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A Stop Smoking in Schools Trial: A process evaluation of the implementation of ASSIST in Scotland

44628469 - cigarettes

In 2014 the Institute for Social Marketing and a team of collaborators were appointed to conduct a process evaluation of ASSIST (A Stop Smoking in Schools Trial). ASSIST is a peer-led, school-based smoking prevention programme that encourages the dissemination of non-smoking norms by training students aged 12-14 to work as peer supporters. ASSIST was previously evaluated via a large cluster randomised trial of 59 schools in South Wales and Avon, England. Results from this trial showed that ASSIST was effective and cost effective at reducing smoking prevalence in young people (Campbell et al 2008), (Hollingworth et al 2012). This led to the wider roll out of ASSIST in parts of England and Wales and more recently in Scotland.

The overall aim of the study was to evaluate the process of implementing ASSIST in Scotland.

Three different delivery models were piloted in three NHS boards. This did not impact on fidelity or acceptability which was rated highly. Partnership working, from the onset, was viewed as being key to successful delivery and securing school participation. Feedback was overwhelmingly positive regarding the wider benefits of taking part in ASSIST for peer supporters (i.e. personal and communication skills) but also for the school and communities. There was less certainty regarding the extent of message diffusion and the impact this may have an adolescence smoking prevalence. Student survey results showed no significant change in self-reported smoking prevalence between baseline (1.6%) and follow-up (1.8%) and conversation recall with a peer supporter was low at 9%.

However, it is important that the current context (where regular smoking prevalence is 2% overall in 13 year olds in Scotland (SALSUS, 2015 is taken into account. Opportunities to have informal conversations about smoking with peers may now be limited due to the ongoing decline in adolescent smoking since ASSIST was first developed. In addition, the data collection mode was a self-complete survey, so there is a possibility that by follow-up (12 weeks after baseline) young people may simply not remember conversation(s) with a peer supporter or may not have known that they had spoken with a peer supporter.

Overall, this study has demonstrated that it is feasible and acceptable to deliver the ASSIST programme in Scottish schools, although questions remain about the extent of message diffusion. Further consideration is required to assess whether delivery of ASSIST still offers a suitable return on investment and what role it may play in schools in areas of deprivation where smoking rates are higher. Now may be the time to consider whether, 13 years on from the original Randomised Control Trial, an implementation trial of ASSIST is warranted to determine if it is still effective and cost effective.

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Fiona Dobbie
24 March 2017

Photo Copyright: tum2282 / 123RF Stock Photo

Research with Impact: Investing in Tobacco, Alcohol and Substance Use Research

researchwithimpact_bannergreenThe University of Stirling Impact Research Studentships support outstanding novel research projects that can demonstrate a link to the Universities strategic priorities and be high impact. Researchers in Health Sciences were successful in gaining three of these awards in spring 2016.

Dr Crawford Moodie, Dr Niamh Fitzgerald and Dr Tessa Parkes appointed three excellent researchers to these studentships in summer 2016 and all three started their studies in October.   Our new colleagues will be contributing to the globally-recognised work of the Tobacco, Alcohol and Substance Use Research Group.


Andriana Manta

Andriana Manta will be working on a comparative analysis between Scotland and Greece. She aims to examine various genres of representations of the ‘drug problem’, how these representations are being reflected in the governance of the ‘drug problem’, as well as to explore possible associations with concerning changes in key indicators of public health among people who inject drugs for contributing to the wider community. The study will use a “what’s the problem represented to be” (WPR) approach to follow the construction of the drug problem, involving discourse analysis and visual analysis. The studentship is funded by the University of Stirling.

Andriana has a background in mental health research, having worked for the programme Anti-Stigma at the Athens University Mental Health Research Institute, where she was involved with both qualitative and quantitative methods of research on the stigma surrounding mental health conditions. Moreover, Andriana has an educational background in drugs and alcohol studies; she has also worked variously in the field of drugs and alcohol treatment, in Scotland and Greece, having gained a good grasp of the ‘drug problem’ realities faced by both countries.


