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TRANSCRIPT
An Intervention to prevent High School Children from taking
up Smoking.Lucy Hives
MSc Health Psychology
Word Count: 4000
Overview
‘Cigarette smoking has long been recognised as a major public health problem and the single most preventable cause of death’ (Chen & Millar, 1998). The vast majority of smoking interventions, to date, focus on adults who are regular smokers and are in need of support to help them quit their habit (See Appendix 1). However, statistics have shown that there is the largest increase in the number of smokers between the ages of 11 and 15, with between 11-21% of 11 to 15 year olds now regular smokers. The proposed intervention therefore aims to target children from the age of 11 and follow them through until the age of 15, to develop their knowledge and attitudes towards smoking as a negative health behaviour. The intervention is based on the concepts of Ajzen’s (1985) Theory of Planned Behaviour model, which states that attitudes towards smoking, beliefs about subjective norms of smoking, and perceived behavioural control around smoking al have an impact on an individual’s intention to smoke, and this intention is largely indicative of whether a person will display actual smoking behaviour, or not. It is hypothesised that if children grow up in the presence of an anti-smoking intervention such as the one which is proposed here, their values and beliefs will include smoking as a bad health behaviour, and one to avoid. The intervention will be tested for effectiveness by recruiting participants (aged 11 at onset) from 8 different schools (7 experimental groups and 1 control group), and each school will take part in a different set and number of stages of the intervention (namely: teaching sessions, anti-smoking magazine, and parent information) which are described further in the proposal. Each group will receive an Adapted-National Youth Tobacco Survey Questionnaire to measure their scores on the Theory of Planned Behaviour constructs and to measure their smoking behaviours. Statistical tests will aim to show which aspects of the proposed intervention are the most effective in terms of maintaining low percentages of childrens’ smoking intentions and behaviours, in the short-term (while the intervention is being implemented) and also in the long term (on follow up measures at 6 months, 1 year, 2 years, 5 years and 10 years).
Justification of need
The long-term effects of smoking in adults have been a major focus of health professionals for many years, as smoking is a negative health behaviour in which initially people can choose whether they will start or not. Smoking is the most costly negative health behaviour which is ultimately avoidable, unlike genetics for example which are unavoidable. Up to date, health professionals have directed their attention towards smoking cessation; that is helping people to quit smoking and their efforts are applied mainly to adult smokers. Because of this primary focus on adults who are regular smokers, little effort has been made to design smoking interventions for school children, although research and statistics have clearly demonstrated a need for them.
It is surprising to learn that around 207,000 children between the ages of 11 and 15 begin smoking every year, in England alone (The NHS Information centre for health and social care, 2012). To put it into perspective, this means that by the age of 15, 11% of children in England report being regular smokers. And even this shocking figure is now thought to be understated, with many children wanting to keep their smoking behaviours a secret they may be unlikely to report the truth. It is thought that the true prevalence of smoking children under the age of 16 could be as high as 21% in boys and 19% in girls.
Despite the long term effects of smoking seeming a distant and avoidable future for children who smoke, these adolescent years are of particular importance when establishing smoking behaviours throughout their adult lives (Chassin, Presson, Rose, & Sherman, 1996). When adult smokers were questioned about the age at which they begun smoking, 40% admitted to starting smoking before the age of 16 (Ash Fact Sheet, 2013), showing that a large percentage of people who start smoking during adolescent years struggle to kick their habit. As well as establishing a person’s lifetime smoking behaviour, starting smoking at such a young age can be even more harmful to an individual’s health than starting at a later age, because the body and its organs have not fully developed. There has been a lot of research into the additional risks associated with childhood smoking initiation, and these include a higher risk of lung damage (Wiencke et al., 1999) and for those who start smoking before the age of 15, there is double the risk of developing lung cancer compared to those who start smoking at the age of 20 or later (Peto et al., 2000; Doll & Peto, 1981). Also, for those who start smoking at a younger age, they are more likely to develop heart disease at a younger age (The Royal College of Physicians, 1992).
