National survey of tobacco-related work with young people

Publication

National survey of tobacco-related work with young people

Acknowledgements

The researchers wish to thank all those who responded to the survey, giving considerable time out of their busy working day to contribute to the overall understanding of tobacco-related work with young people in Scotland.

Summary

Following the White Paper on Tobacco Smoking Kills and an expert seminar on Young People and Smoking, HEBS and ASH Scotland commissioned a national survey to determine current and planned tobacco-related work targeted at young people in Scotland. The survey was also intended to act as a baseline against which to monitor the development of work in this area.

Method

A postal survey was utilised to reach the range of agencies potentially involved in tobacco-related work across Scotland. The 210 completed questionnaires represent a broad coverage across Scotland and across different agency types - health promotion, primary care, trading standards, statutory and voluntary youth work sectors, social inclusion partnerships (SIPs) and national tobacco and youth agencies. A relatively high final response for this type of project was achieved (62%).

Are there strategies and approaches which underpin tobacco-related work with young people in Scotland?

Respondents' feedback indicated limited salience of an evidence base in informing practice in this area of work.

There appears to be a reasonable level of inter-agency working, with only 2% of respondents not having contact with other agencies.

How are key areas of work addressed across Scotland?

The greatest levels of reported involvement were in the area of prevention and education (69% of respondents), followed by cessation (47%) and enforcement (23%). There were low levels of involvement in training provision (20% in-house and 10% for other agencies) and the development of support materials (14% for internal use and 9% for other agencies).

In relation to prevention and education, over half (59%) of those who worked in this area felt that their activities were targeted directly at those within the 10-20 year old age range. Activities tended to be generalised such as providing materials to users / clients and awareness raising.

Work incorporating youth smoking cessation was reported by less than half the respondents, and only half of these stated that they undertook activities targeted directly at the 10-20 year range (50 respondents). Providing smoking cessation materials to service users is the highest reported area of involvement (56% of those currently undertaking cessation work). Of the range of approaches described, structured support groups or classes were most frequently highlighted but only in around a quarter of activities. Importantly, only a small number of these focussed on young people, with ten youth specific cessation programmes reported across Scotland. Less structured general support, one-to-one interactions, and opportunistic approaches which might also make an appropriate contribution were also described but at lower levels.

Areas of planned new activity in relation to prevention and cessation appear to be in the youth work and FE/HE sectors, together with electronic based activities such as internet sites. Planned activity in youth cessation also focussed on school settings.

For enforcement activities, the majority of respondents are from trading standards departments, with a very small number scattered across other sectors. Enforcement and support of underage sales regulation is the most common activity, involving 54% of respondents. Relatively little new activity was planned, although respondents' indicated a wish to undertake 'test purchasing' as part of enforcing underage sales regulation, currently halted pending results of the Lord Advocate's review.

In terms of training, only a minority (36%) had received some form of training, primarily those in health promotion and primary care. The main sources of training were local Health Promotion Departments (51% of training recipients) with Fast Forward, HEBS and ASH mentioned by much lower numbers. Tobacco awareness (38%) and smoking cessation (36%) form the bulk of training experienced.

In relation to provision of training, 20% of respondents stated that their organisation provided in-house training and 10% indicated that they provided training for other agencies. Main reported targets were youth workers, leaders and community educators (38%).

Development of support materials either for internal or external use was reported by 18% of respondents, mainly resource packs and leaflets/booklets.

What activities are undertaken among nationally based organisations?

Nationally based organisations who responded included national and UK tobacco-related agencies, agencies focusing on cancer, asthma or the well-being of young people, 'uniformed' organisations and agencies with a broader health remit. As with other agencies, the nationally based organisations' work with young people was most likely to include prevention/education activities (50%), followed by cessation (32%), enforcement (23%) and provision of training and materials (around 20%). A relatively large proportion indicated they were involved in campaigning and lobbying activities (around 30%).

In describing individual activities, only a few mentioned approaches which had a national spread. In general, localised activities were more commonly reported including local young people and youth leader training events.

What is the scope of tobacco-related work with young people across geographical areas of Scotland?

NHS Board areas were used as convenient geographical units. Prevention and education activity across the NHS Board areas was broadly similar to the national level of 69% reporting this kind of work, but relatively higher proportions reported preventive activities in Tayside, Fife, Lanarkshire and Dumfries and Galloway. Young people specific activities were proportionately higher in Argyll and Clyde, Lanarkshire, Forth Valley and Ayrshire and Arran.

Recording of cessation activities across the NHS Board areas tended to be closer to the national proportion of 47%. However, higher levels are apparent in Dumfries and Galloway, Grampian and Forth Valley. More positive ratios towards young people specific activities are observed in Highland, Argyll and Clyde, Ayrshire and Arran and Forth Valley.

In relation to enforcement, recorded involvement is relatively higher than the total proportion (23%) in Ayrshire and Arran, the Islands and Lothian. Provision of training was at a relatively low level overall but reporting of in-house training was relatively higher in Grampian and Dumfries and Galloway, and training for other agencies was higher in Dumfries and Galloway, the Islands and Forth Valley.

Development of materials for internal use was at a low level, but was more likely to be reported in Tayside and Ayrshire and Arran, largely reflecting activities in the youth sector. There was little geographical variation from the overall reporting of 9% involvement in developing materials for other agencies. There was no reporting of each of these activities respectively in four NHS Board areas.

Conclusions

Tobacco-related work with young people was identified across Scotland and across different agency types. There is considerable interest in addressing this issue, and there are positive indications of increasing activity and innovative approaches. However, in terms of access for individual young people, provision is still relatively thinly spread.

Cessation provision is particularly limited. Just under half of respondents reported any involvement in cessation (98), and only 10 youth specific programmes or classes were described. One-to-one and opportunistic advice and broader lifestyle approaches which may also have an appropriate role in youth cessation were reported in similarly small numbers.

Only a third of respondents reported experiencing any kind of training in tobacco-related work, with many relying on 'picking it up' and past experience with other issues. While not all workers need to be 'experts', dissemination of basic knowledge could be enhanced, and it is also important that appropriate specialist services are available and are well 'sign-posted'.

Enforcement activities are widespread, but many trading standards officers expressed a wish to employ test-purchasing by under-16s, suspended pending the Lord Advocate's decision on the matter.

Finally, a considerable mix and overlap of approaches was apparent. For some workers and settings there was a lack of distinction between areas of work, particularly prevention and cessation, and it appeared that activities reported were not always discrete entities. Often this reflects a valuable holistic and flexible approach, but it might also indicate a limited priority in planning and structuring of tobacco-related activities.

1. Introduction

In December 1998 the White Paper on Tobacco Smoking Kills was published. It sets out a framework for tobacco control in Scotland and includes a range of measures:

a ban on tobacco advertising and sponsorship
measures to tackle underage tobacco sales
measures to reduce smoking in public places (including workplace and schools)
a new approved code of practice on smoking in the workplace
new smoking cessation services
new education and prevention work

Smoking Kills identified young people as a priority group for action. In a later White Paper, Towards a Healthier Scotland HealthH (1999), targets were set for a reduction in the proportion of 12-15 year olds who smoke from the 1995 level of 14% to 12% by 2005 and 11% by 2010. The subsequent Scottish Health Plan reiterated a commitment "to battling against the impact of tobacco - especially on our young people" (Scottish Executive 2000).

In response to these policy initiatives HEBS and ASH Scotland brought together researchers and practitioners from the UK and Europe at an expert seminar to consider evidence on the effectiveness of interventions designed to prevent the uptake of smoking and to aid cessation among young people. A key recommendation from the seminar was the need to develop a comprehensive tobacco control strategy for young people (ASH/HEBS 1999).

In light of this recommendation both agencies commissioned a national survey to determine current and planned tobacco-related work targeted at young people in Scotland. It was also intended that the survey will act as a baseline against which to monitor the development of work in this area.

Report structure

This document presents the findings from the survey. Following an outline of the project aims, method and final sample, the report addresses strategies and approaches underpinning tobacco-related work (Chapter 4) and an examination of specific areas of work across Scotland as identified in the research objectives – prevention/education, cessation, enforcement, training and development of materials (Chapter 5). The following chapters explore the scope of activity among nationally based organisations (Chapter 6) and across geographical areas (Chapter 7). Chapter 7 also includes details of individual activities described. A summary, discussion and conclusions are provided in Chapter 8.

Additional appendices bound separately from this document provide (1) details of all the activities described by respondents and (2) main tables giving response to all questions.

In reading the report, it is important to remember that, whilst a largely quantitative framework is employed and percentages are given to facilitate understanding of the overall picture and making broad comparisons, in some contexts the numbers are very small. In addition, it is apparent that there is considerable mix and overlapping of activities. The categories set in the questionnaire were not always clear to respondents in their work, and it should be borne in mind that to some extent the results suggest boundaries that are 'artificial' in the context of common practice. A fluid and changing picture emerged, often identifying work and approaches that encompass tobacco and smoking among other health and social issues and as part of every-day work, rather than discrete, focussed projects. These issues are discussed further in Chapter 8.

2. Aims and objectives

The aims of the survey were:

to identify current and planned work with young people on tobacco issues at a national and local level, covering prevention and education, cessation, media activity, strategic development, smoking policies and training and development
to identify the value base and strategic framework for work with young people within which smoking issues are being addressed
to determine the primary targets, key partners, content and approaches taken, funding and duration of initiatives
to determine the extent to which work is considered to be consistent with the existing evidence base
to map national and local initiatives and determine the extent to which they are linked to tobacco strategies.

For the purposes of the survey the core definition of young people was individuals aged 10 to 20 years, although it is recognised that work is carried out in the youth sector among those aged less or more than that age span.

3. Method and sample

3.1 Method

Given the large number of agencies potentially involved in tobacco-related work across Scotland, a postal survey was considered the most feasible approach. A highly structured questionnaire was developed and piloted. A cover letter and the questionnaire introduction highlighted key details, such as the source, purpose, layout and methods of completion and identified a contact for any enquires, and reply paid envelopes were included for the return of questionnaires. Named recipients who considered the questionnaire to be irrelevant to their work were encouraged to either pass it to another person in their organisation or to inform the researchers. A three stage fieldwork procedure was used where a first reminder letter was sent to all potential respondents who failed to respond to the first mail out within 14 days, followed by a further letter and questionnaire two weeks later.

3.2 Questionnaire content

Questions focussed on work with young people on tobacco-related issues. The group of interest was defined as 10-20 year olds, although respondents were encouraged to also include work which expanded outside this age group. The questionnaire (Appendix 1) was structured around five topic areas (Table 3.1) with response options to clarify the age groups to which activities are targeted, and whether these were youth specific or incorporated young adults as part of a broader population approach.

Table 3.1 Questionnaire topic areas

(1) Background Information	Type of department/organisation. Departments /organisations role in tobacco issues and young people. Any strategy/plan in relation to tobacco issues and young people. Links with national/local strategies/plans. Contacts in relation to tobacco issues and young people.
(2) Training and Resources	Training Media resources, eg. leaflets, posters, packs, videos. Funding resources and staff time in relation to tobacco issues and young people.
(3) Prevention and Education	Work in prevention and education in relation to young people and tobacco issues. Recent initiatives/activities (focus on three most recent). Any planned activities.
(4) Cessation	Any work on cessation in relation to young people and tobacco issues. Recent initiatives / activities (focus on three most recent). Any planned activities.
(5) Enforcement	Any work in enforcement in relation to young people and tobacco issues such as under-age sales, access to 'cheap' cigarettes etc. Recent initiatives / activities (focus on three most recent). Any planned activities.

Given the length and complexity of the questionnaire considerable efforts were made to ensure clear routing and 'signposting' from section to section.

3.3 Distribution and response rate

The questionnaire was sent to individuals working in health promotion, primary care, trading standards, statutory and voluntary youth work sectors, and Social Inclusion Partnerships (SIPs) and Drug Action Teams (DATs). National tobacco and youth agencies were also included. Names were drawn from lists provided by a range of central agencies, for example, ASH Scotland, Community Learning Scotland and Community Health Exchange (CHEX). Details for Primary Care, SIPs and DATs respondents were accessed through web sites.

A total of 506 questionnaires were distributed to a range of agencies and organisations potentially involved in this area of work (see Table 3.2).

Table 3.2 Response to mail-out (%)

Base: Total mail-out	Total mail-out	Health Promotion / Board	Primary Care	Trading Standards	Youth Work	National Organisations	SIPs	DATs	Others
Base: Total mail-out	(506) %	(56) %	(83) %	(32) %	(180) %	(62) %	(48) %	(19) %	(26) %
Completed questionnaires	42	32	43	91	46	35	27	-	35
Not involved	21	-	16	6	13	44	42	58	35
Shared response indicated	11	52	7	-	7	-	6	26	4
No return*	27	16	34	3	34	21	25	16	27

*Includes: No-one in this post (5); Refusal (2)

The survey achieved a relatively high response for this type of project, and respondents showed a high commitment to the study, for example contacting the CSM if their reply was delayed or they were unclear about relevance for completion. As shown in Table 3.2, 210 completed questionnaires were returned (42% of the mail-out). A further 11% indicated that another questionnaire completed by a colleague or another agency would reflect their work, strengthening the scope of the survey findings. In addition, 105 individuals (21%) responded by indicating that they or their organisation were not involved in tobacco-related work with young people. Finally, five questionnaires were returned because post held by intended respondent was vacant, and there were two refusals. The final response rate of 62% was calculated as:

Completed questionnaires + respondents indicating 'not involved' in the activity

Original mail-out

There were varied response rates across different agencies (Table 3.2). Nearly all Trading Standards Departments replied, with 91% of questionnaires completed. In contrast, there were no completed questionnaires from Drugs Action Teams, although the majority responded, with a quarter suggesting that their area of work would be reflected in another agency s response, and over half indicating that they were not involved in this area of work.

In addition to DATS, a relatively high proportion of SIPs and National Organisations also indicated that they were not involved in tobacco-related work with young people, although some respondents recognised that there was scope to address this. A third of the questionnaires originally sent to Health Promotion and other Health Board departments were returned completed, representing at least one response per Health Board area, and a further 52% indicated that their response would be reflected in one 'departmental' return. The level of completed questionnaires from other agency types ranged from 27% to 46%.

There appeared to be a 'grey area' in recognition of whether or not an organisation or individual undertook tobacco-related work. For example, some agencies might have responded that they were 'not involved', perhaps only having leaflets available, whilst another agency that did respond might have described a similar relatively low level of activity.

3.4 Sample profile

The composition of the final sample is summarised in Table 3.3.

Table 3.3 Sample profile: area of work

Base: All respondents (210)
	%	n
Health Promotion / Board	9	(18)
Primary Care	17	(36)
Trading Standards	14	(29)
Statutory youth work	29	(61)
Voluntary sector youth work	10	(22)
National organisations	10	(22)
SIPs	6	(13)
Other	4	(9)

The youth work area makes up the largest proportion (29% statutory and 10% voluntary sectors) in part reflecting the larger mail-out. Health related agencies form relatively smaller groups (health promotion 9% and primary care 17%), followed by trading standards officers (14%). The 'national organisations' category (10%) includes tobacco focused agencies, those concerned with tobacco-related health problems, those addressing support of young people and 'uniformed' organisations. The 'others' category includes local council officers, and those working in training agencies, activity provision and agencies with a non-tobacco focus.

In addition, a broad coverage was achieved across Scotland. NHS Board areas were used as convenient units, and all areas are represented (Table 3.4).

Table 3.4 Sample profile: geographical distribution

Base: All respondents (210)
	%	n
Greater Glasgow NHS Board	14	(29)
Argyll and Clyde NHS Board	10	(22)
Lothian NHS Board	9	(19)
Lanarkshire NHS Board	9	(19)
Grampian NHS Board	9	(19)
Tayside NHS Board	8	(16)
Forth Valley NHS Board	7	(15)
Ayrshire and Arran NHS Board	6	(12)
Highland NHS Board	4	(8)
Borders NHS Board	4	(8)
Fife NHS Board	3	(7)
Dumfries and Galloway NHS Board	3	(6)
Shetland NHS Board	2	(4)
Orkney NHS Board	*	(2)
Western Isles NHS Board	*	(2)

Nationally based organisations	10	(22)

It should be noted that questionnaires were completed by a range of work categories within each main agency type. For example, within primary care, responses came from LHCC managers, health visitors, school nurses and, in a few cases, from those in designated tobacco-related posts. Youth work respondents ranged from area managers to individual project workers. Linked with this, there were indications that some respondents felt they might not be fully aware of the extent or nature of tobacco-related work in the area for which they were responding, implying that it would be too time-consuming to thoroughly check all activity.

4. Strategies and approaches which underpin tobacco-related work with young people in Scotland

This section explores the prevalence of internal tobacco-related strategies relating to work with young people and the influence of broader level strategies, together with working links with other agencies.

4.1 Internal tobacco-related strategies

Respondents were asked to indicate whether their organisation or department has a strategy/plan or protocol in relation to any aspect of tobacco-related work with young people.

Figure 4.1 Internal strategies in relation to tobacco-related work with young people

Figure 4.1 Internal strategies in relation to tobacco-related work with young people
Base: All respondents (210)

It can be seen from Figure 4.1 just under half of respondents were aware of any related internal strategy within their organisation. Only 7% of respondents worked in organisations with a specific strategy relating to tobacco-related work with young people. The majority of these came from trading standards departments (7), with the remaining small numbers made up from statutory youth work (3), primary care (2), and national organisations (2). A further 41% claimed that tobacco-related work with young people was incorporated in a broader young person strategy, such as substance use. The responses to further questions related to internal strategies indicated that the majority of all reported strategies were linked to a prevention/education approach (77%), with 51% saying this area had highest priority. Cessation activities and training and materials provision were each mentioned by just under half of respondents reporting an internal tobacco-related strategy, but were given highest priority by only 7% and 5% respectively.

4.2 Links with broader national or local strategies

Table 4.1 outlines responses to an open question which asked respondents to list any broader national or local strategies or plans to which their work is linked. Nearly two-thirds of respondents (63%) were able to identify such links, often referring to more then one strategy. There was a relatively even spread across mentions of national and local strategies (56% and 48% respectively). However, smoking specific strategies did not predominate, being mentioned at a similar level to general health approaches at a national level, and only minimally at a local level, although it is probable that tobacco-related issues feature in many local 'health' strategies. The relatively low number of mentions of Smoking Kills/Tobacco White Paper (17%) might reflect the lower frequency of cessation specific interventions. The 'other' strategies mentioned were predominantly descriptions of approaches taken such as community learning and community health initiatives.

