Smoking Prevention

Using an Asset-based Approach and An Innovative Methodology to Evaluate Smoking Awareness Campaigns in Fife Schools (2014)
(Funded by NHS Fife)

This project applied the principles of asset-based approaches and co-production to explore the impact of health education and promotion programmes in primary and secondary schools in Fife. In particular, it assessed two interventions used to reduce the uptake of smoking:

  1. Smoke Free Class (S1 competition), which aimed to delay or prevent the onset of smoking; prevent young people who were experimenting with tobacco becoming regular smokers; and de-normalise smoking and promote a 'smoke-free' message.
  2. Smoke Factor (Primary 5/6, 6 and 7 intervention), which was an evidence based tobacco education initiative designed to compliment the 'Curriculum for Excellence'.

An innovative methodology was used so pupils could engage through co-produced radio news quizzes, factual programmes and dramas.

ISM Staff: Marisa de Andrade

Publications:
de Andrade M, Angus K and Hastings G (2015 Online). Teenage perceptions of electronic cigarettes in Scottish tobacco-education school interventions: co-production and innovative engagement through a pop-up radio project. Perspectives in Public Health, online 5th November. doi:10.1177/1757913915612109

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A Process Evaluation of the Implementation of ASSIST Scotland (2014-2017)
(Funded by Scottish Government Chief Scientist Office (CSO))

What is ASSIST?

ASSIST (A Stop Smoking in Schools Trial) is a school based programme to prevent smoking in young people aged 12-13. It works by training students to become ‘peer supporters’ who then talk to their friends about the risk of smoking and the benefits of not smoking. ASSIST has been evaluated by a randomised controlled trial funded by the Medical Research Council. The trial found ASSIST to be effective in reducing weekly smoking prevalence over a two year period (odds ratio, 0.78 (95% CI: 0.64-0.96), as well as reducing smoking frequency among pupils who had ever smoked before. Based on a 21.7% prevalence of weekly smoking in the control group at 2-year follow-up, this effect, adjusted for baseline differences and other potential confounders was equivalent to a reduction in prevalence of 10% (Campbell et al, 2008).

What’s the point of the process evaluation? 

ASSIST has been delivered in several schools in England and Wales but none in Scotland. The Scottish Government committed to support a pilot of ASSIST in Scotland as part of their Tobacco Control Strategy. As noted above, ASSIST is already an evidence-based programme, so the purpose of this research was to evaluate the implementation rather than the effectiveness of the newly funded ASSIST in Scotland. The results from this study will be used to ensure that the necessary structures and relationships are in place if the scheme is extended to ensure any effects are as large as possible and sustained.

What does the evaluation involve?

The process evaluation was conducted over two and a half years with a sample of 20 schools. The research design was mixed method and consisted of three elements: 1) evaluating the implementation planning process; 2) evaluating delivery in schools and; 3) documentary review and assessment of costs. A range of stakeholders (school staff, trainers; people who work in health and education and students) were consulted via in-depth interviews, paired interviews, mini focus groups and observation along with a before and after survey to gather data from students.

ISM Staff: Linda Bauld, Fiona Dobbie and Richard Purves

Publications:
Final Report
Research Findings

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Preventing Uptake of Smoking in School-aged Children (2013-2016)
(Funded by the National Institute for Health Research)

Cigarette smoking is the biggest preventable cause of illness and death in the UK. Most smokers start smoking when they are still at secondary school. Smokers who start at this early age are less likely to quit and more likely to be affected by smoking-related illness during their lives. It is therefore important to try to prevent children taking up smoking. Following a period of development work we trialled a smoking prevention package which combined educational resources for use in schools with materials for use with children’s families or caregivers to reinforce the anti-smoking message.

The project was run by researchers at the University of Nottingham, in collaboration with ourselves, University of Birmingham, University of York, King’s College London, and Kick It, the Hammersmith and Fulham Stop Smoking Service.

ISM Staff: Linda Bauld 

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A Review of Young People and Smoking in England (2008-2009) 
(Funded by the Public Health Research Consortium) 

The aim of this project was to produce a report which outlined and reviewed the evidence base on young people (11-24 years) and smoking, particularly in relation to smoking prevention, in order to help inform the Department of Health's consultation process and subsequent policy development. It addressed three key questions: What are the current patterns and trends in smoking in young people in England by key socio-demographic variables?; What is known about why young people start and continue to smoke?; What is the current tobacco control policy context and future policy options on smoking prevention and cessation for young people in England and their likely effectiveness? The project collected and reviewed relevant information primarily from national surveys and recent national and international reviews. Towards the end of the project an expert workshop brought together around 20 experts in young people and smoking to consider the draft report, identify any significant gaps in the research review and consider the evidence on the likely effectiveness of future policy options.