As a vulnerable population, it can be argued that children are the most susceptible to social pressures when it comes to smoking. They are affected greatly, for example, by socio-economic status (Conrad et al., 1992), pressures they may experience from peers (Baker et al., 2004; Conrad, Flay & Hill, 1992; Tyas & Pederson, 1998), and role models such as parents (Kardia et al., 2003; Rossow & Rise, 1994; Fergusson et al, 2007), older siblings (Bricker et al., 2006) and celebrities (Dalton et al., 2003). With these pressures, together with a lack of clear understanding about the negative health effects of smoking, it becomes clear that children are one of the most vulnerable groups when it comes to smoking initiation.
Theoretical Background
The health behaviour model which has been chosen as a basis for designing an intervention to prevent children from smoking is Ajzen’s (1985) Theory of Planned Behaviour, which is shown in Figure 1.
Figure 1: Theory of Planned Behaviour (Ajzen, 1985)
The theory relies on the idea that people will behave in a way in which they intend to behave. This central stage is made up of three components which all contribute to an individual’s intentions and therefore impact on their behaviour. These components are a) behavioural attitude, which addresses a person’s outlook and beliefs about a certain behaviour b) Subjective Norms, which refer to how prevalent the behaviour is and how often an individual comes into contact with a person displaying the certain behaviour, and c) Perceived Behavioural Control which looks at the individuals belief about their ability to carry out the behaviour and how in control they are.
The Theory of Planned Behaviour has been used to study many different health behaviours, for example condom use (Reinecke, Schmidt & Ajzen, 1996), exercise (Norman & Smith, 1995), testicular self-examination (McClenahan, Shevlin, Adamson, Bennett & O’Neill, 2006), and dieting (Conner, Martin, Silverdale & Grogan, 1996). Armitage and Conner (2001) conducted a meta-analysis of the research using this theory and reported that on average the three components of the Theory of Planned Behaviour model (behavioural attitude, subjective norms, and perceived behavioural control) were able to predict 39% of the variance in peoples’ intentions to perform a certain behaviour and 27% of the variance in the behaviour being performed. Sutton (1998) also carried out a meta-analysis which revealed that the Theory of Planned Behaviour can explain between 40 to 50% of variance in peoples’ intentions and between 19 and 38% of the variance in peoples’ actual behaviours.
Many researchers have also used the Theory of Planned behaviour to look into smoking initiation (Higgins & Conner, 2003; Droomers, Schrijvers, & Mackenbach, 2004; Godin, Valois, Lepage, & Deshamais, 1992; Norman, Bell, & Conner, 1999). In their 2010 meta-analysis of 35 studies including 267,977 people, Topa and Moriano revealed that in the context of smoking behaviour, perceived behavioural control (r= .24) was the best predictor of an individual’s intention to smoke and this was followed by the subjective norms component (r= .20) and then the attitude component (r= .16). The overall intention to smoke accounted for, on average, 30% of the variance in smoking behaviour.
Despite these good results, the effect sizes for the constructs of the Theory of Planned Behaviour are nearly always found to be moderate to small, indicating that the probability of being able to predict correctly whether a person will smoke or not based on their intentions is around the same as, or just greater than, by chance. However, the aim of the current intervention was not to measure current intentions and use these to predict future behaviours, but to closely monitor current intentions and behaviours over a period of 5 years, and use these to shape children’s beliefs and values which should, in effect, influence their future decisions. It is therefore predicted that the effect sizes for the present study will be higher than those which only take one measure of the Theory of Planned Behaviour constructs and use these results to predict behaviour at one given time.
Intervention Design
The proposed intervention is a three-stage programme which aims to address the three constructs (perceived behavioural control, subjective norms and attitudes) of the Theory of Planned Behaviour model. The basic framework for the programme is outlined in Figure 2.
Figure 2: Intervention Framework
Teaching Sessions
Older peers will lead discussions about childrens’ knowledge of the harmful effects of smoking.
They will clear up any issues raised about smoking.
Accounts from older peers who have never smoked and those who have smoked and their health problems and difficulties quitting smoking.
Anti-smoking Magazine
Children will be given an anti-smoking magazine to take home with them to remind them of the issues raised in each teaching session
Pages will include smoking statistics, celebrities who are opposed to smoking and who have quit smoking, and real life stories.
