School-based interventions to prevent smoking
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This document provides an overview of NICE guidance on implementing school-based interventions to prevent smoking among children and young people. It covers the background on smoking prevention, the scope of the guidance, key recommendations including developing smoke-free policies, integrating anti-smoking curriculum, adult-led and peer-led interventions, training for staff, and ensuring a coordinated community approach. It also discusses potential costs and savings of the recommendations and opportunities to link with existing health programs.
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School-based interventions to prevent smoking
- 1. School-based interventions to prevent smoking Implementing NICE guidance 2010 NICE public health guidance 23
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- ABOUT THIS PRESENTATION: This presentation has been written to help you raise awareness of the NICE public health guidance on school-based interventions to prevent the uptake of smoking among children and young people. The guidance is for commissioners, managers and practitioners who have a direct or indirect role in, and responsibility for, preventing the uptake of smoking by children and young people . This includes those working in the NHS, local authorities, education and the wider public, private, voluntary and community sectors. I t may also be of interest to children and young people, their parents or carers and other members of the public. The guidance and a quick reference guide are available from NICE. You may want to hand out copies of the quick reference guide at your presentation so that your audience can refer to it. See the end of the presentation for ordering details. You can add your own organisation’s logo alongside the NICE logo. We have included notes for presenters broken down into ‘key points to raise’, which you can highlight in your presentation, and ‘additional information’ that you may want to draw on, such as the rationale, or an explanation of the evidence, for a recommendation. DISCLAIMER This slide set is an implementation tool and should be used alongside the published guidance. This information does not supersede or replace the guidance itself. PROMOTING EQUALITY Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent with compliance with those duties.
- NOTES FOR PRESENTERS: In this presentation we will start by providing some background to the guidance and why it is important. We will then present the recommendations. Next, we will summarise the costs and savings that are likely to be incurred in implementing the guidance. Then we will open up the meeting with a list of questions to help prompt discussion on local issues which may affect how the guidance is put into practice. Finally, we will end the presentation with further information about the support provided by NICE. Key points to raise The recommendations cover the following: ‘ Whole-school’ approach; Adult-led interventions; Peer-led interventions; Training and development; Coordinated approach. ‘ Schools’ in this context include: maintained and independent primary, secondary and special schools; city technology colleges and academies; pupil referral units, secure training and local authority secure units; further education colleges; ‘extended schools’ where childcare or informal education is provided outside school hours. Additional information Recommendations 1-3 are aimed at head teachers, school governors, teachers, support staff and others who work with primary and secondary schools and further education colleges. This includes: Healthy Schools and Healthy Further Education Programme leads; personal, social, health and economic (PSHE) education coordinators; school nurses; counsellors . Recommendation 3 is also aimed at young people. The target audience for recommendation 4 is head teachers, school governors, public health commissioners, teacher training bodies and providers of continuing professional development. Recommendation 5 is aimed at government departments, school inspectorates, school governing bodies and school commissioners; local authority children’s and youth service leads, primary care trusts and regional and national health commissioners and local tobacco control alliances.
- NOTES FOR PRESENTERS: Key points to raise: NICE recommendations are based on proven best practice. By implementing them, schools and other educational establishments are demonstrating to parents and Ofsted that they take pupils’ health and wellbeing seriously. NICE guidance can help schools choose evidence-based activities and interventions that will help them with their school improvement plans, the Ofsted self-evaluation form and pupil-level wellbeing indicators. (Note: 'Referring to NICE guidance is recommended by the Healthy Schools enhancement model (stage 5) ). School governors can use NICE guidance to demonstrate that they are fulfilling their remit to ensure the health and wellbeing of pupils, as set out in the Education and Inspections Act (Department for Education and Skills 2006). This Act places a duty on governing bodies to promote wellbeing and community cohesion and to take the local area ‘Children and young people's plan’ into consideration. It also makes it a legal requirement to implement many of the proposals set out in the schools white paper: ‘Higher standards, better schools for all’. Additional information: As part of their self-evaluation, schools are expected to indicate the extent to which Department for Children, Schools and Families standards are being met. Ofsted assesses (among other things) the school’s contribution to wellbeing. ‘Wellbeing’ in this context is defined in terms of the five outcomes in ‘Every child matters’: be healthy ; stay safe ; enjoy and achieve ; make a positive contribution; and achieve economic wellbeing. The five outcomes are mutually reinforcing. For example, children and young people learn and thrive when they are healthy, safe and engaged and the evidence shows that educational achievement is the most effective route out of poverty. A signposting document ‘Schools and evidence-based action – NICE recommends’ summarises NICE recommendations that are relevant to schools. Each page provides a link to the specific guidance via the NICE website as well as a link to related Department for Children, Schools or Families or Department of Health guidance. This document is updated annually and is available from the NICE website: www.nice.org.uk/usingguidance/niceimplementationprogramme/ NICE’s work programme is decided by the Department of Health and informed by the Department for Children, Schools and Families.
