Preventing Child and Adolescent Smoking Practice Resource (only) Downloaded from www.rch.org.au/ccch
Practice Resource: Preventing Child and Adolescent Smoking Table of Contents Overview... 2 Glossary... 6 Section 1: Introduction Setting the scene... 7 Prevalence of smoking in children and adolescents... 7 Impact of smoking on children and adolescents... 8 Factors found to influence smoking in children and adolescents... 9 Introduction... 10 Understanding interventions to prevent child and adolescent smoking... 10 School-based programs... 10 Community programs... 12 Media campaigns... 12 What you can do... 13 Information for parents... 14 Key Messages for Professionals... 15 Key Messages for Managers... 16 Section 3: What the research shows Summary of the evidence on preventing child and adolescent smoking... 17 Key research findings... 18 About child and adolescent smoking... 18 About interventions for child and adolescent smoking... 19 Annotated summary of intervention studies... 21 Summary of intervention studies... 21 Child and adolescent smoking... 22 References... 24 Appendix 1: Centre for Community Child Health... 25 Appendix 2: Telstra Foundation... 26 Appendix 3: Criteria for selecting topics... 27 Appendix 4: NHMRC Guidelines for Levels of Evidence... 28 Appendix 5: Glossary of Terms Research Methodology... 29 Centre for Community Child Health 2006 1
Glossary Cognitive-behavioural therapy Environmental tobacco smoke An arrangement in which client and professional work together to identify and understand problems by looking at the relationship between thoughts, feelings and behaviour. Smoke from the end of a lit cigarette or breathed out by a smoker. Nicotine fading Changing the type of cigarette smoked to one with less nicotine. Nicotine-replacement therapy Using a medication that reduces cravings for cigarettes. Passive smoking Breathing tobacco smoke in the environment. Social influence training Involves altering the thoughts as well as behaviour. Refer to Appendix 5 for a glossary of terms related to research methodology terminology. Centre for Community Child Health 2006 6
Introduction Three main forms of intervention have been trialled to prevent children and adolescents from taking up smoking or to encourage those who smoke to stop. These are: School-based programs Community programs Media campaigns While each of these interventions has been successful in at least one trial, on the whole there is only minor research support for interventions aimed at reducing child and adolescent smoking at this stage. School-based programs using social influences training have been the most successful intervention to date. However not all studies have found these programs to be successful. In Australia the focus has been on reducing adult rates of smoking with the expected reduction in associated smoking rates in children and adolescents. Understanding interventions to prevent child and adolescent smoking School-based programs Key points Social influences training is a key part of each school-based program that been successful in reducing smoking behaviour. This training is carried out in a group setting (typically classrooms) and is based on an understanding of the reasons children and adolescents take up smoking and continue to smoke. The training equips them with skills to resist these influences and say no when offered a cigarette. Social influences training involves altering the thoughts of children and adolescents as well as their behaviour. For example, they are encouraged to be realistic about the number of people who smoke and to think about the health consequences of smoking. Centre for Community Child Health 2006 10
When the health consequences of smoking are discussed, typically particular emphasis is placed on short-term effects that have direct relevance for children and adolescents, for example, the effect of smoking on performance in sporting activities. School-based programs are typically short and intensive (approximately five to ten sessions over one to two weeks). The programs are run by either a trained health educator or a classroom teacher who has participated in a short training course. Some school-based programs also include broader antismoking initiatives such as placing anti-smoking posters around the school or efforts to prevent the sale of tobacco to minors. More about social influences training A typical social influences course involves: Correcting adolescents' overestimates of the rate of smoking by adults and adolescents Helping them to recognise high-risk situations Increasing their awareness of media, peer, and family influences Assisting them to learn about and practise refusal skills Encouraging them to make public commitments not to smoke Often courses aim to increase participants confidence and ability to refuse not only tobacco but also alcohol and illegal drugs. A range of activities designed by QUIT can be implemented in schools to increase children s and adolescents awareness of smoking-related issues. The QUIT: Primary and Secondary School Fact Sheets can be found at the following link: www.quit.org.au/index2.html School-based programs using social influences training have been the most successful intervention to date. Centre for Community Child Health 2006 11
Community programs Key points Community programs are based on the understanding that young people are strongly influenced by their social environment; therefore these programs promote a nonsmoking attitude in the community. Community programs are typically multi-faceted and diverse. They can include such initiatives as making cigarettes harder to buy, increasing the price of cigarettes, creating tobacco-free public places, communicating nonsmoking messages through the media and establishing antismoking clubs for young people. While some community programs have succeeded in reducing the smoking rates of youth, most have not been evaluated as successful. Media campaigns Key points Use of mass media has played an important role in many programs to reduce smoking because of its strong influence on the behaviour of children and adolescents. A major advantage of mass media campaigns is that they have the potential to reach a large proportion of young people and to modify their knowledge, attitudes and behaviour. These campaigns are often designed with principles of social learning theory in mind. Positive role models who reject smoking are used in the hope that their behaviour will be a model for the target audience. Media campaigns have not been widely trialled, and preliminary trials show mixed results. Centre for Community Child Health 2006 12
