Preventing Child and Adolescent Smoking Practice Resource Downloaded from www.rch.org.au/ccch

Practice Resource: Preventing Child and Adolescent Smoking Table of Contents Overview ................................................................................................................... 2 Glossary.................................................................................................................... 6 Section 1: Introduction Setting the scene ..................................................................................................... 7 Prevalence of smoking in children and adolescents............................................ 7 Impact of smoking on children and adolescents.................................................. 8 Factors found to influence smoking in children and adolescents...................... 9 Section 2: What works? Introduction ............................................................................................................ 10 Understanding interventions to prevent child and adolescent smoking ......... 10 School-based programs ...................................................................................... 10 Community programs .......................................................................................... 12 Media campaigns ................................................................................................ 12 What you can do .................................................................................................... 13 Information for parents.......................................................................................... 14 Key Messages for Professionals .......................................................................... 15 Key Messages for Managers................................................................................. 16 Section 3: What the research shows Summary of the evidence on preventing child and adolescent smoking ........ 17 Key research findings............................................................................................ 18 About child and adolescent smoking ................................................................... 18 About interventions for child and adolescent smoking ........................................ 19 Annotated summary of intervention studies....................................................... 21 Summary of intervention studies ......................................................................... 21 Child and adolescent smoking............................................................................. 22 References.............................................................................................................. 24 Appendix 1: Centre for Community Child Health................................................ 25 Appendix 2: Telstra Foundation ........................................................................... 26 Appendix 3: Criteria for selecting topics ............................................................. 27 Appendix 4: NHMRC Guidelines for Levels of Evidence.................................... 28 Appendix 5: Glossary of Terms – Research Methodology ................................ 29

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Introduction There is now a large amount of research evidence about the range of strategies that can make a real difference to the health, development and wellbeing of children and young people. Many professionals are unsure about how this evidence impacts on the services they provide for families and their professional practice. The Centre for Community Child Health has therefore developed eleven “Practice Resources”. Each Practice Resource provides professionals with: • an introduction to the topic • a summary of the latest research, and • practical strategies to support their daily work with young children and their families. These Practice Resources will help professionals consider and understand the issues and the range of researched options and strategies available to discuss with parents and carers in addressing their concerns and increasing their confidence. They will also support management to make sensible decisions about the use of resources and directions for services to address important issues for children. The project to develop these eleven Practice Resources has been made possible through funding from the Telstra Foundation. See Appendix 1 and 2 for more details about the Centre for Community Child Health and the Telstra Foundation respectively.

The Practice Resources have been designed to bridge the gap between research and practice. Most professionals do not have the time to sift through and interpret the relevant research that can inform how they work with children and families, nor do they have access or opportunity to attend relevant professional development. The aim of the Practice Resources is to broadly translate the research evidence on a number of important topics into easily understood practical information that can be readily used by a range of professionals, assisting their daily work with young children and their families. While each resource is written for professionals working with children and families, the information will also be useful to managers of services.

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Practice resource:

Why were Practice Resources developed?

PREVENTING CHILD AND ADOLESCENT SMOKING

Overview

What is the structure of each Practice Resource? These resources are designed to be easy to use and inform professional practice. The structure of the Practice Resources enables access to information at different levels of detail depending on the user’s needs. Each resource has the following structure: • Glossary Definitions of key terms. • Section 1: Introduction This includes definitions, how frequently problems occur, information about normal development (where relevant), effects of the problem, and whether the focus should be on promotion, prevention, or early intervention. • Section 2: What works? This includes a simple summary of the research and outlines what works and therefore the strategies that should be implemented. Whilst this section is brief, strategies are sufficiently detailed and specific for action. To support the professional there is also: - Parent information: Pointers to existing web based parent information are provided. This information has been reviewed to ensure the messages are consistent with those in the resource. - Key messages: A single page summary is provided outlining the most important messages for professionals and managers. • Section 3: What the research shows Annotated summary tables of the research evidence and intervention studies is included, with information provided about the level of evidence, see Appendix 4. Also included are the more detailed key research principles that are fully referenced.

To make these Practice Resources easy for professionals to access and use, references are not included within “Section 1: Introduction” and “Section 2: What Works”. In “Section 3: What the research shows” references are included in the text. A full list of the references relevant to each topic can be found separately in the References section.