Danielle Mitchell

Danielle Mitchell will be working in the Institute for Social Marketing on the use of innovative tobacco packaging to deter smoking. The study will use both qualitative and quantitative methods to explore beyond the recent implemented plain packaging in the UK, in order to discover innovative methods to further deter smoking both in terms of encouraging cessation and the onset of smoking in youth.

Danielle has a background in marketing with both a BA Honours Marketing degree and an MSc in International Fashion Marketing.  Having gained knowledge and experience from carrying out mixed methods research in both her undergraduate and masters dissertations, her interest for continuous research grew and the prospect of using marketing and research techniques to impact upon the behaviour of individuals in a positive manner whilst also contributing to valuable social research.


Clare Sharp

Clare Sharp will be working in the Institute for Social Marketing on a study which aims to understand how Nalmefene, a drug treatment for alcohol dependence, has been used in the UK, and the factors which have influenced prescribing for this drug. The study will used a mixed methods approach, involving quantitative analysis of prescribing data and qualitative methods to explore perceptions around the role of Nalmefene in treating alcohol dependence, key influences on prescribing behaviour and views about how the regulations and marketing of the drug have been handled.  The studentship is part-funded by Alcohol Research UK and the University of Stirling.

Clare has a background in social research, having worked in ScotCen Social Research for a number of years. Here, she gained considerable experience as a survey researcher, having been involved in the development, management and analysis of some of Scotland’s flagship surveys including Scottish Health Survey, Scottish Social Attitudes Survey, Growing Up in Scotland and the Scottish Crime Survey. Clare has also worked on mixed methods studies involving alcohol and tobacco, including the evaluation of the Alcohol Licensing Act and the DISPLAY project to evaluate the tobacco point of sale promotions ban.

Dr Tessa Parkes, Senior Lecturer, commented “We are delighted to welcome Danielle, Clare and Andriana to our Faculty and Research Group and wish them all well as they embark on their exciting projects.”

20 October 2016

Growing the research evidence on e-cigarettes

The use of e-cigarettes has risen rapidly, with great potential to aid tobacco harm reduction, but also uncertainty over uptake and potential negative consequences. Professor Linda Bauld reviews the unanswered questions and need for further research.

Check the full post on the Research at CRUK blog here.

29 April 2016

Youth Alcohol Intervention – Jonathan Bryce writes about his award-winning research


Jonathan Bryce, MRes Graduate

Jonathan Bryce graduates from the University of Stirling this Friday 27 November with a MRes – Health Research.

He has been awarded a University Integrating Research Into Learning Award for his Youth Alcohol Intervention dissertation research. Jonathan writes:

What was it about?

I wrote the dissertation as part of the Master of Research in Health Research course at the University of Stirling. The dissertation was made up of three parts – a funding proposal, an ethics application and a journal article.

The overall topic of the work was based around investigating the effectiveness of an intervention to reduce harmful or hazardous alcohol consumption in young people aged 16 – 24 years old. The main component of the proposal was exploring the use of a conversational style of discussing alcohol use with young people. The aim would be to do this in a way that is non-confrontational and that focuses on strengthening the motivation of the individual to make changes about their alcohol use.

Why was it needed?

The motivation behind the choice of topic follows from high rates of alcohol consumption and alcohol-related ill health in Scotland over recent decades. Data shows that approximately one-third of women and almost half of men regularly drink at levels that exceed government guidelines.

Young people also have high rates of harmful or hazardous drinking, meaning they can be exposed short-term risks such as being a victim of crime or injuring themselves. Late adolescent drinking has also been linked to dependence in later life as well as premature death.

How would it be carried out?

The research proposed was designed for use in an informal youth work setting.  Examples of these may include drop-in or outreach services offering support to young people on issues such mental or sexual health, education and careers advice.