Table 4.1 Links with broader national or local strategies / plans

Base: All whose work is currently linked to broader national or local strategies (132)
	%	n
National strategies / plans	56	(74)
Smoking Kills (Tobacco White Paper)	17	(22)
Other smoking-related, eg. HEBS / ASH guidelines, CAN, STA, SCCOT, etc	13	(17)
No Smoking Day	2	(3)
General health strategy, eg. Healthier Scotland	17	(22)
Heart / cancer-related	8	(10)
Other	6	(8)
Young people related	8	(11)
Social Inclusion	3	(4)
Other national	6	(8)
Local strategies / plans	48	(64)
General health local strategies, eg. HIPs, HIFs and named local plans	26	(33)
Health promotion	5	(7)
LHCC plans	5	(6)
Young people focus, eg. education / local authority / information-giving	9	(12)
Substance misuse	5	(6)
Tobacco control	5	(6)
SIPs strategies	2	(2)
Other strategies	10	(13)
Not stated	7	(9)

The range of strategies displayed in Table 4.1 indicates that there is no common core theme running through the different tobacco-related activities and settings across Scotland.

4.3 Evidence base

Respondents were asked to indicate any evidence base or models used in relation to their work in specific activities reflecting each of the key areas of practice. The returns indicated limited salience of an evidence base in informing practice overall. The majority response was 'none'/'unsure' or no response at all in relation to prevention/education and cessation (around 60% of those working in these areas) and in relation to enforcement (around 80% of those working in enforcement). The relatively small numbers who indicated a model or evidence base in relation to prevention cited guidelines/good practice (18), previous experience (9) and existing models and resources (9), with minimal mention of published literature (8), HEBS' materials (6) and peer education models (3). In relation to cessation activities, models of practice were mentioned by 16 respondents, including Maudsley (an adult cessation programme), the Stages of Change model and No Smoking Day. Mention was also made of use of research base/published literature (15), previous experience (7) and guidelines (5) such as those published by ASH and Thorax. Among those working in enforcement, a small minority related practice to 'previous experience/implementing existing schemes' (8) and formal guidance from the Scottish Office/Crown Office (5).

4.4 Funding

Originally, questions were included regarding funding resources for tobacco-related work. However, it was acknowledged at the outset that this might not yield particularly useful data. Many respondents indicated difficulty in answering these sections, with the majority explaining it was not possible to accurately specify the level of resource investment. In part, this might reflect much of the activity described being incorporated in 'every day' work rather than discrete initiatives requiring specific protocols and funding proposals. Of the extremely small number of sources reported, health promotion departments predominated, followed by 'Smoking Kills'/'White Paper', the Scottish Executive and ASH Scotland. Even less frequent mentions included charities, drug companies, local pharmacies and banks, as well as health boards, SIPs and the local police force.

4.5 Range of tobacco-related activities

Respondents' involvement with a range of tobacco-related activities offered as prompts is outlined in Figure 4.2. Further exploration of key areas of work is given in Chapter 5.

Figure 4.2 Role in tobacco-related work with young people %

Figure 4.2 Role in tobacco-related work with young people (%)
Base: All respondents (210)

This illustrates the higher prominence of prevention and education services reported by two-thirds of respondents in comparison to cessation services provision. No Smoking Day linked activities were also frequently reported.

Table 4.2 Highest priority role in tobacco-related work

Base: All respondents (210)
	%	n
Providing prevention / education services to users / clients	40	(83)
Enforcement	13	(27)
Providing cessation services to users / clients	9	(18)
No Smoking Day activities	6	(12)
Providing support materials	5	(10)
Giving advice to other professionals / organisations / companies	3	(7)
Giving training to other professionals / organisations / companies	2	(4)
Campaigning	1	(3)
Lobbying	1	(2)
Electronic activities, eg. internet sites	-	(-)
Other	5	(10)
Not stated	16	(34)

Provision of prevention / education services was the most frequently prioritised area of work (40%) as shown in Table 4.2, particularly among those in the youth work areas (almost 60% of youth work respondents), but also among around a third of those working in primary care and health promotion. Enforcement was prioritised by 13%, almost exclusively by those in trading standards departments. Cessation work was a relatively low priority (9%) and was most likely to be mentioned by those in primary care, who tend to deliver cessation programmes for the population at large rather than youth specific. Although a large number participated in No Smoking Day interventions (Figure 4.2), few felt these were of a high priority (6%), perhaps reflecting the limited time span of involvement. Whilst electronic activities such as internet sites are identified as growth areas (see below) they were not regarded as 'priority areas'.

4.6 Multi-agency working

Multi-agency and partnership working is of interest in enhancing tobacco-related work. Table 4.3 shows there was a range of agencies with which respondents worked (from a pre-coded list). Health promotion departments were the most frequently mentioned agencies with which respondents had contact (71% of respondents) followed by youth groups, education and community education. HEBS was the most frequently cited national agency (64%), followed by ASH Scotland. The wide range of additional 'other' agencies recorded by respondents included the police, local voluntary groups and agencies, local NHS Trusts/Boards, and local authorities.

Table 4.3 Multi-agency working - other agencies respondents have contact with

Base: All respondents (210)
	%	n
Local Health Promotion Department	71	(149)
Youth groups / organisations	58	(121)
Education (schools/FE/HE)	57	(119)
Community education	53	(112)
Community groups / organisations	44	(92)
Primary care	32	(68)
Social work	20	(43)
Trading Standards	17	(35)
Industry	8	(16)

Other local agencies	12	(25)

HEBS	64	(134)
ASH Scotland	49	(103)
Other national agencies	8	(16)

No contact with other agencies	2	(4)
Mean number of mentions of working with other agencies Health promotion respondents mentioned contacts with an average of 7.8 other agencies Primary care respondents........................................................... 5.4 other agencies Statutory youth work respondents............................................... 5.0 other agencies SIPs respondents......................................................................... 5.0 other agencies Voluntary youth work respondents.............................................. 4.5 other agencies Trading Standards respondents................................................. 3.6 other agencies National organisations respondents........................................... 3.4 other agencies

It can be seen from the table that health promotion respondents are those most involved in working with other agencies. However, across the board there appears to be a reasonable level of inter-agency contact with only 2% of respondents not having contact with other agencies.

4.7 Smoking policies

Finally the prevalence and nature of smoking policies within organisations was explored as an indication of awareness of tobacco-related issues in premises visited by young people. Nearly all respondents claimed their organisation had a smoking policy, the majority having a written code (Table 4.4).

Table 4.4 Smoking policies

	%	n
Whether organisation has a smoking policy Base: All respondents (210)
Has a written policy	79	(165)
Has an informal policy	16	(33)

No policy	3	(7)

Smoking policy Base: All who have a policy (198)
*Staff*
Not permitted to smoke on work premises	67	(133)
Permitted to smoke in designated areas / rooms only	35	(70)
Not permitted to smoke in front of young people	2	(4)
Staff permitted to smoke on premises	2	(4)
Other policy for staff	3	(6)
*Users / clients / visitors*
Not permitted to smoke on premises	56	(111)
Permitted to smoke in designated areas / rooms only	24	(48)
Users / visitors permitted to smoke on premises	2	(3)
Other policy for users / clients / visitors	2	(3)

It can be seen from the table that refusing permission to smoke throughout the premises is the most commonly adopted smoking policy, although a considerable minority of organisations have designated smoking areas. A very small proportion of youth work sector respondents reported extending limits on workers to not smoking in front of young people, presumably outside the workplace. 'Others' comments included indications of flexibility in buildings with varying user groups, for example AA attenders might be allowed to smoke, and some specific sites. Responses often indicated a blanket application of no smoking policies, for example, across all local authority or Health Board premises, and response from one area outlined the process of developing a local authority policy. A few respondents highlighted the negative impact of 'imposed' smoking restrictions on attendance among young people, for example, in drop-in cafes in local authority premises.

5. The scope and key areas of tobacco-related work with young people across Scotland

Five key areas of activity were identified in the study aims; prevention and education, cessation, enforcement, training and provision of materials. This chapter outlines how these areas are addressed Scotland-wide and concludes with future planned activities.

5.1 Overview of involvement in key areas of wark

As an introduction, Figure 5.1 visually summarises response to questions at different stages of the questionnaire which asked respondents to indicate their involvement in the key areas of work.

Figure 5.1 Overview of involvement in key areas of work (%)

Figure 5.1 Overview of involvement in key areas of work (%)
Base: All respondents (210)

The greatest levels of reported involvement fall into the category of prevention and education (69% of respondents), followed by cessation and enforcement (47% and 23% of respondents respectively). Training provision to other agencies and the development of support materials for other agencies showed low numbers of participants and the figures have been amalgamated.

5.2 Prevention and education

The prevention and education category was the most frequently mentioned in relation to activities currently taking place throughout Scotland. Table 5.1 shows that over half (59%) of these felt that activities were targeted directly at those within the 10-20 year old range (86 respondents). The focus on young people predominated across all agency types, with the exception of primary care respondents and the small number of trading standards officers who reported prevention and education activities.

Table 5.1 Prevention and education work with 10-20 year olds

Base: Organisations/departments which undertake work in the area of smoking prevention and education (146)
	Total		Health Promotion	Primary Care	Trading Standards	Statutory Youth Work	Voluntary Sector	National Organisations	SIP	Other

	(146) %	n	(15) %	(33) %	(5) %	(51) %	(18) %	(11) %	(6) %	(7) %
Activities targeted directly at those within 10-20 year old range	59	(86)	67	39	20	61	78	64	100	57
Activities which potentially include 10-20 year olds, but not specifically targeted at this group	40	(58)	33	61	60	37	22	36	-	3
No involvement at all of young people (10-20 years old)	1	(2)	-	-	20	2	-	-	-	-

Figure 5.2a shows the outcome of a prompted question asking respondents to indicate their involvement in different prevention and education activities in relation to past, current and planned activity. The figures for this chart can be found in Appendix 2.

Figure 5.2a Prevention and education activities - involvement and timescale (prompted)

Figure 5.2a Prevention and education activities - involvement and timescale (prompted)
Base: All whose organisation / department undertakes work in the area of smoking prevention and education which intentionally and potentially includes young people (144)

It can be seen from the figure that providing smoking prevention materials to service users is the highest reported area of involvement (51% current activity). This activity was predominately reported by those in the primary care and statutory youth work sectors. Nearly three-quarters of those in health promotion and primary care and those in SIPs agreed this was a current part of their work.

Raising awareness, youth group/community prevention interventions, and school-based prevention interventions were also areas of high involvement; again with the majority of participants coming from primary care and statutory youth work.

Figure 5.2b provides further details of the prevention and education activities planned within the next year, showing whether these activities are a continuation of existing work or whether they are completely new. Key growth areas of activity appear to be youth group/community interventions (reflecting the large number of youth work respondents), further and higher education prevention interventions, electronic based activities (eg. internet sites) and training. Electronic-based activities in particular appear to be on the increase and plans for new activities of this nature were reported by participants from the majority of agency types involved in the audit.

Figure 5.2b Further education activities

Figure 5.2b Further educational activities
Base: All whose organisation / department undertakes work in the area of smoking prevention and education which intentionally or potentially includes young people (144)

5.2.1 Prevention and education activities described

Following prompted questions about their involvement in prevention and education work, a mix of open and closed questions encouraged respondents to give information on a maximum of three activities which their organisation or department carries out. A total of 232 activities were described from across Scotland, although only a fifth described three activities and one sixth did not specify any activities. Tables summarising responses are provided in Appendix 3 and examples of individual projects are given in Chapter 7.

Just under half of the activity topics highlighted by respondents were specifically smoking related such as giving information and raising awareness. This includes one fifth of activities focused on No Smoking Day interventions, which are relatively time delimited. Around a quarter of activities incorporated smoking in broader health issues and events, such as health fairs, with a small number linking it with substance misuse or addiction (14).

The most commonly used approach for this type of work appears to be of an interactive nature, namely discussions/groupwork/workshops, closely followed by information giving and talks (each just over a quarter of activities). Displays and stalls were mentioned by smaller numbers (20). One-to-one advice, peer education, drama, and opportunistic responses were each mentioned in less than 5% (8-10) of activities. Only five website development activities were described in this context although this is indicated as a growth area.

The most common target groups are school students and youth group attenders, although other groups of current interest also feature, albeit at a low level, for example, looked after/accommodated teenagers, FE/HE students and young people with special needs (around 20-24 respectively). Reflecting the targets, the largest response relating to settings was those which are young people specific, with relatively even distribution between formal youth settings (mostly schools) and informal youth work (25% and 20% respectively).

5.3 Cessation

This section explores the cessation activities outlined by respondents. A smaller proportion of respondents undertake cessation work compared with prevention (47% vs. 69%). Around half of these (52 respondents) undertake activities targeted directly at those within the 10-20 age range (Table 5.2). Youth work was proportionately less well represented in this area of work than in prevention, but the work undertaken in this sector was more likely to be young person specific compared with the health sector (health promotion and primary care) and SIPs.

Table 5.2 Smoking cessation work with 10-20 year olds

Base: All whose organisation / department undertakes work in the area of smoking cessation (104)
	Total		Health Promotion (16) %	Primary Care (29) %	Trading Standards (1) %	Statutory Youth Work (31) %	Voluntary Sector (12) %	National Organisations (7) %	SIP (5) %	Other (3) %
	(104) %	n	Health Promotion (16) %	Primary Care (29) %	Trading Standards (1) %	Statutory Youth Work (31) %	Voluntary Sector (12) %	National Organisations (7) %	SIP (5) %	Other (3) %
Activities targeted directly at those within 10-20 year old range	50	(52)	38	17	-	68	83	86	40	67
Activities which potentially include 10-20 year olds, but not specifically targeted at this group	44	(46)	63	66	100	29	17	14	60	33
No involvement at all of young people (10-20 years old)	4	(4)	-	10	-	3	-	-	-	-
Unsure / not stated	2	(2)	-	-	-	-	-	-	-	-

Figure 5.3a shows the results from a prompted question which asked respondents to indicate their involvement in a list of smoking cessation activities in relation to past, current and future roles. Percentages are given in Appendix 2.

Figure 5.3a Cessation activities involvement and timescale (prompted)
Base: All whose organisation / department undertakes work in the area of smoking cessation which intentionally or potentially includes young people (98)

The chart shows that providing smoking cessation materials to service users is by far the highest reported area of involvement (56% currently involved). This activity was mainly reported by those in the primary care, youth work, and health promotion sectors. Raising awareness and youth group/community-based cessation interventions also appear to have high levels of involvement, with the highest participation coming from the sectors mentioned above, with youth work predominating in the latter.

Figure 5.3b provides further details of the smoking cessation activities planned within the next year. It indicates whether these activities are a continuation of existing work or whether they are completely new.

Figure 5.3b Cessation activities - future plans

Figure 5.3b Cessation activities - future plans
Base: All whose organisation / department undertakes work in the area of smoking cessation which intentionally or potentially includes young people (98)

The main areas where activity appears to be growing are youth group-based and school cessation interventions, further and higher education cessation interventions; and electronic-based activities (such as web-site design). The majority of respondents reporting new activities in these categories were in the health promotion and primary care sectors, including new activity in the youth work area.

5.3.1 Cessation activities described

Following the prompted questions about involvement in smoking cessation activities, more detailed descriptions of activities were given in response to a mix of open and closed questions. A total of 134 activities were described by 81 respondents, but with only 17 describing the maximum of three activities. Tables summarising the characteristics of interventions described are provided in Appendix 3 and examples of individual projects are given in Chapter 7.

Only 39% of the topics described by the respondents were smoking cessation specific (52 activities). Primary care respondents were more likely to respond than youth work but, with some exceptions, tended to describe general population programmes rather than young people focused work. A minority addressed smoking cessation among general health and well-being issues or felt it formed part of a more general smoking programme (28 and 15 activities respectively). No Smoking Day related activities were included as cessation interventions by a small minority (12) with some describing more sustained interventions than just focussing on the single day, and a Quit and Win programme was mentioned by one respondent.

In terms of approach used, structured support groups or classes were the most reported but only in relation to a minority of activities (37). Importantly, only a small number focussed on young people, with ten youth specific cessation programmes reported across the whole of Scotland. Most of the programmes were described by primary care respondents and were aimed primarily at the general population with young people visualised as only potentially accessing them. Less structured general support/counselling activities and one-to-one interactions were also described (26 and 14 respectively) and ten activities indicated an opportunistic/drop-in approach. More general approaches such as awareness raising and information giving rather than specific programmes were mentioned by a relatively large minority (30). Other activities mentioned in small numbers but indicating an innovative approach include: coping advice such as habit breaking, avoiding weight gain and alternative activities (7); positive lifestyle advice such as confidence building and stress reduction (8); peer education (4); and advice prior to attending a cessation service (2). Research and needs assessment were also mentioned (3). Whilst most of the approaches outlined were predominantly described by primary care and health promotion respondents, those in the youth work sector were more likely to highlight workshops/discussion sessions and drama work (10:4 and 4:1).

The major target groups are youth group attenders and school students (62 and 43), as with prevention, although in this case the wider community is relatively more predominant (42) reflecting the inclusion of cessation work which has a broader population focus. Other target groups of current interest were also mentioned but in smaller numbers: FE/HE students (20), looked after/accommodated teenagers and young people with special needs (each 13) and ethnic minority groups (8). Reflecting this, where settings were indicated, there is a fairly even spread over the three largest responses, namely youth work, school-based and primary care (each between 19 and 22 activities).

5.4 Enforcement

This section describes the enforcement activities as reported by respondents. Twenty-three percent of all respondents (48 individuals) indicated that their organisation or department undertook work in this area, much lower than levels of involvement in prevention and cessation (69% and 47% respectively). The majority of these respondents are from trading standards departments, with very small numbers being scattered across the other sectors, notably health promotion and nationally based organisations.

Figure 5.4a shows the results of a prompted question asking respondents to indicate their level of involvement in various enforcement activities in relation to past, current and planned activities.

Figure 5.4a Enforcement activities - involvement and timescale

Figure 5.4a Enforcement activities - involvement and timescale
Base: All whose organisation / department undertakes work in the area of enforcement in relation to tobacco-related work with young people (48)

From Figure 5.4a it would appear that the enforcement of underage sales regulation is the most common activity for those working within this sector, involving 54% of respondents, together with education of retailers in relation to this issue. Individual activities are summarised below (5.4.1).

Figure 5.4b Enforcement activities - future plans

Figure 5.4b Enforcement activities - future plans
Base: All whose organisation / department undertakes work in the area of enforcement in relation to tobacco-related work with young people (48)

Figure 5.4b above provides further details of the enforcement activities planned within the next year. There does not appear to be much new activity planned within each of the highlighted areas of work, although respondents' comments indicated a hope to be able to undertake 'test purchasing', a key area in enforcing underage sales regulation, which currently banned pending the results of the Lord Advocate's review.

5.4.1 Enforcement activities described

Respondents were also asked to provide further information on individual enforcement activities run by their department or organisation, using a range of open and closed questions. Forty-two respondents described a total of 84 activities, with 15 outlining the maximum of three. Tables summarising the activities are provided in Appendix 3, and examples of individual activities are given in Chapter 7.

