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Preventing smoking among 9-10 year old primary school children: evaluation of SmokeFree Sports

McGee, C (2015) Preventing smoking among 9-10 year old primary school children: evaluation of SmokeFree Sports. Doctoral thesis, Liverpool John Moores University.

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Smoking in childhood is a predictive risk factor for smoking in later life and increases the likelihood of early mortality from smoking-related morbidities. Preventing the uptake of smoking in childhood is an important public health priority (Public Health England, 2014a). Evidence suggests physical activity participation may be protective against smoking uptake in children and thus physical activity is recommended as an active component for future smoking prevention efforts (Audrian-McGovern et al., 2013). Therefore SmokeFree Sports (SFS) was designed to explore whether physical activity could be used as a vehicle to prevent children within deprived neighbourhoods from starting to smoke. The research within this thesis forms part of a wider programme of research and evaluation of SFS. The aims of the research conducted within this thesis were to (1) explore the influence of social factors (mother, father, sibling and friend smoking) on preadolescent (aged 9-10) boys and girls cognitive vulnerability (e.g. smoking-related intentions, attitudes and refusal self-efficacy) towards smoking, (2) explore the feasibility and acceptability of SFS with primary school settings from the perspectives of children, teachers and coaches, and (3) examine the impact of SFS on preadolescents cognitive vulnerability towards smoking and explore perceived intervention impact from the perspectives of children, teachers and coaches. To address and answer the research questions within this thesis a mixed-methodological approach was undertaken.
In 2012, a cross-sectional study involving 43 primary schools in Merseyside, England was conducted to explore the influence of social factors on preadolescent boys and girls cognitive vulnerability towards smoking (n =1143; 50.7% girls; 85.6% White British). 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 were analysed using multilevel linear and logistic regression models, adjusting for individual cognitions, school and deprivation level. Findings showed that social factors were associated with children’s cognitive vulnerability towards smoking, with the smoking behaviour of siblings and friends being identified as important influences. Further, whilst the majority of 9-10 year old children living in deprived communities had high non-smoking intentions and refusal self-efficacy, a substantial proportion displayed pro-smoking attitudes that could be addressed through smoking prevention efforts. Research suggests that physical activity participation is protective against youth smoking initiation (Audrian-McGovern et al., 2013) and increased smoking (Horn et al., 2013). Therefore, SFS, a UK multi-component initiative that aimed to deliver smoking prevention education to primary school children (aged 9-10 years) through the medium of sport and physical activity was developed and piloted in among 9-10 year old children in primary schools across Merseyside, England.

In the preliminary phase to piloting the city-wide SFS intervention, a formative study was employed in three primary schools situated in Liverpool City and North. Children received six weeks of coaching activities (football and dance) for two hours each week. Key messages surrounding the effects of smoking on health and sporting performance were incorporated into activity sessions. Children also received SFS branded materials, attended a SFS launch and celebration event, and were encouraged to sign a pledge to be smoke free. In total, forty-five children (51% boys; 93% White British) participated in focus groups (n= 6 single sex and n= 3 mixed sex groups), and Year 5 teachers (n=3; 3 male) and SFS coaches (n=5; 3 male) participated in semi-structured interviews. Findings from this formative study revealed schools were a suitable setting to deliver SFS. Further, the use of physical activity as a mechanism to deliver smoking prevention education was considered acceptable by children, teachers and coaches but further modifications were made to ensure its acceptability and aid effectiveness for a larger SFS pilot study.

This formative study was therefore integral to the development of SFS pilot intervention which included compulsory and optional components delivered by multiple implementers, including SFS coaches and primary school teachers. In 2013, a non-randomised SFS controlled-trial was conducted among Year 5 children (n=972; 50.7% Female) in primary schools across Merseyside, England. Schools were clustered into intervention (n=32) and comparison groups (n=11). Outcome measures that were employed in the cross-sectional study (Study 1) were assessed again at post-intervention (2-weeks from intervention end) and again at follow-up (approx. 12 months post intervention). Quantitative findings indicated that the SFS intervention did not impact on children’s non-smoking intentions, which remained high across both groups. However, qualitative data revealed that SFS reinforced children’s opinions about smoking and made them more determined not to smoke. Further, children in the intervention schools displayed significantly more negative attitudes towards smoking at post-intervention and at follow-up than those in the comparison group. Whilst no significant intervention effects were found for refusal self-efficacy at post-intervention, positive intervention effects were observed at follow-up. These findings may lend support for physical activity as one strategy for smoking prevention efforts targeted at preadolescent children residing in deprived neighbourhoods.

In summary, the research within this thesis examined the influence of social factors on preadolescent’s cognitive vulnerability towards smoking, and explored the feasibility and acceptability of a novel smoking prevention intervention that used physical activity to deliver smoking education to UK primary school children, and examined its impact on preadolescent’s smoking-related cognitions. Utilising physical activity to deliver smoking prevention education appears to work at least as well as smoking prevention delivered through class-based learning. Importantly, teachers and coaches viewed physical activity as an acceptable method to engage children in smoking prevention. Nevertheless, strategies to increase the sustainability of SFS and embed intervention components into the school curriculum require further investigation.

Item Type: Thesis (Doctoral)
Subjects: L Education > L Education (General)
G Geography. Anthropology. Recreation > GV Recreation Leisure > GV561 Sports
Divisions: Sport & Exercise Sciences
Date Deposited: 04 Nov 2016 16:15
Last Modified: 03 Sep 2021 23:26
DOI or ID number: 10.24377/LJMU.t.00004400
Supervisors: Foweather, L and Murphy, R
URI: https://researchonline.ljmu.ac.uk/id/eprint/4400
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