Select Committee on Health Appendices to the Minutes of Evidence


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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