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Practice resource:

• References All references used to inform the resource are listed.

PREVENTING CHILD AND ADOLESCENT SMOKING

Overview

What topics are covered? Promotion • Breastfeeding • Literacy Prevention • Injury • Overweight and obesity • Smoking during pregnancy • Passive smoking effects on children • Child and adolescent smoking Early Intervention • Language • Settling and sleep • Behaviour • Eating behaviour

How were the topics selected? A number of criteria were used to select topics. These included: • The importance of the issue in relation to children’s health and development • Requests from professionals • Expression of need from communities • Parental needs and concerns • Perceived gap between evidence and practice • Ease of including in daily professional practice • Lack of information from other sources

Practice resource:

See Appendix 3 for more detail about the selection criteria.

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PREVENTING CHILD AND ADOLESCENT SMOKING

Overview

How were the Practice Resources developed? The content of the resources were drawn from the published research, expert advice, and information about innovative and promising practices. An expert committee oversaw the development of the content, and an expert in the field reviewed the content of each resource. The format and design of the resources was focus tested and modified accordingly.

Are there limitations to these Practice Resources?

Practice resource:

For a number of topics there were limited numbers of well researched interventions and strategies available in the literature. Therefore it is important to note the following: • Where possible National Health and Medical Research Council principles of assessing evidence were applied to research reviewed. For some topics there was very little evidence of high quality. • Interventions and strategies included in the resources were based on a combination of research-based principles and expert advice. • It is highly likely that the evidence for most topics will change over the next few years; suggested strategies may require ongoing review.

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PREVENTING CHILD AND ADOLESCENT SMOKING

Overview

Cognitive-behavioural therapy

An arrangement in which client and professional work together to identify and understand problems by looking at the relationship between thoughts, feelings and behaviour.

Environmental tobacco smoke

Smoke from the end of a lit cigarette or breathed out by a smoker.

Nicotine fading

Changing the type of cigarette smoked to one with less nicotine.

Nicotine-replacement therapy

Using a medication that reduces cravings for cigarettes.

Passive smoking

Breathing tobacco environment.

Social influence training

Involves altering the thoughts as well as behaviour.

smoke

in

the

Practice resource:

Refer to Appendix 5 for a glossary of terms related to research methodology terminology.

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PREVENTING CHILD AND ADOLESCENT SMOKING

Glossary

Section 1: Introduction

Focus:

Prevention

Topic inclusion: Reducing or eliminating smoking in children and adolescents Age range:

Children and adolescents under 18 years of age

Age group:

Approximately 5 – 18yrs

Tobacco causes more illness and a larger number of deaths than any other drug. Most adults begin smoking while they are in their teens. Research estimates that one in two lifetime smokers who start smoking as teenagers will die from a disease caused by their smoking. Many smokers also suffer from reduced enjoyment of life as a result of smoking-related diseases. Many campaigns and interventions have now been implemented to target child and adolescent smoking. Such interventions aim to reduce rates of smoking uptake as well as help smokers quit.

• • •

• • •

Young people who smoke tend to start between the ages of 12 and 16. 90% of adult smokers start smoking as adolescents. The Australian Secondary School Students Survey (2002) found that: − 6% of 12 year olds had smoked in the previous week. − 25% of 17 year olds had smoked in the previous week. An estimated 205,000 Australian school-aged children 12 to 17 years are smokers. Smoking becomes more common as Australian students progress through secondary school. There is little difference between the smoking rates of males and females in both younger children and in 17 years olds.

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Practice resource:

Prevalence of smoking in children and adolescents

PREVENTING CHILD AND ADOLESCENT SMOKING

Setting the scene

• • • •

However, smoking is more common among girls than boys in middle secondary school (14-16 year age groups). On average, Australian boys and girls aged 12 to 17 years smoke similar numbers of cigarettes per week. In Australia, smoking decreased between 1984 and 1990 and then started to rise again between 1990 and 1993. The prevalence of smoking began to decline after 1996 (with the exception of current smoking rates among 16 to 17 year olds), and this decline has continued to 2002. At this stage, no later data on smoking prevalence are available.

Impact of smoking on children and adolescents

Smoking can have an immediate impact on children and adolescents.