- NOTES FOR PRESENTERS: Key points to raise: Smoking is the main cause of preventable morbidity and premature death in England. In 2007, it is estimated that 82,900 adults aged 35 and over died as a result of smoking. Those who start smoking before the age of 16 are also more likely to be heavier smokers. Children and young people show signs of addiction within 4 weeks of starting to smoke, even before they start to smoke regularly. The earlier children become regular smokers, the greater their risk of developing lung cancer or heart disease if they continue smoking into adulthood. Additional information: Delaying the onset of smoking is worthwhile, as young people who take up smoking later in life are more likely to stop smoking. Children and young people are more likely to smoke if they have: - used alcohol or drugs - poor educational attainment or are ‘disengaged’ from school - mental or emotional health problems - a parent or step-parent who smokes. The ‘Smoking kills’ white paper (DH 1998) set targets to reduce the number of children aged 11–15 who were regularly smoking. The targets were to reduce the total smoking from 13% (in 1996) to 11% by 2005 and to 9% by 2010 (DH 1998). A new government tobacco control strategy was announced in February 2010. This sets out three objectives: ’to stop the inflow of young people recruited as smokers; to motivate and assist every smoker to quit; and to protect families and communities from tobacco-related harm’. The strategy aims to halve the proportion of people who smoke – from 21% to 10% – by 2020. The Health Act 2009 will remove tobacco displays in shops and creates regulations making powers to ban tobacco sales from vending machines Current prevalence figures report a smoking rate of 6% within the 11-15 year age group. NHS Information Centre (2008) Smoking, drinking and drug use among young people in England .
- NOTES FOR PRESENTERS: Key points to raise: The following groups are not covered in this guidance: Children under 5 who do not attend an educational institution. Children and young people who are educated at home. Children and young people who are excluded from school. Young people aged over 16 who are not in education. Anyone aged 19 and older.
- NOTES FOR PRESENTERS: Key points to raise: This slide covers recommendation 1. Recommendation 1 also says: The organisation-wide smokefree policy should be developed in consultation with young people and staff and should include smoking prevention activities (led by adults or young people) and staff training and development. No area in the grounds should be designated for smoking (with the exception of caretakers’ homes, as specified by law). Refer to NICE guidance on ‘Workplace interventions to promote smoking cessation’ (NICE public health guidance 5). For recommendation 1 in full, see the quick reference guide Additional information: Although this recommendation mentions NHS Stop Smoking Services, please note that this guidance focuses on preventing the uptake of smoking. For NICE guidance on smoking cessation go to www.nice.org.uk/guidance/PH10. The Department for Children, Schools and Families website and the Healthy Schools website both feature resources that could be used to support this work, including an exemplar school premises smokefree award scheme. Smokefree premises signs and information can be accessed via www.smokefreeengland.co.uk/resources Also see ‘School-based interventions on alcohol’ (NICE public health guidance 7); ‘Smoking cessation services’ (NICE public health guidance 10); and ‘Social and emotional wellbeing in primary education’ (NICE public health guidance 12).
- NOTES FOR PRESENTERS: Key points to raise: This and the next slide covers recommendation 2. C lassroom discussions about tobacco could be relevant when teaching a range of subjects including biology, chemistry, citizenship, geography, mathematics and media studies. Additional ‘booster’ activities may include school health fairs and guest speakers. Parents could be encouraged to get involved by, for example, setting homework projects they can help with. For recommendation 2 in full, see the quick reference guide. Additional information: Resources to support delivery are available via the Healthy Schools website and the Training and Development Agency for Schools website. Examples of resources to help involve young people in the design of programmes are available via The Drug Education Forum at www.drugeducationforum.com/publications
- NOTES FOR PRESENTERS: Key points to raise: Recommendation 2 also says interventions should be: ethnically, culturally and gender-sensitive delivered by teachers and higher-level teaching assistants who are credible and competent in the subject - or by external professionals trained to work with children and young people on tobacco issues. For recommendation 2 in full, see the quick reference guide. Additional information: See also: ‘Behaviour change’ (NICE public health guidance 6); ‘School-based interventions on alcohol’ (NICE public health guidance 7); and ‘Preventing the uptake of smoking by children and young people’ (NICE public health guidance 14).
