Primary schoolchildrens' perceptions of smoking: implications for health education

Short term effects of the REAL media e-learning media literacy substance prevention curriculum: An RCT of adolescents disseminated through a community organization

BACKGROUND

The primary aim of this study was to evaluate the short-term effects of testing an e-learning program to reduce adolescent substance use and abuse. Early initiation of substance use is linked to a variety of negative outcomes, thus effective intervention programs are needed. One approach is to use media literacy to capitalize on adolescents' immersion with media in a variety of forms. We developed, implemented, and tested an engaging substance use prevention program by collaborating with a youth-oriented community partner (4-H).

METHODS

639 middle adolescents from nine U.S. states participated in an RCT of REAL media. Participants completed a series of online surveys and were randomized to use an online substance prevention program (REAL media) or serve as control (delayed program use). Self-report surveys were administered at three points in time. This short-term evaluation uses data from the pretest (Time 1) and short-term posttest three-month surveys, which measured demographics, self-efficacy to counterargue, and injunctive and descriptive substance use norms.

RESULTS

Participants who completed the REAL media program reported increased self-efficacy to counterargue and decreased positive injunctive norms compared to control participants who did not complete the program. No significant differences were observed for descriptive norms.

CONCLUSIONS

We found support for the REAL media program in changing key predictors of youth substance use demonstrating (1) the efficacy of media literacy interventions targeting adolescents and (2) that e-learning substance use prevention efforts can be adapted for and implemented through community organizations.

Welsh Primary Schoolchildren's Perceptions of Electronic Cigarettes: A Mixed Methods Study

There are concerns that the growing popularity of e-cigarettes promotes experimentation among children. Given the influence of the early years on attitude and habit formation, better understanding of how younger children perceive vaping before experimentation begins is needed, to prevent uptake and inform tobacco control strategies. We explored Welsh primary schoolchildren’s (aged 7–11) awareness of e-cigarettes relative to tobacco smoking, their understanding of the perceived risks and benefits and their intentions and beliefs about vaping. Data was collected using a mix of methods in June and July 2017 from 8 purposively selected primary schools across Wales. Four hundred and ninety-five children (52% female) aged 7 years (n = 165), 9 years (n = 185) and 11 years (n = 145) completed a class-administered booklet encompassing a draw and write exercise and survey. Ninety-six children participated in 24 peer discussion groups comprised of 2 boys and 2 girls from each year group. Data were analysed independently and findings triangulated. Survey analyses used frequencies, descriptive statistics and chi-squared tests. Content analysis was undertaken on the draw and write data and peer discussion groups were analysed thematically. Study findings highlight that primary schoolchildren have general awareness of e-cigarettes. Vaping was perceived to be healthier than smoking and there was some recognition that e-cigarettes were used for smoking cessation. Understanding of any health harms was limited. Few children intended to smoke or vape in the future but almost half thought it was okay for grownups. Children’s perceptions were influenced by exposure through family and friends. Findings suggest a need for e-cigarette education in primary schools, to highlight the associated risks of e-cigarette experimentation including the potential for tobacco initiation.

The impact of social inequalities on children's knowledge and representation of health and cancer

Reducing inequalities in the field of cancer involves studying the knowledge and mental representations of cancer among children. A qualitative study was conducted on 191 children aged 9 to 12 using the "write and draw" technique to get spontaneous mental representations of "healthy things", "unhealthy things" and "cancer". We grouped the voluntary schools according to two deprivation levels. In response to the request to "write or draw anything you think keeps you healthy", the main responses categories were physical activity, healthy food and basic needs. Smoking, drinking alcohol, sedentary lifestyles/lack of sport were identified as "unhealthy". The first theme associated with "cancer" is the "cancer site" implying children have a segmented perception of cancer. Deprived children have radically different views about the key items representing cancer: they are more likely to believe the illness is systematically deadly. They are less likely to believe it is a treatable illness. They are less likely to associate cancer with risky behaviors, particularly alcohol consumption.

