Starting young? children’s experiences of trying smoking during pre-adolescence

Although the risks smoking poses to health are now well known, many young people continue to take up the habit. While numerous crosssectional studies of adolescents have identified correlates of smoking initiation, much less prospective, longitudinal research has been conducted with young children to gather their accounts of early experiences of smoking, and this study fills that significant gap. Quantitative and qualitative data, collected using questionnaires, interviews and focus groups, are presented from the pre-adolescent phase of the Liverpool Longitudinal Study of Smoking. By age 11, 27% of the cohort had tried smoking, 13% had smoked repeatedly and 3% were smoking regularly. Rates of experimentation increased over time. Qualitative data revealed that curiosity and the role of peers were central to children’s accounts of early smoking. By preadolescence, children are at different stages in their smoking careers, therefore interventionsmust be targeted to their varied experiences. Current prevention strategies often focus on restricting access to cigarettes, but a broad range of intervention measures is required which take account of the multifactorial nature of smoking onset. To be effective, policies that aim to prevent smoking must be grounded in children’s lived experiences

Perspectives on smoking of Liverpool primary schoolchildren in their early years.

There is a dearth of smoking research involving young children despite the knowledge that the developmental proocess begins in early childhood. This paucity hinders the development of effective smoking prevention strategies, which need to be based on an accurate understanding of the perspectives of the target group. Therefore basic research is required, to discover where primary school children are at in their thinking about smoking before any potent anti-smoking initiatives can be devised. Such an endeavour however, is exacerbated by the lack of appropriate methods of data collection for this particular age group. The aim of this research study was to explore the perspectives that Liverpool primary schoolchildren in their early years (four to eight years of age) have about smoking by examining the beliefs, knowledge, perceptions and behavioural intentions that inform their attitudes about the habit and subsequently, to assess any changes in these factors over time. This work not only provides the understanding and insight fumdamental to the development of proactive health promotion programmes aimed at tackling the increasing prevalence of smoking among local children but also the empirical evidence needed to fill the significant gap in the existing literature on smoking as well. To achieve these aims ,a multi-method, child-centred participatory approach was used. This between-methods traingulation included questionnaires The Draw and Write Technique, semi-structured interviews and focus group interviews. For the cross-sectional study, a representative sample of primary schoolchildren in their early years from wards of varying socio-economic status participated. All were involved in the quantitative method and a subsample partook in the qualitative methods. For the longitudinal study, the same research design was used to track one birth cohort - the children from Reception for a period of three years to document any changes in perspective over time. The research findings from both studies demonstrated that the children in this investigation had considerable understanding about the nature of tobacco smoke, had as yet to take up the habit and generally expressed little intention to smoke in the future. Their perspectives were predominantly negative, very stable and relatively homogenous. They were grounded in a broad knowledge base that was primarily influenced by cognitive development and socio-cultural experiences. They acknowledged the importance of the family and perceived parents to be both preventers and promoters of the habit. The children also harboured some misconceptions, believing that the health implications from smoking were far greater for children than adults. This belief has cultivated a widespread notion that smoking is an intrinsic part of adulthood. The study findings have substantive implications for the development of proactive smoking interventions in primary schools. The results suggest that any prevention strategy devised must be implemented as early as possible in the school curriculum, that it should be developmental in nature and more than knowledge- based. A grass roots approach, one that fosters empowerment tbrough the active involvement of the children in both the development and implementation of the strategy, in collaboration with the school, the home and the community is recommended, as this work has confirmed that children in their early years can be reliable and valid participants in the research process

Effect of a sport-for-health intervention (SmokeFree Sports) on smoking-related intentions and cognitions among 9-10 year old primary school children: a controlled trial.