What you can do For suggestions on strategies to be used in discussions with parents of children or adolescents who smoke (or with the child or adolescent themself) see the Preventing Passive Smoking Effects on Children practice resource. A range of other ways health professionals can assist smokers of any age to cut down or quit smoking have been suggested by QUIT Australia. These include: Giving those interested in quitting a Quit Book Providing information about products available to help an individual quit Setting up a smoke-free display and ensuring smoking cessation resources are available in waiting rooms Arranging training from QUIT Australia on using counselling to help individuals to quit For further information about QUIT Australia s Health Professionals Program, see the following link: www.quit.org.au/index2.html Interestingly, few interventions for child and adolescent smoking have focused on individual counselling with health professionals. This may be due to the different degree of nicotine dependence in children compared to adults. In adult smokers efforts to reduce their smoking or quit consist of the professional suggesting specific cognitive and behavioural strategies that can help with quitting. there is only minor research support for interventions aimed at reducing child and adolescent smoking. In Australia the focus has been on reducing adult rates of smoking with the expected reduction in associated smoking rates in children and adolescents. Centre for Community Child Health 2006 13
Information for parents The following resource was produced by QUIT and is designed to assist parents in discussing smoking behaviour with their child or adolescent. In particular, it aids parents in promoting a positive attitude towards saying no to smoking: www.quit.org.au/quit/pdf/clearing_the_air.pdf The following resource is recommended by QUIT and is a tool for assisting individuals of any age to quit smoking once they have begun to smoke regularly: www.thequitcoach.org.au/index.asp?content=dsp_welcome.asp Centre for Community Child Health 2006 14
Key Messages for Professionals The Australian Secondary School Students Survey (2002) found that 6% of 12 year olds and 25% of 17 year olds had smoked in the previous week with little difference between the smoking rates of males and females. Children of smokers are twice as likely as children of non-smokers to take up smoking. Children who believe that their parents disapprove of them smoking are seven times less likely to be smokers than those who perceive their parents as approving. Smoking can harm lungs by impairing lung growth and tissue maturation in children and adolescents. It has also been associated with a greater number of asthma-related symptoms in adolescents suffering from asthma, and less effective asthma control overall. Child and adolescent smoking has also been associated with smoking-related illnesses later in life. Factors influencing adolescents taking up smoking Environmental factors: parents smoking, parents attitudes, siblings smoking, family environment, relationships with parents, peers smoking, and peer attitudes and norms Socio-demographic factors: age, ethnicity, socioeconomic status of parents, and personal financial situation Behavioural or individual factors: mental health, school performance, lifestyle, self-esteem, attitudes to smoking or smokers, health concerns, stress (especially in females), chronic illness, and desire to control weight Community factors: cost, access to vending machines and advertising. Helping to reduce child and adolescent smoking Only moderate support exists for interventions that prevent or stop adolescent and child smoking. In Australia the focus has been on reducing adult rates of smoking with the expected reduction in associated smoking rates in children and adolescents. Some recommendations about likely best practice when attempting to reduce the smoking rates of children and adolescents include: Help children and adolescents resist media and peer influences, recognise high-risk situations, and have realistic perceptions of smoking rates (only a minority of children and adolescents smoke) Provide specific and simple strategies to adolescents that can be used to help them stop smoking immediately. Cognitive and behavioural strategies (used for adults) can be referred to for ideas but must be tailored to address children s developmental stage. Provide information to parents to assist them in discussing the issue of smoking with their child www.quit.org.au/quit/pdf/clearing_the_air.pdf Centre for Community Child Health 2006 15
Key Messages for Managers The Australian Secondary School Students Survey (2002) found that 6% of 12 year olds and 25% of 17 year olds had smoked in the previous week with little difference between the smoking rates of males and females. Children of smokers are twice as likely as children of non-smokers to take up smoking. Children who believe that their parents disapprove of them smoking are seven times less likely to be smokers than those who perceive their parents as approving. Factors influencing adolescents taking up smoking Environmental factors: parents smoking, parents attitudes, siblings smoking, family environment, relationships with parents, peers smoking, and peer attitudes and norms Socio-demographic factors: age, ethnicity, socioeconomic status of parents, and personal financial situation Behavioural or individual factors: mental health, school performance, lifestyle, self-esteem, attitudes to smoking or smokers, health concerns, stress (especially in females), chronic illness, and desire to control weight Community factors: cost, access to vending machines and advertising. Helping to reduce child and adolescent smoking Only moderate support exists for interventions that prevent or stop adolescent and child smoking. Of the interventions trialled, school-based programs have the strongest research base and can be implemented by staff of primary and secondary schools. Programs that have been successful typically: Focus on social influences such as understanding the reasons children and adolescents take up smoking (and continue to smoke) Equip children and adolescents with the skills to resist smoking influences Target as key influences media campaigns, relaxed family attitudes on smoking and high-risk situations of peer influence Are short, intensive and run by a trained health educator or a teacher. Staff in schools and services are important role models for children and adolescents. Smoking policies should be in place to discourage staff from smoking in front of children and young people. Community factors that influence rates of smoking such as access to vending machines are potential ways to reduce child and adolescent smoking. Centre for Community Child Health 2006 16