Find Papers by Expertise
Search by Name or Keyword
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
Dr Ciara McGee, Joanne Trigwell, Stuart Fairclough, Rebecca Murphy, Dr Lorna Porcellato, Michael Ussher, Lawrence Foweather
BMC Public Health, BMC series – open, inclusive and trusted 16:445, 2016.
Abstract: 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.
Influence of family and friend smoking on intentions to smoke and smoking-related attitudes and refusal self-efficacy among 9–10 year old children from deprived neighbourhoods: a cross-sectional study
Dr Ciara McGee, Joanne Trigwell, Rebecca Murphy, Dr Lorna Porcellato, Michael Ussher, Lawrence Foweather
BMC Public Health 15:225, 2015.
Abstract: Background: Smoking often starts in early adolescence and addiction can occur rapidly. For effective smoking prevention there is a need to identify at risk groups of preadolescent children and whether gender-specific intervention components are necessary. This study aimed to examine associations between mother, father, sibling and friend smoking and cognitive vulnerability to smoking among preadolescent children living in deprived neighbourhoods. Methods: Cross-sectional data was collected from 9–10 year old children (n =1143; 50.7% girls; 85.6% White British) from 43 primary schools in Merseyside, England. Children completed a questionnaire that assessed their smoking-related behaviour, intentions, attitudes, and refusal self-efficacy, as well as parent, sibling and friend smoking. Data for boys and girls were analysed separately using multilevel linear and logistic regression models, adjusting for individual cognitions and school and deprivation level. Results: Compared to girls, boys had lower non-smoking intentions (P = 0.02), refusal self-efficacy (P = 0.04) and were less likely to agree that smoking is ‘definitely’ bad for health (P < 0.01). Friend smoking was negatively associated with non-smoking intentions in girls (P < 0.01) and boys (P < 0.01), and with refusal self-efficacy in girls (P < 0.01). Sibling smoking was negatively associated with non-smoking intentions in girls (P < 0.01) but a positive association was found in boys (P = 0.02). Boys who had a smoking friend were less likely to ‘definitely’ believe that the smoke from other people’s cigarettes is harmful (OR 0.57, 95% CI: 0.35 to 0.91, P = 0.02). Further, boys with a smoking friend (OR 0.38, 95% CI: 0.21 to 0.69, P < 0.01) or a smoking sibling (OR 0.45, 95% CI: 0.21 to 0.98) were less likely to ‘definitely’ believe that smoking is bad for health. Conclusion: This study indicates that sibling and friend smoking may represent important influences on 9–10 year old children’s cognitive vulnerability toward smoking. Whilst some differential findings by gender were observed, these may not be sufficient to warrant separate prevention interventions. However, further research is needed.
Process evaluation of a sport-for-health intervention to prevent smoking amongst primary school children: SmokeFree Sports
Joanne Trigwell, Dr Ciara McGee, Rebecca Murphy, Dr Lorna Porcellato, Michael Ussher, Katy Garnham-Lee, Zoe Knowles, Lawrence Foweather
BMC Public Health 15:347, 2015.
Abstract: Background: SmokeFree Sports (SFS) was a multi-component sport-for-health intervention aiming at preventing smoking among nine to ten year old primary school children from North West England. The purpose of this study was to evaluate the process and implementation of SFS, examining intervention reach, dose, fidelity, acceptability and sustainability, in order to understand the feasibility and challenges of delivering such interventions and inform interpretations of intervention effectiveness. Methods: Process measures included: booking logs, 18 focus groups with children (n = 95), semi-structured interviews with teachers (n = 20) and SFS coaches (n = 7), intervention evaluation questionnaires (completed by children, n = 1097; teachers, n = 50), as well direct observations (by researchers, n = 50 observations) and self-evaluations (completed by teachers, n = 125) of intervention delivery (e.g. length of sessions, implementation of activities as intended, children’s engagement and barriers). Descriptive statistics and thematic analysis were applied to quantitative and qualitative data, respectively. Results: Overall, SFS reached 30.8% of eligible schools, with 1073 children participating in the intervention (across 32 schools). Thirty-one schools completed the intervention in full. Thirty-three teachers (55% female) and 11 SFS coaches (82% male) attended a bespoke SFS training workshop. Disparities in intervention duration (range = 126 to 201 days), uptake (only 25% of classes received optional intervention components in full), and the extent to which core (mean fidelity score of coaching sessions = 58%) and optional components (no adaptions made = 51% of sessions) were delivered as intended, were apparent. Barriers to intervention delivery included the school setting and children’s behaviour and knowledge. SFS was viewed positively (85% and 82% of children and teachers, respectively, rated SFS five out of five) and recommendations to increase school engagement were provided. Conclusion: SFS was considered acceptable to children, teachers and coaches. Nevertheless, efforts to enhance intervention reach (at the school level), teachers’ engagement and sustainability must be considered. Variations in dose and fidelity likely reflect challenges associated with complex intervention delivery within school settings and thus a flexible design may be necessary. This study adds to the limited scientific evidence base surrounding sport-for-health interventions and their implementation, and suggests that such interventions offer a promising tool for engaging children in activities which promote their health.