Activity related to retail outlets is clearly the main area – reported in relation to 67 activities (80%). Within this topic, the various areas described were fairly evenly distributed amongst respondents. They included routine inspections and enforcement of statutory notices (16 and 13) and investigation of complaints (11). Surveillance of shops and other premises were described (12) and more specifically surveillance of sales activities near schools, for example from ice-cream vans (5). More proactively, test purchasing, both in relation to underage sales and sales of single cigarettes were reported (10) although the former area of work is at a halt at the moment. Education of retailers was seen as part of the work (10) and some reported broader awareness raising interventions with young people (8). Proof of Age cards were also initiated in some areas (10), and tend to include wider functions such as access to services and price reductions to make them more attractive to young people. Finally, some organisations reported representation and lobbying activities (7).

Linked with the core focus on retail activity, shopkeepers are clearly the main target group for this area of work (60). Management of pubs and clubs were also important targets (35), as were sellers/providers of illegal cigarettes (25). Young people themselves were also targeted, primarily in education and awareness raising initiatives (28) as were those working with young people such as teachers, parents and youth workers (15, 13, 11 respectively).

5.5.1 Training received by respondent or organisations

Respondents were asked to indicate whether they or anyone else in their organisation had received training on tobacco-related work with young people. Around a third of all respondents (76) reported receiving some form of training, primarily those in health promotion and primary care (just over half of respondents in these agencies) followed by those in the youth work sector.

Table 5.3 Training received by respondent or organisation

Base: All respondents receiving training (76)	%	n
Source of Training
Local health promotion / health board	51	(39)
Fast Forward	12	(9)
HEBS / ASH study day	9	(7)
ASH	9	(7)
HEBS	4	(3)
Trading Standards	4	(3)
Primary Care / LHCC	3	(2)
Local worker / local project / in-house	9	(7)
Other	20	(15)
Topic / Focus for Training
Smoking / tobacco issues / awareness	38	(29)
Cessation	36	(27)
Prevention	16	(12)
No Smoking Day	11	(8)
Enforcement	7	(5)
Addiction / substance misuse	7	(5)
Health issues	3	(2)
Other	7	(5)

The main sources of training were local Health Promotion Departments (51% of those who had received training), with Fast Forward, HEBS and ASH mentioned by much lower numbers (Table 5.3). Training from health promotion departments was reported by over two-thirds of youth workers and primary care workers who had received training. Over half of health promotion respondents reported attending sessions provided by Fast Forward and HEBS/ASH initiatives as did small numbers of those in primary care and youth work sectors. However, much of the reported events were seminars and study days rather than on-going or formal training.

Tobacco awareness topics (38%) and smoking cessation (36%) form the bulk of training experienced, reported primarily by those working in primary care, youth work and health promotion. It should be remembered that these represent small numbers. For example, only 27 respondents reported receiving training in cessation (13% of the total sample), and for some primary care staff this was not young person specific. Thus, although cessation might be increasingly addressed, there is little evidence of training in this area. Despite prevention being the most common focus of the activities undertaken by respondents, this area of work accounts for an even lower percentage of training received.

5.5.2 Training provided by organisation

Respondents were asked to indicate whether their organisation provides any forms of training (both internally and externally). The first section of Table 5.4 below summarises involvement in these activities, with 20% of respondents saying that in-house training was provided and 10% indicating that they provided training for other agencies. This represents 50 respondents overall, because 13 reported both in-house training and provision for other agencies.

Table 5.4 Training provided by organisation (%)

Whether provide training Base = All respondents (210)	% n
Provide in-house training for staff	20 (41)
Provide training for other agencies	10 (22)

Target Group		Outline / Focus
Base: All mentions of target group (72)	% n	Base: All mentions of outline/focus (73)	% n
Youth workers / leaders / community education	38 (27)	Awareness / education about smoking	32 (23)
Young people	28 (20)	Cessation	23 (17)
Health professionals / nurses / midwives	21 (15)	Prevention	12 (9)
Teachers / education	13 (9)	Drugs related	11 (8)
Enforcement staff	3 (2)	General smoking / tobacco issues	11 (8)
		Health issues	8 (6)
Others	14 (10)	Skills / approaches, eg. group work	7 (5)
		Implementation of programmes / packs	7 (5)

		Other	15 (11)

Main reported targets were youth workers/community education (38%), followed by young people (28%) and health professionals including school nurses (21%). As with training received, awareness and cessation were again the main areas of the training delivery reported, with prevention, drugs related work and general smoking issues and health issues each mentioned by less than one-sixth of respondents.

5.5.3 Development of support materials

A small proportion of respondents are involved in the development of support materials, as shown in Table 5.5. This represents 37 respondents because 10 reported developing materials for internal and external use.

Table 5.5 Development of support materials by organisation (%)

Whether develop support materials
Base: All respondents (210)	%	n
Develop materials for use internally	14	(29)
Develop materials for other agencies	9	(18)
Types of support materials
Base: All who develop support materials (37)	%	n
Resource packs	24	(9)
Leaflets / booklets	22	(8)
Posters	14	(5)
Questionnaires / quizzes / games	14	(5)
Lesson plans / teachers notes	14	(5)
Information / fact sheets	11	(4)

Others	24	(9)

The main types of materials being developed by respondents' organisations were resource packs and leaflets/booklets.

5.6 Planned activities

A closing question asked respondents to outline any planned activities not currently in place and around a quarter indicated they had future plans in tobacco-related work with young people (Table 5.6).

Table 5.6 Planned activities (%)

Whether have any planned activities currenlty in place Base: All respondents (210)	%	n
Yes	26	(55)
No	55	(115)

Base: All planned activities mentioned (74)
Main Focus	% n	Settings	% n	Targets	% n
Cessation	58 (43)	Formal education (schools, FE)	28 (21)	Young people	72 (53)
Prevention	47 (35)	Youth work / clubs / community	22 (16)	Everyone / generic	7 (5)
Enforcement / Proof of Age	9 (7)			Retailers	5 (4)
		Other setting	7 (5)	In / leaving care	3 (2)
Other focus	14 (10)			Pregnant women	3 (2)

				Other target	15 (11)

Seventy-four activities were mentioned by 55 respondents. The main focus was cessation (58% of planned activities) indicating increased activity in this area compared with prevention work (47%), although some described activity as both cessation and prevention. Enforcement was mentioned by a small proportion, focusing on Proof of Age programmes, largely initiated by trading standards' respondents, but often in partnership with other agencies such as health promotion. Trading standards' respondents also indicated a hope to be able to renew test purchasing of cigarettes by under-16s, depending on the Lord Advocate's review. Planned needs assessment and strategy development initiatives were also highlighted in very small numbers, as were awareness raising and education and training initiatives for those working with young people. Settings were divided between formal education including both schools and FE/HE contexts and informal youth work. Key targets were young people but a small number of additional targets included 'everyone', retailers, those in or leaving care, and pregnant women. 'Other' individually mentioned targets included homeless people, households with children, prevention services for younger children and those working with young people including youth workers and school nurses.

5.5 Training and materials

The final key area to be explored is the experience and provision of training and the development of support materials.

6. Scope of activity among nationally based organisations

This section gives insight into the range of activities undertaken by nationally based organisations with an interest in tobacco-related work with young people. These included national and UK tobacco-related agencies (ASH Scotland and No Smoking Day), agencies focused on cancer and asthma issues (4), national organisations concerned with the well-being of young people (8), such as Childline, and 'uniformed' organisations (4). Four other national agencies with a broader health and well-being remit also responded. The relative extent of involvement in key activities is addressed in the previous sections and details of the 'main activities' described by respondents are presented in a separate Appendix.

As with other agencies, the nationally based organisations' tobacco-related work with young people was most likely to include prevention/education activities (50%), followed by cessation (32%) and enforcement (23%). Around one-fifth provided training and materials. In addition, a relatively large proportion in this agency type indicated they were involved in campaigning and lobbying activities although with a small number seeing these activities as their highest priority (3 and 2 respectively). Figure 6.1 summarises the numbers involved in each activity area.

Figure 6.1 National organisations: overview (n)

	Total	Prevention/ education: Directly	Prevention/ education: Potentially	Cessation: Directly	Cessation: Potentially	Enforcement	Training: In-house	Training: Other agencies	Support materials: Internal use	Support materials: Other agency
		10-20 Q15	10-20 Q15	10-20 Q25	Q34	Q12	Q12	Q12	Q13	Q13
Tobacco Focus	2	1	-	1	1	1	-	-	-	2
Young People	8	3	2	2	-	-	1	1	-	-
'Uniformed' Organisations	4	2	1	1	-	1	1	-	1	-
Cancer / Asthma Focus	4	1	1	2	-	2	1	1	2	1
Others	4	-	1	-	-	-	-	-	-	-

When asked to describe their main activities in detail, only a few mentioned approaches which had a national spread, apart from the No Smoking Day organisation. For example, only one organisation highlighted lobbying and campaigning activities. Other 'national' activities included counselling callers to Childline (estimated 125 callers per annum for preventive/educational reasons and 150 seeking cessation advice) and two organisations reported web-site development covering prevention/education and cessation designed for young people but accessible to all. Some organisations offer training and education addressing prevention and cessation issues. This is either aimed at young people and youth workers across the wider population or targeted at youth members of their organisations, the latter often incorporating broader healthy lifestyles and development training or drugs misuse issues. Finally, one organisation described a research initiative exploring young people's smoking cessation needs across Scotland (Fast Forward).

In general, however, localised activities were more commonly reported. For example, ASH Scotland reported funding small grants for three preventive projects and one cessation project in different areas of Scotland. Two of the preventive projects incorporated young people undertaking a mix of investigations and workshops leading respectively to video documentaries and a drama production, which were disseminated across the local community and schools and youth groups. A third preventive intervention was linked with sports activities. An innovative cessation intervention piloted support sessions prior to potentially joining routine quitting services. Another example is a cancer charity which has promoted interventions primarily in the West of Scotland. These include funding a Smoking Prevention and Young People Co-ordinator who attends schools and youth groups addressing tobacco awareness, and establishing several school-based smoking cessation groups for older children.

Remaining activities described included development of targeted materials including one organisation supporting a young person in the development of a peer education initiative in schools, undertaking local surveys and developing databases in relation to smoke free areas. Finally, local youth leader training events were identified.

7. Scope of tobacco-related work with young people across geographical areas of Scotland

This section explores the scope of tobacco-related work with young people in greater detail than the earlier overview sections. It provides a geographical breakdown using NHS Board areas as a convenient unit and is illustrated by specific examples of activities indicating good practice.

Section 7.1 gives a geographical overview. The remaining sections cover each board area in order of number of respondents, and address prevention, cessation, enforcement and training. Examples of activities described by respondents are presented, largely using their own words. Cases were chosen as representing youth focussed approaches with a tobacco related aim or element. Projects with a broader base are also included if they address harder-to-reach and minority groups. Finally, many respondents reported No Smoking Day activities, but examples are only included here if they appear to encompass broader based activities rather than one-day awareness raising events.

Details of all the individual activities respondents have described are provided in a separately bound Appendix, grouped by geographical area and the key areas of prevention, cessation, enforcement and training. Finally, whilst the response rate of 62% was relatively high for a survey of this nature, it is acknowledged that there may be other relevant activities and interventions which are not reported here because of lack of data.

7.1 Geographical overview

The range of tobacco-related work with young people is summarised on a geographical basis in Table 7.1. Figures are presented as percentages to facilitate comparison but it is important to remember that the numbers are very small in some areas.

Table 7.1 Overview of specific aspects of work by location: NHS Board area (%)

Base: All respondents
	Total *(210)* %	GG *(29)* %	A&C *(22)* %	Lothian *(19)* %	Lanark- shire *(19)* %	Grampian *(19)* %	FV *(15)* %	Tayside *(16)* %	A&A *(12)* %	Highland *(8)* %	Borders *(8)* %	Fife *(7)* %	D&G *(6)* %	Islands *(8)* %
Prevention / education	69	69	64	74	84	63	60	94	67	75	38	86	83	63
10-20 years specifically	41	31	59	21	63	37	47	50	50	38	25	43	33	38
10-20 years potentially	28	38	5	53	21	26	13	44	17	38	13	43	50	25

Cessation	47	45	45	42	53	63	60	38	50	25	50	57	67	38
10-20 years specifically	25	10	41	16	16	32	40	19	42	25	13	29	33	13
10-20 years potentially	22	34	5	26	37	32	20	19	8	-	38	29	33	25

Enforcement	23	21	23	32	11	16	13	31	42	13	25	29	17	38

Training provision
In-house	20	17	14	21	26	37	13	13	25	-	25	29	33	13
For other agencies	10	3	5	16	16	11	20	-	8	13	-	14	33	25

Develop support materials
For internal use	14	14	18	11	16	11	-	25	25	-	-	14	-	38
For other agencies	9	14	9	11	5	5	13	6	8	-	-	-	-	13

Prevention and education activity across the NHS Board areas was broadly similar to the national overall total of 69% reporting this kind of work. However, relatively high proportions reported preventive activities in Tayside, Fife, Lanarkshire and Dumfries and Galloway (94%, 86%, 84% and 83% respectively) and a relatively lower proportion was recorded in Borders (38%). As with the national total, most areas recorded higher proportions of young people specific activities in comparison to more general activities which would potentially include 10-20 year olds. The preponderance of young people specific activities was highest in Argyll and Clyde, Lanarkshire, Forth Valley and Ayrshire and Arran, but the balance was reversed in Lothian, Dumfries and Galloway and Greater Glasgow.

Recording of cessation activities across the NHS Board areas tended to be closer to the national proportion of 47%. However, higher levels are particularly apparent in Dumfries and Galloway, Grampian and Forth Valley (67%, 63% and 60% respectively). Reported levels in Highland were relatively low. In identifying young people specific cessation interventions, the overall national experience is relatively equally divided between those targeted at young people and those potentially reaching 10-20 year olds, largely reflecting a more general focus among primary care respondents (25% : 22%). However, more positive ratios towards young people specific activities are notable in Highland, Argyll and Clyde, Ayrshire and Arran and Forth Valley. A relatively lower proportion of youth specific work was reported in Greater Glasgow, Borders, Lanarkshire and the Islands.

In relation to enforcement, recorded involvement is relatively higher than the total proportion of 23% in Ayrshire and Arran, the Islands and Lothian (42%, 38% and 32% respectively) and relatively lower in Lanarkshire, Forth Valley and Highland (11%, 13% and 13% respectively). Responses were received from nearly all trading standards departments, all of whom are involved in enforcement activities. Thus, variation in these proportions largely reflects the extent to which more than one local authority based department is included in an NHS Board area. An additional factor is the extent to which respondents from other agency types reported involvement in enforcement. In Argyll and Clyde, Lothian, Tayside, Ayrshire and Arran and Western Isles respondents from health promotion and/or primary care indicated involvement together with youth work agencies in Greater Glasgow, Borders and Fife.

As already discussed, provision of training was at a relatively low level overall (20% in-house and 10% provision for other agencies). Reporting of in-house training was relatively higher in Grampian and Dumfries and Galloway (37% and 33%) and provision of framing for other agencies was higher in Dumfries and Galloway, the Islands and Forth Valley (33%, 25% and 20% respectively).

Development of support materials was not a widespread activity. Development of materials for internal use were more likely to be reported in Tayside and Ayrshire and Arran (25% and 25% compared with 14% overall) largely reflecting activities in the youth sector. There was no reporting of this activity from four NHS Board areas. There was little variation from the overall reporting of 9% involvement in developing materials for other agencies, although this activity was not reported at all in four NHS Board areas.

7.2 Greater Glasgow NHS board area

Greater Glasgow NHS Board area encompasses a large urban area including extensive areas of deprivation. The main local authority is Glasgow City Council, but four other local authority areas overlap the boundaries. This area includes the largest number of respondents (29) reflecting its size.

Table 7.8 Greater Glasgow NHS Board area: overview (n)

	Total	Prevention/ education: Directly	Prevention/ education: Potentially	Cessation: Directly	Cessation: Potentially	Enforcement	Training: In-house	Training: Other agencies	Support materials: Internal use	Support materials: Other agency
		10-20 Q15	10-20 Q15	10-20 Q25	Q34	Q12	Q12	Q12	Q13	Q13
Health Promotion / Health Board	1	1	-	-	1	-	-	-	-	1
Primary Care	7	-	7	-	6	-	2	-	-	-
Trading Standards	4	-	1	-	-	4	-	-	1	1
Statutory Youth Work	6	3	1	2	-	1	2	1	3	1
Voluntary Sector	5	3	2	1	2	1	1	-	-	-
SIPs	3	1	-	-	1	-	-	-	-	-
Other	3	1	-	-	-	-	-	-	-	-

Reported current involvement in prevention and cessation interventions focussed on young people is at a relatively low level in this area (Table 7.8). Health promotion activities are focused mainly on preventive work, but primary care respondents reported that they did not undertake youth specific work, although, as noted in Figure 7.8a, some were involved in school-based activities. Enforcement activities were reported by trading standards officers with additional involvement from two youth work agencies. Training provision was relatively low and only highlighted by youth work and primary care respondents. Youth work was the main sector describing development of support materials, followed by the trading standards sector.

Prevention and education

Relatively few individual prevention and education activities were outlined considering the size of Glasgow and many of these were one-off or short-term events. Figure 7.8a outlines projects which are both smoking and youth specific, including No Smoking Day focussed activities, but also includes examples of smoking being addressed among other issues. There are also indications of approaches which would encompass smaller and harder to reach target groups such as ethnic minority groups, young people with special needs, young homeless people, looked after/accommodated young people and those leaving care.

Cessation

As Figure 7.8b indicates, specific cessation projects were difficult to identify. The examples illustrate: a cessation group targeted at the local general population but including 16 and 17 year olds as well as 18+ years; group work activities exploring the issue of smoking; and information giving activities. One case indicates youth worker activities located in school settings, and this was also reported by a different respondent in relation to prevention.

Enforcement

The enforcement activities outlined in Figure 7.8c are broadly similar to those in other areas, for example, routine inspection of premises to ensure warnings are displayed, visits to locations for vending machines and response to complaints. Less commonly reported enforcement activities listed are:

use of press releases asking the public to give information on illegal sales
discussion on contraband cigarettes in the context of 'law and rights' reported by a youth worker
Community Action with shopkeepers and young people, reported by a voluntary sector respondent.

Training

The main source of training reported was the local Health Promotion Department - Smoking Concerns. Training from them addressed young people and smoking as well as general smoking cessation approaches. ASH and Fast Forward were also mentioned as sources of training on tobacco and young people, primarily by health promotion and primary care respondents. Within the youth work sector, training sources included Community Education, and Youth Health Spot, a local project, and the Jewish Youth Movement. In relation to training provision, one primary care respondent highlighted general cessation training for their staff members and one youth organisation reported tobacco training for their workers. A voluntary sector respondent highlighted peer led health promotion training for homeless young people.

