Emma Croghan

The importance of social sources of cigarettes to school students

Objective: To discover the importance of social sources of tobacco to young people as opposed to commercial sources; to describe the peer market for cigarettes in schools and the consequences for young people of their involvement in it. Study design: Cross sectional questionnaire survey, one-to-one interviews, and focus groups. Setting: Seven schools in Birmingham, UK. Subjects: All students in two randomly selected classes from each school completed the questionnaire, and never smokers, occasional smokers, and regular smokers were interviewed. Results: Two thirds of occasional smokers and one quarter of regular smokers obtained cigarettes socially, mostly for free. A few smokers regularly bought their cigarettes from others. Among friendship groups, both smokers and non-smokers were involved in the exchange of cigarettes, often for money, which is a common activity. A few young people use the selling of cigarettes to fund their own smoking. Some young people, smokers and non-smokers, are involved in semi-commercial selling of cigarettes. All school students are aware of where to purchase cigarettes from non-friends, which is only used “in emergency” because of the high price. One school had a strong punishment policy for students caught with cigarettes. In this school, more people bought singles from the peer market and the price was higher. Conclusions: The passing and selling of cigarettes in school is a common activity, which from the young persons perspective, ensures that all share cross counter purchases. A few people are prepared to use the peer market for monetary gain and it appears to be responsive to external conditions. The peer market might mean that efforts to control illegal sales of cigarettes are not as effective as hoped.

A randomized controlled trial of smoking cessation for pregnant women to test the effect of a transtheoretical model-based intervention on movement in stage and interaction with baseline stage

OBJECTIVES To examine whether, as predicted by the transtheoretical model (TTM), stage-matched interventions will be more effective than stage-mismatched interventions. DESIGN Randomized controlled trial of smoking cessation advice to pregnant smokers. METHODS Pregnant women currently smoking at 12 weeks gestation were enrolled in a pragmatic three-arm trial of TTM-based interventions to help them stop smoking. One arm constituted standard midwifery advice and a self-help leaflet on stopping smoking, which is generally appropriate for women in preparation. Two arms were TTM-based. Differences in positive movement in stage towards quitting from enrolment to 30 weeks gestation and 10 days post-partum were calculated for each arm of the trial. We then examined whether, as predicted from the TTM, the relative benefit of the TTM-based intervention was greater for women in precontemplation and contemplation, for whom the control intervention was stage-mismatched, than for women in preparation, for whom the control intervention was stage-matched. RESULTS Women in the TTM-based arms were statistically significantly more likely to move forward in stage than were women in the control arm. Contrary to the TTM-derived hypothesis, the greater relative benefit of the TTM-based intervention was seen for women in preparation stage at baseline, rather than women in precontemplation and contemplation. CONCLUSIONS The TTM-based intervention was more effective in stage movement, but this could be due to its greater intensity. The failure to confirm that stage-matching was important casts doubt on the validity of the TTM in explaining smoking cessation behaviour in pregnancy.

Is it as easy as young people claim for them to buy cigarettes?: Comparing the results of realistic test purchases with those from trading standards test purchases

Purpose – There is a discrepancy between the ease of purchase of cigarettes reported by young people themselves and the results of ease of purchase obtained by tests done by official sources such as Trading Standards Units. This discrepancy suggests that either data from young people or from trading standards are unreliable. This research set out to find out whether young peoples’ perceptions of easy purchasing from shops were true.Design/methodology/approach – Six volunteer young people visited shops around the West Midlands region and attempted to buy cigarettes. They conducted the attempt in as realistic fashion as possible. All volunteers were assessed independently as looking under 16. Shopkeeper, shop, area and youth attributes were recordedFindings – Young people were able to make purchases in 31 out of 38 shops. The young people were very surprised by their rates of successful purchase attempts across such a large geographical area.Practical implications – Shopkeepers and communities need to be gi...