CONCLUSION

Social inequalities affect representations of cancer and health literacy from early childhood. Prevention programs taking into account these representations need to be introduced at school. What is Known: • Social inequalities for cancer mortality are observed in all European countries and are particularly pronounced in France. • Reducing these inequalities in prevention programs implies studying the knowledge and mental representations of cancer among children. What is New: • This study identified representations of cancer in young children according to social level. • At age 9, children living in deprived areas are less able to produce content in discussions about cancer and have narrower mental representations and a more fatalistic view.

Family-focussed interventions to reduce harm from smoking in primary school-aged children: A systematic review of evaluative studies

Children living in families where adults smoke are exposed to harmful effects of tobacco smoke and risk a predisposition to smoking initiation. Interventions to support families to reduce risk of harm from smoking have been developed and tested. The purpose of this review is to identify effective family-based interventions used to promote smoke-free home environments in families with primary school age children (aged 5-12years). A systematic search of MEDLINE, Cochrane and CINAHL electronic databases was conducted. Narrative synthesis of included articles was completed. Guidelines for reporting behaviour change interventions were used to summarise and compare intervention timing, content, intensity and delivery. Quality of included studies was critiqued using United States Preventative Services Taskforce (USPST) procedures for internal and external validity. Narrative synthesis was based on methods described by Popay and colleagues. Nineteen articles that evaluated 14 intervention studies focussed on child smoking prevention (n=5), parent smoking cessation (n=4) and environmental tobacco smoke reduction (n=6). Interventions and outcomes were heterogeneous, and were rarely informed by theoretical frameworks relating to family, parenting or child development. Family based interventions may be an important strategy to reduce the effects of smoking for children. There is a need for interventions to be informed by theory relevant to children, parenting and families.

“Thinking about drinking”

Purpose

The purpose of this paper is to explore perceptions of alcohol held by schoolchildren using the “Draw and Write” tool, to inform the planning of alcohol education in the classroom setting.

Design/methodology/approach

A specifically designed “Draw and Write” booklet was used with 169 children aged nine to ten years (Year 5) across seven primary schools in a small Local Authority in North West England. Written responses were thematically coded.

Findings

Results demonstrated that the children had a good basic understanding of alcohol, including who drinks, where it can be purchased and the range of products available. Participants were aware that alcohol could be harmful and held mainly negative views. Findings suggest that alcohol education at this age is both appropriate and necessary to help children explore, understand and clarify their perceptions and misconceptions in a safe classroom environment.

Practical implications

The range and depth of responses from the children demonstrated that Draw and Write can be used successfully to explore children’s perceptions of alcohol. The tool can be used as a baseline assessment to inform classroom-based alcohol education for primary school teachers and those supporting delivery at local level, in line with national policy recommendations.

Originality/value

This paper adds to the existing literature on the use of “Draw and Write” in personal, social and health education, demonstrating that it can be used specifically to investigate children’s knowledge and attitudes about alcohol.

Home-based smoking prevention program Smoke-free Kids on smoking-related cognitions: Secondary outcomes from a cluster randomized controlled trial

OBJECTIVES

The home-based smoking prevention programme 'Smoke-free Kids' did not have an effect on primary outcome smoking initiation. A possible explanation may be that the programme has a delayed effect. The aim of this study was to evaluate the effects on the development of important precursors of smoking: smoking-related cognitions.

METHODS

We used a cluster randomised controlled trial in 9- to 11-year-old children and their mothers. The intervention condition received five activity modules, including a communication sheet for mothers, by mail at four-week intervals. The control condition received a fact-based programme. Secondary outcomes were attitudes, self-efficacy and social norms. Latent growth curves analyses were used to calculate the development of cognitions over time. Subsequently, path modelling was used to estimate the programme effects on the initial level and growth of each cognition.

RESULTS

Analyses were performed on 1398 never-smoking children at baseline. Results showed that for children in the intervention condition, perceived maternal norms increased less strongly as compared to the control condition (β = -.10, p = .03). No effects were found for the other cognitions.

CONCLUSION

Based on the limited effects, we do not assume that the programme will have a delayed effect on smoking behaviour later during adolescence.

Process evaluation of a sport-for-health intervention to prevent smoking amongst primary school children: SmokeFree Sports

Background

SmokeFree Sports (SFS) was a multi-component sport-for-health intervention aiming at preventing smoking among nine to ten year old primary school children from North West England. The purpose of this study was to evaluate the process and implementation of SFS, examining intervention reach, dose, fidelity, acceptability and sustainability, in order to understand the feasibility and challenges of delivering such interventions and inform interpretations of intervention effectiveness.

