Shared learning database

Healthy Lifestyle Service, Gloucestershire Care Services NHS Trust
Published date:
October 2010

Toxic Tobacco Truths lesson resource pack is a unit of six lessons focusing on the wider issues surrounding tobacco. Research around young people and smoking shows that successful educational programmes must address all three influences on smoking uptake: the individual, the personal environment, and the social and cultural environment - this pack seeks to address all three areas.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

To reduce the uptake of smoking in young people by providing an easy to use off-the-shelf resource for all secondary schools to use in the teaching of tobacco (for Key Stage 3). As no single intervention can prevent all young people from taking up smoking it was felt that we should use a variety of programmes to address this issue. In addition to the ASSIST programme and the Fags and Me theatre production (commissioned by NHS Gloucestershire), we wanted to provide all schools with a resource which they could adapt to fit in with their existing programmes of work (within PSHE and Citizenship lessons and health-themed days). Objectives of Toxic Tobacco Truths: 1. The pack should address all three influences on smoking uptake: the individual, the personal environment, and the social and cultural environment. 2. Lessons topics should develop students' knowledge about the wider issues surrounding tobacco thus enabling students to develop an informed choice about whether to smoke or not. 3. The pack should be delivered within an environment facilitating effective delivery. For example, delivery by non-smoking teachers and reinforcing smoking prevention messages across the school curricula until school leaving age. 4. Lessons should be fun and interactive for students and a range of teaching methodologies should be used. 5. Teachers should be provided with key background information on young people and smoking, for example, that 11-15 year olds tend to overestimate how many of their friends smoke.

Reasons for implementing your project

Smoking as a topic has been taught for many years within secondary schools but has tended to have a heavy focus on health (which often has little impact on young people as they see themselves as invincible and often don't care what could happen in old age). Lessons are also often perceived by students as boring as they feel they know all of the health effects associated with smoking such as developing lung cancer. Smoking as a topic is therefore starting to slip off the agenda in many schools. This pack takes a different angle with lesson content and teaches young people about the wider issues, for example, influences on smoking uptake, the tobacco industry, illicit tobacco and advertising and the media. It is hoped that a cross-curricular approach will be taken whereby smoking education is not simply the domain of science and PSHE. The Gloucestershire online pupil survey measures smoking prevalence in years eight and ten. A baseline was taken in February 2010: by Year 10, 33.2% of students had tried smoking. This survey will be carried out every 2 years.

How did you implement the project

In preparation for the writing of the resource, an ideas and development day was held with representation from 4 teaching staff, the Gloucestershire NHS Stop Smoking Service, school nurses, the Cobalt Cancer Appeal Fund and Members of the Youth Parliament. At this day, the group decided on the focus of each of the 6 lessons and planned activities to be included. Following this, four teachers spent 2 days with a project manager writing and developing all of the lessons. Within the pack, lesson plans and resources are provided for each of the six lessons and are based on the format of the Cambridgeshire Personal Development Programme. The 'Measuring Changes in Attitude' methodology has been used throughout the pack so that teachers are able to measure the collective changes in attitude and knowledge of the class over the course of the lesson rather than the recall of specific skills or knowledge by individuals. The lesson plans and resources are all also in Word or PowerPoint format on an accompanying DVD so that teachers can edit the text or images to suit their specific situation or to update information in future years. Permission was given to us to reproduce a short documentary film by Channel Four Television on the accompanying DVD and HMRC gave permission for us to reproduce their photographs of smuggling findings. Once the resource was developed, a launch event was held in December 2009 to highlight: Why the pack was developed and why smoking needs addressed in schools, the importance of adopting a whole-school approach to tobacco (including a smoke free school policy), how cross-curricular links can be made and how to use the resource pack. Leading teachers from the County Council Children and Young People's Health and Wellbeing team then distributed the pack in person to all secondary schools (including pupil referral units and special schools). The pack was also given for free to colleges and youth club localities across the county.

Key findings

We were able to monitor the initial impact of 'Toxic Tobacco Truths' in Gloucestershire through verbal feedback from teachers, school nurses and youth workers whom we came into contact with through other streams of work. All feedback has been very positive so far. Comments indicate that the pack has ensured that tobacco as a topic is being taught more now in schools than before, that students are more engaged as the lessons are more interactive than previously - for example, the creative nature of the lesson on advertising and the media has been very popular. Also, the lesson on illicit tobacco has been very popular with students as they tend to have little previous knowledge about the subject and are fascinated by the 'illicit findings'! Teachers also commented that they liked the way in which they could pick and choose elements of the lessons and re-arrange lesson plans to fit in with individual lesson timings. A more formal feedback questionnaire has been developed this month (October 2010) and is currently being distributed to all schools across the county by the Leading teachers in the County Council Children and Young People's Health and Wellbeing team. The results will be collated and disseminated in January 2011. Following this feedback we would like to implement suggested changes (for example, in relation to individual activity content and timings) and carry out another print-run of the pack in February 2011. Changes to smoking uptake by Year 10 will also be monitored within the Gloucestershire online pupil survey in 2012 and 2014. It has been very apparent over the course of the last year that many areas in the South West have been looking for a new resource to re-engage their schools in the tobacco control agenda. Following much positive feedback about 'Toxic Tobacco Truths', a number of PCTs and County Councils in England have invested in the pack for their localities, for example, Swindon, Leicester, Plymouth, Bristol and Bath.

Key learning points

1) It was crucial that the pack was a joint partnership production between the NHS and County Council so that all of the relevant people were involved in the production and distribution of the pack. Longer-term it has been embedded into NHS training (for example for youth workers and school nurses) and also County Council Healthy Schools work (this is also all part of a localised tobacco control strategy). 2) Where adapted, the pack should be linked to a wider whole-school approach to tobacco. For example, by implementing a new revised smoke free policy incorporating training on tobacco for staff at the same time. 3) Resource packs would have ideally been provided for each age group starting from Primary school but due to limited funding years 7 and 8 were a priority group for preventing the uptake of smoking (there are huge reported increases in smoking between years 8 and 10 in the local online pupil survey). 4) The pack should continue to be provided in both a paper and electronic version. Teachers tend to photocopy resources at short notice but also like to have the option of adapting resources electronically to fit specific abilities and timings. 5) It was important that the pack was distributed in person where possible to ensure that the relevant persons were aware of the pack and could disseminate information about the pack to other staff. (In the small number of cases it was not, it was left on a shelf unused without other staff knowing about it!). 6) No single intervention can prevent all young people from taking up smoking so it is important to use the pack alongside other interventions, for example, the ASSIST programme.

Contact details

Clare Charlton
Health Improvement Facilitator
Healthy Lifestyle Service, Gloucestershire Care Services NHS Trust

Primary care
Is the example industry-sponsored in any way?