Reports available:

CTCR Staff: Gerard Hastings and Kathryn Angus

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HELP Campaign (2005-2010) 
(Funded by Ligaris/LBC Consortium, European Commission) 

"Help - for a life without tobacco" is one of the largest public health awareness-raising initiatives in the world and was launched in 2005 by the European Commission in the fight against smoking. It is a large media campaign aimed at encouraging young people in EU countries to resist smoking. Addressing the key issues of prevention, passive smoking and cessation, Help employs an integrated approach targeting Europeans between the age of 15 and 34 years through national media, television and web-based campaigns.

CTCR Staff: Gerard Hastings, Laura McDermott (left 2008), Louise Hassan (left 2007), Joanne Freeman (left 2008) and Gayle Tait (left 2009) 

Publications:
Walsh G, Shiu E and Hassan LM (2014). Cross-national advertising and behavioural intentions: A multilevel analysis. Journal of International Marketing, 22(1): 77-97.

Hassan LM, Shiu E, Walsh G and Hastings G (2010). HELP - for a life without tobacco: A case study on demarketing across two levels. Marketing, Intelligence and Planning, 27(4): 486-502.

Hassan L, Walsh G, Shiu E, Hastings G, Harris F (2007). Modeling persuasion in social advertising: A study of responsible thinking in antismoking promotion in eight Eastern EU member states. Journal of Advertising, 36(2): 13-28.

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Evaluation of Tobacco and Young People Projects in North and South Ayrshire (2003-2004)
(Commissioned by NHS Health Scotland, formerly Health Education Board for Scotland) 

This study evaluated interventions targeting young people across two local authorities within Ayrshire and Arran Health Board area. Both projects, when established, incorporated aims addressing youth cessation and youth access, in addition to tobacco awareness education (see also South Ayrshire Tobacco Awareness Project). There was little consensus in the literature as to the best way to address these objectives and it was felt that an overall qualitative process evaluation would enable rich lessons to be drawn from both projects, reflecting the different approaches taken and the background context of different local authorities and associated agencies.

CTCR Staff: Susan MacAskill

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Exploratory Study to Evaluate Young People's Response to Mass Media Tobacco Prevention (2003-2004) 
(Funded by Cancer Research UK) 

Smoking prevalence increases rapidly with age. Research has indicated that while only 1% of 11 year olds smoke regularly, over a fifth (21%) of 15 year olds are regular smokers. Targeting young people before smoking initiation in their early teens is critical to reducing smoking rates. Mass media campaigns can play an important role in reaching large numbers of young people directly with prevention messages. Given the current level of debate in this area regarding whether youth prevention is worthwhile and which message theme(s) are most appropriate, this study was conducted to explore young people's views, attitudes and behaviours towards smoking and examine young people's response to different types of message appeals, including normative/denormalisation messages, industry manipulation messages, and information/fear-based messages.

A qualitative research design was employed. A total of 12 focus groups and 18 friendship pairs were conducted in England with 11-14 year olds, half of whom were smoking and half of whom were experimenting with smoking.

CTCR Staff: Elinor Devlin (left 2005), Douglas Eadie, Martine Stead and Gerard Hastings

Publications:
Devlin E, Eadie D, Stead M and Evans K (2007). Comparative study of young people’s response to anti-smoking messages. International Journal of Advertising, 26(1): 99-128.

Devlin E, Eadie DR, Stead M and Hastings GB (2004). Applying marketing communication principles to a mass media youth smoking prevention campaign. Presentation at the European Marketing Academy Conference, Murcia, Spain, 18th-21st May.

Devlin E, Stead M, Hughes K and Eadie DR (2004). Informing a charity mass media campaign using a social marketing framework: the case of youth smoking prevention. Presentation at the 4th International Colloquium on Non-profit, Social and Arts Marketing, London, 15th September.

Devlin E, Hughes K, Eadie DR and Stead M (2004). Youth smoking prevention in the UK: the way forward. Poster presentation at the UICC World Conference for Cancer Organisations, Dublin, Ireland, 17th-19th November.

