care Research Office, NHS South Norfolk

CCG No conflict of interest

Report Author

Dr Caitlin Notley

Professor of Addiction Sciences


Dr Caitlin Notley was successful in securing funding from the SSA for their first ever Post-Doctoral Fellowship post. She began a five year programme of work in May 2013, focusing on tobacco smoking relapse prevention. This work is a public health priority as most people who manage to successfully quit smoking in the short term will relapse back to smoking within 12 months. There are currently no effective interventions to prevent smoking relapse [1], either in the general population or amongst specific at risk populations, such as postpartum women [2]. Dr Notley’s mixed methods programme of work explores the phenomenon of smoking relapse and will develop an intervention to support women to stay abstinent from smoking postpartum.

As part of her fellowship Dr Notley has led and completed two linked research studies:

  • SHARPISH Q – Qualitative study of Self-help and Relapse Prevention in Smoking. This study collected qualitative process evaluation data alongside an HTA funded trial of a self-help relapse prevention intervention. The RCT was a randomised study (n=1407) exploring educational booklets for the specific purpose of preventing relapse to smoking. Process evaluation and qualitative investigation explored patient reported experiences of using the self-help materials, focusing on the response of individuals to the intervention being tested. Dr Notley completed and has widely disseminated the trial process evaluation findings and is undertaking further analytical work on patient experience of smoking lapse and relapse.
  • PReSeRVE – Postpartum Smoking Relapse Prevention Qualitative Systematic Review. This review synthesised patient reported barriers and facilitators for smoking relapse prevention and was published in Addiction: http://onlinelibrary.wiley.com/doi/10.1111/add.13062/abstract.

Dr Notley has been successful in securing additional external funding from Cancer Research UK and the Medical Research Council to lead two further linked studies:

  • ECtra Study (E Cigarette Trajectories) Real world experiences of using e-cigarettes for avoiding relapse to smoking: success or failure. A qualitative study. (Notley, C, Dawkins, L, Holland, R).
  • Preventing Return to Smoking Postpartum (PReS Study) – Development of a complex intervention to sustain smoking cessation in postpartum women. (Notley, C, Ussher, M, Bauld, L, Holland, R, Naughton, F, Hardeman, W).

SSA fellowship funding has supported Dr Notley to lead and develop these interlinked research projects, and has provided her with opportunities for national and international collaboration with other research centres. The funding has enabled Dr Notley to develop her methodological expertise in qualitative research methods and systematic reviewing, through involvement with a supportive network of SSA academics.

[1] Hajek P, Stead LF, West R, Jarvis M, Lancaster T. Relapse prevention interventions for smoking cessation. Cochrane database of systematic reviews (Online) 2009(1):CD003999.
[2] Agboola S, McNeill A, Coleman T, Leonardi Bee J. A systematic review of the effectiveness of smoking relapse prevention interventions for abstinent smokers. Addiction. 2010;105(8):1362-80.

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