Methods

Process measures included: booking logs, 18 focus groups with children (n = 95), semi-structured interviews with teachers (n = 20) and SFS coaches (n = 7), intervention evaluation questionnaires (completed by children, n = 1097; teachers, n = 50), as well direct observations (by researchers, n = 50 observations) and self-evaluations (completed by teachers, n = 125) of intervention delivery (e.g. length of sessions, implementation of activities as intended, children’s engagement and barriers). Descriptive statistics and thematic analysis were applied to quantitative and qualitative data, respectively.

Results

Overall, SFS reached 30.8% of eligible schools, with 1073 children participating in the intervention (across 32 schools). Thirty-one schools completed the intervention in full. Thirty-three teachers (55% female) and 11 SFS coaches (82% male) attended a bespoke SFS training workshop. Disparities in intervention duration (range = 126 to 201 days), uptake (only 25% of classes received optional intervention components in full), and the extent to which core (mean fidelity score of coaching sessions = 58%) and optional components (no adaptions made = 51% of sessions) were delivered as intended, were apparent. Barriers to intervention delivery included the school setting and children’s behaviour and knowledge. SFS was viewed positively (85% and 82% of children and teachers, respectively, rated SFS five out of five) and recommendations to increase school engagement were provided.

Conclusion

SFS was considered acceptable to children, teachers and coaches. Nevertheless, efforts to enhance intervention reach (at the school level), teachers’ engagement and sustainability must be considered. Variations in dose and fidelity likely reflect challenges associated with complex intervention delivery within school settings and thus a flexible design may be necessary. This study adds to the limited scientific evidence base surrounding sport-for-health interventions and their implementation, and suggests that such interventions offer a promising tool for engaging children in activities which promote their health.

Influence of family and friend smoking on intentions to smoke and smoking-related attitudes and refusal self-efficacy among 9-10 year old children from deprived neighbourhoods: a cross-sectional study

Background

Smoking often starts in early adolescence and addiction can occur rapidly. For effective smoking prevention there is a need to identify at risk groups of preadolescent children and whether gender-specific intervention components are necessary. This study aimed to examine associations between mother, father, sibling and friend smoking and cognitive vulnerability to smoking among preadolescent children living in deprived neighbourhoods.

Methods

Cross-sectional data was collected from 9–10 year old children (n =1143; 50.7% girls; 85.6% White British) from 43 primary schools in Merseyside, England. Children completed a questionnaire that assessed their smoking-related behaviour, intentions, attitudes, and refusal self-efficacy, as well as parent, sibling and friend smoking. Data for boys and girls were analysed separately using multilevel linear and logistic regression models, adjusting for individual cognitions and school and deprivation level.

Results

Compared to girls, boys had lower non-smoking intentions (P = 0.02), refusal self-efficacy (P = 0.04) and were less likely to agree that smoking is ‘definitely’ bad for health (P < 0.01). Friend smoking was negatively associated with non-smoking intentions in girls (P < 0.01) and boys (P < 0.01), and with refusal self-efficacy in girls (P < 0.01). Sibling smoking was negatively associated with non-smoking intentions in girls (P < 0.01) but a positive association was found in boys (P = 0.02). Boys who had a smoking friend were less likely to ‘definitely’ believe that the smoke from other people’s cigarettes is harmful (OR 0.57, 95% CI: 0.35 to 0.91, P = 0.02). Further, boys with a smoking friend (OR 0.38, 95% CI: 0.21 to 0.69, P < 0.01) or a smoking sibling (OR 0.45, 95% CI: 0.21 to 0.98) were less likely to ‘definitely’ believe that smoking is bad for health.

Conclusion

This study indicates that sibling and friend smoking may represent important influences on 9–10 year old children’s cognitive vulnerability toward smoking. Whilst some differential findings by gender were observed, these may not be sufficient to warrant separate prevention interventions. However, further research is needed.

Promoting smoking cessation among parents: effects on smoking-related cognitions and smoking initiation in children

BACKGROUND

Parental smoking is associated with an increased risk of smoking among youth. Epidemiological research has shown that parental smoking cessation can attenuate this risk. This study examined whether telephone counselling for parents and subsequent parental smoking cessation affect smoking-related cognitions and smoking initiation among children of smoking parents.