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Practice resource:

Smoking can have an immediate impact on children and adolescents in a number of ways: • It can harm lungs by impairing lung growth and tissue maturation. • Asthma is more common in smokers than non-smokers, with smokers suffering from more symptoms, less effective asthma control, faster decline in lung function, and less benefit from some asthma medications. Research has demonstrated these effects in adolescents as well as adult asthma sufferers. • Smoking also makes it harder to exercise and reduces its benefits to the body. Smokers have more coughs, phlegm and chest infections than non-smokers and take longer to feel well again. • People who start smoking when they are young are more likely to: - Smoke heavily - Become more nicotine dependent - Be at risk of smoking-related illnesses, such as heart disease, lung cancer and emphysema

PREVENTING CHILD AND ADOLESCENT SMOKING

Section 1: Introduction

Factors found to influence smoking in children and adolescents Children of smokers are twice as likely to take up smoking, and children who perceive that their parents disapprove of them smoking are seven times less likely to be smokers than if they felt they approved. Under eighteen year olds are most likely to take up smoking during secondary school, typically in response to peer pressure or as an attempt to achieve adult status.

•

Environmental factors - Parental smoking - Peer smoking - Parental attitudes, eg, approval or disapproval of their child smoking - Sibling smoking - Family environment or parental attachment - Relationship with parents - Peer attitudes and norms

•

Socio-demographic factors - Age - Ethnicity - Parental socio-economic status - Personal financial situation

•

Behavioural or individual factors - Mental health including depressive disorders - School performance - Lifestyle - Self-esteem - Attitudes to smoking and smokers - Stress (especially in females) - Health concerns - Chronic illness including illnesses such as heart disease or diabetes (may be linked to mental health) - Desire to control weight - Moving out of the family home in order to become more independent

•

Community factors - Cost - Access (eg vending machines) - Advertising

Research indicates that tobacco advertising increases the likelihood of children and adolescents taking up smoking.

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Practice resource:

The following factors have been linked to children and adolescent smoking:

PREVENTING CHILD AND ADOLESCENT SMOKING

Section 1: Introduction

Introduction Three main forms of intervention have been trialled to prevent children and adolescents from taking up smoking or to encourage those who smoke to stop. These are: • School-based programs • Community programs • Media campaigns While each of these interventions has been successful in at least one trial, on the whole there is only minor research support for interventions aimed at reducing child and adolescent smoking at this stage. School-based programs using social influences training have been the most successful intervention to date. However not all studies have found these programs to be successful. In Australia the focus has been on reducing adult rates of smoking with the expected reduction in associated smoking rates in children and adolescents.

Understanding interventions to prevent child and adolescent smoking

Key points • Social influences training is a key part of each school-based program that been successful in reducing smoking behaviour. • This training is carried out in a group setting (typically classrooms) and is based on an understanding of the reasons children and adolescents take up smoking and continue to smoke. • The training equips them with skills to resist these influences and say no when offered a cigarette. • Social influences training involves altering the thoughts of children and adolescents as well as their behaviour. For example, they are encouraged to be realistic about the number of people who smoke and to think about the health consequences of smoking.

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Practice resource:

School-based programs

PREVENTING CHILD AND ADOLESCENT SMOKING

Section 2: What works?

•

• •

•

When the health consequences of smoking are discussed, typically particular emphasis is placed on short-term effects that have direct relevance for children and adolescents, for example, the effect of smoking on performance in sporting activities. School-based programs are typically short and intensive (approximately five to ten sessions over one to two weeks). The programs are run by either a trained health educator or a classroom teacher who has participated in a short training course. Some school-based programs also include broader antismoking initiatives such as placing anti-smoking posters around the school or efforts to prevent the sale of tobacco to minors.

More about social influences training A typical social influences course involves: • Correcting adolescents' overestimates of the rate of smoking by adults and adolescents • Helping them to recognise high-risk situations • Increasing their awareness of media, peer, and family influences • Assisting them to learn about and practise refusal skills • Encouraging them to make public commitments not to smoke Often courses aim to increase participants’ confidence and ability to refuse not only tobacco but also alcohol and illegal drugs.

School-based programs using social influences training have been the most successful intervention to date.