- NOTES FOR PRESENTERS: Key points to raise: This slide covers recommendation 3. Recommendation 3 also says: The risks associated with smoking - and the benefits of not smoking – should be discussed when challenging peer and family norms. Peer leaders should be trained by adults with the appropriate expertise. A UK-based example of a peer programme is ASSIST (A Stop Smoking in Schools Trial) (Campbell R, Starkey F, Holliday J et al. (2008) An informal school-based peer-led intervention for smoking prevention in adolescence [ASSIST]: a cluster randomised trial. Lancet [371] 9624: 1595–602). This recommendation refers to delivery in secondary school settings only - based on the available evidence base. See also ‘School-based interventions on alcohol’ (NICE public health guidance 7). For recommendation 3 in full, see the quick reference guide. Additional information: Peer leaders could be the same age or older than the students they will work with. Young people often overestimate the prevalence of smoking. In a 2006 survey, young people estimated that 63% of their peers smoked – the real figure was 29%.
- NOTES FOR PRESENTERS: Key points to raise: This slide covers recommendation 4. Recommendation 4 also refers readers to: ‘Brief interventions and referral for smoking cessation’ (NICE public health guidance 1); ‘Behaviour change’ (NICE public health guidance 6); and ‘Smoking cessation services’ (NICE public health guidance 10). For recommendation 4 in full, see the quick reference guide.
- NOTES FOR PRESENTERS: Key points to raise: Recommendation 5 also says interventions should: be linked to the school’s smokefree policy and be consistent with regional and national tobacco control strategies follow the Healthy Schools enhancement model. It also refers readers to ’Behaviour change’ (NICE public health guidance 6). For recommendation 5 in full, see the quick reference guide. Additional information: For delivery in city colleges and further education settings, interventions should be integrated with and utilise opportunities for Personal Social Development as part of the work towards Healthy Further Education Programme.
- For further information please see the NICE Financial planning tool that accompanies this guidance. NOTES FOR PRESENTERS: NICE has found that implementing this guidance is unlikely to result in any significant changes in resource use, based on national assumptions. However, different areas may vary from the national average and it is important to look at the recommendations most likely to have a resource impact to make sure that local practice matches the national average. These recommendations are: Adult led interventions - costs may include: staff training, purchasing resources for the interventions, and monitoring and evaluation of the programme. Peer led interventions – costs may include those above plus potential staff backfill costs and travel and subsistence payments. Full details can be found in the Financial planning tool which can be accessed via the guidance page on the NICE website.
- NOTES FOR PRESENTERS: These questions are suggestions that have been developed to help provide a prompt for a discussion at the end of your presentation – please edit and adapt them to suit your local situation. If appropriate, you could ask different groups in the audience to consider different questions. Below are more possible questions, depending on your audience. Additional questions: What learning from delivering other health and wellbeing programmes can we apply here? Which aspect of the guidance might be most difficult to implement and why? What would help us with this task? What support is currently available in schools to discourage children and young people from taking up smoking - how does this match up to that needed to implement NICE’s recommendations? Who are the key partners and stakeholders locally and are they currently involved? What steps should we take next?
- NOTES FOR PRESENTERS: You can download the guidance documents from the NICE website. The guidance, which includes the recommendations, details of how they were developed and evidence statements. A quick reference guide, which lists the recommendations. The NICE schools signposting document is a summary of other NICE recommendations for schools, and can be downloaded from the NICE website. This is aimed at head teachers, school governors and teachers. It includes a link to the relevant page on the NICE website and refers to related Department for Children, Schools and Families/Department of Health guidance. For printed copies of the quick reference guide, phone NICE publications on 0845 003 7783 or email publications@nice.org.uk and quote reference number N2083. NICE has developed tools to help organisations implement this guidance. These include a financial planning tool. They can be found on the NICE website.