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A faulty production line

How I... tackled teenage smoking

Dr John Havard describes how smelling smoke on his children clothes spurred him to challenge teenage smoking

Dr John Havard describes how smelling smoke on his children clothes spurred him to challenge teenage smoking

Personal experiences often affect the focus of our interest as GPs. It all started when I noticed the smell of smoke on the clothes of my two teenage children. I was amazed to learn how many teenagers smoke when so many adults are quitting. More than a third of 14-year-old girls – and a smaller percentage of boys – smoke regularly.

I started making a point of asking the schoolchildren I saw in surgery about smoking. I vividly remember one 14-year-old girl who paused, lost in thought for a minute.

I sensed that she was embarrassed because her mum was there, so I tried to end her awkwardness by saying ‘So you can't think of any classmates who smoke?'. Her reply bowled me over. She said she could not think of anyone who did not smoke.

What matters to teenagers

I had not realised the extent of teenage smoking but fully appreciated the power and subtlety of the tobacco industry.

I was interested to see what education took place at schools and Action on Smoking and Health (ASH) have some relevant presentations.

It was quite clear to me – through a mass of ‘whatevers' and ‘likes' – that heart and lung disease mean nothing to this target group and so smoking cessation was a real challenge. And I've always liked a challenge.

The smoking ban gave us a great opportunity to work on adults who seem concerned about health and wealth. Adult smokers gain nothing from smoking but teenage girls perceive that smokers are more sophisticated. I readily accept that my own perception is irrelevant, so I needed a cunning plan.

Involving the target group

I used the help of an obliging cohort of teenagers to devise a leaflet that might influence behaviour. The front page was written in text language and concentrated on things that did matter to teenage girls – wrinkled skin, stained teeth and cost.

I sent this proof to 50 local schools offering two prizes from our practice for £100 each for the schools that contributed most. The senior prize went to Bungay High School for a comprehensive criticism that had no holds barred.

It arrived uncensored with a slightly apologetic letter from the teacher, but the input was really useful and the leaflet was redesigned in the light of this.

The junior prize went to a Woodbridge School year 8, who made some similar observations and also corrected my text spellings!

Up against the might of the tobacco industry

We are fighting a very clever tobacco industry and need all the help we can get. I was struck by one quote from British American Tobacco (BAT) at around the time the industry was being asked to alert children to the risks of smoking. The internal memo (available on the ASH website) seemed to grudgingly support health education about smoking to children provided it was given by ‘boring adult figures of authority' – people just like me.

The sophistication of the advertising is impressive and always one step ahead of legislation. According to ASH's report You've Got To Be Kidding, BAT has promoted its Lucky Strike brand through a strategy: ‘to relaunch and grow the brand by targeting the underground youth community – a community that is left of centre, which sets the trends rather than follows them'.

Globally, BAT links brands to sporting events, celebrity artists and movie stars. It even sponsors music festivals and parties.

Upping our game

The plan must be to show teenagers how they are being influenced by the tobacco giants, especially as they believe they are being cool free spirits. Of all the Government-sponsored adverts and images, the one I feel is the most powerful is the one with the fish-hook in the upper lip. In designing our leaflet I also wanted to include some disturbing images, since they put some people off starting. We also included information about the other major public health killer, obesity.

How has it changed things in my practice?

We now routinely send the leaflet out to our teenagers with another leaflet we produced on local young person's health services. We also send it electronically or give it to patients or relatives who are interested.

I feel we should recruit young, cool ex-smokers to talk to 11- and 12-year-olds when they start senior school. They will have an impact way beyond the reach of ‘boring adult authority figures' like you and me.

Dr John Havard is a GP in Suffolk.

Competing interests None declared

The Saxamundham teenage health leaflet The Saxamundham teenage health leaflet

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