Publication
National survey of tobacco-related work with young people
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?
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?
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.