Professor Karen Hughes, Professor Mark Bellis, Katie Hardcastle, Dr Phil McHale, Andrew Bennett, Robin Ireland, Kate Pike
BMC Public Health 15:244, 2015.
Abstract: Background: Public health concerns regarding e-cigarettes and debate on appropriate regulatory responses are focusing on the need to prevent child access to these devices. However, little is currently known about the characteristics of those young people that are accessing e-cigarettes. Methods: Using a cross-sectional survey of 14-17 year old school students in North West England (n = 16,193) we examined associations between e-cigarette access and demographics, conventional smoking behaviours, alcohol consumption, and methods of accessing cigarettes and alcohol. Access to e-cigarettes was identified through a question asking students if they had ever tried or purchased e-cigarettes. Results: One in five participants reported having accessed e-cigarettes (19.2%). Prevalence was highest among smokers (rising to 75.8% in those smoking >5 per day), although 15.8% of teenagers that had accessed e-cigarettes had never smoked conventional cigarettes (v.13.6% being ex-smokers). E-cigarette access was independently associated with male gender, having parents/guardians that smoke and students’ alcohol use. Compared with non-drinkers, teenagers that drank alcohol at least weekly and binge drank were more likely to have accessed e-cigarettes (adjusted odds ratio [AOR] 1.89, P < 0.001), with this association particularly strong among never-smokers (AOR 4.59, P < 0.001). Among drinkers, e-cigarette access was related to: drinking to get drunk, alcohol-related violence, consumption of spirits; self-purchase of alcohol from shops or supermarkets; and accessing alcohol by recruiting adult proxy purchasers outside shops. Conclusions: There is an urgent need for controls on the promotion and sale of e-cigarettes to children. Findings suggest that e-cigarettes are being accessed by teenagers more for experimentation than smoking cessation. Those most likely to access e-cigarettes may already be familiar with illicit methods of accessing age-restricted substances.
Adverse childhood experiences and associations with health-harming behaviours in young adults: surveys in the European Region
Professor Mark Bellis, Professor Karen Hughes, Nicola Leckenby, Lisa Jones, Adriana Baban, Margarita Kachaeva, Robertas Povilaitis, Iveta Pudule, Gentiana Qirjako, Betul Ulukol, Marija Raleva, Natasa Terzic
Bulletin of the World Health Organization, Online first format, 2014.
Abstract: Objective To evaluate the association between adverse childhood experiences – e.g. abuse, neglect, domestic violence and parental separation, substance use, mental illness or incarceration – and the health of young adults in the eastern European Region. Methods: Between 2010 and 2013, adverse childhood experience surveys were undertaken in Albania, Latvia, Lithuania, Montenegro, Romania, the Russian Federation, The former Yugoslav Republic of Macedonia and Turkey. There were 10’696 respondents – 59.7% female – aged 18–25 years. Multivariate modelling was used to investigate the relationships between adverse childhood experiences and health-harming behaviours in early adulthood including substance use, physical inactivity and attempted suicide. Findings: Over half of the respondents reported at least one adverse childhood experience. Having one adverse childhood experience increased the probability of having other adverse childhood experiences. The number of adverse childhood experiences was positively correlated with subsequent reports of harming behaviours. Compared with those who reported no adverse experiences, respondents who reported at least four adverse childhood experiences were at significantly increased risk of many health-harming behaviours, with odds ratios varying from 1.68 (95% confidence interval (CI): 1.32–2.15) – for physical inactivity – to 48.53 (95% CI: 31.98–76.65) – for attempted suicide. Modelling indicated that prevention of adverse childhood experiences would substantially reduce the occurrence of many health-harming behaviours within the study population. Conclusion: Our results indicate that individuals who do not develop health-harming behaviours are more likely to have experienced safe, nurturing childhoods. Evidence-based programmes to improve parenting and support child development need large-scale deployment in the eastern European Region.
Preventing smoking among nine to ten-year-old children using a novel school-based physical activity intervention: Overview of SmokeFree Sports
Joanne Trigwell, Dr Ciara McGee, Helen Casstles, Rebecca Murphy, Dr Lorna Porcellato, Michael Ussher, Lawrence Foweather
Education and Health, 2014.