Figure 7.8a Greater Glasgow NHS Board area: prevention

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Health Promotion	Smokebusters Club	10-14 years Any young people in age range Includes schools, youth groups, looked after/accommodated young people and those with special needs, ethnic minority groups and community group attenders	Interactive club for non-smoking young people between 10-14 years	Competitions, newsletters, quiz, events Mainly communicate with members via newsletter / Education department Running since 1983 Being reviewed Questionnaires with members / parents to determine impact
	Smoke Free Class	10-15 years School students		Education department
	Smoke Free Me	Primary 6 / Primary 7 In 20 schools: Feb-March 2001	Interactive drama for P6 / P7 - lesson plans to be completed prior to drama. CD provided with songs	Lesson plans, CD, promotional materials? Education department
Primary Care	Health Fayre Local primary school (open day)	Pupils / families and teachers Local primary school	Health checks and advice by HVs and practice nurses	Education / community education / school nurses
Primary Care	Youth Health Promotion	Youth group attenders	Discussed within context of health promoting activity	Ongoing
Statutory Youth Work	PSD classes	10-20 years School students, youth group attenders, young people with special needs, community group attenders	Informal education in classroom setting 1 day a week	Own packs / Local information projects
	Smoke-Free Fest	Youth group attenders	A disco event organised by local youth forum with no smoking message promoted One-off event	Health board materials / GGHB funding for event, police
	Group work	12-25 years Youth group attenders, community group attenders	Issue based group discussions / exercises Done weekly, 1-2 hours x 3-4 weeks	Publicity etc from GGHB, 'No Smoking Day' material
Voluntary Sector	No Smoking Day event “QUITS”	14-18 years Youth group attenders	Made video based on HEBS advert One evening, two afternoons	Video, collage, drama/ External funding from Health Promotion
	Series of health and fitness activities for Asian young people	Ethnic minority groups		Instructors etc / External funding from Health Promotion
	Peer led health promotion training	Young homeless people
SIPs	Written information produced as part of a broader information resource	16-20 years Looked after / accommodated teenagers, those leaving care		Social work
Planned Activity
Primary Care		Secondary school pupils	Health talks on smoking
		12-19 years	Group set up within LHCC to address smoking - planned activity with young people to include consultation and service delivery
Statutory Youth Work		10-17 years	Education about the hazards of smoking and Jewish textual approach

Figure 7.8b Greater Glasgow NHS Board area: cessation

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Statutory Youth Work	Project surgeries in schools	School students	Material and information given as requested to young people and teachers Within school terms times	Smoking leaflets and helpline numbers
Voluntary Sector	Smoking Cessation Group	16-20+ years (all ages) Parents, community group attenders	This was done in an informal setting with people of all ages in the community taking part (12-15) per group. 6 weeks	Videos about quitting smoking, literature, acupuncturist, discussion and support from members of the group/ Homeopathic doctor/ Model based on a project in Easterhouse
	Group work	10-15 years Youth group attenders Community group attenders	Group work on why young people smoke Who smokes in your family? Positives / negatives	(Organisation offers half price hypnotherapy for cessation)
	Provide information on stopping	School students, youth group attenders, young people with special needs, ethnic minority groups, community group attenders, wider community	Provide information at youth information stalls, satellite points etc	GGHB and HEBS leaflets, Smoking, how you can give up - Help your pregnant partner give up - posters, postcards and other information sources
Planned Activity
Health promotion	Cessation support	16-18 years	Development of services to include support for young people
Primary Care	Cessation	Young adults	Currently working on development of this work with colleagues from Smoking Concerns

Figure 7.8c Greater Glasgow NHS Board area: enforcement

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Trading Standards	Retailing inspection	Shop keepers, management of pubs / clubs	Retailing inspection to ensure warnings displayed Trader advice - serve written notice if warnings not displayed As part of yearly inspection programme	Laminated signs supplied if requested
	Routine enforcement - cigarette packs	Shop keepers, management of pubs / clubs, sellers / providers of illegal cigarettes	Check cigarettes packs have health warning as per labelling regulations Officer visits as per enforcement schedule - ongoing	Customs and Excise
	Routine inspection of premises Responding to consultation documents on proposed advertising controls	10-15 years Shopkeepers, management of pubs / clubs etc	Normal programmed visit to premises where cigarette vending machines are located	Customs and Excise
	Seeking information on illegal sales (via local press)	10-15 years Parents, teachers, youth / community group leaders	Press releases asking the public to let us know of retailers selling tobacco to young people Periodic - last done November 1999	Police, local health issues group
	Enforcement regarding consumer complaints		All complaints about illegal sales are investigated Ad hoc - very few complaints received	Police
Statutory Youth Work	Law and rights	12-15 years Young people, youth / community group leaders	Discussion on contraband cigarettes
Voluntary Sector	Community Action with shops and young people	10-15 years Shop keepers, young people	No specific activity	Police (community safety)
Planned Activity
Trading Standards	Introduction of Proof of Age Card - 'Youth Card'	12-18 year olds	The Glasgow Young Scot Card suggested is multi-purpose - has significantly more uses than the proof of age aspect which might be seen negatively by some young people. Card Joined with Young Scot organisation and obtained discounts from services/retailers in Glasgow, Scotland and Europe. Proposed introduction to 40,000 12-18 year olds free of charge. To be launched September 2001 Will hopefully continue to be developed over many years.	Worked with Young Scot, Scottish Executive, HEBS, police. External funding from Scottish Executive and GGHB.
	Retailer awareness Enforce 'Tax Paid' labelling	Retailers	We would, if we had the resources, have a 4 pronged approach to enforcement. The idea would be to raise shopkeepers' awareness of the offences, other than underage sales, they could commit. Re legislation on: Refillable gas lighter Display of underage notice Display of health warnings on packets Display on packs of 'blue' tax paid label From July 2001 trading standards can apply to enforce cigarettes having to bear 'Tax Paid' labelling and we intend to apply
	Planned test purchasing (enforcement > prevention)	10-15 years old Retailers	Test purchase exercises using volunteer young people with strict protocol for all involved. Awaiting decision of Lord Advocate who is presently reviewing his position on the use of such test purchases.
	Information leaflets	Retailers	Produce information leaflets for retailers explaining their statutory responsibilities regarding a wide range of age restricted products - by March 2002

7.3 Argyll and Clyde NHS board area

Argyll and Clyde covers a wide area with both densely populated and often less-well off urban communities and widely spread rural communities. Reported activities indicated a relatively high level of inter-agency working, including, but not exclusively, the Inverclyde Tobacco Control Alliance, a grouping of community, primary care, local authority and health promotion agencies founded in 1995.

Table 7.2 Argyll and Clyde NHS Board area: overview (n)

	Total	Prevention/ education: Directly	Prevention/ education: Potentially	Cessation: Directly	Cessation: Potentially	Enforcement	Training: In-house	Training: Other agencies	Support materials: Internal use	Support materials: Other agency
		10-20 Q15	10-20 Q15	10-20 Q25	Q34	Q12	Q12	Q12	Q13	Q13
Health Promotion / Health Board	1	1	-	1	-	1	1	1	-	-
Primary Care	2	2	-	1	1	-	-	-	-	-
Trading Standards	3	1	-	-	-	3	-	-	-	-
Statutory Youth Work	8	4	1	3	-	-	-	-	2	1
Voluntary Sector	3	2	-	2	-	-	-	-	-	-
SIPs	3	1	-	1	-	-	-	-	-	-
Other	2	2	-	1	-	-	2	-	2	1

As Table 7.2 indicates, there was a high level of involvement in prevention and cessation activities focused on young people across nearly all agency types. Enforcement activities were mainly undertaken by trading standards respondents but the health promotion department and a youth training agency also reported involvement in this area. Training was provided by health promotion and by other agencies - Have a Heart Paisley and Argyll Training - and support materials were developed within the youth work sector and these two agencies.

Prevention and education

As already noted, there were relatively high levels of involvement in young person specific activities. Figure 7.2a illustrates substantive activities from across different agency types, in different settings and using different approaches, as well as the incorporation of No Smoking Day as a basis for broader activities. Two projects are also included which highlight the development of websites with young people, addressing tobacco among a number of issues.

Cessation

The cessation initiatives outlined in Figure 7.2b illustrate multi-agency activity, school and youth work based initiatives, and give an example of No Smoking Day providing a basis for more in-depth activity over a 3-day period. Planned cessation activities were reported primarily by the health promotion respondent, but developments in primary care and youth and community based work were also outlined.

Enforcement

In relation to enforcement a range of activities were reported. Work by trading standards officers reflected similar initiatives undertaken across the country including:

investigating complaints in response to reports of retailers selling tobacco in contravention of legislation
routine inspections of trade premises / shops
education of traders on underage sales (often in the course of routine visits)
surveillance of premises selling tobacco products
investigating sales of single cigarettes (including attempted purchase)
ensuring signs indicating no sales to under-16s are displayed.

In addition, trading standards respondents reported:

the planned introduction of a Proof of Age card
the Young Scot 'Smart Card' which also incorporates identity information - in order to control sale of age restricted products, particularly tobacco
supplying intelligence to Customs and Excise gained from sources.

The health promotion respondent also reported involvement in enforcement by participating in the multi-agency Tobacco Steering Group which is also attended by a Trading Standards representative. One training agency worker reported including awareness of the tobacco industry and contraband as part of a three day programme centred around No Smoking Day.

Training

A minority of youth workers (four) reported receiving tobacco-related training from health promotion / health board sources often focussing on No Smoking Day. The health promotion respondent reported receiving training from Fast Forward on smoking cessation and youth smoking culture. Smoking cessation specific training was provided by health promotion to youth and community workers and schools nurses, giving training in negotiating behaviour skills with a one day introduction followed by a two day education course. The health promotion department also held a one day conference / seminar focussing on issues for young people, women and disadvantaged communities in giving up smoking which was aimed at all workers interested in smoking cessation. Additionally, tobacco issues were included in a general session on health issues for young people. Finally a worker in a training agency reported incorporating tobacco issues in courses for young people, including peer education training, the history of tobacco, poster design and raising awareness.

Figure 7.2a Argyll and Clyde NHS Board area: prevention

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Health Promotion	Supporting school nurses and youth workers in addressing tobacco issues	10-15 years / School students /youth group attenders	Support with project design and activity resources, consultancy, particularly around No Smoking Day	NSD materials and other HP resources on tobacco health, eg. GASP
Health Promotion	Development of website	School, FE/HE students, youth group attenders, looked after / accommodated teenagers, young people with special needs / ethnic minority groups, wider community	Tobacco input developed for Inverclyde Youth Website. Multi-agency project developed through SAD funding November 2000 - ongoing	General resources on tobacco used in development of site / Community police, Inverclyde Council, Youth committee, NHS Funding: SAD
Primary Care	Talks/discussions with 10-13 year olds in school	10-15 years / School students	School nurses give talks/discussions with 10-13 year olds in school	School nurses
Primary Care	Prevention in schools	14-17 years / School students	Campaigns / presentations in primary and secondary schools	HEBS materials / Schools
Trading Standards	Youth seminar	10-20 years / School students, youth group attenders	Organising youth seminar to discuss issues	Health Promotion Unit, Strathclyde Police
Statutory Youth Work	Website development General café programme (We also promote positive lifestyles through non-computing programmes, eg. Duke of Edinburgh's Award)	10-20 years / School/FE/HE students, looked after / accommodated teens, young people with special needs, ethnic minority groups	The Log-in website includes health related information including tobacco issues. (Includes Doc- online service linked to local GP practice - GPs answer queries) The website was developed in February 1999 and continues	www. soft-ware Looked at other websites and later chose suitable link sites Local Health Centre through Doc-online
	No Smoking Day	10-20 years / School/FE/HE students, looked after / accommodated teens, young people with special needs, ethnic minority groups	A week long programme of anti-smoking activities, quizzes, prizes, fun activities	HEBS promotional materials / Health Board
	School leavers' courses for 4^th and 5^th years	School students, youth group attenders	Discussion, group work based on Kiss It Goodbye photocopy kit	ASH website
Voluntary Sector	Short sketch (Drama / Peer education)	12-20 years / Youth group attenders	Sketch written by young person in group will be performed by a group of young people to others June - September 2001	Funding: Inverclyde Tobacco Initiative
Voluntary Sector	Smokes and Ladders game	10-15 years / School students, youth group attenders	Game based on Snakes and Ladders taken around various youth centres locally	White sheet, dice made from box and giveaways - pens etc. Idea for game from HEBS
SIPs	'Just Say No' Drama workshop	10-15 years / School students, youth group attenders, looked after / accommodated teenagers	Drama workshop. This is mostly done with young people in primary school to equip them with the confidence to say no in a real situation	Young people are put into pairs, one is offering a cigarette and the other has to practice different ways of saying 'no' (Youth Health Worker)
Training Centre	Collage (Influence of media)	16-20 years / Training centre attenders; Looked after / accommodated teenagers, young people with special needs	1 day workshop looking at how the media encourages/influences our choices	Magazines, videos, HEBS material
Planned Activity
Health Promotion	Drama based activity	School children	Have a Heart Paisley Demonstration Project is working with school through drama based activity Winter 2001 - Summer 2002	(Potentially cessation also)
Have a Heart Paisley	Interactive theatre	Primary school children (P6 and P7)	Interactive theatre production incorporating 4 lesson plans covering history of smoking, tobacco advertising, effects of smoking, general information. January to March 2002
Have a Heart Paisley	Young person's conference (working party exploring the issues)	School students (S3 repeated in S4)	Currently organising a working group to look at some of the issues and in the autumn will be organising a young person's conference (S3 to be repeated when they are in S4). This conference will be to consult and discuss with young people their attitudes and lifestyles around 3 main factors of heart disease (smoking, healthy eating and physical activity)
Training Centre	Campaigning and lobbying	Young people	Working with young people using material from ASH. November/December 1 week

Figure 7.2b Argyll and Clyde NHS Board: cessation

Role	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Health Promotion	Inverclyde Tobacco Initiative	12-24 years Youth group attenders	Youth Council involved in year long project to support young people to quit smoking March 2000 - March 2001	Stop smoking leaflets - HEBS / Youth Council, Community group, primary care
Primary care	Smoking Cessation Support Clinic	16-20 years GP practice population	Individual counselling and support available +/- Zyban or NRT. Would be available to 16-20 year olds but not planned specifically for them	HEBS and Health Promotion Dept
Statutory Youth Work	Pupil Support Project (Alternatives to Exclusion)	10-15 years School students	Brief discussion on cost, health issues, patterns of smoking time/breaks and reason why started. Ongoing as opportunity arises over past 18 months	School (pupil support project co-ordinator)
Voluntary Sector	Stop Smoking Support Group (Pilot)	10-20 years Youth group attenders Wider community	Developing support group for young women. Highlighting alternative activities, eg. exercise, aromatherapy September - November 2000	HPU, aromatherapist, Second Chance Learning, Council's sport section / Funding: Health Promotion
Voluntary Sector	Recruiting Smokers Who Wish to Stop	10-20 years School students	Talking to high school pupils to encourage group support, recruiting through local newspaper, organizing information day for young parents. June 2001	Dietician, community health project, high school, financial advisors / Funding: Health Promotion
Training Centre	No Smoking Day	16-20 years Training centre attenders, looked after / accommodated teenagers, young people with special needs	Combined with prevention and education 3 days
Planned Activity
Health promotion	The Zone Youth Drop-in	Local young people	Health Centre to undertake a cessation project with local young people - to be offered group support and alternative therapies. Sept 2001 - April 2002
	Awareness raising	Those working with young people	Plan to raise awareness and educate people working with young people in order to support opportunistic interventions - education, motivation, sign-posting to helping agencies. Autumn 2001 -	(Potentially also prevention)
	Training in Tobacco Issues for Youth Workers being planned	Youth Workers	Training needs assessment currently disseminated. Training to be developed in response. Based on results of 'Community Based Approaches to Tobacco Control' (Inverclyde Tobacco Initiative). Autumn 2001
Primary care	Needs assessment / training needs	Young people and pregnant women	Needs assessment being carried out. Also training needs analysis. Smoking cessation counsellor coming into post in LHCC. June 2001-?

7.4 Lothian NHS board area

Lothian NHS Board area encompasses the second largest city in Scotland, together with three other local authority areas with a mix of urban and rural communities. A broad range of socio-economic groupings is found, from well-off communities to extensive areas of deprivation. Reports indicated individual areas with relatively high levels of tobacco-specific and interagency working, including the 'Breathing Space' project in the Wester Hailes and West Lothian Tobacco Issues Group.

Table 7.12 Lothian NHS Board area: overview (n)

	Total	Prevention/ education: Directly	Prevention/ education: Potentially	Cessation: Directly	Cessation: Potentially	Enforcement	Training: In-house	Training: Other agencies	Support materials: Internal use	Support materials: Other agency
		10-20 Q15	10-20 Q15	10-20 Q25	Q34	Q12	Q12	Q12	Q13	Q13
Health Promotion / Health Board	1	-	1	-	1	-	-	1	-	1
Primary Care	4	1	3	1	3	1	1	1	1	-
Trading Standards	3	-	-	-	-	3	1	-	-	-
Statutory Youth Work	4	-	4	-	-	-	-	-	-	-
Voluntary Sector	4	3	1	2	-	1	1	1	1	1
SIPs	2	-	-	-	-	1	-	-	-	-
Other	1	-	1	-	1	-	1	-	-	-

Across Lothian, reported involvement in youth specific prevention and cessation activities is at a relatively low level, although a higher proportion reported broader based activities, especially in relation to prevention (Table 7.12). As well as trading standards respondents, involvement in enforcement activities was also reported by primary care, voluntary sector and SIP respondents. Training activities were reported by low numbers but across a range of agency types. Development of support materials was reported by health promotion, primary care and voluntary sector respondents.

Prevention and education

A relatively high number of projects were selected for inclusion in Figure 7.12a, to convey the varied nature of activities. Interventions are largely young people and tobacco focussed but also show examples of addressing smoking in the context of broader issues such as drugs awareness and healthy living. Examples are given where individuals undertake different activities in different settings rather than a single focus. Looked after/accommodated teenagers are highlighted as a target group in one project. The final example, although not youth specific, highlights the development of a workplace tobacco policy, which would have an impact on young people.

Planned prevention activities were reported by a range of agency types and again suggest considerable cross-agency working.

Cessation

A number of substantive projects addressing smoking cessation and young people are illustrated in Figure 7.12b. Activities are located in a variety of settings; primary care, community schools (primary care), secondary schools (voluntary sector) and youth work (both voluntary sector and primary care respondents).