BACKGROUND: Preventing children from smoking is a public health priority. This study evaluated the effects of a sport-for-health smoking prevention programme (SmokeFree Sports) on smoking-related intentions and cognitions among primary school children from deprived communities. METHODS: A non-randomised-controlled trial targeted 9-10 year old children from Merseyside, North-West England. 32 primary schools received a programme of sport-for-health activities over 7 months; 11 comparison schools followed usual routines. Data were collected pre-intervention (T0), and at 8 months (T1) and one year post-intervention (T2). Smoking-related intentions and cognitions were assessed using an online questionnaire. Intervention effects were analysed using multi-level modelling (school, student), adjusted for baseline values and potential confounders. Mixed-sex focus groups (n = 18) were conducted at T1. RESULTS: 961 children completed all assessments and were included in the final analyses. There were no significant differences between the two study groups for non-smoking intentions (T1: β = 0.02, 95 % CI = -0.08-0.12; T2: β = 0.08, 95 % CI = -0.02-0.17) or for cigarette refusal self-efficacy (T1: β = 0.28, 95 % CI = -0.11-0.67; T2: β = 0.23, 95 % CI = -0.07-0.52). At T1 there was a positive intervention effect for cigarette refusal self-efficacy in girls (β = 0.72, 95 % CI = 0.21-1.23). Intervention participants were more likely to 'definitely' believe that: 'it is not safe to smoke for a year or two as long as you quit after that' (RR = 1.19, 95 % CI = 1.07-1.33), 'it is difficult to quit smoking once started' (RR = 1.56, 95 % CI = 1.38-1.76), 'smoke from other peoples' cigarettes is harmful' (RR = 1.19, 95 % CI = 1.20-2.08), 'smoking affects sports performance' (RR = 1.73, 95 % CI = 1.59-1.88) and 'smoking makes 'no difference' to weight' (RR = 2.13, 95 % CI = 1.86-2.44). At T2, significant between-group differences remained just for 'smoking affects sports performance' (RR = 1.57, 95 % CI = 1.43-1.72). Focus groups showed that SFS made children determined to remain smoke free and that the interactive activities aided children's understanding of smoking harms. CONCLUSION: SFS demonstrated short-term positive effects on smoking attitudes among children, and cigarette refusal self-efficacy among girls. Although no effects were observed for non-smoking intentions, children said that SFS made them more determined not to smoke. Most children had strong intentions not to smoke; therefore, smoking prevention programmes should perhaps target early adolescents, who are closer to the age of smoking onset

A novel mixed-method approach to assess children's sedentary behaviours

Purpose: Accurately measuring sedentary behavior (SB) in children is challenging by virtue of its complex nature. While self-report questionnaires are susceptible to recall errors, accelerometer data lacks contextual information. This study aimed to explore the efficacy of using accelerometry combined with the Digitising Children’s Data Collection (DCDC) for Health application (app), to capture SB comprehensively. Methods: 74 children (9–10 years old) wore ActiGraph GT9X accelerometers for 7 days. Each received a SAMSUNG Galaxy Tab4 (SM-T230) tablet, with the DCDC app installed and a specially designed sedentary behavior study downloaded. The app uses four data collection tools: 1) Questionnaire, 2) Take a photograph, 3) Draw a picture, and 4) Record my voice. Children self-reported their SB daily. Accelerometer data were analyzed using R-package GGIR. App data were downloaded and individual participant profiles created. SBs reported were grouped into categories and reported as frequencies. Results: Participants spent, on average, 629 min (i.e., 73% of their waking time) sedentary. App data revealed most of their out-of-school SB consisted of screen time (112 photos, 114 drawings, and screen time mentioned 135 times during voice recordings). Playing with toys, reading, arts and crafts, and homework were also reported across all four data capturing tools on the app. On an individual level, data from the app often explained irregular patterns in physical activity and SB observed in accelerometer data. Conclusion: This mixed methods approach to assessing SB adds context to accelerometer data, providing researchers with information needed for intervention design

Recovery capital in the context of homelessness, high levels of alcohol consumption, and adverse significant life events

Homelessness and heavy alcohol consumption are increasing global public health concerns. Homelessness is associated with poorer health outcomes, shorter life expectancy, and health risk behaviours. High levels of alcohol consumption intersect with the cause and effect of homelessness making this an important consideration for research. This is explored through a theoretical lens of recovery capital, referring to the resources required to initiate and maintain recovery, and is applied to both heavy alcohol consumption and homelessness. Life history calendars were utilised alongside semi-structured interviews to explore the impact that adverse life events had on alcohol consumption and living situations with 12 participants in contact with homelessness services in North-West England. The findings consider how social, health, and structural-related adverse life events were both a cause and effect of homelessness and increasing consumption of alcohol, which were further exacerbated by a lack of recovery capital. The authors argue for further consideration relating to the intersection of homelessness and high levels of alcohol consumption in relation to recovery capital. The findings have implications for policy and practice by demonstrating the need for relevant services to help individuals develop and maintain resources that will sustain recovery capital

Validating the Sedentary Sphere method in children: does wrist or accelerometer brand matter?

This study aimed to validate the Sedentary Sphere posture classification method from wrist-worn accelerometers in children. Twenty-seven 9-10-year-old children wore ActiGraph GT9X (AG) and GENEActiv (GA) accelerometers on both wrists, and activPAL on the thigh while completing prescribed activities: five sedentary activities, standing with phone, walking (criterion for all 7: observation) and ten minutes free-living play (criterion: activPAL). In an independent sample, 21 children wore AG and GA accelerometers on the non-dominant wrist and activPAL for two days of free-living. Percent accuracy, pairwise 95% equivalence tests (±10% equivalence zone) and intra-class correlation coefficients (ICC) analyses were completed. Accuracy was similar, for prescribed activities irrespective of brand (non-dominant wrist: 77%-78%; dominant wrist: 79%). Posture estimates were equivalent between wrists within brand (±6%, ICC>0.81, lower 95% CI>0.75), between brands worn on the same wrist (±5%, ICC>0.84, lower 95% CI>0.80) and between brands worn on opposing wrists (±6%, ICC>0.78, lower 95% CI>0.72). Agreement with activPAL during free-living was 77%, but sedentary time was underestimated by 7% (GA) and 10% (AG). The Sedentary Sphere can be used to classify posture from wrist-worn AG and GA accelerometers for group-level estimates in children, but future work is needed to improve the algorithm for better individual-level results