Building upon previous research that found that brief alcohol interventions were both acceptable and feasible for use in informal youth settings, interventions would be delivered by youth workers opportunistically. These would then allow the youth worker to engage the young person in a short conversation about their alcohol use and, where appropriate, setting goals such as reducing the quantity or frequency of alcohol the consume.

How will it improve/help practice?

If found to be effective, the intervention has the potential to improve current practice in youth work settings by providing a tool for youth workers that is evidence-based and which can lead to better outcomes for the young people they are in contact with. The most immediate impact is likely to be consideration and discussion about the young person’s alcohol use. Long-term benefits might include improved health and well-being and reductions in alcohol-related ill health.

Jonathan Bryce, MRes Health Graduate
24 November 2015

Pregnancy diabetes is a red flashing light that we can’t ignore

Photo of Dr Josie Evans

Dr Josie Evans

Dr Josie Evans, Reader in Public Health, has been published in The Conversation:

Most people are well aware of two of the main forms of diabetes – type 1, which usually first appears in young people; and the more common type 2, which often emerges in the over 40s and is associated with obesity and sedentary lifestyles. We hear far less about the third form, gestational diabetes, which temporarily affects as many as 16% of pregnant women.

Gestational diabetes is…

Read the full article here.

Ten deadly carcinogens (you’ve probably never heard of)

Photo of Professor Andrew Watterson

Professor Andrew Watterson

Professor Andrew Watterson writes in The Conversation

“Bad news for bacon butty lovers and barbecue afficionados. The World Health Organisation now deems bacon, sausage – and other processed meats – a serious cancer risk.

“With more than 14m new cancer cases occurring around the world each year and more than 8m cancer deaths a year, carcinogens certainly merit serious attention. Asbestos, diesel exhaust fumes, radiation in various forms, nightshift work, tobacco and alcohol are all well-known causes of cancer, but there are lots more besides, including several you may never have heard of.”

Read the full article here.

Does fracking cause cancer and infertility?

Professor Andrew Watterson writes in The Conversation:

“It can be hard to know what to believe when it comes to fracking safety. Campaigners against the controversial oil and gas drilling technique say it can contaminate water supplies, pollute local air and cause dangerous earthquakes. But the fossil fuel industry contradicts these claims by pointing to reports that the risks can be managed and fracking operations set up safely.”

Read the full article here:

26 October 2015

FOI + tobacco = sleepless nights: We got an FOI request from Big Tobacco – here’s how it went

Istitute of Social Marketing logoProf Gerard Hastings, Emeritus Professor at the University of Stirling, writes in The Conversation:

“In a world where knowledge is power, information is the antidote to oppression. We citizens must know what those at the top are doing if we’re going to hold them to account. That’s why freedom of information (FOI) legislation is a vital element of any functioning democracy; it helps rebalance power.”

The full article can be seen here in The Conversation:

1 September 2015

Young people and e-cigarettes: what we know so far

Photo of woman smoking e-cigaretteProf Linda Bauld has blogged in The Conversation:

“Thanks to decades of action against tobacco, smoking rates among children and young people are in decline: far fewer teenagers are now taking up smoking than in the past.

“In England, for example, just 3% of 11 to 15-year-olds are regular smokers, with similar figures in Scotland and elsewhere in the UK. This is welcome news, and will play a significant role in protecting the adults of the future from the 14 types of cancer linked to smoking, as well as other diseases such as heart disease and stroke.

“Over the same period…”

Check the full article here.

Just how useful are licensing laws for improving public health?

Dr Niamh Fitzgerald

Dr Niamh Fitzgerald

Despite legal changes in Scotland, councils are struggling to use public health as an argument against new pubs and off-licences.

We need to reconsider the role of licensing in the context of other ways to achieve the same ends, suggests Dr Niamh Fitzgerald in this London School of Hygiene and Tropical Medicine blog post.