APPENDIX 5
Memorandum by the Roy Castle Lung Cancer
Foundation (TB 7)
SUMMARY
1. Credentials of the Foundation
The Roy Castle Foundation can speak with authority
on smoking issues particularly with regard to the young.
2. Focus of evidence
The focus of evidence will be on consumer protection
with particular reference to children and young people.
3. Need for research base
A great deal of money will be wasted if new
interventions are not properly research-based and submitted to
long term evaluation.
4. Why children?
Virtually all new smokers are children and young
people. Because of the addictive nature of cigarettes and the
long-term health consequences, there is an imperative need to
focus smoking prevention initiatives on this age group.
5. Primary schoolchildren
There is a need for a new emphasis on smoking
education in primary schools based on a knowledge of the attitudes
and perceptions of this age group and the psychosocial factors
which influence these and determine which children start to smoke
and which do not.
6. Teenagers
Telling teenagers who smoke about the health
dangers does not seem to work. New methods of smoking prevention
must be developed. The young people themselves need to be intimately
involved in the development and implementation of any new strategies.
Their idealism and concern for others should be harnessed to find
original ways of motivating them not to smoke.
7. Passive smoking
The effects of environmental smoke on children's
health are well documented. Parents, and indeed all adults, have
a serious obligation to protect their children in this respect.
Children have the right to expect the Government to safeguard
their interests if these are being violated and to ensure an environment
which is healthy and conducive to their well being.
1. CREDENTIALS OF
THE FOUNDATION
The Roy Castle Foundation can speak with authority
on smoking issues particularly with regard to the young
1.2 The Roy Castle Lung Cancer Foundation
has, in addition to an intensive scientific research programme
into the development and prevention of lung cancer, a very active
programme in smoking prevention and cessation which includes the
following.
1.3 Community based stop-smoking project,
Roy Castle Fag Ends, which uses peer to peer smoking cessation
techniques in areas of greatest need. This has been selected by
Merseyside Health Action Zone to provide its smoking cessation
specialist services. With several years experience behind it Fag
Ends provides a model, which is attracting considerable interest
from other HAZ's across the country.
1.4 Smoking prevention co-ordinator for
the city of Liverpool to ensure, through the City Council, a co-ordinated
approach to smoking programmes across the city including the development
of smoking policies for companies and negotiations with the hospitality
industry.
1.5 A four-year research programme into
the attitudes, perceptions, beliefs and smoking prevalence of
Liverpool primary school children. These have been studied from
Reception and are now nine years old. They will be followed through
the age of experimentation with a view to identifying those who
begin to smoke and those who do not. Using this information new
interventions will be devised for use in primary school to prevent
children ever starting to smoke.
1.6 Collaborative programme with Animaction
in which teams of adolescents create short public service announcements
with anti-smoking messages. Videos are shown to school assemblies,
parents, the wider community. Nickelodeon, the Cartoon Network,
has indicated a willingness to become sponsors of this programme
and to show selected items on satellite television.
1.7 The recruitment on to the staff of the
Foundation a Tobacco Control Executive to give specialist attention
to the Foundation's tobacco affairs.
1.8 Presently fundraising for the appointment
of a Professor of Childhood Smoking Prevention at Liverpool John
Moores University. This person will head up the research arm of
the Foundation's Kids Against Tobacco Smoke (KATS) programmes
addressing tobacco issues as they affect children and young people.
1.9 A public voice through all forms of
the media. The Roy Castle name has a very positive and popular
profile in the media and the Foundation is frequently asked to
comment on tobacco matters at national and local level.
1.10 The organisation of national conferences
on tobacco issues, one in London in 1998 on Tobacco and Young
People, at which Tessa Jowell and Commissioner Padraig Flynn both
spoke, and one in Glasgow in 1999 on Tobacco Issues in the Millennium.
2. FOCUS OF
EVIDENCE
2.1 The focus of this evidence will be on
consumer protection with particular reference to children and
young people.
2.2 The committee will receive an abundance
of evidence from many individuals and organisations on the role
of the tobacco companies in suppressing information and its predatory
behaviour towards vulnerable groups such as the poor, the young
and the disadvantaged. We would be prepared to write in support
of this but have nothing new to say that is not already in the
public domain.
2.3 Our submission, therefore, will focus
on the role of Government in providing consumer protection with
particular emphasis on children and young people in which the
Foundation has special experience.
3. NEED FOR
RESEARCH BASE
3.1 A great deal of money could be wasted
if new interventions are not properly research-based and submitted
to long term evaluation.