Views and experiences of hepatitis C testing and diagnosis among people who inject drugs: Systematic review of qualitative research

Background: Many developed countries are facing a major challenge to improve identification of individuals acutely and chronically infected with hepatitis C virus (HCV) infection. We explored the views and experiences of people who inject drugs (PWID) in relation to HCV testing, and diagnosis through a review and synthesis of qualitative research. Methods: Based on the thematic synthesis of qualitative research. Searches were conducted in 14 databases and supplemented by reference checking, hand searching of selected journals, and searches of relevant websites. Studies of any qualitative design that examined the views and experiences of, and attitudes towards, HCV testing and diagnosis among PWID or practitioners involved in their care were included. Key themes and sub-themes were systematically coded according to the meaning and content of the findings of each study which proceeded to the preparation of a narrative account of the synthesis. Results: 28 qualitative studies were identified. We identified a number of overarching descriptive themes in the literature, finding overall that PWID hold complex and differing views and experiences of testing and diagnosis. Three major themes emerged: missed opportunities for the provision of information and knowledge; shifting priorities between HCV testing and other needs; and testing as unexpected and routine. Evidence of missed opportunities for the provision of knowledge and information about HCV were clear, contributing to delays in seeking testing and providing a context to poor experiences of diagnosis. Influenced by the nature of their personal circumstances, perceptions of the risk associated with HCV and the prioritisation of other needs acted both to encourage and discourage the uptake of HCV testing. Undergoing HCV testing as part of routine health assessment, and an unawareness of being testing was common. An unexpected positive diagnosis exacerbated anxiety and confusion. Conclusions: This review has identified that there are modifiable factors that affect the uptake of HCV testing and experiences of HCV diagnosis among PWID. Intervention development should focus on addressing these factors. There is a need for further research that engages PWID from a diverse range of populations to identify interventions, strategies and approaches that they consider valuable

"If You Don't Drink at University, You're Going to Struggle to Make Friends" Prospective Students' Perceptions around Alcohol Use at Universities in the United Kingdom

Background: New students arrive at university with pre-determined perceptions around how alcohol can be used as a tool to overcome anxieties and secure new friendships, which in turn influences students’ drinking behaviors. From a health promotion perspective, the transition to university may present a unique yet understudied opportunity to challenge and reframe situated drinking norms. This paper explores prospective university students’ perceptions of the role that alcohol plays at university and the influence that these perceptions have on behavior. Method: Focus groups with 46 prospective university students (aged 16-20 years) recruited from colleges and sixth forms in the North West of England. Results: Through various sources of information, new students arrive at university with pre-conceived perceptions of a heavy student drinking culture and knowledge around how alcohol can be used to aid successful integration with new peers. Alcohol was viewed by new students as a social lubricant which is key to accruing social capital. Cultural presentations of the student drinker identity led prospective students to formulate negative connotations of those students who transgress from the norms of drinking. Conclusions: The findings provide new insights into how young people conceptualize alcohol at university and the impact that these perceptions have on shaping ideology and influencing drinking behavior. Breaking down these norms presents real challenges for those trying to address excessive drinking in universities, therefore, early intervention which challenges, re-frames and modifies perceptions before students arrive on campus may help to reduce the pressure and expectations to drink in social situations

“I think we should all be singing from the same hymn sheet” – English and Swedish midwives’ views of advising pregnant women about alcohol

Many countries have adopted abstinence guidelines for pregnant women, due to uncertainty around the risk of harm caused by small amounts of alcohol. There is a lack of research exploring frontline midwives’ attitudes towards alcohol use during pregnancy and comparisons of practices in different countries. Sixteen semi-structured interviews were conducted with midwives working in Liverpool, England (n = 7) and Örebro County, Sweden (n = 9). Data were analysed inductively, using thematic analysis with thematic networks. The findings show that all midwives believed pregnant women should be advised not to consume any alcohol during pregnancy and there is a need to tailor their approach to the individual. A key concern among midwives in both countries was how to advise about alcohol exposure that occurs before the pregnancy is known to the woman. English midwives discussed the uncertainty around the risk of consuming small amounts of alcohol, whereas Swedish midwives believed any amount of alcohol was associated with risk. Discussing alcohol was viewed as part of the health professional’s role, but routine questions for all women were perceived to aid discussions about alcohol. Future research should further explore the impact of wider social and political environment on midwives’ attitudes around risks with prenatal alcohol use. © 2018 Informa UK Limited, trading as Taylor & Francis Grou