METHODS

Data of a two-arm randomized controlled trial were used in which 512 smoking parents were recruited into cessation support through their children's primary schools. After the baseline assessment, smoking parents were randomly assigned to tailored telephone counselling or a standard self-help brochure. Parental cessation was measured as 6-month prolonged abstinence at the 12-month follow-up. Children's smoking-related cognitions and smoking initiation were examined at 3-month, 12-month, and 30-month follow-up.

RESULTS

No statistical evidence was found that children of parents who received telephone counselling tailored to smoking parents or children of parents who achieved prolonged abstinence differ in smoking-related cognitions (i.e., smoking outcome expectancies, perceived safety of smoking, self-efficacy to refrain from smoking, susceptibility to smoking) or smoking initiation rate on any follow-up assessment.

CONCLUSIONS

This study is the first to examine the effects of an evidence-based smoking cessation treatment for parents and treatment-induced parental smoking cessation on cognitive and behavioural outcomes among children. Although descriptive statistics showed lower smoking initiation rates among children of parents who achieved prolonged abstinence, there was no statistical evidence that telephone counselling tailored to parents or treatment-induced parental smoking cessation affects precursors of smoking or smoking initiation among youth.

Short-term effects of a home-based smoking prevention program on antismoking socialization and smoking-related cognitions: a cluster randomized controlled trial

OBJECTIVE

This study aims to evaluate the short-term effects of a home-based smoking prevention program called 'Smoke-free Kids' on antismoking socialization and smoking-related cognitions and the moderating role of parental smoking.

PARTICIPANTS AND METHODS

A cluster randomized controlled trial was carried out using one intervention condition compared with a control condition. A total of 1,398 never-smoking children (mean age 10.11 years, SD 0.78) participated. Intention-to-treat and completers-only analyses were performed. Participants in the intervention condition (n=728) received 5 activity modules by mail at 4-week intervals. Modules included communication sheets for their mothers. Participants in the control condition (n=750) received a fact-based intervention only. The main outcomes were the frequency and quality of communication, nonsmoking agreement, house rules, availability of cigarettes, perceived maternal influence, anticipated maternal reactions, attitude, self-efficacy and social norms.

RESULTS

Significant effects of the program were found for frequency of communication (B=0.11, p<0.001), nonsmoking agreement (B=0.07, p<0.01), perceived maternal influences (B=0.09, p<0.05), self-efficacy (B=-0.09, p<0.05) and social norms of friends (B=-0.08, p=0.05) and best friends (B=-0.11, p<0.05). Parental smoking had no moderating effect.

CONCLUSIONS

The Smoke-free Kids program shows promising short-term effects on antismoking socialization and cognitions. Long-term follow-up on the effects of smoking behavior are needed.

The role of environmental smoking in smoking-related cognitions and susceptibility to smoking in never-smoking 9-12 year-old children

Environmental smoking has numerous adverse effects on child health, and children are frequently exposed to environmental smoking. In the present study, we investigated the role of environmental smoking (parental smoking, sibling smoking, peer smoking) in smoking-related cognitions (pros of smoking, perceived safety of casual smoking, cue-triggered wanting to smoke) and susceptibility to smoking among 9-12 year old never-smoking children (N=778). We collected cross-sectional survey data from children attending 15 Dutch primary schools. Using structural equation modelling, we assessed direct as well as indirect relationships among study variables. The results showed that children who were exposed to more smoking parents, siblings, and peers perceived more pros of smoking. Additionally, parental smoking was associated with higher perceived safety of casual smoking and more cue-triggered wanting to smoke. In turn, perceiving a higher safety of casual smoking and more cue-triggered wanting to smoke were associated with a higher susceptibility to smoking in children. No direct effects of environmental smoking on children's susceptibility to smoking were found. However, parental smoking was associated with children's susceptibility to smoking through children's perceived safety of casual smoking and cue-triggered wanting to smoke. The present study indicates that pre-adolescents may already display favourable smoking-related cognitions and that these cognitions may be an early indicator of a child's vulnerability to smoking. Environmental smoking, particularly parental smoking, is associated with more favourable smoking-related cognitions in never-smoking children. In the intergenerational transmission of smoking from parents to children, children's risk perceptions of smoking and the experience of cue-triggered wanting to smoke may constitute mechanisms of action, which need to be investigated in longitudinal research.