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Evaluation of a Tobacco Awareness Programme in South Ayrshire (Young People) (2002-2005) 
(Funded by the Better Living Foundation - formerly New Opportunities Fund Cancer Initiative - through NHS Ayrshire & Arran) 

The South Ayrshire Schools Tobacco Awareness Project was a three-year multi-component tobacco awareness programme for young people in South Ayrshire. It aimed to raise awareness of issues surrounding tobacco use amongst young people, contributing to a positive choice not to smoke. The main objective was repeated exposure to child-focussed tobacco awareness education in Primary 6 and 7 (10 and 11 years old). This was delivered by Class Teachers, supported by the full-time Project Co-ordinator, and used a carefully piloted Tobacco Awareness Resource Pack. Implementation took place in Spring/Summer terms over two years. Our comprehensive programme of impact and process evaluation comprised: 'before/after' surveys undertaken in Primary 6 with cohort follow-up in Secondary 1; and process evaluation through qualitative interviews at the end of each delivery year, including exploring the experiences of participating children and teachers, together with the wider role of the co-ordinator. The project was supported by the South Ayrshire Department of Education, Culture and Lifelong Learning, Ayrshire and Arran NHS Board and the Roy Castle Lung Cancer Foundation. Dissemination included a poster at the second UK National Smoking Cessation Conference in 2006.

CTCR Staff: Susan MacAskill, Gerard Hastings and Laura McDermott (left 2008)

Publications:
MacAskill S and McDermott L (2003). South Ayrshire Schools Tobacco Awareness Project - Baseline Survey: Primary 6 School Children - Report. Glasgow: University of Strathclyde, Centre for Tobacco Control Research.

McDermott L and MacAskill S (2003). South Ayrshire Schools Tobacco Awareness Project - Interim Findings: Process Evaluation Research Primary 6 Stage - Report. Glasgow: University of Strathclyde, Centre for Social Marketing: November.

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Comparative Study of Teenage Anti-smoking Advertising (2002-2004)
(Funded by National Institute for Health (USA). In collaboration with University of Illinois Chicago) 

This study sought to obtain assessments of teenager's appraisals of different anti-smoking advertisements in the UK, US and Australia. Previously, our collaborators in the US had developed, pilot-tested, and completed full data collection for the ad rating component. Eighth, 10th and 12th grade teens viewed one of two rotations of 10 different anti-smoking ads over a one-hour period. After viewing each ad twice, they completed a one page rating form which assessed comprehension and a range of emotional and cognitive responses to the ad, and when all ads had been shown, made an assessment of the ad they liked best. At a one week phone follow-up, measures were made of ad recall and cognitive and emotional processing of ad-specific messages. During March/April 2001, approximately 300 teens completed the protocol in Chicago and Boston for a total of 50 ads. The ads included those broadcast by state and national tobacco control programs, pharmaceutical companies and tobacco companies. A full range of main messages and advertising executions were featured.

This approach was subsequently repeated and administered in the UK and Australia. The purpose of the comparison was to determine the extent to which teenagers from at least broadly similar cultural backgrounds might respond in similar ways to the ads. This pattern of findings would suggest enduring characteristics of ads that can be expected to promote similar responses among teenagers, irrespective of cultural differences and tobacco control context. If this is the case, even for only a subset of particular advertising messages or executional styles or combinations of both, it would lend support for the case for recycling anti-smoking ads, rather than pursuing the more costly option of creating new ads. Such a finding could greatly assist the tobacco control dollar to go further. In addition, our understanding of key anti-smoking messages and executional styles is significantly enhanced by the additional statistical power.

CTCR Staff: Susan Anderson (left 2005) and Gerard Hastings

Findings from the study have been published in Tobacco Control:
Wakefield M, Durrant R, McElrath YT, Ruel E, Balch G, Anderson S, Szczypka G, Emery S and Flay B (2003). Appraisal of anti-smoking advertising by youth at risk for regular smoking: A comparative study in the United States, Australia and Britain. Tobacco Control12(II): 82-86.

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Evaluation of Tobacco Industry Funded 'Youth Smoking Prevention' Advertising Campaign (2001-2002)
(Funded by Cancer Research UK) 

In April 2001 British American Tobacco, Philip Morris and Japan Tobacco International launched a £2.4m advertising campaign on MTV Europe. The industry claimed the campaign was targeting 12-17 year olds with the message 'you can be cool and not smoke'. In 2001, the campaign consisted of six short adverts depicting teenagers doing normal 'cool' activities while being non-smokers. Those running the campaign reported that its aim was to create an environment where adolescents can be cool and not smoke by providing them with non-smoking role models they can look up to.

Qualitative research was conducted to explore young people's response to the Youth Smoking Prevention campaign, and in particular, to explore their comprehension and appreciation of the message, style of execution, and reported impact on their smoking knowledge, attitudes and behaviour. Eight focus groups were conducted with young people age 12-17 years. Purposive sampling was used to ensure the inclusion of smokers and non-smokers and both sexes. The groups were conducted in Scotland during November and December 2001.

