Smoking and Looked-After Children: A Mixed-Methods Study of Policy, Practice, and Perceptions Relating to Tobacco Use in Residential Units.

Lisa Huddlestone,Catherine Pritchard,Elena Ratschen

doi:10.3390/ijerph13060593

Abstract

Despite the implementation of smoke-free policies by local authorities and a statutory requirement to promote the health and well-being of looked-after children and young people in England, rates of tobacco use by this population are substantially higher than in the general youth population. A mixed-methods study, comprising a survey of residential care officers in 15 local authority-operated residential units and semi-structured, face-to-face interviews with residential carers in three local authority-operated residential units, was conducted in the East Midlands. Survey data were descriptively analysed; and interview data were transcribed and analysed using thematic framework analysis. Forty-two care officers (18% response rate) completed the survey, and 14 participated in the interviews. Despite reporting substantial awareness of smoke-free policies, a lack of adherence and enforcement became apparent, and levels of reported training in relation to smoking and smoking cessation were low (21%). Potential problems relating to wider tobacco-related harms, such as exploitative relationships; a reliance on tacit knowledge; and pessimistic attitudes towards LAC quitting smoking, were indicated. The findings highlight the need for the development of comprehensive strategies to promote adherence to and enforcement of local smoke-free policy within residential units for looked-after children and young people, and to ensure appropriate support pathways are in place for this population.

Highlights

Twelve (29%) participants reported being current smokers. Eight of those (67%) reported smoking during working hours, with tobacco use occurring within the grounds of the unit where respondents worked (n = 7, 88%), but out of sight of young people (n = 7, 70%)
This study demonstrates that tobacco smoking is highly prevalent in residential units for looked-after children and young people, and has wide ranging impacts that include exposing young people to the risks of exploitation, psychological harm, and physical health risks that exceed those of tobacco smoking, and appear to be rarely addressed in appropriate ways
A number of potential reasons for permitting smoking within the grounds of residential units were suggested by participants and included the prevention of young people’s involvement in crime or anti-social behaviour [22], or minimizing risks related to child sexual exploitation(CSE) [23], like any responsible parent, residential carers seek to manage the risk that young people may face, and often this requires a balance to be struck between safeguarding and an acceptance of risky health behaviour

Summary

Introduction

Comprehensive smoke-free legislation and public health guidance have reduced rates of smoking among youth in the United Kingdom (UK) over recent decades [1,2,3], tobacco smoking among looked-after children and young people, referred to as young people from hereon in, remains high.Smoking prevalence reaches up to 69% for looked-after young people accommodated in residential units, in comparison to 3% of young people aged 11–15 years within the general population [3,4].Research suggests that, while the factors that contribute to initiation and maintenance of smoking among looked-after young people may not differ significantly from those experienced by youth in the general population, the impact of smoking may be significant due to the increased vulnerability of young people looked-after [5]. Smoking prevalence reaches up to 69% for looked-after young people accommodated in residential units, in comparison to 3% of young people aged 11–15 years within the general population [3,4]. In England, the term ‘looked after children’ is defined in law under the Children’s Act 1989 It refers to a child (under 10 years) or a young person (aged 10–18 years), that are provided, by way of a court order with care and/or accommodation by a local authority. This accommodation may comprise living with birth parents, with foster carers, Int. J. Public Health 2016, 13, 593; doi:10.3390/ijerph13060593 www.mdpi.com/journal/ijerph

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Conclusion