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Practice resource:

A range of activities designed by QUIT can be implemented in schools to increase children’s and adolescents’ awareness of smoking-related issues. The QUIT: Primary and Secondary School Fact Sheets can be found at the following link: www.quit.org.au/index2.html

PREVENTING CHILD AND ADOLESCENT SMOKING

Section 2: What works?

Section 2: What works?

Key points • Community programs are based on the understanding that young people are strongly influenced by their social environment; therefore these programs promote a nonsmoking attitude in the community. • Community programs are typically multi-faceted and diverse. They can include such initiatives as making cigarettes harder to buy, increasing the price of cigarettes, creating tobacco-free public places, communicating nonsmoking messages through the media and establishing antismoking clubs for young people. • While some community programs have succeeded in reducing the smoking rates of youth, most have not been evaluated as successful.

Media campaigns

Practice resource:

Key points • Use of mass media has played an important role in many programs to reduce smoking because of its strong influence on the behaviour of children and adolescents. • A major advantage of mass media campaigns is that they have the potential to reach a large proportion of young people and to modify their knowledge, attitudes and behaviour. • These campaigns are often designed with principles of social learning theory in mind. Positive role models who reject smoking are used in the hope that their behaviour will be a model for the target audience. • Media campaigns have not been widely trialled, and preliminary trials show mixed results.

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Community programs

Section 2: What works?

For suggestions on strategies to be used in discussions with parents of children or adolescents who smoke (or with the child or adolescent themself) see the “Preventing Passive Smoking Effects on Children” practice resource. A range of other ways health professionals can assist smokers of any age to cut down or quit smoking have been suggested by QUIT Australia. These include: • Giving those interested in quitting a Quit Book • Providing information about products available to help an individual quit • Setting up a smoke-free display and ensuring smoking cessation resources are available in waiting rooms • Arranging training from QUIT Australia on using counselling to help individuals to quit For further information about QUIT Australia’s Professionals Program, see the following link: www.quit.org.au/index2.html

Health

… there is only minor research support for interventions aimed at reducing child and adolescent smoking. In Australia the focus has been on reducing adult rates of smoking with the expected reduction in associated smoking rates in children and adolescents.

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Practice resource:

Interestingly, few interventions for child and adolescent smoking have focused on individual counselling with health professionals. This may be due to the different degree of nicotine dependence in children compared to adults. In adult smokers efforts to reduce their smoking or quit consist of the professional suggesting specific cognitive and behavioural strategies that can help with quitting.

PREVENTING CHILD AND ADOLESCENT SMOKING

What you can do

Section 2: What works?

The following resource was produced by QUIT and is designed to assist parents in discussing smoking behaviour with their child or adolescent. In particular, it aids parents in promoting a positive attitude towards saying no to smoking: www.quit.org.au/quit/pdf/clearing_the_air.pdf

Practice resource:

The following resource is recommended by QUIT and is a tool for assisting individuals of any age to quit smoking once they have begun to smoke regularly: www.thequitcoach.org.au/index.asp?content=dsp_welcome.asp

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PREVENTING CHILD AND ADOLESCENT SMOKING

Information for parents

Section 2: What works?

The Australian Secondary School Students Survey (2002) found that 6% of 12 year olds and 25% of 17 year olds had smoked in the previous week with little difference between the smoking rates of males and females. Children of smokers are twice as likely as children of non-smokers to take up smoking. Children who believe that their parents disapprove of them smoking are seven times less likely to be smokers than those who perceive their parents as approving. Smoking can harm lungs by impairing lung growth and tissue maturation in children and adolescents. It has also been associated with a greater number of asthma-related symptoms in adolescents suffering from asthma, and less effective asthma control overall. Child and adolescent smoking has also been associated with smoking-related illnesses later in life.