Enforcement

In addition to routine activities similar to those already described in other areas, such as routine visits and investigation of complaints, the following activities were identified by different trading standards officers:

schools talks, discussing age-related sales, 2-3 times a year
survey of young people at school into smoking habits etc. - questionnaire developed in-house (Spring/Summer 2000)
one-off letter to secondary school head teachers advising of the remit of trading standards re. tobacco
planning a press campaign on under-age smoking.

In addition, a worker from the voluntary sector reported participation in the ASH working group on 'Tobacco Taxation and Smuggling in Scotland' as well as local ongoing lobbying and awareness raising exercises.

Training

Tobacco-related training was received by seven respondents. The most commonly mentioned source was the local health board/health promotion department, with training addressing general cessation, tobacco awareness and 'prevention through participation' (reported by health promotion, primary care and SIP respondents). Other sources included HEBS and ASH Scotland, the West Lothian Drug and Alcohol Service and the Ulster Cancer Foundation. A trading standards respondent highlighted training from the Trading Standards Institute on 'children's and young persons' protection from tobacco'.

Provision of training reported by health promotion and primary care primarily addressed brief intervention and in-depth smoking cessation interventions for health professionals, although this would be targeted at the general practice population rather than young people. Remaining training reported was by a tobacco issues worker in the voluntary sector who outlined annual contact with primary school teachers, which included updating their knowledge about tobacco use and developing skills in tobacco education and use of a resource pack.

Figure 7.12a Lothian NHS Board area: prevention

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Primary Care	Summer group to develop internet site	Secondary school age School students	Group of 4-6 local young people involved in competing to develop a site 1 week	Health information / promotion and IT
	Raising awareness	10-20 years School students, youth group attenders, wider community	Postcards/posters distributed to all households	Postcards / posters Community Health Agency / Health Board
	Poster competition	10-20 years School students Wider community	All local schools invited to participate: Prize giving at Scottish Parliament January-March 2001	No Smoking Day materials used as base / Education Department, voluntary sector Funding: Local authority
	Local 'TIG Talk' magazine (Tobacco Issues Group)		Magazine circulated to all West Lothian Homes: word search competition January-March 2001	Local Authority, voluntary sector
Statutory Youth Work	Breathing Space	10-15 years Youth group attenders	Grant allocation to work with young people re issues around smoking resulting in the production of publicity materials for/target at other young people 10 week programme	Posters, postcards, video / Breathing Space, Wester Hailes Health Agency, WHALE Funding: Breathing Space
	West Highland Walkway	16-20 years Youth group attenders	Used this as medium to discuss issues around smoking etc Part of overall fitness/health programme 16 weeks (still ongoing)	Peer group, examples, HEBS materials, re. facts etc Funding: Woods / Grants / Breathing Space
	Group work	10-15 years Youth group attenders	Allow young people to absorb information and determine a way of illustrating that work to others, i.e. video, painting, photographs Oct 2000 - Sept 2001	Video-making chosen by group / Y2K, Schools Out, Young Mums Funding: ASH Projects
	Drugs Awareness Road show	10-20 years School FE/HE students	Using music as the medium for getting the messages across about drug use including smoking. 5 week period covering secondary schools and local college Nov-Dec 2000	National materials, local drug and alcohol project, 'The Score Facts About Drugs' / Scotland Against Drugs, West Lothian Drug and Alcohol Programme Funding: Scotland Against Drugs
	Healthy living workshops (youth club based)	10-15 Youth group attenders	Workshops, peer education Rolling programme of 4 week inputs	HEBS, materials, and ASH and local materials
	Mainstream youth club provisions	10-15 years Youth group attenders	Ongoing healthy living, discouraging smoking in clubs One/one and group work
Voluntary sector	Prevention materials	10-20 years Youth group attenders Looked after / accommodated teenagers	Leaflets from Lothian Health and posters	Leaflets from Lothian health and posters
	Prevention and education Primary 6 or Primary 7	Primary 6 /7 School students, teachers	Group work discussion based approach carried out over 2 weeks. Factual, covering decision making and skills approach Carried out throughout year	Video - flip chart, smoking machine, cigarettes, leaflets (programme and leaflets submitted) / Education services
	'Girls 4 Health' - video		Young girls group initially established to have health discussions, grow into making video highlighting needs of young people, both in health and resource forms Video/group work 2 ½ years started early 1999	Video/group work / Community education, primary health care staff, voluntary organisations
	Youth work	10-20 years Youth group attenders, FE/HE students, parents, community group attenders, youth leaders	Informal discussion based work with informal settings. Group work, fun, fast and very interactive	Flip chart, pens, CO monitor, leaflets / Community education, staff
(West Lothian Council, Occupational Health	Review and Audit of Tobacco Policy	Work place	Review and Audit of the Tobacco Policy 'Control of Tobacco at Work' resulted in the development and implementation of the Council Extended Policy (copy submitted). This addresses wider tobacco issues (West Lothian Council Tobacco Policy Group).
Planned Activity
Health Promotion	Needs assessment	Young people (through school nursing, community education, primary care etc)	Meetings with school nursing, community education etc to revisit a feasible and potential way forward for targeting smoking interventions specifically at young people (as opposed to them being only potentially included in smoking cessation work) January-March 2002
Health Promotion	Training	Workers with young people - especially primary school age (through school nursing etc)	Depends on results of needs assessment (above). Training workers to provide smoking prevention sessions for younger children (may not happen if needs assessment suggests it's not the appropriate way forward) April 2002 onwards
Primary Care	Small grants scheme		To encourage community development approach to tobacco issues with young people
Trading Standards	Press campaign on under age smoking	Young people	(see Enforcement below)
Voluntary Sector	Electronic based activities	Young people's unit staff	Electronic based activities, eg. internet Work with Young People's Unit staff - current and planned
SIP		Primary 6/7 and Secondary 1/2 school children	Development of early intervention support project Autumn 2001

Figure 7.12b Lothian NHS Board area: cessation

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Primary care	Cessation support	10-20 years School students, youth group attenders Wider community (Priority given to cardio-pulmonary disease / pregnancy)	Individual and group: motivational interviews followed by counselling 6-8 weeks Training / supporting counsellors	Community Health Agency / Health Board
Primary care	Community schools	10-15 years School students, parents, teachers Young people with special needs	Advice re smoking cessation Awareness raising competitions	Education, health care staff, voluntary sector
Smoking cessation with young women	16-23 years Community group attenders (young women)	Local community group for young women of 16-23 years old; group work smoking cessation	Education, health care staff, voluntary sector
Voluntary Sector	Workshops on giving up smoking	10-20 years Youth group attenders, looked after / accommodated children	Identifying motives to stop and set targets	From leaflets
	Youth Setting Cessation group (Community Centre)	10-15 years youth group attenders	Cessation group with young girls (friends), Evening group, requested by group. 16^th July 01 start date	Developmental / Community education
	School Based Cessation Group	10-15 years School students	Group Work approach to cessation, tobacco reduction. Experiential, topic based and group driven. 8 weeks, March 2000	Flip charts, various leaflets, CO monitor
	Young People Research / Needs Assessment	10-20 years School students	Questionnaire format for pupils from S1 to S6 in 2 secondary schools in West Lothian Supported completion Confidential. 2000-2001	Education services
Planned Activity
Health promotion	Needs assessment		Revisit way forward for targeting smoking interventions specifically at young people. January-March 2002 (see Figure 7.12a)
Health promotion	Training	Workers with young people	Training workers to provide smoking cessation interventions for young people (specifically targeted for them as opposed to there being only potentially included in current smoking cessation work) Young people focussed - especially secondary school age (through school nursing, community education etc) Depends on outcome of Needs assessment. April 2002 onwards
Primary Care	Evaluating health needs	Young people	Developing strategy for evaluating health needs of local young people Assume at this point that smoking will be one area to be addressed

7.5 Lanarkshire NHS board area

The Lanarkshire NHS Board area has a predominantly urban population, although there are considerable rural areas to the South. There are extensive areas of industrial decline and socio-economic deprivation, mixed with new housing and modern industrial development.

Table 7.11 Lanarkshire NHS Board area: overview (n)

	Total	Prevention/ education: Directly	Prevention/ education: Potentially	Cessation: Directly	Cessation: Potentially	Enforcement	Training: In-house	Training: Other agencies	Support materials: Internal use	Support materials: Other agency
		10-20 Q15	10-20 Q15	10-20 Q25	Q34	Q12	Q12	Q12	Q13	Q13
Health Promotion / Health Board	1	1	-	-	-	-	1	1	1	-
Primary Care	4	3	1	-	1	-	1	-	1	-
Trading Standards	2	-	-	-	1	2	1	-	-	-
Statutory Youth Work	9	7	2	3	3	-	2	2	1	1
Voluntary Sector	1	-	1	-	-	-	-	-	-	-
SIPs	2	1	-	-	2	-	-	-	-	-
Other	-

Table 7.11 suggests a relatively high level of tobacco-related work focussed specifically on young people in Lanarkshire, especially in the area of prevention. Youth targeted cessation work was at a lower level, but other respondents, including trading standards respondents, reported activities which could potentially encompass young people. Training was provided across a number of agencies and health promotion, primary care and youth work respondents reported the development of support materials.

Prevention

Activities highlighted in Figure 7.11a illustrate discrete projects such as Smokebusters and broader based workshop and discussion approaches addressing prevention issues. An example is given of workers in the primary care context being involved in different settings: schools, workplace and youth groups. Finally the process of organisational development towards health promoting schools and the related smoking policy is reported by a SIP respondent.

In addition to the projects listed here, a number of youth work agencies also described work in the context of healthy lifestyles and drugs-related initiatives that was not specifically focused on smoking, as well as more general awareness raising and information giving activities and discussions. No Smoking Day activities were also highlighted.

The only planned prevention activities reported were described by the health promotion respondent.

Cessation

A limited number of youth-related and cessation-specific projects were reported, although projects aimed at the general public were mentioned more frequently. As Figure 7.11b shows, one project was aimed at young people (25 years and under) in 'harder to reach' groups.

Enforcement

In addition to routine activities reported in this area such as visits ensuring compliance and advising on legislation, one respondent described the following:

preparation of the Youth Empowerment Scheme, the embryonic stages of a Proof of Age card
joint surveillance with police of shops near schools after receipt of complaints
letter to the Crown Office supporting changing to current limits on use of children in test purchase programmes.

No other agencies described involvement with enforcement issues.

Training

Eleven respondents reported receiving related training. Primary care respondents and three youth workers had received training from the health promotion department addressing prevention and tobacco awareness; the health promotion respondent and a youth work respondent had attended Fast Forward and HEBS/ASH seminars; and a trading standards respondent reported input from the Trading Standards Institute addressing enforcement and from ASH Scotland covering tobacco awareness. In relation to training provision, the health promotion respondent reported providing training for youth workers, which addressed attitudes to smoking, influencing factors and helping young people to stop. A trading standards respondent reported in-house training on the difficulties in using children for test purchasing purposes.

Figure 7.11a Lanarkshire NHS Board area: prevention

Agency Type

Title

Age / Target Group / Setting

Methods

Materials /
Other Agencies

Current Activity

Health Promotion

Smokebusters project

8 years >

Primary 5 - Primary 7

School students

Classes (P5 - P7) are asked to register to work towards becoming a Smokebusting classroom

Ongoing

Smokebusting pack. Various smoking related activities (linked to school curriculum).

Forth Valley HB developed the pack and it was localised for use in Lanarkshire with their permission /

Education Department

Primary Care

School involvement as part of health board education package

10-15 years

School students

Talks/workshops, materials

Ongoing over the school term

ASH/HEBS materials, leaflets

Workplace lifestyle screening

16-20 years

Workplace

One to one counselling

6 weeks duration

Information sharing, leaflets, videos

Lifestyle education within Universal Connections

10-20 years

Youth group attenders

Discussions concentrated over 6 weeks programme

Videos, leaflets

Art competition

Awareness raising

16-20 years

School students, parents, teachers

Art competition within primary schools to design poster. Print successful entry for display across area

Spring term 1999

Education Department / Teachers

Statutory Youth Work

Smoking workshops / demonstrations

10-20 years

Youth group attenders

Workshops

Various one off sessions with local youth groups

Use of Smokerlyser and mechanical smoker, quizzes, discussions backed up with support materials and leaflets

Funding from SIP

Discussions

10-20 years

Youth group attenders

As part of wider health issues included in youth work curriculum. Focus changes but smoking related issued covered

Badges, posters etc / Local health authority

Smoking workshops

12-16 years

Youth group attenders

14-15 years

School students

Group work - discussion

One-off session

One 2 hour session

Topic arose as part of an informal discussion with youth group

Leaflets from health promotion department

Awareness raising smoking workshop

12-18 years

Youth group attenders

Workshop - Various activities related to raising awareness of effects of smoking: 'Frankenstein's Monster', 'Alien' and other related activities

2 hours

Junk materials; handouts; skill base of workers

Voluntary Sector

Giving information and advice

14-25 years

All young people 14-25 years

Information and advice giving on smoking as part of our general service when requested

On-going

Smokeline cards, ASH leaflets and other publications

SIP

Health promoting schools

10-20 years

School students, youth group attenders, parents, teachers

Organisational development within schools - smoking policy dev - talks

1999 - 2002

Health promotion materials /

Lanarkshire Health Promotion, South Lanarkshire Council

Funding: Lanarkshire Health Board (and SIP)

Planned Activity

Health Promotion

The Youth Smoking Project

12-14 year olds

School students

Youth workers, school nurses

This is a new project this current financial year. It is split into 3 areas:

1. Smokefree class

Prevention and cessation

First and second year pupils (12-14 years old)

Classes are asked to sign up to the scheme and remain smokefree for 6 months. Monthly inputs consisting of group work and CO-monitoring is provided

Ongoing

2. Training

Prevention and cessation

Youth workers, school nurses

3. Pilot Smoking Cessation Service

(see below in cessation section)

Figure 7.11b Lanarkshire NHS Board area: cessation

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Primary Care	Schools programme smoking cessation advice. leading up to No Smoking Day	12-17 years School students	Talks, videos, poster competition Leading up to No Smoking Day. 1-2 weeks prior for poster competition	Talks, videos, poster competition
Statutory Youth Work	Self help groups, doctor referrals, patches SIP funded projects	All SIP residents	Health Workers, local community work staff 3-6 month period	Funding: SIP and Health Board
SIP	Tackling addiction	25 years and under Looked after / accommodated teenagers, young people with special needs	NRT and counselling via co-ordinator within primary care 2000-2002	NRT / Primary Care Trust, Pharmacy / Funding: PCT and SIP
Planned Activity
Health Promotion	Pilot Cessation Group - The Youth Smoking Project:	Secondary school age	This is a new project this current financial year It is split into 3 areas: Training and Smokefree classes are outlined above (Table 17.11a) Pilot Smoking Cessation Service Secondary school age up to 20 (not confirmed as yet) Setting up of a cessation group for young people wanting to give up. Linking with adult service currently being set up within a SIP area (see next box) At planning stage
Statutory Youth Work	Youth facility users (12+years) School groups (13-15years)	Involved in focus group run by ASH looking at potential projects based on their young women's group pilot First meeting August/September 2001
		11-16 years	Video making about smoking (actual content still to be decided) 8 weeks
	Smoking cessation service	Priority - under 25's or those in households with children Residents of the SIP	Smoking cessation service including advice support and treatment, training of local people, linking with schools, young people and workers 3 years - September 2001 - March 2004

7.6 Grampian NHS board area

The Grampian NHS Board area encompasses the fourth largest city in Scotland, as well as coastal towns and inland rural areas with scattered populations. There are three local authority areas.

Table 7.9 Grampian NHS Board area: overview

	Total	Prevention/ education: Directly	Prevention/ education: Potentially	Cessation: Directly	Cessation: Potentially	Enforcement	Training: In-house	Training: Other agencies	Support materials: Internal use	Support materials: Other agency
		10-20 Q15	10-20 Q15	10-20 Q25	Q34	Q12	Q12	Q12	Q13	Q13
Health Promotion / Health Board	1	1	-	1	-	-	1	1	1	1
Primary Care	3	1	1	1	2	-	1	-	-	-
Trading Standards	3	-	-	-	-	3	-	-	-	-
Statutory Youth Work	8	3	3	3	4	-	3	-	-	-
Voluntary Sector	2	1	-	-	-	-	1	-	1	-
SIPs	1	1	-	1	-	-	1	1	-	-
Other	1	-	1	-	-	-	-	-	-	-

Involvement in youth specific prevention and cessation activities was reported across most agency types (Table 7.9), with more general approaches also reported. Involvement in enforcement was only reported by trading standards respondents. Related in-house training provision was reported by most agency types but development of support materials was reported by health promotion and voluntary sector respondents only.

Prevention

A number of substantive interventions are outlined in Figure 7.9a, representing the majority of activities reported altogether, apart from additional No Smoking Day events. Projects cover work in schools, including primary schools, and in youth group settings and include No Smoking Day activities focussed on young people and youth workers.

Cessation

As with prevention, substantive youth cessation projects were reported (Figure 7.9b). Health promotion described cessation services targeted at the 16+ year old age group and a pilot project in school settings. A project described by a statutory youth work respondent took a broader approach in exploring smoking, undertaken in conjunction with health promotion and ASH Scotland. A No Smoking Day activity is included because of attendance by a cessation counsellor.

Enforcement

Trading standards officers were the only respondents recording involvement in enforcement in this area. In addition to routine inspections and response to complaints about alleged illegal sales to under-16s already described in other areas, respondents also mentioned:

media activity, giving press releases and responding to media enquiries
monitoring of use of tobacco vending machines, especially in premises in the vicinity of schools, mentioned by one respondent
checks of refusals registers which show where and when an attempt purchase is stopped when staff are not sure of the age of the customer

In relation to planned activity, one respondent highlighted a planned series of test purchase programmes as a means of gathering evidence for reports to the Procurator Fiscal, but recognised this is currently not available to Scottish local authorities.

Training

Twelve of the 19 respondents from this area outlined training they had received. The health promotion department was the main source of training, reported across primary care, youth work and SIP respondents, with some also mentioning joint training with the Great Northern Partnership. The health promotion respondent and one primary care respondent also reported receiving training from Fast Forward and HEBS and ASH Scotland. Topics addressed included smoking cessation, prevention, tobacco-awareness and No Smoking Day. Reflecting the above picture, the health promotion respondent reported offering smoking cessation training for community education and voluntary sector workers and health service staff, together with tobacco awareness training for community education workers. However, one youth work respondent commented that ‘we do not separate tobacco from other drugs and offer our youth workers training in a more wide-ranging way’. Another commented that ‘informally, full-time workers can train, encourage and support part-time staff on this issue’.