Parent Information
Parents will be given information about the effects of smoking around their children and how this can have an impact on their children starting to smoke.
Information will include the most up to date research.
The information will be sent to parents once every 6 months.
The first and main stage of the programme are peer-led teaching sessions. Older peers aged 16-18 will be trained by a registered health psychologist to be able to lead class discussions about smoking. These older peers will raise issues such as the negative health effects and the effects of peer pressure so that they can learn what level children are at in terms of their knowledge of smoking. Peers can then teach children the facts about smoking including the long-and-short-term health impacts, struggling with addiction and how difficult it could be to give up smoking once started. Older peers will include individuals who have never smoked, but also individuals who are current smokers who can describe why they regret starting to smoke, and ex-smokers who can describe their decisions to quit smoking and how difficult this was. This first stage aims to address all three components of the theory of planned behaviour model. Initially the teaching sessions will contribute to altering the childrens’ attitudes towards smoking by making children more aware of the negative effects of smoking. As well as this the subjective norms component will be addressed because smoking peers will talk about their struggle to quit smoking and how smokers are a minority in all social settings, including schools. Finally the perceived behavioural control component will be addressed because children will be taught how to say no to cigarettes.
The second stage of the programme includes children being given an anti-smoking magazine (see Appendix 2) to take home and read. The magazine will highlight and reiterate points which have been discussed in the teaching sessions and will include smoking statistics, quotes from celebrities who are opposed to smoking and who have quit smoking, and real life stories. This part of the programme addresses the subjective norms component of the theory of planned behaviour because some celebrities will speak about how they have quit smoking and why they have chosen to quit, and others will speak about why they have never decided to start smoking. As well as this the attitude component will again be addressed because
physical images and diagrams will be presented to highlight facts about the risks associated with smoking.
The third and final stage of the intervention will be to provide parents with information regarding parental modelling. The information will update parents on research which has been conducted which explores the effects that smoking around children can have on their future smoking behaviours. This stage will address the subjective norms component of the Theory of Planned Behaviour model because hopefully the information will result in less parents smoking around their children and so children will come into contact with smoking much less.
Implementation Strategy
To test the interventions effectiveness at stopping school children from taking up smoking behaviours, eight schools will take part in a research study. The study will start at the beginning of the academic year, September, with children who are starting year 7 and are 11 years old. The study will follow this year group as they progress through high school, up until the age of 16 in all eight schools. The study will take five years to complete and then after these five years, a follow-up survey will be completed to see what effect, if any, the intervention has had on the participants’ long-term smoking behaviours.
Each school will take part in a different set of stages of the intervention to see which components of the intervention are the most effective. School 8 is the control group which will not take part in any stages of the intervention but will be given the Adapted-National Youth Tobacco Survey Questionnaire to complete at the same times as all experimental groups. Group 8 will act as a comparison group to discover the benefits of the intervention as appose to no intervention on the percentage of smoking children. The different groups are detailed in Figure 3 below.
Figure 3: Components of the intervention which each school will take part in
School Teaching Sessions Anti-smoking Magazine
Parent Information
1 ✔2 ✔3 ✔4 ✔ ✔5 ✔ ✔6 ✔ ✔7 ✔ ✔ ✔8 (control)
The year group from school 1 will take part in only the teaching sessions which will run once at the start of each academic year, once just before and once just after the Christmas break, once just before and once just after the Easter break, and once just before the summer holidays. Therefore each year will consist of six teaching sessions, with a total of 30 teaching sessions over the five years. School 2 will be given only the anti-smoking magazines, which
will be handed out at the same times as the teaching sessions will run in the other groups; once at the start of the academic year, once just before and once just after the Christmas break, once just before and once just after the Easter break, and once just before the summer holidays. There will be six issues of the magazine per year, with 30 issues in total over the 5 years. Parents of children from school 3 will be given information about the effects of smoking on their childrens’ smoking behaviour. Parents will receive this information once every 6 months, starting from their child’s first day in year 7. Each issue will include research updates on the subject of parental modelling, in the context of smoking initiation. Schools 4, 5 ad 6 will take part in a different set of two components of the intervention, for example, school 4 will take part in the teaching sessions and will receive anti-smoking magazines, school 5 will take part in the teaching sessions and parents will be sent information, and school 6 will receive anti-smoking magazines and parents will be sent information. Group 7 will take part in the complete intervention including all three components; the teaching sessions, anti-smoking magazines and parent information, and group 8 will not take part in the intervention at all.
