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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

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 (%)
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)
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 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
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
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
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
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.