Case study: helping children quit

In most schools, the emphasis is on trying to prevent children from starting smoking rather than helping them stop. But it's important to support those who have already taken up the habit, and "giving-up" is an issue all schools should tackle.

But there are particular difficulties in persuading children to quit. Our own research in Lewisham found that only around 2 per cent of boys in Years 8, 9 and 10 who are regular smokers want to give up. The figure for girls is slightly higher, but still only 7 per cent. On a brighter note, there were a considerable number of pupils who had given up, of their own accord, and classed themselves as ex-smokers at the age of 15. So it can be done.

Part of the problem is that most anti-smoking material centres around the health risks, yet the perception among young people is that they will never die. A recent "Big Puff Forum" with pupils from five local secondary schools suggested that those who wanted to give up had two main fears: "I don't know if I can" and "I don't know how to do it". A survey of 15-year-old smokers found that most preferred the idea of cutting down to quitting, but most were willing to try an organised cessation programme if it was free and "if my friends come along too".

One point that put students off joining a programme was the worry that it would mean their parents would find out they smoked. The forum also highlighted the apparent hypocrisy of school staff telling pupils not to smoke. "You should smell some of the teachers," said one respondent. "How can they tell me to give up when they do it themselves? Some even ask for a puff of my cigarette."

Perhaps the answer is for schools to persuade staff and pupils to give up together. Deptford Green secondary school, for example, developed a smoking cessation programme in July last year, aimed at Year 9 and 10 students but also open to staff. The sessions were run over six weeks at lunchtimes.

Relaxation methods such as acupuncture and deep breathing exercises were used to combat the urge to smoke, along with stickers, positive praise and target-setting. There was also a "smokealyser" to catch out the cheats.

Students banked the money they would have spent on cigarettes, and this financial incentive proved more effective in some cases than warnings about cancer or heart disease. Regular group work and the creation of individual plans all boosted confidence. The crunch point was when we set a quit date (with a contingency plan).

At the end of the programme students were delighted that "my sense of taste has returned" and "I can run further and faster". Overall, 20 per cent of students and staff managed to quit. Factors that contributed towards potential quitters' success or failure included the level of trust between the participant and the facilitators, and the motivation and involvement of the person trying to quit. The support of senior management and governors, time to plan, adequate funding and access to on-going advice were also important in making the project work.

Although our focus has so far been on secondary schools, we want to design sessions with primary children in mind. The Smoking Book Pack for secondary school pupils, for example, designed by Lewisham, Southwark and Lambeth Healthy Schools, is being adapted for primaries. Whilst the focus of these packs is on prevention rather than cessation, they could be used as an aid for groups trying to quit.

We also want to develop more groups that work with staff and students together. Obviously, we need to think about issues of confidentiality and we'd have to be careful about group dynamics. We don't want to compromise staff professionalism. It's not yet clear whether groups work best if young people are on their own, or if it's more effective to run a mixed group with adults. But the best way to find out is to encourage more schools to allow teachers and pupils to face up to the challenge together.

Sarah Blackshaw is drug education adviser in the London borough of Lewisham

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