Helping to reduce child and adolescent smoking Only moderate support exists for interventions that prevent or stop adolescent and child smoking. In Australia the focus has been on reducing adult rates of smoking with the expected reduction in associated smoking rates in children and adolescents. Some recommendations about likely best practice when attempting to reduce the smoking rates of children and adolescents include: • Help children and adolescents resist media and peer influences, recognise high-risk situations, and have realistic perceptions of smoking rates (only a minority of children and adolescents smoke) • Provide specific and simple strategies to adolescents that can be used to help them stop smoking immediately. Cognitive and behavioural strategies (used for adults) can be referred to for ideas but must be tailored to address children’s developmental stage. • Provide information to parents to assist them in discussing the issue of smoking with their child www.quit.org.au/quit/pdf/clearing_the_air.pdf

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Practice resource:

Factors influencing adolescents taking up smoking • Environmental factors: parents smoking, parents’ attitudes, siblings smoking, family environment, relationships with parents, peers smoking, and peer attitudes and norms • Socio-demographic factors: age, ethnicity, socioeconomic status of parents, and personal financial situation • Behavioural or individual factors: mental health, school performance, lifestyle, self-esteem, attitudes to smoking or smokers, health concerns, stress (especially in females), chronic illness, and desire to control weight • Community factors: cost, access to vending machines and advertising.

PREVENTING CHILD AND ADOLESCENT SMOKING

Key Messages for Professionals

Section 2: What works?

The Australian Secondary School Students Survey (2002) found that 6% of 12 year olds and 25% of 17 year olds had smoked in the previous week with little difference between the smoking rates of males and females. Children of smokers are twice as likely as children of non-smokers to take up smoking. Children who believe that their parents disapprove of them smoking are seven times less likely to be smokers than those who perceive their parents as approving.

Helping to reduce child and adolescent smoking Only moderate support exists for interventions that prevent or stop adolescent and child smoking. Of the interventions trialled, school-based programs have the strongest research base and can be implemented by staff of primary and secondary schools. Programs that have been successful typically: • Focus on social influences such as understanding the reasons children and adolescents take up smoking (and continue to smoke) • Equip children and adolescents with the skills to resist smoking influences • Target as key influences media campaigns, relaxed family attitudes on smoking and high-risk situations of peer influence • Are short, intensive and run by a trained health educator or a teacher. Staff in schools and services are important role models for children and adolescents. Smoking policies should be in place to discourage staff from smoking in front of children and young people. Community factors that influence rates of smoking such as access to vending machines are potential ways to reduce child and adolescent smoking.

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Practice resource:

Factors influencing adolescents taking up smoking • Environmental factors: parents smoking, parents’ attitudes, siblings smoking, family environment, relationships with parents, peers smoking, and peer attitudes and norms • Socio-demographic factors: age, ethnicity, socioeconomic status of parents, and personal financial situation • Behavioural or individual factors: mental health, school performance, lifestyle, self-esteem, attitudes to smoking or smokers, health concerns, stress (especially in females), chronic illness, and desire to control weight • Community factors: cost, access to vending machines and advertising.

PREVENTING CHILD AND ADOLESCENT SMOKING

Key Messages for Managers

Summary of the evidence on preventing child and adolescent smoking Each of the interventions outlined in Section 2: What works? has had some success in influencing the smoking behaviour of children and adolescents. The most successful interventions for decreasing smoking have been school-based programs, and tobacco advertising has been extremely successful in increasing smoking. Intervention focus

Recommended intervention

Effectiveness*

Adolescents and children

School-based program: programs run in classes or throughout the school that aim to deter tobacco use in children and adolescents; some programs aim simply to provide information about tobacco while others have more complex goals

ÏÏ

Adolescents and children

Media campaigns: use communication channels such as television, radio, newspapers, billboards, posters, leaflets or booklets; intended to reach large numbers of young people and influence their smoking behaviour

?

? Community programs: interventions targeted at entire communities or parts of it with the intention of influencing the smoking behaviour of young people ?

Adolescents and children

Tobacco advertising: use of media to create positive product imagery or associations or to connect the product with desirable personal traits, activities or outcomes

Practice resource:

Individual counselling: one-on-one sessions between a health professional and a child or adolescent where strategies to resist or quit smoking are discussed ±±±

* See next page for key to symbols

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Section 3: What the research shows

Section 3: What the research shows Level of evidence

Effectiveness

Key

Strong to good evidence

Beneficial

ÏÏÏ

Not beneficial

±±±

May be beneficial

ÏÏ

May not be beneficial

±±

May be beneficial (promising)

Ï

May not be beneficial (not likely)

±

Unknown benefits

?

Fair level of evidence

Requires more studies

Refer to Appendix 5 for a glossary of terms related to research methodology terminology.