3.2 There is a tendency in health promotion
for people to have good well meant and sometimes original ideas
and to implement these without an underlying rigorous research
programme on which to base the ideas and subsequently to evaluate
them. Evaluation is becoming the norm but fundamental research
is still lagging behind.
3.3 A strong, properly funded research base
is essential to the successful implementation of any new interventions
to prevent and stop smoking. Without proper knowledge of the multiple
and complex psychosocial factors responsible for people smoking,
any new resources put into new smoking prevention initiatives
could be wasted resulting in a great flurry of hype and activity
with no meaningful gains at the end. This has been the case to
some extent in recent years when, in spite of all the activity
of government and other organisations, the number of young people
smoking has risen significantly and continues to rise.
3.4 The new funds which the Government is
making available must make a real difference and, to achieve this,
some of it must first be channelled into properly conducted university
based research programmes which actively recruit and involve the
people to be targeted by any new smoking prevention initiatives.
Meticulous evaluation must accompany these initiatives both during
and after the process. This evaluation must also be long term,
initially with annual follow-up if a true measure of effectiveness
is to be obtained.
4. WHY CHILDREN?
4.1 Virtually all new smokers nowadays are
children and young people. Because of the addictive nature of
cigarettes and the long-term health consequences, there is an
imperative need to focus smoking prevention initiatives on this
age group.
4.2 Virtually all new smokers nowadays are
children and young people. Gone are the days when adults started
to smoke. Some of the new smokers are as young as seven and eight
years old and most of them will be found in areas of deprivation
with all its attendant social problems. In this context it would
be wrong to look at smoking in isolation but it is the factor
more than all the others put together which will lead to long
term illness, underachievement, poor self image and premature
death. It has been estimated that half of the teenagers smoking
regularly will die from a smoking related disease if they do not
stop.
4.3 The World Health Organisation has stated
that 250 million children alive in the world today will die from
a smoking related disease and in most cases this will be preceded
by years of illness and incapacity.
4.4 Smoking, however, is not restricted
to children from poorer families. The number of young people in
universities and in employment is rising, particularly young women.
4.5 Because of the addictive nature of cigarettes,
most young people who smoke will continue to do so with all the
resulting consequences for their health. Nicotine is rapidly addictive
and Clifford Douglas has demonstrated seven major ways in which
the tobacco companies enhance the nicotine content of cigarettes
and its effects on the brain.
4.6 There is evidence from American scientists
that the first changes of lung cancer can be demonstrated in the
genes of lung cells within eight years of the onset of smoking.
These may be irreversible, because of the young age of many new
smokers, they may be demonstrable by the age of 20 years. In years
to come, therefore, we will be seeing many patients with lung
cancer and by corollary other smoking related diseases, in their
middle to late thirties. And it must be remembered that 95 per
cent of patients with lung cancer die within five years of diagnosis.
4.7 For these reasons there is an imperative
need to focus smoking prevention on children and young people.
For many adult smokers the progression o lung cancer, the most
common of the cancers, is inevitable irrespective of whether they
give up smoking. More and more patients present nowadays with
lung cancer who are ex-smokers because the genetic events leading
up to the clinical disease have been well established and will
inevitably lead to malignancy in the lung.
(The scientific research programme of the Roy
Castle Foundation is aimed at identifying these genetic events
and finding ways of repairing them or at least of preventing their
progression to clinical lung cancer).
5. PRIMARY SCHOOL
CHILDREN
5.1 There is a need for a new emphasis on
smoking education in primary schools based on a knowledge of the
attitudes and perceptions of this age group and the psychosocial
factors which influence these and determine which children start
to smoke and which do not.
5.2 Because smoking has been mainly a habit
of teenagers, little emphasis has been attached to smoking prevention
in children in primary school. In fact there has been a resistance
to this among educators since it is not seen as a problem at this
age. There has been a concern about raising awareness of the smoking
habit in young children and any smoking education has been generally
mixed up with other social teaching on drugs, sex and alcohol.
5.3 We believe that smoking education should
be given a much higher priority because of the scale of the long
term health and social consequences. Although this receives some
mention in the curriculum for Key Stage 2 it is at the discretion
of the teacher. There is no provision at all in Key Stage 1.
5.4 We would argue that, if we are to reduce
the number of pre-teens and early teenagers smoking (and there
are increasing numbers of these), special consideration should
be given to educating children aged four to nine years and to
understand the psychosocial factors which influence them subsequently
to smoke.
5.5 New educational strategies and health
promotion techniques, including the improvement of personal and
social skills, must be developed for use in primary schools, the
sole purpose of which should be to reduce the number of children
starting to smoke.