P hysical activity (PA) is associated with many health benefits, including reduced risk of of hypertension, coronary heart disease, stroke and heart disease (Chief Medical Officers, 2011). From an educational perspective, PA has been found to improve cognitive functioning, aiding children’s learning through improved concentration (Norlander et al., 2005), attention (Maher, 2011) and memory (Kamijo et al., 2011). Children participate in PA in multiple ways; for example, active play, physical education (PE), and extra-curricular and community sport programmes. Moreover, children enjoy participating in PA and often want to increase their participation (Ridgers et al., 2006). Given that there is evidence that taking part in PA may be protective against smoking uptake (Audrain-McGovern et al., 2003; Rodriguez and Audrain-McGovern, 2005; Kaczynski et al., 2008), it is suggested that PA contexts such as PE and sport could be utilised as a vehicle for smoking prevention. The use of sport to deliver smoking education has previously been trialled in the US and Canada with initiatives such as Tobacco Free Sports (The US Centers for Disease Control and Prevention, 2007), Tobacco Free Athletes (www.tobaccofreemaine.org) and Play, Live, Be Tobacco Free.
Dr Ivan Gee, Sean Semple, Adrian Watson, Andrea Crossfield
Tobacco Control Online First, 2012.
Tobacco control campaigns frequently make use of statistical and scientific information to inform the public and policy makers about the dangers of tobacco smoke. It is clearly crucial for the credibility of tobacco control programmes that accurate scientifically valid information is used in these campaign materials, and Siegel1 highlights the importance of ensuring that the evidence base of these materials is scientifically sound. In 2002, the British Medical Association produced a report on passive smoking that indicated: “Almost 85 per cent of secondhand smoke is in the form of invisible, odourless gases.”2 This referenced a US National …
The relationship between workers’ self-reported changes in health and their attitudes towards a workplace intervention: lessons from smoke-free legislation across the UK hospitality industry
Laura MacCalman, Sean Semple, Karen Galea, Martie van Tongeren, Scott Dempsey, Shona Hilton, Dr Ivan Gee, Jon Ayres
BMC Public Health, 12, p 324, 2012.
Abstract: Background: The evaluation of smoke-free legislation (SFL) in the UK examined the impacts on exposure to second-hand smoke, workers’ attitudes and changes in respiratory health. Studies that investigate changes in the health of groups of people often use self-reported symptoms. Due to the subjective nature it is of interest to determine whether workers’ attitudes towards the change in their working conditions may be linked to the change in health they report. Methods: Bar workers were recruited before the introduction of the SFL in Scotland and England with the aim of investigating their changes to health, attitudes and exposure as a result of the SFL. They were asked about their attitudes towards SFL and the presence of respiratory and sensory symptoms both before SFL and one year later. Here we examine the possibility of a relationship between initial attitudes and changes in reported symptoms, through the use of regression analyses. Results: There was no difference in the initial attitudes towards SFL between those working in Scotland and England. Bar workers who were educated to a higher level tended to be more positive towards SFL. Attitude towards SFL was not found to be related to change in reported symptoms for bar workers in England (Respiratory, p = 0.755; Sensory, p = 0.910). In Scotland there was suggestion of a relationship with reporting of respiratory symptoms (p = 0.042), where those who were initially more negative to SFL experienced a greater improvement in self-reported health. Conclusions: There was no evidence that workers who were more positive towards SFL reported greater improvements in respiratory and sensory symptoms. This may not be the case in all interventions and we recommend examining subjects’ attitudes towards the proposed intervention when evaluating possible health benefits using self-reported methods.
Beth Milton, Lindsey Dugdill, Dr Lorna Porcellato, Jane Springett
Children & Society, Volume 26, Issue 2, pp 89–99, 2012.
Abstract: While studies have shown that adults use smoking to deal with stress, little research has been carried out with children to explore their perceptions of smoking as a coping strategy. Qualitative questionnaire and interview data were generated with children aged 9–11 years. Participants perceived that adults smoked to relieve boredom and stress, and suggested that children might smoke for the same reasons. Children were more likely to know that adults smoked to deal with stress if they lived in a deprived area. Girls were more likely to believe that some children need to smoke as a coping strategy.
Framing health messages for adolescents: Should we use objective time periods, temporal benchmarks, or both?
Dr Michael McKay, Jon Cole, Professor Harry Sumnall, Andrew Goudie
Journal of Youth Studies 15(3), 351-368, 2012.
Abstract: Time perspective is a cognitive-motivational construct, which has been shown to be related to decision-making, motivation and adjustment. The majority of research into time perspective has been conducted in college students and/or general population samples. Focus groups were held as part of a larger investigation into the relationship between adolescent time perspectives and alcohol-related behaviours. Results show that adolescents conceptualise time in both objective and more abstract ways. In particular, they appear to conceptualise short-term past and future more objectively and long-term past and future in more abstract terms. Their conceptualisation of the present predominated on immediate events, although in some cases the present was an extended one, covering a school-related period of time.