Key research findings About child and adolescent smoking •

90% of adult smokers start smoking as adolescents.1,2

•

Young people smoking is a serious problem in Australia, with many taking up the habit in their teens. 3 An estimated 205,000 Australian school-aged children 12 to 17 years are current smokers. This includes approximately six per cent of 12 year olds and 25 per cent of 17 year olds. •

•

Children and adolescents are strongly influenced by their parents’ views and behaviour regarding smoking.4 Children of smokers are twice as likely to take up smoking, and children who perceive that their parents disapprove of them smoking are seven times less likely to be smokers than if they felt their parents approved.

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Practice resource:

Only minor differences exist in the smoking rates of Australian boys and girls.3 There is little difference between the smoking rates of males and females in younger Australian children and 17 year olds. However, smoking is more common among girls than boys in middle secondary school (14-16 year age groups). On average, Australian boys and girls smoke similar numbers of cigarettes per week.

PREVENTING CHILD AND ADOLESCENT SMOKING

Guide to recommendation of effectiveness category

Section 3: What the research shows A range of environmental, socio-demographic and individual factors has been linked to smoking behaviour in children and adolescents.4 Child and adolescent smoking has been linked to parental smoking, sibling smoking, peer smoking, peer attitudes and norms, ethnicity, parental socio-economic status, personal financial situation, school performance, self-esteem, health concerns, being in transition (for example moving out of the family home in order to become more independent), stress and desire to control weight.

About interventions for child and adolescent smoking

•

The child and adolescent intervention studies reviewed have generally targeted 5-18 year olds who may or may not have experimented with cigarettes before. Some participants targeted were from high-risk groups based on parental education, income level or living in a low income area.

•

Overall, support for the interventions that have been tried to prevent or stop adolescent and child smoking is moderate. Support for the effectiveness of tobacco advertising in increasing smoking rates, however, is very strong.

•

School-based programs have received the most support. Eight studies of high quality focusing on the impact of social-influence training found significant reductions in smoking compared to controls. However further research is required, as eight additional studies of high quality focusing on the impact of either social-influence training or socialcompetence training did not find significant reductions. 5

•

Community programs were found to be ineffective when considered as a whole, with only a small number leading to significant reductions in smoking rates. However, the large variation in the structure of the programs suggests that it may not be valid to consider community interventions collectively at this stage. When considered individually, four community programs were found to reduce smoking rates significantly for children and adolescents. Two were general cardiovascular-disease-prevention programs and two were comprehensive anti-tobacco programs that focused on media advocacy, family activities and school-based activities. 6

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Practice resource:

Key findings

PREVENTING CHILD AND ADOLESCENT SMOKING

•

Media campaigns have not been trialled as widely as other interventions in studies of high quality, and preliminary data suggest mixed support for this type of intervention. The two studies that found media campaigns to be effective included conducting preliminary research to design the campaign message and broadcasting that was reasonably intense and extended. Advertising campaign targeted at adults have also been found to be effective in young people in reducing rates of smoking.7

•

Tobacco advertising (through mass media or giving away tobacco-related products) was found to lead to significantly higher rates of smoking in young people in nine longitudinal studies with over 12,000 participants. 8

Practice resource:

•

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PREVENTING CHILD AND ADOLESCENT SMOKING

Section 3: What the research shows

Section 3: What the research shows

Because of the large number of studies of high quality that exist to assess the effectiveness of interventions for smoking reduction or cessation, the studies cited below are systematic Cochrane reviews of these studies. For information on the strict criteria that authors of Cochrane reviews are required to meet, see the following link: www3.interscience.wiley.com/cgibin/mrwhome/106568753/HOME?CRETRY=1&SRETRY=0

Summary of intervention studies Intervention

Authors

Child and adolescent smoking

Community programs6

Sowden, Arblaster and Stead (2003)

Media campaign7

Sowden and Arblaster (1998)

School-based programs5

Thomas (2005)

Tobacco advertising8

Lovato, Linn, Stead, and Best (2003)

Practice resource:

Target

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PREVENTING CHILD AND ADOLESCENT SMOKING

Annotated summary of intervention studies

© Centre for Community Child Health 2006

Study

Participants

Intervention

Results

Sowden, Arblaster and Stead (2003)6

17 randomised control trials or control trials or randomised trials

community programs

community intervention (controls): 2 of 13 studies showed significant reduction

Comments

8 to 24 years community intervention (school-based): 1 of 3 studies showed significant reduction

Sowden and Arblaster (1998)7

6 control trials

media campaign

community intervention (mass media campaign alone): 1 study showed significant reduction 2 of 6 studies showed significant reduction

9 to 18 years Both used preliminary research to design the campaign message and the broadcast was reasonably intense over extensive period of time.