5.6 These strategies and techniques must
be based on high quality research programmes, such as those being
funded by the Roy Castle Foundation, into the perceptions and
beliefs of children in this age group and the psychosocial factors
which influence or even overcome these and which determine which
children start to smoke and which do not.
6. TEENAGERS
6.1 Telling teenagers who smoke about the
health dangers does not seem to work. New methods of smoking prevention
must be developed. The young people themselves need to be intimately
involved in the development and implementation of any new strategies.
Their idealism and concern for others should be harnessed to find
original ways of motivating them not to smoke.
6.2 Always bearing in mind the significant
addictive properties of tobacco, the reasons why teenagers smoke
are complex and varied. We sometimes think we understand these,
but if we do, we have been singularly unsuccessful in converting
this knowledge into effective smoking prevention.
6.3 Young people seem to have discounted
the health implications of smoking—or at least those of
them who smoke. The consequences are too far distant for their
young minds. The attempts made to influence their motivation to
smoke have not worked and care must be taken not to throw money
at the problem for the sake of appearing to do something without
some firm evidence that any new measures will be more effective
than the old ones.
6.4 Youth is an age of idealism and they
are genuinely concerned by environmental issues, the third world
and personal freedom and adult hypocrisy. Examples of how these
could be used to motivate young people against tobacco include:
(i) The destruction of forests to make cigarette
paper, packets, advertising etc.
(ii) The use of arable land in poor countries
for tobacco and not food.
(iii) Exploitation of the young and the poor
by the tobacco industry for profit.
(iv) A European Parliament which authorises
grants to member countries to grow tobacco and at the same time
preaches to them about the dangers of tobacco consumption.
(v) School governors who allow teachers and
adult members of staff to smoke in designated areas at school
whereas they themselves are punished for so doing.
6.5 Peer to peer education by young people
about tobacco is likely to be much more effective than lectures
and admonitions from adults. In addition young people know what
motivates them and their friends and have much to contribute to
the formulation of new smoking prevention strategies for their
age group. They need to be intimately involved in the development
and implementation of these. Their ideas must be seriously considered
and not only from an adult perspective. They will come up with
original ideas which might shock an adult but which appeal to
and might influence for good the young mind.
6.6 The experience of the Florida Truth
campaign exemplifies some of the benefits of this type of approach.
7. PASSIVE SMOKING
7.1 The effects of environmental smoke on
children's health are well documented. Parents, and indeed all
adults, have a serious obligation to protect their children in
this respect. Children have the right to expect the Government
to safeguard their interests if these are being violated and to
ensure an environment which is healthy and conducive to their
well being.
7.2 Passive smoking is a real thing and
the breakdown products of tobacco can be measured in the blood
and urine of those subjected to it.
7.3 All public areas to which children are
admitted should be completely smoke free. For an adult to smoke
in the presence of a child, particularly in an enclosed space
is not only giving bad example to that child but is also denying
that child its basic human rights. Children have a fundamental
right to good health and clean air. Unlike adults they usually
do not have any choice about where they are taken nor the wherewithal
to object if adults smoke in areas of children's activities and
entertainments as they do at Butlin's in Skegness.
7.4 The Foundation has campaigned for the
following:
(i) Adults should be barred from taking children
under 16 years of age into designated smoking areas in pubs, restaurants,
airports, railway stations etc etc.
(ii) School premises should be entirely smoke
free with no concessions for teachers or other staff.
(iii) Smoking should be banned in places
where children's entertainment is provided.
(iv) An intensive publicity campaign to persuade
parents not to smoke in the home in rooms used by children.
RECOMMENDATIONS
1. New anti-smoking initiatives must be
properly research based and subject to long term evaluation. Adequate
funding must be provided for this.
2. The major focus of smoking prevention
must be children and young people who constitute virtually all
new smokers and who become addicted at that age to a life time
habit with the inevitable health consequences.
3. A greater emphasis must be placed on
smoking eduation in primary schools aimed at preventing children
ever starting to smoke.
4. Teenagers must be intimately involved
in the development and implementation of any new strategies aimed
at them. Their idealism and concern for others must be harnessd
to find original ways of motivating them not to smoke.
5. Government must protect children's rights
with regard to the effects of passive smoking. Adults should be
prohibited from taking children into designated smoking areas
in restaurants, railway stations, pubs etc.
6. School premises should be entirely smoke
free.
7. Smoking should be banned in all areas
where children's entertainment is provided.
8. There should be an intensive publicity
campaign to persuade parents not to smoke in the home in rooms
used by children.
September 1999
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