To measure the effectiveness of the intervention all children will be given a questionnaire to complete once at the start of each academic year (after children and parents have received their specific interventions), once just after the children start back at school after the Christmas holidays (after the intervention), once just after children start back at school after the Easter holidays (after the intervention), and once just before schools close for summer (after the intervention). The questionnaire used was the Adapted-National Youth Tobacco Survey Questionnaire (see Appendix 3) which was adapted from an American version (National Youth Tobacco Survey, 2012) for use in the UK. The questionnaire included 42 multiple choice questions which asked about smoking habits, attitudes towards smoking, knowledge of smoking, social issues, the prevalence of smoking, addiction and the media. The questionnaire was coded so that it would measure the three components of the theory of planned behaviour model. Overall an individual’s score was out of 34 for their attitude towards smoking, with a higher score indicating a more negative attitude towards smoking, out of 27 for the subjective norms component, with a higher score indicating a belief that smoking is not a common behaviour, and out of 29 for perceived behavioural control, with a higher score indicating a greater perceived behavioural control over not starting to smoke. As well as these scores it was noted whether individuals had intended to smoke and whether they had smoked since the previous questionnaire to see whether a higher score on the three component measures meant that peoples’ intentions to smoke were lower and therefore they were less likely to carry out smoking behaviour.
Evaluation
The scores collected from each participant will be their score out of 34 for the attitude component, out of 27 for the subjective norms component and out of 29 for the perceived behavioural control component of the Adapted-National Youth Tobacco Survey Questionnaire. Also scores of intentions to display smoking behaviours will be scored either a 0 (for not intention to smoke) or a 1 (for an intention to smoke) and actual smoking behaviour will be scored either a 0 (for no smoking behaviour) or 1 (for smoking behaviour). The results from each year will be displayed in separate tables, for example Figure 4 below.
Figure 4: Results from seven different schools who took part in different components of the Youth smoking intervention programme (Year 1).
School Intervention Attitude score
Subjective Norms score
Perceived Behavioural Control score
% of children with an intention to smoke
% of children who display smoking behaviour
1 A 14 13 16 5 22 B 10 12 15 7 33 C 9 8 12 5 34 A+B 16 17 18 3 25 B+C 14 16 17 4 26 A+C 15 16 16 3 27 A+B+C 18 19 21 2 18 (control) n/a 8 8 10 10 4
Interventions: A= Teaching Sessions, B= Anti-smoking Magazine, C= Parent Information.
Results will be input into SPSS for statistical analysis and graphs will be drawn using Microsoft Excel (see Appendix 4). The graphs show which combination of the three parts of the intervention are the most effective in improving childrens attitudes, subjective norms and perceived behavioural control over the five years of the study. Separate graphs will also show the percentage of children who have intended to smoke and who have smoked in each school over the five years of the study, and these will indicate whether childrens’ attitudes, subjective norms and perceived behavioural control scores link to their smoking intentions and attitudes.
For each schools results after the 5 year study, a stepwise multiple regression analysis was conducted to see which aspects of the programme could predict the most variance in smoking intentions and behaviour. The study also aimed to see whether the programme worked best as an overall model or whether one or two aspects worked better on their own when predicting smoking intentions and behaviours.
After the initial study, a follow up study will indicate whether the intervention has had any lasting effects on the participants’ long term smoking intentions and behaviours. A percentage of participants who have become smokers since the study has been completed will be recorded for each school, 6 months after, 1 year after, 2 years after, 5 years after, and then 10 years after the end of the initial study
Process measures were recorded after each part of the intervention was provided. After each teaching session, anti-smoking magazine and parent information letter were given out, participants were given a short questionnaire to fill in (see Appendix 5). The questionnaire asked about which aspects of the intervention they felt were the most effective and helpful and which parts perhaps needed to be developed more.