Figure 7.9a Grampian NHS Board area: prevention

Agency Type

Title

Age / Target Group / Setting

Methods

Materials /
Other Agencies

Current Activity

Health Promotion

Kids in Condition Session

8-11 years

Primary schools

Tobacco workshop for primary school aged children

Ongoing

Smoke free shopper, Smoke free me. GASP stickers / bookmarks / Project tobacco leaflet etc /

Primary schools

No Smoking Day Campaigns 2000/2001

10-15 years

School, FE / HE students, youth group attenders, workplace, parents, teachers,, community group attenders, wider community

Specific focus on young people in tobacco industry school work. Workshops / support for youth work tobacco focus

Feb - April 2000, Jan - March 2001

(Evidence includes: PR in the playground, Florida Truth Campaign, Smoke Free Kids)

Cigarettes, I quit, A4 Velcro poster / NSD materials / Gasp: Smoke out / Breakfree teachers pack

Agencies: Community Education, Education Department , Secondary Care, Workplace, Primary Care

Primary Care

Teen clinic

School students

½ hour appointment for each child where discussion re. health issues.

Ongoing

Community Education

Primary schools as part of curriculum

Primary school students

Utilising materials from health promotion

Models, charts, hand-outs /

Education

Part of Social Education in Secondary schools

10-18 years

Secondary schools students

Discussion, questions, video, demonstration

(also part of school nurse role when doing medicals)

Video, Smokerlyser, carbon monoxide monitor /

Education

Teen group

12-16 years

Group of professionals GPx2, HV, HP rep, LC rep, 2 school nurses, 1 guidance teacher, 2 teenagers

April 2000 - ongoing (still to tackle smoking)

Writing local leaflets with information advice

Statutory Youth Work

Group Youth Work

Tobacco Awareness

10-15 years

Youth group attenders

Tobacco Awareness Discussions

ongoing

Leaflets, staff experience

No Smoking Day activity

14-26 years

School, FE / HE students, youth group attenders, workplace, ethnic minority groups, community group attenders, wider community

No smoking in the building, handout for young people and their families, cessation counsellor

On the day

No Smoking Day pack

/ Local Child and Family Centre

Voluntary Sector

Exercise games - quizzes - puzzles

10-15 years

youth group attenders

Using above games to show the risks of smoking and costs of smoking

Smokerlyser - giant cigarette - model of human organs damaged - pictures and prices of attractive possessions

SIP (1)

Smoking Awareness Session

10-20 year olds

youth group attenders, community group attenders

Quizzes to gauge knowledge

1-2 hours

Smokerlyser - breathing equipment to test level of smoking /

Health Promotions / SIP

Planned Activity: No planned activities were described.

Figure 7.9b Grampian NHS Board area: cessation

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Health Promotion	Smoking Advice Service (Cessation) (SAS)	16+ years FE / HE students, workplace, parents, teachers, looked after / accommodated teenagers, ethnic minority groups, community group attenders, wider community	Service targeted at 16 plus. Referred or self-referred. Jan 2000 - ongoing	A4 leaflets / info sheets / smoking cessation literature Agencies: Health professionals, community education, voluntary
	Smoking Advice Service for young people aged 11-18	11-18 years School students	Cessation service for young people Pilot in schools in one Local Authority area. Self selected programme of 6 weeks. January 2001 - June 2001 (Evidence includes: Review of smoking cessation and young people, Health Canada, S/C pilot, University of Texas, Adolescent smoking cessation Ulster Cancer Foundation)	A4 information sheets, fags and hash leaflet / Cancer: Comic Co. leaflet plus others. Agencies: Education Department / schools Funding: Grampian Heart Campaign and HIF
	Mobile information bus	12-18 years No specific target among young people	Covers rural areas working with local youth teams on a range of health issues 6 months in each LA area	Varied Agencies: Youth work, community education
Statutory Youth Work	Discussion Group Keep Fit / Gym Beauty Therapy	14-20 years Teenage Mums	Discussion group with input about cost and effects of smoking Attending gymnasium to tone up body Facials, manicures, hair care - how smoking affects appearance	Provided by Health Promotion Funding: ASH / Health Promotion
Statutory Youth Work	Cessation counselling (No Smoking Day)	14-26 years School, FE / HE students, workplace, parents, ethnic minority groups, community group attenders, wider community	Counsellor at project on No Smoking Day One day	No Smoking Day materials, posters, flyers, smelly jars etc Health Promotions, Great Northern Partnership
SIP	Cessation Workshop (Pilot)	10-20 year olds Youth group attenders, community group attenders	Cessation workshop adapted to suit young people. Breaking up cigarette. List of chemicals in cigarettes. Methods on how to stop. Chilled vegetable as alternatives. 1-2 hour Follow-up workshop To check if have continued to stop smoking 1-2 hours	Tar Jar, Giant cigarettes with chemicals. Tick sheets re. cravings and all aspects of smoking Health Promotions / SIP
Planned Activity
Health Promotion	Tobacco training including smoking cessation component	Youth, teaching staff	Training will be offered as two 3 hour sessions, first session covers tobacco issues, and second session is about smoking cessation. Offered one session every 2 months
Primary Care	Drop-in centre	Young people	Looking to work with other 3 LHCCs across city to open drop-in centre for city wide population of young people (Register of 12-16 year olds in LHCC - 3,466 ) Writing information leaflets from working group
Voluntary Sector	Youth Cafes and Drop-ins	Young people	Work with young people in Youth Cafes and Drop-ins

7.7 Forth Valley NHS board area

Forth Valley NHS Board area is centrally situated, with substantial towns and smaller rural hinterlands. There are three local authorities within the area.

Table 7.7 Forth Valley NHS Board area: overview (n)

	Total	Prevention/ education: Directly	Prevention/ education: Potentially	Cessation: Directly	Cessation: Potentially	Enforcement	Training: In-house	Training: Other agencies	Support materials: Internal use	Support materials: Other agency
		10-20 Q15	10-20 Q15	10-20 Q25	Q34	Q12	Q12	Q12	Q13	Q13
Health Promotion / Health Board	3	2	-	1	2	-	1	3	-	1
Primary Care	2	1	1	-	1	-	1	-	-	-
Trading Standards	2	-	-	-	-	2	-	-	-	-
Statutory Youth Work	5	1	1	2	-	-	-	-	-	-
Voluntary Sector	2	2	-	2	-	-	-	-	-	-
SIPs	-
Other	1	1	-	1	-	-	-	-	-	-

Reported involvement in youth specific prevention and cessation intervention is relatively high and across most agency types, especially in relation to prevention (Table 7.7). Enforcement involvement was only reported by trading standards respondents. Training provision was undertaken by health promotion and primary care respondents and development of materials was only reported by one respondent.

Prevention

Substantive projects were reported in this area, mainly based in schools settings. Smokebusters and Smokefree Class interventions were reported by the health promotion respondent, together with school-based prevention activities undertaken by primary care respondents (Figure 7.7a). Youth work activities tended to focus on No Smoking Day. Finally, a local council substance misuse officer highlighted a Don't Start and Win initiative. Remaining activities not reported here covered No Smoking Day events and general information provision in the youth work sector.

Cessation

The main cessation projects reported are outlined in Figure 7.7b. They include Quit and Win, a primary care-based cessation programme that can be used by 16+ year olds and youth work discussion-based approach.

Enforcement

Trading standards officers were the only respondents reporting involvement in this area. In addition to spot checks and advice and warnings to retailers on alleged underage sales, the following were also mentioned:

earlier test purchasing exercises reported by both respondents
issuing of 'Validate' Proof of Age cards to 12-18 year old secondary school pupils reported in one area. This also targeted shop keepers and management of pubs and clubs and entailed visits to all the secondary schools

No new enforcement activities were outlined, linked with the current restrictions on test purchase.

Training

Eight respondents reported receiving training in this area. The health promotion department was the reported source for most respondents across primary care, statutory youth work and voluntary sector agencies. Health promotion respondents reported receiving training from HEBS/ASH Scotland, Fast Forward, and Dumfries and Galloway NHS Board. Training topics mainly addressed cessation but prevention, Smokebusters and No Smoking Day topics were also highlighted. One trading standards officer mentioned training from the Trading Standards Institute addressing underage sales. Reflecting the picture already outlined, health promotion respondents were the only reported providers of training. Targets included school nurses and youth workers (cessation); primary school and PSE secondary school teachers (Smokebusters and Smokefree class); and community education workers (awareness raising).

Figure 7.7a Forth Valley NHS Board area: prevention

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Health Promotion	Smokebusters	10-12 years School students, teachers	Development of teaching pack/piloted pack with teachers Group work / skills training for pupils / training for teachers Pilot Oct 99 – Mar 00. Training May 00/Oct 00. Use of pack ongoing	Forth Valley Smokebusting teaching pack Individual schools and Education Departments from 3 council areas
Health Promotion	Smokefree Class	12-14 years School students, teachers	Competition based initiative with 2^nd years including 6 inputs in PSE classes over 6 months – group work / discussions /info giving/ skills training Piloted Oct 00-March 01. Planned to start again in Oct 01	Forth Valley Smokefree Class pack Individual schools and Education Departments from 3 council areas
Primary Care	Smoking prevention	10-15 years School students	Encouraging young children to look after themselves. 'Healthy Bodies'. Short sessions	Smokebusters pack, Roy Castle video
Primary Care	Smoking prevention session	10-15 years School students		Video, leaflets, questionnaire
Statutory Youth Work	General information giving during No Smoking Day Week	16-20 years Youth group attenders	Informal information giving at youth group. Discussion around advertising etc On going	Posters, leaflets sent to us for the week
Voluntary Sector	No Smoking Day workshops	10-20 years School students, youth group attenders	Role plays, quizzes	Materials provided by FVHB
Local Council (Development officer, substance misuse)	Don't Start and Win (Quit and Win)	10-15 years		Health Promotion, Community Services, Community Groups
Planned Activity: No planned activities were described.

Figure 7.7b Forth Valley NHS Board area: cessation

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Health Promotion	Planning advertising approach on cessation to young people	16-20 years FE / HE students	Involved with group of MSC students at Stirling University	Own materials on advertising campaign devised by MSC students
	Quit and Win / Don't Start and Win (also reported by Local Council Development Officer- substance misuse)	10-15 years Youth Group attenders	Competition based using peer support to help young people give up smoking. Young people developed materials e.g. diary 3 months	Various leaflets, but young people developed their own e.g. diary. Joint funded – FVHB and Off The Record Project a Forth Valley wide voluntary organisation
Primary Care	Smoking Cessation Clinic	16+ years Wider community	Motivational support, supply of NRT / Zyban in clinic setting on a one-to-one approach. Started March 2001, ongoing weekly basis	Leaflets from HEBS. Material from Smoking Cessation Co-ordinator at Health Promotion
Statutory Youth Work	Youth group – smoking cessation	16-18 years youth group attenders	Youth group looking to review habits and experiment in different types of relaxation July 2001 onwards	Various – to be set up Funding from Health Promotion
Planned Activity
Health promotion		Young people 12-18 in a deprived community	HIF grant awarded for work in 3 youth group members £4,000 per year 2001-2004	HIF Grant
Primary care		High School students	High School students
Statutory Youth Work		Young people	Appointing sessional youth worker in cessation context Work funded but priorities and activities not set yet

7.8 Tayside NHS board area

Tayside NHS Board is situated in the East of Scotland and includes large cities and coastal towns as well as a rural hinterland. It encompasses three local authority areas.

Table 7.15 Tayside NHS Board area: overview (n)

	Total	Prevention/ education: Directly	Prevention/ education: Potentially	Cessation: Directly	Cessation: Potentially	Enforcement	Training: In-house	Training: Other agencies	Support materials: Internal use	Support materials: Other agency
		10-20 Q15	10-20 Q15	10-20 Q25	Q34	Q12	Q12	Q12	Q13	Q13
Health Promotion / Health Board	1	-	1	-	1	1	-	-	-	-
Primary Care	2	-	2	-	1	1	-	-	-	-
Trading Standards	3	-	2	-	-	3	-	1	1	-
Statutory Youth Work	9	7	2	3	1	-	1	-	3	1
Voluntary Sector	-
SIPs	1	1	-	-	-	-	-	-	-	-
Other	-

Reported involvement in youth specific prevention and cessation is focussed on youth sector respondents, although more respondents from other agency types are involved at a general level (Table 7.15). Involvement in enforcement activity is reported by health promotion and a respondent from primary care. Reported training provision is relatively limited, but youth work and trading standards respondents reported development of support materials.

Prevention

A variety of projects were reported in this area (Figure 7.15a). In addition to school-based sessions and No Smoking Day related interventions, projects that have been less commonly described elsewhere include: the 'Healthy Dundee' Smoking Challenge Fund; use of the internet and video making; peer education; Drug and Alcohol Free Time (DAFT); and awareness raising of enforcement issues.

Cessation

A small number of cessation specific projects were outlined. Remaining activities, in addition to those included in Figure 7.15b, incorporated No Smoking Day activities.

Enforcement

Two Trading Standards officers reported earlier test-purchasing initiatives, one of whom also mentioned a survey of retailers on this issue. Another addition to more routine inspections reported was a one-day exercise observing sales from mobile shops to under-16s outside schools with police assistance. Issuing Proof of Age cards was mentioned in one area utilising HIPs funding (see prevention) and a health promotion respondent reported involvement in support of this scheme.

Training

Six respondents outlined training experience. As with other areas, health promotion was the main source of training for most agencies. The health promotion respondent had attended HEBS/ASH Scotland seminars on cessation. One youth worker had attended training given by Inverclyde Council on raising the issue of tobacco with young people. Reports of provision of training indicated little which was young person specific, but in the statutory youth work sector, YES workers were given training in information giving, prevention and cessation.

Figure 7.15a Tayside NHS Board area: prevention

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Health Promotion	'Healthy Dundee' Smoking Challenge Fund	10-20 years School students, youth group attenders, community groups, general public, uniformed organisations	Financial Support (up to £100) for organisations and groups relating to young people to develop an initiative relating to smoking prevention April 2000-2001	Trading Standards, environmental health, public health Internal funding: 'Healthy Dundee'
Health Promotion	Support for New Community Schools	10-20 years Schools	Health promotion support for development of health curriculum, including smoking	School nurses, teachers
Primary Care	No Smoking Day	10-15 years Secondary school students (several schools)	Focus on NSD, encouragement to remain non-smoking	NSD materials
Trading Standards	Schools education	16-20 years School students	Issue of Proof of Age cards - awareness raising	Proof of Age cards
Statutory Youth Work	Internet access to information on smoking	8-18 years Youth group attenders	Internet
	Peer Education / Action Research project	School students, youth group attenders
	DAFT - Drug and Alcohol Free Time – non-smoking activities
	Discussion groups – youth congress / council	10-20 years Youth group attenders
	Smoking sessions with Primary 6/7	Primary 6 and 7	Sessions in class looking at image and health – sometimes as part of wider approach to drugs (1.5 hour sessions)	Snakes and ladders / attitudes to smoking
	Drug awareness	10-20 years Wide range including looked after / accommodated teenagers and those with special needs	Discussions	Variety of commercial and in service materials DAT, police, drug agencies
SIP	Video of young people's attitudes	10-20 years	Young people interviewing other young people about their lives - sections on health and well being	CSV Media
Planned Activity: No planned activities were described.

Figure 7.15b Tayside NHS Board area: cessation

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Primary Care	High risk primary relatives of Coronary Heart Disease Patients	16 years + Primary relatives of CHD Patients	Encouraged to remain non-smoking If smoking, brief intervention , more help if wished (NRT since May 2000) Over 3 years	Local materials
Statutory Youth Work	Planning to stop Awareness raising Healthy sporting activities / fruit tester	10-20 years Youth group attenders	Action plans for stopping smoking, info on long term and short term risks Raise awareness of long term risks of smoking Young people experience alternatives to smoking	Internet, artwork, cigarette filters Funding Tayside Health Promotion 'Smoking Challenge'
Planned Activity
Health Promotion	Cessation groups	Further Education	To organise and run smoking cessation groups in the FE college sector Three years: April 2002 - April 2005
Primary Care	Information	Secondary schools and higher education	Working with school nursing services to provide more information on where and how help can be obtained. September 2001 onwards	(Prevention and cessation)

7.9 Ayrshire and Arran NHS board

The Ayrshire and Arran NHS Board area is a mix of small towns, some with pockets of deprivation, and rural areas. There are three local authority areas within its boundaries.

Table 7.3 Ayrshire and Arran NHS Board area: overview (n)

	Total	Prevention/ education: Directly	Prevention/ education: Potentially	Cessation: Directly	Cessation: Potentially	Enforcement	Training: In-house	Training: Other agencies	Support materials: Internal use	Support materials: Other agency
		10-20 Q15	10-20 Q15	10-20 Q25	Q34	Q12	Q12	Q12	Q13	Q13
Health Promotion / Health Board	2	1	-	-	1	1	-	-	-	1
Primary Care	3	2	1	2	-	1	2	-	-	-
Trading Standards	3	-	-	-	-	3	-	1	-	-
Statutory Youth Work	3	2	1	2	-	-	1	-	2	-
Voluntary Sector	1	1	-	1	-	-	-	-	1	-
SIPs	-
Other	-

A relatively high level of reported involvement in youth-specific prevention and cessation activities was reported (Table 7.3). As well as trading standards, other agencies also reported involvement in enforcement. Training provision was reported by primary care, trading standards and statutory youth work respondents and development of materials was highlighted in the youth work sector.

Prevention

The examples given in Figure 7.3a illustrate a variety of approaches across a variety of settings, including individual respondents citing more than one approach and target. Less commonly reported work highlighted here was the utilisation of drama-based approaches, and the highlighting of young parents as the main target in one activity.

Cessation

Figure 7.3b outlines examples drawn from the small number of cessation activities reported, including a school-based peer education project. Additionally several school-based smoking cessation groups in secondary schools have been developed in the area and are supported by a facilitator from the Roy Castle Lung Cancer Foundation (see Chapter 6).

Enforcement

In addition to more common activities reported, including routine inspection and leaflet distribution and with covert surveillance, the following was identified: Proof of Age scheme, with free Proof of Age cards issued to young people aged 16+ years, together with free display materials issued to traders, reported in one local authority area. This was also mentioned by the health promotion respondent who indicated supporting the development of the scheme.

Training

Only two respondents reported receiving related training, both focussing on cessation: one primary care worker had received training from a youth training centre and one had attended a Fast Forward seminar. Interestingly, four respondents reported providing training, including training of youth workers within the youth work sector and a smoking cessation update for school nurses reported by a primary care respondent. A trading standards respondent outlined training interventions targeting all 16+ year olds, together with traders, retailers and licensees in relation to underage sales and the Proof of Age scheme.

