Publication
National survey of tobacco-related work with young people
| Contents: | Acknowledgements Summary 1. Introduction 2. Aims and objectives 3. Method and sample 4. Strategies and approaches which underpin tobacco-related work with young people in Scotland 5. The scope and key areas of tobacco-related work with young people across Scotland 6. Scope of activity among nationally based organisations 7. Scope of tobacco-related work with young people across geographical areas of Scotland 8. Summary, discussion and conclusions 9. References |
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
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 (%)
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.