Bidirectional influences between parents and children in smoking behavior: a longitudinal full-family model

BACKGROUND

The present study investigated longitudinal associations and bidirectional influences between family members in smoking behavior using a longitudinal full-family design. Family systems provide a powerful social context in which modeling and imitation take place. In current literature, however, bidirectional associations between parents and children in smoking behavior are seldom considered.

METHODS

Participants were 426 families, including mothers, fathers, and 2 adolescent children. Associations were assessed over 5 waves with yearly intervals using a cross-lagged model in structural equation modeling.

RESULTS

Findings demonstrate that families resemble an interactive system affording smoking contagion across family members. Results suggest that associations between parents and children are bidirectional, that is, parental smoking behavior influences adolescent smoking behavior and adolescent smoking behavior influences parental smoking behavior. There is insufficient evidence to conclude that longitudinal associations between family members are generally bidirectional, as only unidirectional longitudinal associations were found between between siblings and partners.

CONCLUSIONS

The present study extends previous research on the intergenerational transmission of smoking behavior by demonstrating bidirectional influences between parents and children in smoking behavior. Moreover, the present study suggests that family members may be susceptible to adjust their smoking behavior across time in response to smoking behavior within the family.

Effectiveness of proactive telephone counselling for smoking cessation in parents: study protocol of a randomized controlled trial

Background

Smoking is the world's fourth most common risk factor for disease, the leading preventable cause of death, and it is associated with tremendous social costs. In the Netherlands, the smoking prevalence rate is high. A total of 27.7% of the population over age 15 years smokes. In addition to the direct advantages of smoking cessation for the smoker, parents who quit smoking may also decrease their children's risk of smoking initiation.

Methods/Design

A randomized controlled trial will be conducted to evaluate the effectiveness of proactive telephone counselling to increase smoking cessation rates among smoking parents. A total of 512 smoking parents will be proactively recruited through their children's primary schools and randomly assigned to either proactive telephone counselling or a control condition. Proactive telephone counselling will consist of up to seven counsellor-initiated telephone calls (based on cognitive-behavioural skill building and Motivational Interviewing), distributed over a period of three months. Three supplementary brochures will also be provided. In the control condition, parents will receive a standard brochure to aid smoking cessation. Assessments will take place at baseline, three months after start of the intervention (post-measurement), and twelve months after start of the intervention (follow-up measurement). Primary outcome measures will include sustained abstinence between post-measurement and follow-up measurement and 7-day point prevalence abstinence and 24-hours point prevalence abstinence at both post- and follow-up measurement. Several secondary outcome measures will also be included (e.g., smoking intensity, smoking policies at home). In addition, we will evaluate smoking-related cognitions (e.g., attitudes towards smoking, social norms, self-efficacy, intention to smoke) in 9-12 year old children of smoking parents.

Discussion

This study protocol describes the design of a randomized controlled trial to evaluate the effectiveness of proactive telephone counselling in smoking cessation. It is expected that, in the telephone counseling condition, parental smoking cessation rates will be higher and children's cognitions will be less favorable about smoking compared to the control condition.

Trial registration

The protocol for this study is registered with the Netherlands Trial Register NTR2707.

Children talking: emerging perspectives and experiences of cigarette smoking

Despite efforts to prevent the onset of smoking, the rate among older children remains high. In this article, the authors report on a longitudinal, qualitative study of 11 to 16-year-old children describing children's construction of what it means to be a smoker, the reasons given for children smoking, and their views of smoking behavior. Findings indicate that children adopt broad interpretations of what constitutes smoking behavior; although they strongly disapprove of children who smoke, they are less disapproving of older children or adult smokers and are increasingly tolerant of smoking behavior as they get older. Children's disapproval of smoking acts as a protective mechanism against smoking for younger participants. Participants' broad interpretation of what it means to be a cigarette smoker, their association of smoking with adulthood, and their increasing tolerance of and exposure to smoking behavior as they move into adolescence appears to increase susceptibility to becoming cigarette smokers.