Reflection
When first trying to think of a negative health behaviour to base my intervention on, there were a wide range of possibilities. However, with it being described as the most costly negative health behaviour which is ultimately avoidable, I chose to focus on smoking. While there have been a number of different smoking interventions which have focussed on adults and helping them to quit smoking, when I think back to my time at high school, there was really no teaching of the negative effects of smoking within the curriculum or any real acknowledgement of teenage smoking. Throughout my research into smoking interventions within schools, I quickly learnt that there is still nothing set in stone and widely used throughout the UK.
Further, my research lead me to some quite shocking statistics when I discovered just how many teenagers between the ages of 11 and 15 identify as being regular smokers, and this really gives me a clear grounding as to why my intervention is needed, especially when it comes to justifying the target audience, children. My intervention centres on teaching children about smoking and focussing their opinions of smoking on the negative, and therefore helping them to grow as individuals to associate smoking with something to be avoided.
The participants recruited to test the smoking intervention will be year 7 pupils from seven different state-funded high schools, to control better for socio-economic status, and I would hope to recruit about 200 students from each school. All participants will be aged 11 at the start of the study, and will be followed throughout their high school years until they reach the end of year 11, by which time all participants will be 16 years of age. All schools recruited will be in the county of Yorkshire, which has one of the highest smoking rates in England.
Ethical issues are obviously a major part of any study, and especially those studies involving children. I would firstly have to gain consent from the seven schools and then letters would have to be sent home to the parents of the children who would be starting the school in the coming September. The letters would be quite brief and tell parents that as a new teaching requirement, their children are going to be taught about smoking as part of the curriculum and this will aim to prevent children from taking up smoking throughout school and in their adult lives. Parents will be asked to sign a slip if they wish for their child to be opted out of the intervention, and so not signing the slip will indicate consenting to their child taking part in the intervention.
During the intervention there may also be many ethical issues to consider. For example, if participants are affected by any of the issues raised in the group discussions. It is therefore essential that the children are aware that the school will have a councillor on site who they can go to talk to about these issues, and that this information will remain confidential. Children will also be provided with contact numbers for the Samaritans and other helplines which they may phone if they do not wish to talk to the school councillor.
Appendices
1 Adult Smoking Interventions2 Anti-smoking Magazine3 Adapted -National Youth Tobacco Survey
Questionnaire4 Result Graphs5 Process Measures Questionnaire
Appendix 1
Appendix 2
Appendix 3
Adapted -National Youth Tobacco Survey Questionnaire
This survey is about smoking. We would like to know about you and the things you do that may affect your health. Your answers will be used for programmes for young people like
yourself.
DO NOT write your name on this survey. The answers you give will be kept private.
NO ONE will know what you write. Answer the questions based on what you really do and know.
Completing the survey is voluntary. Whether or not you answer all the questions will not affect your school grades. Try to answer all the questions. If you do not want to answer a
question, just leave it blank. There are no wrong answers.
Thank you very much for your help.
The first three questions ask for some background information about you.
