Scotland's Future is Smoke Free: A Smoking Prevention Action Plan

CHAPTER 3
HEALTH EDUCATION AND PROMOTION

"Public Health Policy is as much about preventing ill-health as it about treating it": Shona Robison MSP, Minister for Public Health, NHS Annual Conference, and June 2007

Current activity

3.1 There is currently a wide range of health promotional and educational activity going on at both national and local level in Scotland. The SPWG report assesses these efforts which include:

• Activities undertaken by NHS Boards as part of their tobacco control programmes.
• Multi-media campaigns orchestrated by NHS Health Scotland, including in conjunction with Young Scot and Youth Media, which currently devotes some £1.5m per annum across a range of programmes to these.
• Smoking education undertaken as part of substance use education which is offered in the vast majority of Scottish schools, and more generally the whole school approach to promoting physical, social, spiritual, mental, emotional wellbeing of pupils and staff fostered through Health Promoting Schools.
• Community-based programmes such as the experimental health promotion initiative Breathing Space which aimed to tackle smoking in a low-income area in Edinburgh but showing somewhat disappointing impact.

Future direction

3.2 The evidence presented in the SPWG report and the response to the consultation suggests the need for a fundamental rethink of health promotion and education to enable renewed efforts to be made encourage children and young people to make positive lifestyle choices. In determining the way forward, key points borne in mind were:

• Research undertaken between February 2004 and July 2005, " The Evaluation of the Effectiveness of Drugs Education in Schools"⁸ suggesting that while there is much good practice in Scotland on substance use education, more can be done to enhance its effectiveness, particularly through clearer guidance on evidence-based methods and approaches; and on continuity and progression; further training and support to boost teachers' knowledge, skills and confidence; and more attention to resources.
• The suggestions made in the SPWG report that A Curriculum for Excellence⁹ programme which aims to achieve transformational change in education in Scotland provides an good opportunity to take stock of future direction.
• The general perception from the young people's focus group element of the consultation that less time is spent in schools on tobacco education than on alcohol and drugs (and for some sex). The hypothesis being that this is because smoking is seen as less dangerous and education on it of less relevance to people than other topics.
• The fact that many young people start to smoke or progress to regular smoking once they leave school, suggests there is a need for educational efforts to continue beyond schools, including into further and higher education and into non-school settings.
• The evidence suggesting that the uptake of smoking by young teenagers is about the same across social classes at age 15 but by mid twenties most youngsters from higher social classes have quit. It would be important to learn more about the factors influencing more affluent youngsters not to continue and how these might be translated to lower income communities.
• The work being undertaken by the National Institute of Clinical Excellence ( NICE) to develop guidance on preventing the uptake of smoking by children and young people, and the NHS Health Scotland Commentary on this guidance that will follow from its publication in July 2008.
• The Schools (Health Promotion and Nutrition) Scotland Act 2007 which will ensure health promotion will have a central and continuing focus in education and the related guidance and in education generally.
• The commitment in section 2.4 of the "Better Health, Better Care" action plan to identifying and scaling up effective approaches to reaching and engaging with the most vulnerable groups of people to improve their physical and mental health.
• The importance of involving young people, especially those young people most likely to take up and sustain smoking habits, directly in the planning and delivery of services and initiatives to ensure a young person's perspective is reflected in order to give maximum opportunity for innovative ideas and approaches to emerge.
• The important contribution third sector organisations can make to spreading smoking prevention messages.

Actions

Against this background, the Scottish Government proposes:

1. To facilitate the adoption of a holistic approach to health and well-being in Scottish schools to be fostered through the Health Promoting School and a Curriculum for Excellence, which will be aimed at ensuring the school ethos, policies, services and extra-curriculum activities all foster the health and wellbeing of all the pupils.
Delivery lead: the Scottish Government/Learning Teaching Scotland. Timescale: Ongoing

2. To produce advice, guidance and proposals aimed at helping schools and authorities via an expert steering group looking at substance misuse education in schools, to achieve the improvements sought through Curriculum for Excellence and The Schools (Health Promotion and Nutrition) Act 2007 (taking into consideration the key findings of the Evaluation of the Effectiveness of Drugs Education in Schools), particularly so that appropriate teaching materials are available and are being used most effectively, and education is planned and delivered in partnership with inputs from health, the Police and the community.
Delivery lead: Scottish Government. Timescale: Ongoing

3. To explore with relevant interests, including universities and colleges of further education and other major training providers, student associations and the National Union of Students, steps which they might take to discourage and support students and trainees from starting to smoke as a core part of wider substance use and other risk-taking behaviour programmes.
Delivery lead: NHS Health Scotland. Timescale: 2008/09

4. To explore with relevant interests and agencies steps which might be taken to engage with harder to reach groups such as those who are not in employment, education or training or who are in occupations or settings with higher than average smoking levels, including through engagement with the Scottish Prison Service and HM Forces.
Delivery lead: NHS Health Scotland/ PATH. Timescale: 2008/09

5. To encourage all those responsible for smoking prevention activity aimed at children and young people to actively involve children and young people themselves in the planning and delivery of services and programmes to ensure their perspective is fully reflected in the approaches adopted and to encourage active citizenship.
Delivery lead: All relevant agencies - NHS Boards, Local Authorities etc. Timescale: Ongoing

6. To embrace tobacco issues within the Health Improvement Social Marketing Strategy ( HISMS) to ensure that future national campaigns and the local activity underpinning this, including by third sector organisations, provides a clear, supportive and inclusive route map to positive behaviour leading to a healthy life.
Delivery lead: Scottish Government. Timescale: Ongoing

7. To consider, as part of the collaborative planning and approval mechanisms under the HISMS, the value of developing a multi-faceted campaign, integrated with local services and initiatives and engaging the full range of health and other professionals, which is targeted at parents to raise awareness of the impact of tobacco on their children's health, including from second-hand smoke, specifically aimed at encouraging smoke-free lifestyles, homes and family vehicles.
Delivery lead: Scottish Government/ NHS Health Scotland. Timescale: Ongoing

8. To ensure as part of the youth strand of the HISMS an ongoing multi-stranded media campaign is in place to discourage uptake of smoking by young people and which has a specific strand focusing on girls and young women in disadvantaged areas.
Delivery lead: Scottish Government Timescale: Ongoing

9. To encourage schools and all youth work/community settings where young people gather to adopt clear no smoking policies and in addition we ask that they reinforce messages concerning the addictiveness and health risks associated with smoking.
Delivery lead: Local Authorities/Community Learning and Development Partnerships/YouthLink Scotland/ NHS Boards. Timescale: Ongoing

10. To develop and assess the feasibility of a small number of pilot interventions designed to discourage the uptake and/or encourage smoking cessation in young people, particularly those living in disadvantaged circumstances; and, if appropriate, to evaluate the effectiveness of the most promising intervention(s).
Delivery lead: NHS Health Scotland/Partnership Action on Tobacco and Health. Timescale: September 2009/10