Antismoking initiatives: effects of analysis versus production media literacy interventions on smoking-related attitude, norm, and behavioral intention

This study developed inoculation-driven antismoking interventions aimed at changing attitudes, norms and intentions about smoking to influence smoking behavior in adolescents. This study explored the efficacy of 2 intervention approaches designed to help adolescents to refrain from smoking initiation. Participants were junior high students (6th, 7th, and 8th grade) from schools in the Northeast. Two kinds of experimental workshops and a control group were designed as stimulus material in a repeated measure nonequivalent group experimental design. The 2 intervention workshops developed included: analysis + analysis (where participants discussed and analyzed cigarette and antismoking ads) and analysis + production (where participants discussed, analyzed, and then created their own antismoking ads). The analysis + production workshop was generally more successful than the analysis + analysis workshop and control group in changing participants' behavioral intention to smoke and attitude toward smoking but not subjective norms over time. Implications and directions for future research are discussed.

Tobacco promotion and the initiation of tobacco use: assessing the evidence for causality

OBJECTIVE

We sought to determine whether there is evidence of a causal link between exposure to tobacco promotion and the initiation of tobacco use by children.

METHODS

We conducted a structured search in Medline, PsycINFO, and ABI/INFORM Global to identify relevant empirical research. The literature was examined against the Hill epidemiologic criteria for determining causality.

RESULTS

(1) Children are exposed to tobacco promotion before the initiation of tobacco use; (2) exposure increases the risk for initiation; (3) there is a dose-response relationship, with greater exposure resulting in higher risk; (4) the increased risk is robust; it is observed with various study methods, in multiple populations, and with various forms of promotion and persists after controlling for other factors; (5) scientifically plausible mechanisms whereby promotion could influence initiation exist; and (6) no explanation other than causality can account for the evidence.

CONCLUSIONS

Promotions foster positive attitudes, beliefs, and expectations regarding tobacco use. This fosters intentions to use and increases the likelihood of initiation. Greater exposure to promotion leads to higher risk. This is seen in diverse cultures and persists when other risk factors, such as socioeconomic status or parental and peer smoking, are controlled. Causality is the only plausible scientific explanation for the observed data. The evidence satisfies the Hill criteria, indicating that exposure to tobacco promotion causes children to initiate tobacco use.

Children's hedonic judgments of cigarette smoke odor: effects of parental smoking and maternal mood

Age-appropriate tasks were used to assess 3- to 8-year-old children's liking, identification, and preference for a variety of odors, including that of exhaled cigarette smoke. Children whose parents smoke took longer to decide whether they liked the cigarette odor and were significantly more likely to prefer the odor of cigarette to the neutral and unfamiliar odor of green tea compared with children of nonsmokers. Among children of smokers, relative preferences for the cigarette odor were related to maternal mood disturbance and depression scores. These findings suggest that some early learning about cigarette smoke odor is based on sensory experiences at home and anchors it to the emotional context in which their mothers smoke.

'Stop it, it's bad for you and me': experiences of and views on passive smoking among primary-school children in Liverpool

This article looks at how children between the ages of 4 and 8 years report they feel when they are exposed to passive smoking and how they react in these situations. Data were collected annually from a cohort of 250 primary school children, which was tracked from their Reception Classes to Year 3 across six Liverpool schools. Quantitative and qualitative methods were employed--including a survey, the Draw and Write investigative technique and semi-structured interviews. Findings showed that children had some understanding of the health problems that passive smoking posed to both themselves and the smoker. Between the ages of 4 and 7 the majority of children held negative feelings about being exposed to smoke, but at the age of 8 there is a clear decline in negative expressions. Most of the children were prepared verbally to confront a smoker, usually a parent, in order to get them to stop, but rarely took direct action and left the room themselves. Results suggest that children would be receptive to information on the dangers of smoking during the early years of primary school, while the dialogue between children and their parents suggests that the latter have a key role to play in strategies to tackle passive smoking in the home.

Young children's understandings of cigarette smoking

AIMS

We explore young children's attitudes toward, beliefs about, and life-style associations with cigarette smoking using direct and indirect measures.

