healthscotland.com

Primary school tobacco education: A needs assessment

3. Conclusions and recommendations

The data gathered from teachers in this survey can be seen to have significant implications for future resource material. The main points to be drawn are outlined below.

Resources should be linked to the Scottish 5-14 curriculum.

• Pupils’ activities must be justifiable in terms of the prescribed learning outcomes. Teachers are much more likely to choose to resources which are clearly marked with the attainment targets and the achievement levels
• The main curricular areas are health education, and PSD. With careful reference to the 5-14 guidelines, resources could also be linked in to drama, language, art, and science.
• Most schools teach tobacco education as part of a drugs package. Issues relating to smoking are also of relevance to other drugs, and resources should recognise this link.
• Drug education begins in the early stages of primary school, and it has been suggested that children would benefit from their first tobacco education between the ages of four and eight (Porcellato et al 1999). There may be some benefit in designing materials that could be used as the children progress through the school.

Resources should not be highly prescriptive

• Teachers design their lessons to suit the pupils in their class, and will vary their approaches with different groups of children. They select the resources that meet their needs for that particular class, and readily modify materials for their own purposes. A prescriptive lesson or series of lessons would not meet the varying requirements of pupils, and although teachers may take ideas from such materials, they would not often follow them closely.
• This flexible approach to teaching would be best served by a range of different resources which address different learning styles, and which give rise to a variety of activities.

The purpose of class resources is to stimulate activity.

• Teachers were constantly looking for materials that could stimulate interactive or creative activities, particularly discussion and role-play, but also experiments, creative writing, functional writing and art. Resources needed to be visually exciting, and convey their message in a concise and direct way. Pupils would be put off by too much written information, or by worksheet style activities. Instead teachers preferred posters, discussion cards, videos, practical demonstrations or other ways of delivering direct messages.
• Teachers did not require the resources to direct the activities, although they appreciated suggestions, teachers preferred to use their own professional judgement regarding classroom management.

Health messages must be relevant to the children’s view of the world.

• De Meyrick (2001) pointed out that health messages to young people must be concrete, verifiable and in their own time frame. This was borne out by teachers who considered that their pupils could not identify with long-term health warnings about smoking (such as cancer risks).  Issues of social relevance were thought to be of greater interest to primary pupils, or the immediate impact of smoking on their sporting prowess. It is important to present a wide range of health messages to children, to allow for their differential responses. In particular, there may be a gendered response to the social and sport related issues.
• Of particular concern, both to academics (De Meyrick 2001, Halpern et al 2003) and to teachers is the childrens’ vulnerability to tobacco addiction as a result of social smoking. Primary teachers felt that their pupils did not easily relate the concept of addiction to themselves. Any resources which could address this issue, in a child-centred way, would be welcomed by the schools.
• Not only the content, but the presentation of educational materials must relate to the children’s experiences and interests. Teachers repeatedly suggested the use of other children, or teenagers to present the messages, in a context which related to their social world. Pop stars, media personalities and sports celebrities would also create interest amongst children, and could be influential in their decision making.

Role-play scenarios should be grounded in teenage reality

• Role-play was commonly used as a means of preparing children for social situations involving tobacco use. Most teachers thought up their own ideas on which to base their role-play, although some used videos as a starting point.  In most cases the types of scenario were based on the rather outdated notion that young people start to smoke reluctantly, as a result of peer pressure or coercion, in order to avoid losing face in a situation over which they have little control. There was little evidence of teachers understanding the active choices that young people make when they decide to become smoke (Mitchell 1997). Consequently the type of strategies that young people were developing were of use only in the short term, to evade a tricky situation (for example “ I’d love a cigarette, but I’ve got to be getting home for my tea”). They did not address longer-term issues of maintaining status by other means, whilst remaining a non-smoker.
• Health promoters have a role to play in filling this gap, by the production of drama materials that relate more closely to the recent research findings in the fields of smoking initiation, together with explanatory teachers notes.

To make an informed choice, children need to see both sides of the case

• The paradoxes at the centre of tobacco education can only serve to confuse children. On the one hand teachers are expected to be impartial, and on the other hand it is their duty to deliver an anti-smoking message. Children are told that it’s their own choice whether or not they become smokers, and then in most cases are bombarded with anti-smoking information. Children can only make a balanced choice if they are supplied with all of the information, which would include a recognition of the reasons why people do choose to smoke. Most teachers did not know of any resources suitable for primary school pupils that looked realistically at the pros and cons of smoking; the one exception being the practical activity (using a balance) described by a teacher in school 13. There is clearly a gap here that could be filled by some thoughtfully designed materials.

Teaching should take account of the smoking patterns of significant adults.

• Children who live with parents or siblings who smoke are statistically more at risk of becoming smokers than children from non-smoking homes. Yet teachers often dilute the health messages they give to these children. This is done for the best of intentions; so the children are not frightened by their parents health prospects, so that they do not become critical of their parents, and to avoid any conflict between home and school. But for these children, to whom adult smoking is the norm, tobacco education must be confusing. The task facing a teacher wishing to impart a healthy lifestyle message is particularly difficult, and requires more, not less education.
• Existing resources offer teachers no assistance in handling this dilemma, and this is an issue which could usefully be addressed. This links in strongly with the need to examine the reasons why their parents smoke, but also raises wider questions.   

Teachers need resources too

• Teachers make a clear distinction between resources for pupil use, and resources for their own use, although they can presented as part of the same package. Like pupils, teachers find large quantities of script off-putting, and do not have time for reading lengthy tomes. Booklets for teachers must be concise and informative.
• Primary teachers like to have up-to-date facts and figures at their fingertips, and were particularly keen on the “teacher factsheets” used in the discussions.
• In addition, teachers need to be updated on most recent research findings that could be relevant to their teaching. Rarely do teachers have the opportunity or inclination to read recent health promotion publications, so resource packages should attempt to offer updates.

Outside agencies are a useful human resource

• A large number of the schools in the sample invited visitors to the school to deliver aspects of the health curriculum. These included police, nurses, drama workshops and a mobile interactive classroom. The expertise of these groups was widely appreciated by teachers, who felt that the messages had a greater impact on the pupils. Schools should be encouraged to take advantage of these opportunities. The funding of some of these organisations was a concern to teachers who felt that their financial support was well worth while.

Good communication links are needed between schools and health promoters

• An important part of health promotion in schools is encouraging teachers to use the resources produced. Schools vary enormously in their awareness of available resources, with some teachers claiming to be over-resourced for smoking, and some apparently having none at all. Their attention must be drawn to new resources, with subsequent reminders. E-mails with links to a website could be a possible means of achieving this.
• There is a real need for in-service training of teachers in this area, and this could perhaps be linked to launching any new materials. Teachers’ interest would also be enhanced if they could be involved in the design or piloting before publication. Such an exercise would raise awareness of the materials in production, it would ensure their suitability for classroom use, and it would increase teachers’ confidence to buy and use them.