Focusing on the challenges ahead

UK Personal Annual Direct Debit £135 Direct Debit (quarterly) £34 Cheque or credit card £140 UK Student Annual Direct Debit £111 Direct Debit (quarterly) £29 Cheque £121 UK Institutional (Libraries) Annual £367 Europe Personal £140 Institutional (Libraries) £367 Rest of the World Personal (Band 1) £199 Institutional (Band 1) £367 Personal (Band 2) £83 Institutional (Band 2) £88 Subscription Rates Emma Croghan (Consultant Editor) Independent Public Health Consultant Yinglen Butt Nurse Consultant, Department of Health, London Simon Cawley Mental Health Nurse and Dramatherapist, Connect CAMHS and First Steps, Stoke-on-Trent Richard Cotton School Charge Nurse, Stoke-on-Trent Elizabeth Cox Paediatric Continence Nurse Specialist (retired) Josephine Johnson Matron (Universal Children’s Services), Harrogate and District NHS Foundation Trust Stephen Hackney Director, Lead Health Assessor, Changing Education Kath Lancaster Independent Nurse Consultant Liz Plastow Independent Consultant and Professional Adviser to the Association for Nurse Prescribing Barbara Richardson-Todd School Nurse Co-ordinator and Practice Teacher, Suffolk PCT Sarah Sherwin Course Leader, SCPHN School Nursing, University of Wolverhampton Frances Weston Accredited Counsellor and Psychotherapist, Uttoxeter Jane Wright Senior Lecturer, SCPHN School Nursing, Buckinghamshire New University

The right numbers, skills and targets

www.school-nursing.co.uk www.internurse.com � Emma Croghan (Consultant Editor) Independent Public Health Consultant Yinglen Butt Nurse Consultant, Department of Health, London Richard Cotton School Charge Nurse, Stoke-on-Trent Elizabeth Cox Paediatric Continence Nurse Specialist (retired) Josephine Johnson Matron (Universal Children’s Services), Harrogate and District NHS Foundation Trust Stephen Hackney Specialist Community Public Health Nurse (School Health, Deputy Team Leader), Cheshire Kath Lancaster Independent Nurse Consultant Liz Plastow Independent Consultant and Professional Adviser to the Association for Nurse Prescribing Catherine Powell Consultant Nurse Safeguarding Children, Portsmouth City Teaching PCT Helen Ross Locality Team Leader for Children’s Services Barbara RichardsonTodd School Nurse Co-ordinator and Practice Teacher, Suffolk PCT Sarah Sherwin Course Leader, SCPHN School Nursing, University of Wolverhampton Frances Weston Accredited Counsellor and Psychotherapist, Uttoxeter Sharon White UK Professional Officer, School and Public Health Nurses Association Jane Wright Senior Lecturer, SCPHN, Buckinghamshire New University Barbara Young Independent Nurse Adviser, Children and Young People’s Public Health, Kent Consultant Editor Editor Sales Director Classified Sales Production Manager Publisher Associate Publisher Design Executive Medical Illustrator Managing Director Emma Croghan Caroline Voogd Roger Allen Rachel McElhinney Jon Redmayne Matt Cianfarani Alice Hall Peter Constantine HFS Imaging Mark Allen

Changing will into action

The campaign to increase the numbers of qualified school nurses is really heating up. It has been heartening to hear the responses from school nurses, MPs and others about the campaign, the work of school nurses and about the journal. Your letters and emails are greatly appreciated so please keep sending them.

The need to prove cost-effectiveness

Close your eyes for a moment and consider the future. What do you see? Do you see confident, well informed commissioners making decisions based on local need and responding to child-centred public health priorities? A place where school nurses are well educated, well trained, well supported, well rewarded and well respected health professionals—the first port of call for information, advice and care for children and their families? A world in which school nursing services are commissioned to provide comprehensive universal and targeted interventions to support individuals, families and communities to maximize their health and wellbeing potential? A world in which school health delivery contributes to reductions in rates of youth smoking, childhood obesity, youth alcohol use, teenage pregnancy, youth drug use and increases in child and youth emotional and physical health and wellbeing?

Sprinting into summer

As the summer holidays approach, it seems that there is more to do than ever. For children and young people the stress of the exams (from SATs to A levels) may be bringing more worries to your door. In addition you may be managing the demands of organizing the last term of the year, while you also have the stress of ensuring continuity of care for children, young people and their families.

The impact of the HPV immunization

Dear colleagues, Around about now, the human papillomavirus (HPV) vaccination programme is kicking off, with plans for all 12 and 13 year old girls to be offered the three doses in 6 months vaccine from 4th September 2008.

New year: healthy new start?

Dear Reader, Welcome to the first edition of BJSN for 2008! I do hope that 2008 brings all of us in school health exciting progressions towards achieving better outcomes for children and families and furthering the professional expertise and knowledge to provide best practice.