1. How old are you?
a. 11 years old
b. 12 years old
c. 13 years old
d. 14 years old
e. 15 years old
f. 16 years old
2. What year are you in?
a. Year 7
b. Year 8
8 items measuring behavioural attitude= score out of 34
4 items measuring subjective norms= score out of 27
8 items measuring perceived behavioural control= score out of 29
c. Year 9
d. Year 10
e. Year 11
3. What sex do you identify as?
a. Female
b. Male
c. Neither male nor female
The next seventeen questions ask about your use of cigarettes
4. Have you ever been curious about smoking a cigarette?
a. Definitely yes
b. Probably yes
c. Probably not
d. Definitely not
5. Have you ever tried smoking a cigarette?
a. Yes
b. No
6. Do you think you will smoke a cigarette in the next year?
a. Definitely yes
b. Probably yes
c. Probably not
d. Definitely not
7. Do you think you will try a cigarette soon?
a. Definitely yes
b. Probably yes
c. Probably not
d. Definitely not
8. If one of your best friends were to offer you a cigarette, would you smoke it?
a. Definitely yes
b. Probably yes
c. Probably not
d. Definitely not
9. How old were you when you first tired cigarette smoking?
a. 8 years old or younger
b. 9 years old
c. 10 years old
d. 11 years old
e. 12 years old
f. 13 years old
g. 14 years old
h. 15 years old
i. 16 years old
10. About how many cigarettes have you smoked in your entire life?
a. I have never smoked cigarettes
b. 1 or more puffs, but never a whole cigarette
c. 1 cigarette
d. 2 to 5 cigarettes
e. 6 to 15 cigarettes
f. 16 to 25 cigarettes
g. 26 to 99 cigarettes
h. 100 or more cigarettes
11. During the past 30 days, on how many days did you smoke cigarettes?
a. 0 days
b. 1 or 2 days
c. 3 to 5 days
d. 6 to 9 days
e. 10 to 19 days
f. 20 to 29 days
g. All 30 days
12. During the past 30 days, on the days that you smoked, how many cigarettes did you smoke per day?
a. I did not smoke cigarettes during the past 30 days
b. Less than 1 cigarette per day
c. 1 cigarette per day
d. 2 to 5 cigarettes per day
e. 6 to 10 cigarettes per day
f. 11 to 20 cigarettes per day
g. More than 20 cigarettes per day.
13. When was the last time you smoked a cigarette?
a. I have never smoked cigarettes, not even one or two puffs
b. Earlier today
c. Not today, but sometime during the past 7 days
d. Not during the past 7 days but sometime during the past 30 days.
e. Not during the past 30 days, but sometime during the past 6 months
f. Not during the past 6 months but sometime during the past year.
g. 1 to 4 years ago
h. 5 or more years ago.
14. How likely is it that you will try to purchase cigarettes within the next 30 days?
a. I do not smoke cigarettes
b. Very likely
c. Somewhat likely
d. Somewhat unlikely
e. Very unlikely
15. During the past 30 days, how did you get your own cigarettes?
a. I did not get cigarettes during the past 30 days
b. I bought a pack of cigarettes myself
c. I had someone else buy me a pack of cigarettes
d. I asked someone to give me a cigarette
e. Someone offered me a cigarette
f. I bought cigarettes from another persons
g. I took cigarettes from a shop or another person
h. I got cigarettes some other way.
16. During the past 30 days, did anyone refuse to sell you cigarettes because of your age?
a. I did not try to buy cigarettes during the past 30 days
b. Yes
c. No
17. During the past 30 days, have you had a strong craving or felt like you really needed to smoke a cigarette?
a. Yes
b. No
18. During the past 30 days, was there a time when you wanted to smoke a cigarette so much that you found it difficult to think about anything else?
a. Yes
b. No
19. How soon after you wake up do you want to smoke a cigarette?
a. I do not smoke
b. Within 5 minutes
c. From 6 to 30 minutes
d. From more than 30 minutes to 1 hour
e. After more than 1 hour but less than 24 hours
f. I rarely want to smoke
20. How true is this statement for you? I feel restless and irritable when I don’t smoke for a while.
a. I do not smoke
b. Not at all true
c. Sometimes true
d. Often true
e. Always true
The next five questions ask about different issues related to smoking
21. How easy do you think it is for people your age to buy cigarette in shops?
a. Easy
b. Somewhat easy
c. Not at all easy
22. When you use the internet, how often do you see any ads for cigarettes?
a. I do not use the internet
b. Never
c. Rarely
d. Sometimes
e. Most of the time
f. Always
23. When you read newspapers or magazines, how often do you see any ads for cigarettes?
a. I do not read newspapers or magazines
b. Never
c. Rarely
d. Sometimes
e. Most of the time
f. Always
24. When you watch TV or films, how often do you see actors and actresses using cigarettes?
a. I do not watch TV or films
b. Never
c. Rarely
d. Sometimes
e. Most of the time
f. Always
The next two questions will ask about different issues related to tobacco warning labels
25. A warning label tells you if a product is harmful to you and can be either a picture or words. During the past 30 days, how often did you see a warning label on a cigarette pack?
a. I did not see a cigarette pack during the last 30 days
b. Never
c. Rarely
d. Sometimes
e. Most of the time
f. Always
26. During the past 30 days, to what extent did warning labels on cigarette packs make you think about the health risks of smoking?
a. I did not see a warning label on a cigarette pack in the last 30 days
b. Not at all
c. A little
d. Somewhat
e. A lot
The next four questions are about quitting smoking
27. Are you seriously thinking about quitting cigarettes?
a. I do not smoke cigarettes
b. Yes, within the next 30 days
c. Yes, within the next 6 months
d. Yes, within the year
e. Yes, but not within the year
f. No, I am not thinking about quitting cigarettes.