Figure 7.3a Ayrshire and Arran NHS Board area: prevention

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Primary Care	Teenage health clinic	10-20 years School students	In GP practice, HV led primary prevention. Weekly	Smoking - the facts
	School health promotion programme	10-20 years School students	Discussion groups Mainholm Academy Community School	Relevant HEBS materials
	Work with Schools as part of the curriculum		School nurse and HV role
	Ingredients of cigarette Discussion Quiz	10-15 years School students	Information given re. some ingredients and their addiction, cancer causing agents and causes of heart disease General debate about whether agree or disagree with statement given on flash cards Quiz questions to see if pupils have picked up information given	Cardboard cigarette and cards given to pupils with ingredients - to decide which is in cigarette or not Flash cards Quiz sheets
Statutory Youth Work	No Smoking Day promotion	10-15 years Youth groups attenders	Display stands / publicity leaflets and information quizzes and discussion Focus on day - but awareness raising throughout year	In-house produced quiz, AAHB resource materials All activities are ongoing as part of our work with young people
	Letterbox project	11-18 years Youth groups attenders	Although primarily tackling sexual health issues - general health inducing smoking is an ongoing focus	Health Board materials Relationship with young person is important in effecting change in their lifestyle and choices Funding: AAHB and CES
	Target leisure project	10-20 years Youth groups attenders, looked after / accommodated teenagers, young people with special needs	Has a focus on drugs/alcohol misuse - but again aims to affect change in lifestyle and choices	Focus on outdoor/adventure activities linked to healthy lifestyles (Personal development plans) Social Work Department Funding: SIP and CES
	Highs and lows board game and drama smoking project	10-20 years School students, youth group attenders, youth workers	Peer education with young people aged 13+ on a drug awareness board game and writing a play on smoking issues. 9 months	Group designed their own materials posters, board game and play Local health promotion unit, Bridge Project
	Young parents project	16-20 years Young parents	Discussion groups with young parents regarding issues relating to smoking, included as part of a healthy programme. Fire safety also looked at smoking in the home 6 weekly programme	HPU materials, open university materials, leaflets from fire safety officer Primary Care, Health visitors, Health Promotion, Fire Service
	Youth group	10-20 years School students, youth group attenders	Short discussion and distribution of information to young people on smoking related issues	Materials received from health promotion unit (HPU), posters etc Bridge Project, HPU
Voluntary Sector	Smokerlyser Health Promotion Department		Used amongst young people to assess lung capacity and effects of smoking ad hoc	Smokerlyser
Planned Activity
Health Promotion	Tobacco awareness sessions - primary schools	10-15 years Primary school students, parents	Development of resource pack and familiarisation training for staff and school nurses - secured NOF funding 3 years from Sept 2001	Resource created Primary Care Trust, Roy Castle Lung Cancer Foundation, Local Authority
Primary Care	Tobacco use strategy review	Children and young people, adults	To look at strategy for primary prevention and provision of services for tobacco use within the LHCC family	(potentially also cessation)
Primary Care		Secondary and primary school pupils	HIF monies 3 years	(potentially also cessation)
Statutory Youth Work	NSD promotion and support	Youth club members	Follow-up and NSD promotion with support group

Figure 7.3b Ayrshire and Arran NHS Board area: cessation

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Primary Care	Opportunistic one-to-one	10-20 years School students, parents	In health centre, GP practice, school or family home setting - individual goal setting	HEBS - local smoking cessation packs and helpline numbers
Primary Care	Peer Group Smoking Cessation	12-18 School students	Trained peer supporters working with school population Dec 2000 - Mar 2001	Smokerlyser, educational materials Dietician, dental hygienist, school nurse, teachers
Voluntary Sector	Ongoing verbal support	10-20 years Youth group attenders	During drop-in, staff provide ongoing support and discouragement of smoking to young smokers
Planned Activity: No planned activities were described.

7.10 Highland NHS board area

Highland NHS Board area is geographically extensive, with a largely rural and scattered population.

Table 7.10 Highland NHS Board area: overview (n)

	Total	Prevention/ education: Directly	Prevention/ education: Potentially	Cessation: Directly	Cessation: Potentially	Enforcement	Training: In-house	Training: Other agencies	Support materials: Internal use	Support materials: Other agency
		10-20 Q15	10-20 Q15	10-20 Q25	Q34	Q12	Q12	Q12	Q13	Q13
Health Promotion / Health Board	1	1	-	1	-	-	-	1	-	-
Primary Care	2	-	2	-	-	-	-	-	-	-
Trading Standards	1	-	-	-	-	1	-	-	-	-
Statutory Youth Work	1	-	-	-	-	-	-	-	-	-
Voluntary Sector	1	1	-	1	-	-	-	-	-	-
SIPs	1	1	-	-	-	-	-	-	-	-
Other	1	-	1	-	-	-	-	-	-	-

A relatively high proportion of respondents reported involvement in prevention activities, but cessation activities were less prominent (Table 7.10). Enforcement activities were only reported by the trading standards respondent and no training provision or development of support materials were described.

Prevention

Despite the small numbers, some substantive prevention and education projects are apparent as shown in Figure 7.10a, including a three year school-based project, a needs assessment exercise and peer education workshops.

Cessation

As shown in Figure 7.10b, a schools-based cessation project was identified. Remaining projects reported were linked to the prevention projects shown in Figure 7.10a. The planned cessation activities described relate to looked after and accommodated young people.

Enforcement

In addition to routine inspection and investigation of complaints alleging under age supply, the trading standards respondent also reported: a survey of shops using underage volunteers to determine levels of under-age supply (December 1999 - January 2000).

Training

The health promotion respondent and the respondent from the voluntary sector both reported receiving training. The former cited HEBS/ASH events and attending an ENYPAT meeting which addressed prevention and cessation; and the latter received training from health promotion focusing on tobacco awareness. No training provision for workers was outlined by respondents.

Figure 7.10a Highland NHS Board area: prevention

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Health Promotion	Smokefree project	10-15 years Primary school students	Curriculum based materials for primary schools Duration 3 years	Training packs, curriculum materials, leaflets Teachers European funding
Health Promotion	Needs assessment	10-20 years	Focus groups April-December 2000 Smoking cessation budget
Voluntary Sector	Healthy living workshops	10-20 years School students	In school setting On going for past 3 years	Paper based leaflets Funding: Comic Relief
Voluntary Sector	Peer education workshop	10-20 years Youth group attenders, community group attenders	In school setting and youth café workshops
Planned Activity: No planned activities were described.

Figure 7.10b Highland NHS Board area: cessation

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies

Health Promotion	Schools based cessation project	14-16 years School students	Peer support / group work Aug 2001-2004	Youth workers / Teachers
Planned Activity
Health Promotion	Group and 1-to-1 support	Looked after and accommodated young people	Group and 1-to-1 support for this target group 3 years (December 2001-2004?)

7.11 Borders NHS board area

The Borders NHS Board is in a predominantly rural area, with many of the population on low incomes reflecting economic change in the area.

Table 7.4 Borders NHS Board area: overview (n)

	Total	Prevention/ education: Directly	Prevention/ education: Potentially	Cessation: Directly	Cessation: Potentially	Enforcement	Training: In-house	Training: Other agencies	Support materials: Internal use	Support materials: Other agency
		10-20 Q15	10-20 Q15	10-20 Q25	Q34	Q12	Q12	Q12	Q13	Q13
Health Promotion / Health Board	1	1	-	-	1	-	1	-	-	-
Primary Care	2	-	-	-	2	-	-	-	-	-
Trading Standards	1	-	-	-	-	1	-	-	-	-
Statutory Youth Work	2	1	1	-	-	1	-	-	-	-
Voluntary Sector	2	-	-	1	-	-	1	-	-	-
SIPs	-
Other	-

There was a relatively low proportion of youth targeted involvement reported (Table 7.4) across both prevention and cessation. In addition to the trading standards officer, one statutory youth worker reported related enforcement activities. In-house training provision was reported by health promotion and a voluntary sector respondent.

Prevention

There were no substantive youth and tobacco focussed projects identified in this area, but the projects outlined in Figure 7.4a indicated that smoking would be addressed in work with young people in the school and youth work context. The planned activities described focussed on facilitating school nurses in tobacco-related issues.

Cessation

One activity supporting youth cessation work was described, again in the school context (Table 7.4b). The remaining cessation project described related to a health centre population and covered all ages. No planned cessation activities were described, although a new post of Smoking Cessation Co-ordinator has been created in the Primary Care Trust.

Enforcement

The trading standards respondent reported the investigation of complaints about sales to underage children, and the issuing of warning letters reflecting the difficulty of lack of evidence for proceedings. In addition:

a Proof of Age scheme was reported as being investigated by trading standards
an earlier underage survey was reported using volunteers to effect test purchase, in co-operation with the Education Department, the Health Board, and the Police
a statutory youth worker described undertaking talks and group work with youth group attenders addressing enforcement issues

Training

Three respondents described receiving training. The health promotion respondent had attended the Fast Forward event on preventive work with young people and a statutory youth worker reported training by the health promotion department on smoking cessation and prevention. One respondent reported attending a course at Queen Margaret University College, Edinburgh, on 'Education for Change'. No respondents outlined providing training for workers.

Figure 7.4a Borders NHS Board area: prevention

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Health Promotion	Developing health promoting school approach	10-20 years School students, teachers	Developing health promoting school approach within New Community Schools and other schools within area Audit, identification of priorities, encouraging positive ethos / environment	Encouraging use of smoking materials with teachers as and when requested
Statutory Youth Work	Supply of resources to other youth organisations	10-20 years School students, youth group attenders	No smoking pack sent out to youth organisations in Berwickshire	ASH and HEBS
	Youth information	10-15 years School students	'Open Door' sessions at school
	Youth work curriculum	12-17 years Youth group attenders	Within youth work programmes, smoking issues are part of the curriculum
Planned Activity
Primary care	School nurse support	Young people at school	To work with school nurses raising awareness of tobacco inequalities/health issues. To provide training/support for the school nurses.

Figure 7.4b Borders NHS Board area: cessation

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Health Promotion	Support for school nurses' smoking cessation work	10-20 years School students	Providing support for school nurses' smoking cessation work through the secondary school drop-in clinics	Providing health information resources, e.g. Comic Company
Planned Activity: No planned activities were described.

7.12 Fife NHS board area

Fife NHS Board area is located in the East Coast of Scotland, with a mix of urban population to the South and coastal areas and a more rural population inland.

Table 7.6 Fife NHS Board area: overview (n)

	Total	Prevention/ education: Directly	Prevention/ education: Potentially	Cessation: Directly	Cessation: Potentially	Enforcement	Training: In-house	Training: Other agencies	Support materials: Internal use	Support materials: Other agency
		10-20 Q15	10-20 Q15	10-20 Q25	Q34	Q12	Q12	Q12	Q13	Q13
Health Promotion / Health Board	1	-	1	1	-	-	-	1	1	-
Primary Care	3	2	1	1	1	-	1	-	-	-
Trading Standards	1	-	-	-	-	1	-	-	-	-
Statutory Youth Work	2	1	1	1	1	1	1	-	-	-
Voluntary Sector	-
SIPs	-
Other	-

A relatively high proportion of respondents reported involvement in youth focussed prevention and cessation activities (Table 7.6), especially from primary care and youth work. As well as trading standards, one youth worker also expressed involvement in enforcement issues. Training provision and development of support materials were undertaken by health promotion, and primary care and statutory youth work respondents also reported training activities.

Prevention

The activities identified show that work relating to smoking is addressed in school and youth work contexts, the former by school nurses based in primary care (Figure 7.6a). Apart from one discussion workshop and a No Smoking Day event which encouraged pupil and teacher participation, activities tended to be more opportunistic, addressing smoking as it arose among other issues.

Cessation

A substantive smoking cessation programme was described by the health promotion respondent based in a school setting (Figure 7.6b). Development of a teen health website in the youth work context was reported by a respondent from primary care. Remaining projects described related to information provision.

Enforcement

Reported activities related to investigation of complaints - visiting the shop and issuing informal warnings; followed up with surveillance if necessary - and inspection of display of statutory 'under-16s' notices. The following was also noted: utilisation of retailers' packs developed by Fife Health Care Health Promotion.

Training

Four respondents reported receiving training in their area. Three were primary care respondents, who outlined the following sources: a HEBS/ASH workshop, health promotion, and the primary care trust. Topics included research issues, brief intervention, prevention/cessation and tobacco awareness. The trading standards respondent reported receiving training from the health promotion department in relation to point of sales materials for retailers.

Figure 7.6a Fife NHS Board area: prevention

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Primary Care	Education	School students	School nurses in PSE classes, single sessions	HEBS posters / Funded Health Promotion
	Workshops	Youth health project	Workshops at youth health project Single sessions	HEBS materials / Social Work Department, Community Services
	No Smoking Day	10-20 years School students, teachers	On national NSD Raising awareness in school community, pupil and staff participation in manning displays etc.	Displays, quiz. National and local
	One to one health promotion (during appointment sessions)	10-15 years School students	General health information to include specific smoking information Daily as part of 20 minute appointments	Leaflets backed up by verbal information
Statutory Youth Work	Discussion workshop	10-20 years School students, youth group attenders	Informal discussions with group of non smokers 1 evening
Statutory Youth Work	Part of general health/fitness	10-20 years Youth group attenders, community group attenders, wider community	Various short-term events and activities - group work, discussion, providing starter information, part of general health/fitness	Health promotion
Planned Activity: No planned activities were described.

Figure 7.6b Fife NHS Board area: cessation

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Health Promotion	"No Nicoteens" (cessation sessions)	3^rd and 4^th year (female) school students	5 x ½ hour lunch time sessions held in school. Informal approach giving 3^rd and 4^th year girls ownership of their group. Emphasis on getting advice and weight matters. 8^th May - 5^th June 2001	Gasp 'Why not quit now?' Quit smoking guide for young people / School nurse, Primary Care Trust
Primary Care	Youth development work/ developing website	16-20 years School students, youth group attenders, wider community	Youth development work addressing teenage health aspects Developing a teenage web site	In development / Health professionals, education sector
Statutory Youth Work	Group work / information provision	10-20 years Youth group attenders, community group attenders, wider community	Occasional events, group work, providing information	Health promotion
Planned Activity
Health promotion	Sessional input on cessation and prevention	Young people in a geographic location	Multi-agency youth initiative to provide sessional input to a specific geographical area on prevention and cessation with young people. October/November 2001 start	Health Promotion, Leisure and Recreation, Community Education, Voluntary Sector
Primary care	Group support and NRT	Young homeless people	8 week group support (counselling and NRT with backup from staff in unit) October-November 2001, for 8 weeks
Statutory Youth Work	Training	Youth workers	Training courses for youth workers enabling them to develop curriculums

7.13 Dumfries and Galloway NHS board area

The Dumfries and Galloway NHS Board area is geographically extensive, with a largely rural and scattered population.

Table 7.5 Dumfries and Galloway NHS Board area: overview (n)

	Total	Prevention/ education: Directly	Prevention/ education: Potentially	Cessation: Directly	Cessation: Potentially	Enforcement	Training: In-house	Training: Other agencies	Support materials: Internal use	Support materials: Other agency
		10-20 Q15	10-20 Q15	10-20 Q25	Q34	Q12	Q12	Q12	Q13	Q13
Health Promotion / Health Board	1	-	1	-	1	-	1	1	-	-
Primary Care	2	1	1	-	1	-	1	1	-	-
Trading Standards	1	-	-	-	-	1	-	-	-	-
Statutory Youth Work	2	1	1	2	-	-	-	-	-	-
Voluntary Sector	-
SIPs	-
Other	-

Although respondent numbers are low, there is a proportionately high involvement in prevention and cessation activities, although not all are youth specific (Table 7.5). The trading standards respondent was the only one reporting involvement in enforcement and training was provided by health promotion and primary care.

Prevention

Smoking focussed interventions were reported in schools and in youth work settings, including use of a peer education approach and utilisation of No Smoking Day as a trigger for activities (Figure 7.5a).

Cessation

Opportunistic cessation support was outlined in both school and youth work settings (Figure 7.5b) although with low numbers. Future activities reported, indicated an expansion towards work in the FE sector.

Enforcement

The following activities were reported by the trading standards respondent:

The introduction of a Proof of Age card. In conjunction with general publicity, cards were introduced in the local secondary school. A wide range of targets were identified in addition to the young people - parents, teachers, shop keepers, management of pubs and providers of illegal cigarettes. Local police and businesses were also involved. The respondent is chair of the local Proof of Age group
National Consumer Week '99. A mobile display moved around the region over a three month period, visiting schools and libraries. School classes were held.

Training

None of the respondents in this area reported receiving training. Health promotion and primary care respondents reported providing training to health professionals and the voluntary sector covering a brief intervention approach to cessation, but not necessarily youth specific. Within the youth work sector, one respondent commented that training is linked to provision and responding to needs identified by workers, to help them to provide settings 'where many issues, including smoking, can be examined'.

Figure 7.5a Dumfries and Galloway NHS Board area: prevention

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Health Promotion	Health Promoting School	5-9 years 10-15 years School students, teachers	Smoking is an issue addressed within this context
Primary Care	School based work		Providing lessons on tobacco industry etc
Statutory youth work	Peer education work (in secondary school setting)	12-16 years school students	Community worker working with peer-education group: W.I.L.D. @ Stranraer Academy (Working to Improve Lifestyles Daily) informally in school setting. Theme: smoking Discussions, role play, art, activities Group met 1 lunchtime per week 26 Oct 2000 - 1 Mar 2001	Own materials for sessions
	Countdown to No Smoking Day fun event	12-18 years School students, teachers	Event held in Stranraer Academy, all pupils and teachers invited. Pupils involved through art lessons in designing a T-shirt for no smoking day theme, fitness competitions, wordsearch competition, information and displays on smoking and planning to stop	Own display materials and information leaflets on smoking/not smoking / stopping smoking etc from Dumfries and Galloway Health Board, Health Promotion Department and 'Kiss it Goodbye'. No Smoking Day 2001 promotional materials
	Games and activities evening - youth club setting.	10-15 years Youth group attenders	Games and activities evening centred round 'No Smoking Day' theme. Also display and information leaflets on smoking/stopping smoking etc. One evening - March 2000	Own games/activities. Info from D&G Health Board Health Promotion Department
	Provision of materials as required		Provision of materials as required, re. stopping smoking /dangers of smoking and discussion where required. The informal nature of this work encourages serious debate whilst not exerting pressure, but supporting young people to analyse the issues regarding smoking	Where materials required (publicity leaflets etc) these will be sourced through for example the Health Board
Planned Activity: No planned activities were described.