Analysis showed the majority of young people did not engage well with the campaign for three reasons. First, they found the message unrealistic and lacking in credibility. Second, the style and execution jarred with their lifestyles making it difficult for them to identify with, and relate to, the adverts. For example, the adverts showed scenarios that were geographically and culturally distant from young people. Third, they strongly disliked the central characters in the adverts, seeing them as 'too perfect' and 'snobby'. The net effect of these unattractive attributes was to make respondents more, rather than less, disposed towards smoking.

CTCR Staff: Lynn MacFadyen, Elinor Devlin (left 2005) and Gerard Hastings

Publications:
Devlin E, MacFadyen L, Hastings G and Anderson S (2002). Evaluation of the industry funded 'Youth Smoking Prevention' (YSP) campaign. Proceedings of the 3rd European Conference on Tobacco or Health, Warsaw, June.

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Developing Improved Cigarette Warning Labels for Young People (2000)
(Funded by Cancer Research UK) 

This research was conducted to examine young smokers' engagement with cigarette packaging and responses to current UK cigarette warnings labels, and to identify potential improvements in the content and design of labels. The manner in which young people engaged with health warnings, the effects of this on smoking attitudes, behaviour and brand image were also explored.

Sixteen mini-focus groups were conducted with young people aged 12-17 years. The groups were purposively sampled according to: gender, socio-economic group and smoking experience. The research was conducted in two stages. The first stage examined young people's responses to packaging concepts in general and explored how they engaged with packaging and used on-pack information. Their responses to cigarette warnings labels were examined in this context. The second stage examined their responses to cigarette warnings labels in more detail, and their response to potential improvements in content and design explored.

The research found that current health warnings are not very visible, credible or influential. Furthermore, that they lack novelty and sympathy with young people's needs. However, young people do notice health warnings and have genuine concerns for the health consequences of smoking. Health warnings, when improved, can be more visible, credible and effective and encourage greater processing of the health risks, particularly when pictorial warnings are included.

CTCR Staff: Lynn MacFadyen, Anne Marie Mackintosh, Elinor Devlin (left 2005) and Gerard Hastings

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Smoking and Youth Images - An Exploration of Images, Perceptions and Messages in Magazines and the Implications for Cessation in Older Teens (1999-2000) 
(In collaboration with the University of Edinburgh, Commissioned by the Department of Health)

This Department of Health funded study explored the nature, extent and potential influence of smoking images and messages in youth style magazines. The research, which combined quantitative and qualitative methods, found that young men's style magazines contained large amounts of pro-tobacco advertising and editorial, that pro-tobacco advertising and supportive editorial has increased during the 1990s, and that style magazines helped young people define their identity through the magazine's own brand imagery and the lifestyle alternatives they present. The research concluded that research-driven policy should aim to control smoking imagery in the advertising and editorial sections of youth style magazines (2003).

CTCR Staff: Lynn MacFadyen and Gerard Hastings

Publications:
MacFadyen L, Amos A, Hastings GB and Parkes E (2003). 'They look like my kind of people' - Perceptions of smoking images in youth magazines. Social Science and Medicine56(3): 491-499.

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National Survey of Tobacco-related Work with Young People (1999) 
(Commissioned by the Health Education Board for Scotland (HEBS) and ASH Scotland) 

An expert seminar convened by HEBS and ASH Scotland to consider evidence on the effectiveness of tobacco-related interventions among young people highlighted the need to develop a comprehensive tobacco control strategy for young people (HEBS/ASH 1999). This national survey of current and planned tobacco-related work targeted at young people in Scotland was designed to act as a baseline against which to monitor the development of work in this area. The questionnaire was sent to 506 professionals, representing the experiences of: health boards, the Scottish Tobacco Control Alliance members, voluntary and statutory youth work, trading standards, local health care co-operatives, social inclusion partnerships, drugs action teams, community health projects, voluntary sector organisations and other national experts.

Health Education Board for Scotland/ASH Scotland (1999). Report of ASH/HEBS Expert Seminar on Tobacco and Young People. Health Education Board for Scotland, 23 April.

CTCR Staff: Susan MacAskill and Emma Cooke (left 2002)

Publications:
MacAskill S and Cooke E (2002). National Survey of Tobacco-related Work with Young People. Glasgow: University of Strathclyde, Centre for Tobacco Control Research.

Report available in PDF format
 

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