28. If you decided to quit cigarettes for good, how likely is it that you would succeed?
a. I do not smoke cigarettes
b. Very likely
c. Somewhat likely
d. Somewhat unlikely
e. Very unlikely
29. During the past 12 months, how many times have you stopped smoking for one day or longer because you were trying to quit smoking for good?
a. I did not smoke during the past 12 months
b. I did not try to quit during the past 12 months
c. 1 time
d. 2 times
e. 3 to 5 times
f. 6 to 9 times
g. 10 or more times
30. When you last tried to quit for good, how long did you stay off cigarettes?
a. I have never smoked cigarettes
b. I have never tried to quit
c. Less than a day
d. 1 to 7 days
e. More than 7 days but less than 30 days
f. More than 30 days but less than 6 months
g. More than 6 months but less than 1 year
h. 1 year or more
The next eight questions ask about your thoughts on smoking
31. Do you think smoking cigarettes make young people look cool or fit in?
a. Definitely yes
b. Probably yes
c. Probably not
d. Definitely not
32. Do you think young people who smoke cigarettes have more friends?
a. Definitely yes
b. Probably yes
c. Probably not
d. Definitely not
33. How long do you think someone has to smoke before it damages their health?
a. Less than a year
b. 1 year
c. 5 years
d. 10 years
e. 20 or more years
34. How much do you think people harm themselves when they smoke a few cigarettes every day?
a. No harm
b. Little harm
c. Some harm
d. A lot of harm
35. How much do you think people harm themselves when they smoke a few cigarettes some days but not every day?
a. No harm
b. Little harm
c. Some harm
d. A lot of harm
36. How much do you think people harm themselves when they smoke 10 or more cigarettes every day?
a. No harm
b. Little harm
c. Some harm
d. A lot of harm
37. How strongly do you agree with the statement ‘smoking is dangerous’?
a. Strongly agree
b. Agree
c. Disagree
d. Strongly disagree
38. In the past 30 days, how often have you thought about the harmful chemicals in cigarettes?
a. Never
b. Rarely
c. Sometimes
d. Often
e. Very often
The next question asks about the smoking habits of other people in your year
39. Out of every 10 students in your year, how many do you think smoke cigarettes?
a. 0
b. 1
c. 2
d. 3
e. 4
f. 5
g. 6
h. 7
i. 8
j. 9
k. 10
The next three questions are about your experiences at home
40. How many people smoke in your household?
a. 1
b. 2
c. 3
d. 4
e. 5 or more
41. Who smokes in your family? (tick all that apply)
a. Nobody smokes
b. Mother
c. Father
d. Older brother
e. Older sister
f. Younger brother
g. Younger sister
h. Other
42. During the past 12 months, have your parents or guardians talked with you about not smoking?
a. Yes
b. No
Appendix 4
year 1 year 2 year 3 year 4 year 50
5
10
15
20
25
A Graph to show the Subjectve Norms scores of the different intervention groups over the 5 years of the study.
school 1 school 2 school 3 school 4school 5 school 6 school 7 school 8
year 1 year 2 year 3 year 4 year 50
5
10
15
20
25
A Graph to show the Perceived Behavioural Control scores of the different intervention groups over the 5 years of the study
school 1 school 2 school 3 school 4school 5 school 6 school 7 school 8
Appendix 5
Dear Student/ Parent/ Guardian,
Please take a few minutes to provide us with feedback for the most recent smoking intervention materials which have been delivered to you.
As a whole, the most recent materials I received were interesting:
Disagree Agree
The materials I received have changed my attitude towards smoking:
Disagree Agree
The materials I received have changed some aspect of my behaviour:
Disagree Agree
If agree, what have the materials changed about your behaviour?
Which aspects of the materials did you find the most beneficial?
Which aspects of the materials do you think need to be developed or changed?
Thank you for your time.
References
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