Public Health Directorate Smoke Free Car Campaign Using

Public Health Directorate Smoke Free Car Campaign: Using theory to influence beliefs and attitudes Dr Rhona Reardon – Lead Nurse & Health Psychologist, Smoking Cessation Service Dr Julie Luscombe – Senior Health Improvement Officer External Consultant –Sasha Cain, Consultant Health Psychologist June 2016

Jersey Prevention of Suicide Strategy • Martin Knight • Public Health Department

Creating a Generation of Non Smokers Prevention of Suicide Strategy Jersey Tobacco Strategy 2016 -2021

How are we going to get there? Prevention of Suicide Strategy 1. Prevention • Strengthening arrangements to reduce sales to those under the age of 18 • Engaging young people to develop the work of the strategy • Addressing packaging regulations for tobacco products 2. Protection • Developing the ‘Smoke Free’ brand • Regulations for controls on e-cigarettes • Reduce the affordability of tobacco 3. Cessation • Targeting marginalised and deprived groups by developing the specialist service • Making every contact count – education of other professionals • Developing the harm reduction aspect of the service lth Department

Smoke Free Consultation 2014 Prevention of Suicide Strategy

Smoke Free Consultation 2014 Prevention of Suicide Strategy Question: What are the views of the general public for creating smoke free places in outside environments where children are present, homes and cars carrying children under 18 years old? • Assessing the readiness of the community to move towards extending smoke free environments in outside public places where children are present, family homes and cars carrying children under 18 years • Barriers within the community to move towards extending smoke free environments in outside public places where children are present, family homes and cars carrying children under 18 years • Perceived harm of second-hand smoke exposure to children • Perceived understanding of smoke free environments • Ways to educate Islanders on the harms of second-hand smoke

Findings Prevention of Suicide Strategy Clear community support • 87% including ¾ of all smokers who responded said it is important for the States of Jersey to protect children from second-hand smoke • 76% supported a Smoke Free cars law • 82% supported Smoke Free playgrounds However… • Age decline in both smokers and non smokers over the age of 45 less supportive of voluntary smoke free areas • Male smokers only 28% v important • Non smokers generally more supportive than smokers 81% vs 53% Conclusion: • High levels of support exist for the States of Jersey to protect children by extending Smoke Free spaces

Smoke Free Car Legislation Prevention of Suicide Strategy In Jersey it became illegal to smoke in a motor vehicle carrying young people under the age of 18 from 1 st September 2015

Using Theory to Influence Attitudes and Beliefs Prevention of Suicide Strategy • Qualitative findings from consultation: • Amount of time in car is low in Jersey – messages about coping • Perception of safety around smoking in cars rather than health issue -messages about the vulnerability of young people to smoking in cars • Calls for dramatic advertising – we wanted to avoid emotive campaigns, e. g. neglect of children

Smoke Free Car Competition Prevention of Suicide Strategy June to September 2015 • Aims: • To increase awareness of the new law • To increase awareness of the harms of smoking in cars with young people • To influence beliefs and attitudes around smoking in cars carrying young people

Using Theory to Influence Attitudes and Beliefs Prevention of Suicide Strategy • Health behaviour models considered • Protection Motivation Theory - threat and coping appraisals (Rogers, 1975, Rippetoe & Rogers, 1983). • Theory of Planned Behaviour – Attitudes, subjective norms, perceived behavioural control (Ajzen, 2002).

Protection Motivation Theory Perceived severity: Smoking in cars may cause asthma attacks in children Threat appraisal Vulnerability: The received vulnerability of second- hand smoke on young people Protection Motivation Efficacy of preventive behaviour: Not smoking in cars protects children’s health Coping appraisal Perceived self-efficacy: The person’s confidence to not smoke in the car when young people are present Adapted from Marks et al. , 2015

Threat Appraisal Message Prevention of Suicide Strategy • Martin Knight • Public Health Department • Focus on children’s vulnerability and severity of effects of second-hand smoke • Normative information – high level of support for Smoke Free cars • Awareness raising of new law

Coping Appraisal Message Prevention of Suicide Strategy • Martin Knight • Public Health Department • Focused on low costs of responding • Most car journeys short in length making it easier to cope without smoking • General awareness raising

Awareness on the Road Prevention of Suicide Strategy • Martin Knight • Public Health Department

Influencing Social Norms – Smoke Free Car Competition Prevention of Suicide Strategy • Bottom up approach – early adopters • Children took home a sign-up pack to families • Winning school had the highest proportion of forms completed by parents/guardians/grandparents • Families encouraged to display Smoke Free sticker on their car - visual sign of acceptance of the new law • Prize of £ 250 of sports vouchers

Additional Awareness Raising Prevention of Suicide Strategy • Media work – Press releases – one for the law and one to promote the Smoke Free car competition – Media Interviews • Boosted Facebook posts and graphics • Twitter messages • Roadside banners, sited on key locations, including school gates, outside supermarket car parks, main route into town

Roadside Banner Prevention of Suicide Strategy

Evaluation Prevention of Suicide Strategy • To date, no one has been charged by the police. Is this success? • Plan to send a questionnaire to families who provided an email contact for later evaluation • Has the number of children who report exposure to second-hand smoke in cars reduced?

Acknowledgements Prevention of Suicide Strategy • Thank you to Sasha Cain - Consultant Health Psychologist, SCCH Consulting LLP for her expertise in designing the campaign • Thank you to colleagues in Public Health who were involved in the original consultation and who conducted face to face data collection

References and Links Prevention of Suicide Strategy Azjen, I. (2002). The theory of planned behaviour. Available: www. people. umass. edu/ajzen Health Intelligence Unit (2014). A picture of health, Jersey 2014: Reflections on the health and lifestyle of young people aged 10 -15 years. Jersey: HSSD. Available: http: //www. gov. je/government/pages/statesreports. aspx? reportid=1148 States of Jersey (2014). Protecting our Children from second-hand smoke: results of a public consultation. Jersey: HSSD. Available: http: //www. gov. je/Government/Consultations/Pages/Second. Hand. Smoke. Consultation. aspx Rippetoe, P. A. , & Rogers, R. W. (1887). Effects of components of protection-motivation theory on adaptive and maladaptive coping with a health threat. Journal of Personality and Social Psychology, 52, (3), 596 -604. Rogers, R. W. (1975). A protection motivation theory of fear appeals and attitude change. Journal of Psychology, 91, 93 -114.