DESIGN, SETTING AND PARTICIPANTS

Second (n = 100) and fifth grade (n = 141) elementary school students (i.e. 7-8 and 10-11-year-olds) were excused from class and individually interviewed.

METHODS

Participants selected pictures in response to the questions: who would like to smoke cigarettes the most and who would like to smoke cigarettes the least? Their picture choices were probed using open-ended prompts designed to elicit the beliefs and life-style associations underlying their choices. Survey-based measures of attitudes and beliefs were also collected.

FINDINGS

Second graders reported life-style associations with cigarette smoking that were consistent with those of fifth graders. While their associations with smoking are generally negative, children appear to perceive that others feel that smoking makes them look cool and feel cool and also helps them to fit in. By fifth grade, many children believe that smoking can help to reduce stress and alleviate negative mood states. The presence of a smoker in the household does not appear to affect these associations, suggesting that they may be being shaped by external socialization agents.

CONCLUSION

Young children appear to be developing understandings of cigarette smoking that go beyond knowing that cigarettes are products that are smoked. As some of their perceptions appear likely to predispose them for future experimentation, young children need to be included in prevention research so that age-appropriate interventions can be developed.

Lies, damned lies and statistics? Reliability and personal accounts of smoking among young people

Smoking remains a major problem among young people in Europe. However, within the research community examining the issue, debate continues about the best way of assessing the extent of that problem. Questions have been raised about the extent to which existing techniques for generating statistical representations of patterns of youth smoking can address a range of problems connected with identifying, accounting for and correcting unreliable self-report smoking data. Using empirical data from the UK Liverpool Longitudinal Smoking Study (LLSS), this paper argues that self-report measures of smoking, treated in isolation from participants' personal accounts, can disguise problems with the reliability and validity of a given study. Using longitudinal qualitative and quantitative data in dialogue, two main factors contributing to unreliable data are discussed: (a) participants' access to and familiarity with frameworks of everyday cultural knowledge about the practice of smoking, and (b) participants' retrospective revision of events in line with their current goals, aspirations and self-understandings. The conclusion drawn is that research has to employ multiple methods, minimally incorporating some personal contribution from participants, to explore the complex character of the problem of smoking and to avoid the difficulties posed by the models of smoking behaviour embodied within stand-alone statistical research.

Why do primary school children smoke? A longitudinal analysis of predictors of smoking uptake during pre-adolescence

The objectives of this longitudinal study were to determine the prevalence of smoking among primary school children in Liverpool, and to identify the predictors of experimentation with cigarettes during pre-adolescence. A cohort of children (n = 270) completed questionnaires that elicited patterns of child smoking behaviour and children's experiences of smoking in their families and communities each year between the ages of 9 and 11 years. Parents also completed questionnaires. Children's first trials with cigarettes and repeated smoking were reported. The independent variables measured were socio-economic status, familial and peer smoking, and intentions to smoke. By age 11, 27% of children had tried smoking, 12% had smoked repeatedly and 3% were smoking regularly. Variables measured at age 9 predicting experimentation with cigarettes by age 11 were male gender 9P = 0.041) paternal smoking (P = 0.001) fraternal smoking (P = 0.017) a best friend who smoked (P = 0.026) and knowing someone with a smoking-related disease (P = 0.006) Intentions to smoke at age 9 did not predict smoking at age 11 (P < 0.001). In univariate analyses, child smoking was also associated with maternal smoking (P = 0.002 at age 11), living in a low-income household (P < 0.001 at age 10) and living in a deprived area ( P = 0.025 at age 11). Early smoking presents a considerable challenge to health promoters, not least because it is socially patterned. The interventions required must tackle the structural and social pressures that shape smoking behaviour during childhood.

Children's Perceptions of Dangerous Substances

The aim of this research was to examine age differences in children's perceptions of dangerous substances. Children's responses to photographs of child models encountering alcohol, a syringe, medicine, glue, and household bleach were coded for recognition of substance, awareness of potential danger, and understanding of danger or harm. Responses from 59 children (28 girls and 31 boys, who were all children of the required age in an urban primary school) were compared across three age groups (6–7 years, 8–9 years, and 10–11 years). 15 to 18 of 20 children in each of three age groups recognised all the dangerous substances. Significant differences across age groups were found for awareness of the potential harm from alcohol, glue, and medicine, but not for the syringe or bleach. Children reported less serious consequences from ingesting alcohol than other substances, the consequences of sniffing glue tended to be confused with the sticking properties of glue, children's understanding of transmission of germs, disease, and AIDS through syringes was varied, and there was a tendency among the older children to underestimate the potential harm of self-administration of medicines. Findings were discussed in relation to children's concepts of danger and safety education.