Figure 7.5b Dumfries and Galloway NHS Board area: cessation

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Health Promotion	Offering cessation support through schools	10-20 years School students	Smoking is an issue addressed within this context	Smoking Matters Service, guidance teacher / Smoking cessation money ringfenced (overall service not targeted)
Statutory Youth Work	Galloway Youth Enquiry Service	12-25 years School/FE/HE students, youth club attenders, teachers	Providing young people with easily accessible and understandable information (to enable them to make informed decisions and choices about their lives including, where requested, smoking). Weekly YES in Academy, College, Youth Café etc.	Various info leaflets from Dumfries and Galloway Health Board, Health Promotion Department
Planned Activity
Primary care	Planned work in FE and with health promotion	14-18 years and 18-30 years	Targeting in FE and partnership with health promotion (all at planning stage)

7.14 Shetland NHS board area

Shetland is a predominantly rural area with the population scattered over 15 inhabited islands as well as centred in the main town of Berwick.

Table 7.14 Shetland NHS Board area: overview (n)

	Total	Prevention/ education: Directly	Prevention/ education: Potentially	Cessation: Directly	Cessation: Potentially	Enforcement	Training: In-house	Training: Other agencies	Support materials: Internal use	Support materials: Other agency
		10-20 Q15	10-20 Q15	10-20 Q25	Q34	Q12	Q12	Q12	Q13	Q13
Health Promotion / Health Board	1	-	1	-	1	-	1	1	1	1
Primary Care	-
Trading Standards	1	-	-	-	-	1	-	-	-	-
Statutory Youth Work	1	-	1	-	-	-	-	-	-	-
Voluntary Sector	1	1	-	-	-	-	-	-	-	-
SIPs	-
Other	-

Overall there was a proportionately low involvement in youth specific prevention and cessation projects. Training provision and development of support materials relating to this area of work was undertaken by health promotion.

Prevention

The prevention activities shown in Figure 7.14a identify smoking specific projects, with No Smoking Day being used as a basis for wider activities.

Cessation

The following activity in Figure 7.14b gives greater detail of an ASH funded project in the context of cessation. The only additional cessation activity was reported in the context of primary care and aimed at the adult practice population. The planned activities noted in Figure 7.14a in relation to prevention also potentially address cessation.

Enforcement

The trading standards respondent reported undertaking a routine inspection and monitoring of compliance with requirements to display notices regarding sales to under-16 year olds.

Training

Activities reported by health promotion related to cessation training sessions for practice and community nurses in their work with practice populations, and for midwives focussing on smoking in pregnancy and passive smoking issues.

Figure 7.14a Shetland NHS Board area: prevention

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Health Promotion	No Smoking Day		Newspaper article, free pack of helpful information from health promotion or occupational health 1 week	Pack of detailed information around smoking, benefits of stopping - not starting
Voluntary sector	ASH project	10-15 years Youth group attenders	Partner in delivery of programme to young people in specific area promoting healthy lifestyles 8 weeks Sept / Oct 2001	Leaflets, quizzes, questionnaires / Health Promotion Department, youth worker, community organisation Funding - ASH grant
Planned Activity
Health Promotion		10-20 year olds	Tobacco forum to be formed and will identify gaps and prioritise work in these areas On going	(Prevention and cessation)
Health Promotion		12-17 years Secondary schools	Details to be finalised. Discussion groups, video (Mission Impossible) possibly cessation work

Figure 7.14b Shetland NHS Board area: cessation

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Health Promotion	ASH Scotland - smoking and low income	12-17 years and 18+ years School students, youth group attenders	Two groups - one women 18+ - one mixed 12-17 year old. Women concentrated on feeling good, building self-esteem, reflexology, aromatherapy etc. Mixed group concentrated on sport/being active Jan 2001 - Sept 2001	HEBS 'Stopping smoking made easier' Helping people to stop smoking Keeping your weight under control while kicking the habit Community workers, youth workers, volunteers Funding - ASH Scotland
Planned Activity: See Figure 7.14a.

7.15 Orkney NHS board area

The Orkney NHS Board area has relatively low population numbers, largely scattered across the islands.

Table 7.13 Orkney NHS Board area: overview (n)

	Total	Prevention/ education: Directly	Prevention/ education: Potentially	Cessation: Directly	Cessation: Potentially	Enforcement	Training: In-house	Training: Other agencies	Support materials: Internal use	Support materials: Other agency
		10-20 Q15	10-20 Q15	10-20 Q25	Q34	Q12	Q12	Q12	Q13	Q13
Health Promotion / Health Board	1	-	1	-	1	-	-	-	-	-
Primary Care	-
Trading Standards	-
Statutory Youth Work	1	1	-	-	-	-	-	-	-	-
Voluntary Sector	-
SIPs	-
Other	-

The two respondents were drawn from health promotion and statutory youth work. There was little involvement in youth specific work or training and development of support materials (Table 7.13).

Prevention

The prevention activities reported focussed on information provision and development of the local strategy on drugs, alcohol and smoking (Figure 7.13a). Promotion of No Smoking Day was also reported.

Cessation

One youth related activity was reported in addition to the development of a general population cessation service (Figure 7.13b).

Enforcement

No enforcement activities were described, but in this context the health promotion respondent referred to the multi-agency strategy (Figure 7.13a) which would have enforcement implications.

Training

Cessation training for health professionals was reported by the health promotion respondent.

Figure 7.13a Orkney NHS Board area: prevention

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Health Promotion	Develop local strategy and action plan on drugs, alcohol and smoking	All ages, wider community	Throughout year 2000-2002 and ongoing	Social services, Education, Trading Standards, Environmental Health, Voluntary Sector, local businesses
Statutory Youth Work	General information	10-15/16 years Youth group attenders	(Also member of DASAT group)	Youth group membership and workers
Planned Activity
Health Promotion	Multi-agency action plan	Everyone including young people	Multi-agency action plan following on from recently developed drugs, alcohol and smoking strategy: From Sept 2001	(Potentially prevention, cessation and enforcement)
Health Promotion		10-24 years Multi-agency audience	Presentation of research from ENYPAT Spring school to multi-agency audience

Figure 7.13b Orkney NHS Board area: cessation

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Health Promotion	Attend ENYPAT spring school	All Range of settings including wider community	EU funded seminar on young people and smoking March 2002
Planned Activity
Health Promotion	Pilot cessation	10-24 years	Hope to develop pilot with other Island Boards on cessation with ASH/HEBS funding

7.16 Western Isles NHS board area

The Western Isles NHS Board area encompasses widely dispersed island communities.

Table 7.16 Western Isles NHS Board area: overview (n)

	Total	Prevention/ education: Directly	Prevention/ education: Potentially	Cessation: Directly	Cessation: Potentially	Enforcement	Training: In-house	Training: Other agencies	Support materials: Internal use	Support materials: Other agency
		10-20 Q15	10-20 Q15	10-20 Q25	Q34	Q12	Q12	Q12	Q13	Q13
Health Promotion / Health Board	1	1	-	1	-	1	-	1	1	-
Primary Care	-
Trading Standards	1	-	-	-	-	1	-	-	-	-
Statutory Youth Work	-
Voluntary Sector	-
SIPs	-
Other	-

The two respondents were from health promotion and trading standards (Table 7.16). Health promotion showed involvement in youth specific prevention and cessation activities, together with related training and development of materials.

Prevention

The only prevention activity reported - Smokebusters - is shown in Table 7.16a.

Cessation

The youth cessation intervention reported related to a GP referral scheme (Figure 7.16b).

Enforcement

In addition to checking compliance with age warning notices and responding to tobacco-related complaints, the following activities were reported:

'Validate' Proof of Age card was mentioned by the trading standards and health promotion respondents, highlighting partnership working
responsible Retailer Award was mentioned by the health promotion respondent

Training

The health promotion respondent reported receiving prevention and cessation training from HEBS and ASH Scotland. She also outlined providing training for education staff on tobacco and now it fits in the curriculum.

Figure 7.16a Western Isles NHS Board area: prevention

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Health Promotion	Smokebuster Project	10-15 years School students, youth group attenders	Follows the lines of the N. Ireland Smokebusters evaluation. School and youth club based Ongoing part-time worker (permanent)	Newsletters, SB packs etc
Planned Activity: No planned activities were described.

Figure 7.16b Western Isles NHS Board area: cessation

Agency Type	Title	Age / Target Group / Setting	Methods	Materials / Other Agencies
Current Activity
Health Promotion	GP referral cessation service	16-20 years School students	Medical alert patients / clients, eg. diabetes, asthma 1-1 cessation support NRT voucher (only 2 clients) Referred by GP or self-referral	NRT voucher
Planned Activity
Health Promotion		14-25 years	Depending on funding joint 3 island bid to ENYPAT in conjunction with research unit Highlands and Islands University 2 years Oct 2001-2003

8. Summary, discussion and conclusions

Summary

Are there strategies and approaches which underpin tobacco-related work with young people in Scotland?

Less than half of respondents reported organisational strategies relating to tobacco-related work with young people. Only 7% of respondents highlighted strategies relating specifically to this issue, although a further 41% felt it was incorporated in a broader based young person strategy. Nearly two-thirds of respondents (63%) were able to identify links in their work to broader national or local strategies, although smoking specific strategies did not predominate. Respondents' feedback indicated limited salience of an evidence base in informing practice in this area of work. There appears to be a reasonable level of inter-agency working, with only 2% of respondents not having contact with other agencies.

How are key areas of work addressed across Scotland?

For enforcement activities, the majority of respondents are from trading standards departments, with a very small number scattered across other sectors. Enforcement and support of underage sales regulation is the most common activity, involving 54% of respondents. Relatively little new activity was planned, although respondents indicated a wish to undertake 'test purchasing' as part of enforcing underage sales regulation, currently halted pending results of the Lord Advocate's review.

Development of support materials either for internal or external use was reported by 18% of respondents, mainly resource packs and leaflets/booklets.

What activities are undertaken among nationally based organisations?

What is the scope of tobacco-related work with young people across geographical areas of Scotland?

Discussion

The survey identified a considerable range of tobacco-related work with young people across Scotland and across the various agencies contacted. It appears there is considerable interest in this issue, as reflected in the commitment to the study, and there are positive indications of innovative approaches and increased planned activity. However, it should be remembered that when viewed from the perspective of individual young people spread across the country, the spheres of influence are relatively low, and the survey suggests there will be local areas with no workers or activities with a tobacco-related interest and focus.

A very varied picture emerged across and within agency types. Health promotion departments, and to a slightly lesser extent, trading standards, were the only agency types that consistently claimed involvement in this area. Within primary care, youth work, SIPs, DATs and nationally based organisations, the picture was more varied. Involvement in tobacco-related work with young people was more ad hoc and appeared to reflect local organisational priorities together with the interests of individual workers, as well as inter-agency working and support, including more structured 'alliances'. Nationally based youth organisations with a broad reach across Scotland might be a useful target group (40% of potential respondents in this category reported that they were not involved in this work). Some responses from 'uniformed' organisations acknowledged that this was an area that they should address, in line with existing policies and initiatives relating to drugs and alcohol.

Variations in agency types included variations in relevant posts within organisations. Within primary care, respondents included school nurses, health visitors with a young person remit, Smoking Cessation Co-ordinators and Public Health Facilitators. Some SIPs employed Youth Health Workers, and one voluntary organisation included a Tobacco Issues Worker. In some areas, health promotion officers are seconded part-time to primary care settings to facilitate tobacco-related activities.

The picture described above is very fluid and likely to change. For example, responses indicated considerable movement within jobs, especially in the youth work sector. As workers move from post to post, skills and motivations will vary in relation to tobacco as well as other issues, as will the build up of links with other workers and agencies and client groups. New posts are also anticipated, in particular public health and smoking specific roles in LHCCs, which should enhance the scope in this area.

Focusing on the tobacco-related activities themselves, there was also considerable variation within and across the categories set in the study objectives (prevention/education, cessation, enforcement, training and support materials). It was apparent that these divisions were not always clear to respondents, and it should be borne in mind that to some extent the reporting suggests boundaries that are 'artificial' in the context of common practice. Thus, some respondents outlined the same or very similar activities in the prevention and the cessation sections, for example making leaflets and posters available, No Smoking Day events, health fairs and displays. Some respondents reported initiation of Proof of Age cards as a preventive rather than an enforcement activity. Training of workers could be recorded as an intervention or as a training activity. The development of a website could be undertaken by an organisation to make information available or could be seen as an intervention in itself, led by young people with the process enhancing their tobacco awareness and perhaps triggering cessation as well as providing other benefits. In addition, the two main settings of youth groups and schools, supported primarily by youth workers and primary care based workers respectively, might also be targeted by workers from both sectors describing activities in the 'opposite' sector, such as YES workers located in schools and health visitors working in youth settings. Similarly, trading standards officers not only worked with retailers, but also reported educational activities with young people themselves. Finally, as well as tobacco and smoking sometimes being set in the context of broader health and social issues, more specific fields included alcohol and drugs related interventions and lifestyle/decision-making approaches.

Thus there is considerable mix and overlap in tobacco-related activities. This is not necessarily a negative point, although it could also suggest limited recognition of tobacco as an issue and lack of structuring of activities. Arguably, there is a case for tobacco and smoking to be addressed within a broader holistic approach rather than in isolation. While often more challenging, this approach could be more actively recognised and supported. A 'holistic' approach was particularly reported in the youth work sectors where a number of respondents stressed the importance of responding to individual young people and their concerns at the time rather than imposing 'initiatives' - to "enable them to make informed decisions on a range of issues including, where requested, smoking" (Youth Worker). This made it difficult to plan or assess effectiveness in relation to one particular topic (and made it difficult to complete the questionnaire!). For example defining an activity as cessation would be "dependent on whether the Informal Social Education approach encourages a young person to stop smoking" (Youth Worker).

Perhaps the goal is to ensure that tobacco-related issues are on the agenda for those working with young people in all sectors, if not always at the forefront of day-to-day activity. Workers from different sectors may not need to be 'experts' but it is important that firstly, there are youth-appropriate specialist sources in an area and secondly, that good sign-posting is provided for workers and for young people themselves, whether it be for information or cessation support.

No Smoking Day appears to have a useful role in maintaining the place of tobacco 'on the agenda'. Over half the respondents across many agency types reported undertaking No Smoking Day activities including many youth workers. Many of these had attended related training sessions, often the only tobacco-related training they received. Reported activities tended to be limited to 'the day' but a sizable minority reported relatively longer-term interventions with a No Smoking Day Focus.

Linked with the merging of divisions between tobacco-related categories, it was also apparent that interventions ranged from clearly defined 'discrete' projects to something that was considered very much part of everyday work, with tobacco often being one of many issues addressed opportunistically. Thus, while some projects were sustained and longer-term, although commonly planned in months rather than years, others would be one-off and short-term, for example No Smoking Day, and some were unplanned and reactive to individual requests. Different parts of the spectrum might occur within one post or organisation so that a planned activity, perhaps with a clear protocol as would be required for a funding bid, might run in parallel with more general tobacco-related information and support provision and with work in other areas. Similarly, it appeared that many reported activities were perhaps more likely to have 'evolved' than be the outcome of specific planning, although individual structured projects were also highlighted.

Focussing on cessation interventions, it is important to note that among the activities reported, there were only ten examples of young people-specific group programmes or classes reported across Scotland. Other programmes were described, primarily in primary care, which were targeted at the general public or practice population but could potentially be accessed by young people. However, adult health services are often inappropriate for young people (eg. Community Learning Scotland 2000). In addition, the limited guidance and general discouragement of provision of NRT to those under 18 years brings the issue into focus, with only two respondents appearing to offer NRT to this age group. Within the context of cessation, others described one-to-one counselling and opportunistic responses to request for help, as well as information provision, workshops and discussion sessions, and broader positive lifestyle and coping advice. While increased provision of specific classes and programmes is desirable, it may be that more flexible and opportunistic approaches are also important, reflecting young smokers' 'on-off' acknowledgement of having a habit and their unfamiliarity with service provision. Some of these issues are addressed in the ASH Scotland small grants projects, some of which encourage consideration of quitting and preparation to join cessation services rather than actually providing cessation support.

It is also important to note that cessation support of any kind is relatively thinly spread. Only 98 respondents reported cessation work of any kind, suggesting limited availability of support with young people unlikely to travel far for help. In addition, only 27 respondents reported receiving training on cessation approaches, and these were not always young people focussed.

Cessation interventions were more commonly described as occurring in youth group settings but school-based intervention were also frequently reported, although there is no clear evidence that this is an optimal setting. However, it might be that New Community Schools with integrated provision of services and the ethos of addressing the needs of young people 'in the round' (New Community Schools) may increase effectiveness.

The limited extent of training is also important. Only a third of respondents had received any training in tobacco-related issues, primarily in health promotion and primary care, and this was more likely to be one-off seminars rather than formal training. Thus, many respondents, especially but not exclusively in youth work, relied on past experience and approaches used in relation to other issues when addressing tobacco-related work. Where an opportunistic approach is taken, responding to smoking as one of many issues potentially raised by young people, will there be sufficient knowledge and skills to respond appropriately, either directly or by referral to other services? Again, it may not be important that all workers are fully trained, but arguably, basic skills and knowledge should be widely disseminated and access to specialist advice and support should be available and clearly signposted.

Finally, although there was frequent mention of the importance of responding to young people and their declared needs, there was a very low level of reporting of formal needs assessment or consultation with young people.

Conclusions

Tobacco-related work with young people was identified across Scotland and across different agency types. There is considerable interest in addressing this issue, and there are positive indications of increasing activity and innovative approaches. However, in terms of access for individual young people, provision is still relatively thinly spread.
Cessation provision is particularly limited. Just under half of respondents reported any involvement in cessation (98), and only 10 youth specific programmes or classes were described. One-to-one and opportunistic advice and broader lifestyle approaches which may also have an appropriate role in youth cessation were reported in similarly small numbers.
Only a third of respondents reported experiencing any kind of training in tobacco-related work, with many relying on 'picking it up' and past experience with other issues. While not all workers need to be 'experts', dissemination of basic knowledge could be enhanced, and it is also important that appropriate specialist services are available and are well 'sign-posted'.
Enforcement activities are widespread, but many trading standards officers expressed a wish to employ test-purchasing by under-16s, suspended pending the Lord Advocate's decision on the matter.
Finally, a considerable mix and overlap of approaches was apparent. For some workers and settings there was a lack of distinction between areas of work, particularly prevention and cessation, and it appeared that activities reported were not always discrete entities. Often this reflects a valuable holistic and flexible approach, but it might also indicate a limited priority in planning and structuring of tobacco-related activities.

9. References

Community Learning Scotland (2000). Walk the Talk. Edinburgh: CLS.

HEBS/ASH (1999). Report of ASH/HEBS expert seminar on Tobacco and young people.

New Community Schools website. http://www.scotland.gov.uk/education/newcommunityschools

Scottish Executive (2000). Our National Health: A Plan for Action, A Plan for Change. Edinburgh.

The Scottish Office (1999). Towards and Healthier Scotland - A White Paper on Health. Edinburgh.

« Back to publication

Section navigation:

healthscotland.com

Publication