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Practice resource:

PREVENTING CHILD AND ADOLESCENT SMOKING

Section 3: What the research shows

Child and adolescent smoking

Participants

Intervention

Results

Comments

Thomas (2005)5

76 randomised control trials

school-based programs:

16 studies classed as ‘high quality’, all but 1 social influence interventions - 8 showed significant effect on smoking prevalence 7 showed no effect

at least 6-month follow-up

5-12 and 13-18 year olds prevention focus

• • • • •

Lovato, Linn, Stead and Best (2003)8

over 12,000 participants at baseline not regular smokers (18 years or younger)

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9 longitudinal studies (compared receptive to non-receptive adolescents)

Practice resource:

classroom programs for deterring tobacco use information programs social influence approaches generic social competence drug and alcohol community programs

tobacco advertising: mass media channels – advertising delivered through television, radio, newspapers, billboards, posters etc.

1 (Hutchinson Smoking Prevention Project, an 8 year project) found no long term effect studies of provision of information alone not considered ‘high quality’. Adolescents more receptive to tobacco advertising were significantly more likely to have experimented with cigarettes or started smoking.

Follow-ups ranged from 4 months to 5 years.

tobacco promotion – giveaways such as t-shirts and other items bearing tobacco industry logos

PREVENTING CHILD AND ADOLESCENT SMOKING

Section 3: What the research shows

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Study

1.

Hill D & Borland R. Adults' accounts of onset of regular smoking: influences of school, work and other settings. Public Health Reports 1991; 109: 181-185.

2.

Taioli E & Wynder EL. Effect of the age at which smoking begins on frequency of smoking in adulthood. [Letter]. N Engl J Med 1991; 325: 968-969.

3.

White V. and Hayman, J. (2004). Smoking behaviours of Australian secondary school students in 2002. National Drug Strategy Monograph Series, No. 54. Canberra: Australian Government Department of Health and Ageing.

4.

NHS Centre for Reviews and Dissemination (1999). Preventing the uptake of smoking in young people. Effective Health Care, 5(5), 1-12.

5.

Thomas, R. (2002) School-based programmes for preventing smoking. The Cochrane Database of Systematic Reviews 2002, Issue 2.

6.

Sowden, A., Arblaster, L. and Stead, L. (2003). Community interventions for preventing smoking in young people. The Cochrane Database of Systematic Reviews 2003, Issue 1.

7.

Sowden A. and Arblaster, L. (1998). Mass media interventions for preventing smoking in young people. The Cochrane Database of Systematic Reviews 1998, Issue 4.

8.

Lovato, C., Linn, G., Stead, L. and Best, A. (2003). Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours. The Cochrane Database of Systematic Reviews 2003, Issue 3.

Other references used in developing the resource

QUIT - The Cancer Council. Tobacco: Smoking Rates: Youth Smoking Rates. www.quit.org.au/index2.html. Accessed January 4th 2005.

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Practice resource:

QUIT – Cancer Council Victoria www.quit.org.au. Accessed 4th January 2005.

PREVENTING CHILD AND ADOLESCENT SMOKING

References

Appendix 1

The Centre for Community Child Health’s mission is to improve the health and wellbeing of all children. At the forefront of Australian research into early childhood development and behaviour, the Centre has a particular interest in children’s mental health; obesity; language, learning and literacy; hearing; and the development of quality early childhood services. The Centre is committed to disseminating its research findings to inform public policy, service delivery, clinical care and professional practice. Professor Frank Oberklaid, an internationally renowned researcher, author, lecturer and consultant, leads a team of over 90 staff from a range of disciplines including paediatrics, psychology, education, early childhood, public health and communications. Located at The Royal Children’s Hospital, Melbourne, the Centre is a key research centre of the Murdoch Childrens Research Institute and an academic centre of the University of Melbourne.