An exploration of the problems faced by young women living in disadvantaged circumstances if they want to give up smoking: can more be done at general practice level?

OBJECTIVES

The purpose of this study was to explore the barriers faced by women living in deprived circumstances if they want to give up smoking and to determine what help they would like at general practice level.

METHODS

The study was set in general practice in an area of socio-economic deprivation in North West Edinburgh. The practice has >10 000 patients. In the first stage of the study, GPs and nursing staff at the practice were asked about their opinions of the effectiveness of well-known smoking cessation interventions using a Likert scale format (n = 23). In the second stage, a random sample of 18 female smokers in the 18-40 age group were contacted by post and asked to complete the following four measures: (i) the Hospital Anxiety and Depression Scale; (ii) a self-complete measure of knowledge of health risks for themselves and for babies and children of women smokers; (iii) opinions on effectiveness of well-known smoking cessation interventions (as completed by GPs and nursing staff); and (iv) an open-ended questionnaire, allowing qualitative responses about their smoking.

RESULTS

The findings gave insights into how the women felt about their smoking habit, their knowledge of health risks, their mental health, the needs that smoking meets for them, the difficulties faced in attempts at smoking cessation and what they think would help.

CONCLUSIONS

Smoking for the women in the study group is a socially and culturally ingrained behaviour pattern with influences dating back to childhood. It is a coping mechanism--many of the women displayed anxiety symptoms which they thought smoking helped with. Guilt was the overwhelming emotion associated with their habit, and this related to worries about their children's and their own health in particular. Most had tried to give up but had failed, and there was a sense of hopelessness about this relating to the difficulty involved for them. Most of the study group were highly motivated to give up, and this needs to be harnessed effectively in cessation support. Smokers and health care workers have different beliefs about what will be effective in smoking cessation. A reluctance to receive help at general practice level highlights the importance of the approach taken by GPs.

Public and private self-consciousness and smoking behavior in head and neck cancer patients

Patients who continue to use tobacco following treatment for head and neck cancers are at a greater risk for cancer recurrence and earlier mortality. This study examined the unique effects of public and private self-consciousness and negative affect on smoking behavior in a sample of 40 patients with cancers of the head and neck. Measures of public and private self-consciousness and negative affect were administered and assessments of past and current smoking behavior were obtained. Only public self-consciousness was a significant predictor of continued smoking following oncologic treatment. Specifically, individuals with low levels of public self-consciousness were nearly 13 times more likely to continue smoking compared to those with relatively higher levels of public self-consciousness. This pattern is interpreted in the context of previous theorizing that suggests individuals high in public self-consciousness are more likely to discontinue habitual behavior that is perceived as socially undesirable or incorrect.

Anxious adults vs. cool children: children's views on smoking and addiction

Tobacco addiction represents a major public health problem, and most addicted smokers take up the habit during adolescence. We need to know why. With the aim of gaining a better understanding of the meanings smoking and tobacco addiction hold for young people, 85 focused interviews were conducted with adolescent children from economically deprived areas of Northern Ireland. Through adopting a qualitative approach within the community rather than the school context, the adolescent children were given the opportunity to freely express their views in confidence. Children seem to differentiate conceptually between child smoking and adult smoking. Whereas adults smoke to cope with life and are thus perceived by children as lacking control over their consumption, child smoking is motivated by attempts to achieve the status of cool and hard, and to gain group membership. Adults have personal reasons for smoking, while child smoking is profoundly social. Adults are perceived as dependent on nicotine, and addiction is at the core of the children's understanding of adult smoking. Child smoking, on the other hand, is seen as oriented around social relations so that addiction is less relevant. These ideas leave young people vulnerable to nicotine addiction. It is clearly important that health promotion efforts seek to understand and take into account the actions of children within the context of their own world-view to secure their health.