Practice resource:

Further information about the Centre for Community Child Health can be found at www.rch.org.au/ccch

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Centre for Community Child Health

Appendix 2

In 2002, as part of its strong tradition of community involvement, Telstra established the Telstra Foundation, a program devoted to enriching the lives of Australian children and young people and the communities in which they live. The Telstra Foundation supports projects that develop innovative solutions and new approaches to issues affecting children and young people aged 18 years and under, are based on sound research, and develop practical applications of new knowledge and have an emphasis on early intervention. The Telstra Foundation has two main programs, with the Community Development Fund providing the funding for the practice resource. The Community Development Fund provides grants to charitable organisations for projects that have wide impact and intervene early to address causal factors affecting the health, well-being and life chances of Australia's children and young people.

Practice resource:

Further information about the Telstra Foundation can be found at: http://202.12.135.148/dir148/tfweb.nsf/webdocs/home~home?o pendocument

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Telstra Foundation

Appendix 3

There were a number of criteria used for selecting the topic for each practice resource. These included:

•

Importance of the issue in relation to children’s health and development There are a number of issues that are very prevalent and impact both on the immediate health and development of the child as well as the impact over the life course. Provider need Through various forums providers have requested easier access to research based information that will assist directly in their daily interactions with children and families.

•

Community need Around Australia there is increasing community activity focusing on early childhood. A number of these communities have begun to articulate the desire to support families more effectively through providing services that engage in family centred practice and use research based strategies to address issues that concern parents.

•

Parent need and concern National consultations have highlighted the issues that parents want more information about. In addition, Australian research has shown that there are a small number of issues that cause parents the most concern about their children.

•

Perceived gap between evidence and practice There are a number of areas of practice which in general do not reflect research evidence in spite of sound evidence from that research.

•

Can be readily incorporated into routine practice The primary aim of each resource is to assist professionals in their interactions with children and families. Priority was given to issues about which strategies could be relatively easily incorporated into practice.

•

No duplicating of effort Consideration was given to whether issues had been addressed elsewhere in similar ways for the same audience.

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Practice resource:

•

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Criteria for selecting topics

NHMRC Guidelines for Levels of Evidence Evidence obtained from a systematic review of all relevant randomised controlled trials.

II

Evidence obtained from at least one properly designed randomised controlled trial.

III-1

Evidence obtained from well-designed pseudorandomised controlled trials (alternate allocation of some other method).

III-2

Evidence obtained from comparative studies with concurrent controls and allocation not randomised (cohort studies), case-control studies, or interrupted time series with a control group.

III-3

Evidence obtained from comparative studies with historical control, two or more single-arm studies, or interrupted time series without a parallel control group.

IV

Evidence obtained from case series, either posttest or pre-test and post-test.

Practice resource:

I

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Appendix 4

Glossary of Terms – Research Methodology

Case-control study

A study that compares people with a disease or outcome of interest (cases) with people from the same population without that disease or outcome (controls), and which seeks to find associations between the outcome and exposure to particular risk factors

Cochrane Review

Systematic summaries of evidence of the effects of health care interventions, intended to help people make practical decisions. For a review to be called a Cochrane Review it must be in the Cochrane Database of Systematic Reviews or the Cochrane Review Methodology Database. These are administered by the Cochrane Collaboration, an international organisation that aims to help people make well-informed decisions about health care.

Control

A participant in a randomised controlled trial who is in a group that acts as a comparator for the experimental intervention(s); alternatively, a participant in a case-control study who is in a group that does not have the disease or outcome of interest.

Control trials

Studies in which participants are assigned to an intervention or control group using specific criteria.

Effectiveness

The extent to which a specific intervention, when used under ordinary circumstances, does what it is intended to do.

Evidence

Up-to-date, accurate information about the effects of interventions.

Randomised controlled trial (RCT)

An experiment in which two or more interventions are compared by being randomly (like tossing a coin) allocated to participants.

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Practice resource:

Note: Wherever possible these definitions are taken from the Glossary of Terms in the Cochrane Collaboration, Version 4.2.5, updated May 2005.

PREVENTING CHILD AND ADOLESCENT SMOKING

Appendix 5