HEALTH EDUCATION RESEARCH Vol.14 no.1 1999Theory & Practice Pages 71–83

Primary schoolchildrens’ perceptions of smoking:implications for health education

L. Porcellato, L. Dugdill1, J. Springett and F. H. Sanderson2

Abstract

This paper suggests that there is a need, asearly as Reception, to implement smoking inter-vention programmes in the local school curric-ulum. Findings from a cross-sectional studyhave shown that primary schoolchildren (4–8years old) possess negative attitudes and beliefsabout smoking, have as yet to establish regularpatterns of smoking behaviour, and have abroad understanding of the nature of smoking.Health educators need to capitalize on thisnegative disposition toward smoking via earlyintervention; however, to date, there are nosmoking-specific health education measures forthis age group. The implementation of proactiveprogrammes, before the habit manifests itself,has many supporters but little research hasbeen conducted. This study was devised to fillthis significant gap in the literature on smoking.Data was collected on a representative sampleof primary schoolchildren in the city ofLiverpool. A triangular methodology wasadopted consisting of questionnaires (N J1701), the Draw and Write investigative tech-nique (NJ 976), and semi-structured interviews(N J 50). The results highlight the need toimplement smoking intervention programmesfrom Reception onward, the importance ofdeveloping a model that is more than just

School of Health, Liverpool John Moores University,Liverpool L2 2ER, 1School of Human Sciences, LiverpoolJohn Moores University, Liverpool L3 2ET and2Liverpool Business School, Liverpool John MooresUniversity, Liverpool L3 5UX, UK

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knowledge based and the necessity of involvingthe family in any school-based health educationstrategies.

Introduction

There has been little change evident in patterns ofsmoking among youth in Great Britain over thelast decade (OPCS, 1994; Reid, 1996). Currentresearch has concluded that the rates of smokingamong Britain’s teenagers are at the highest ratesever, with 40% of boys and 50% of girls havingtried smoking by age 13 (ASH, 1996).

Locally, in the city of Liverpool, where both theprevalence of adult smoking (30%) and the lungcancer mortality rates (134.2 for males and 82.7for females per 100 000 population) are some ofthe worst in the country, a recent survey has foundthat the percentage of local 10 and 11 year oldssmoking is higher than the national average(Dawson, 1995). Such trends persist despite com-pelling scientific evidence linking tobacco smoke tolung cancer and pervasive anti-smoking campaignstargeted specifically at adolescent smokers.

Although studies have shown that school-basedanti-smoking strategies can somewhat delayrecruitment to the habit (Nutbeam and Aaro, 1991;Stead et al., 1996), most programmes to datehave been relatively ineffectual (Reid, 1996). Onepossible explanation for such futility is that smok-ing intervention strategies tend to be reactive, i.e.implemented into the school curriculum at a stagewhen attitudes and beliefs toward smoking havelong been established and experimentation withcigarettes is often underway.

At present, in the UK, for example, there is no

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mandatory forum to address the issue of smokingin Key Stage 1 of theNational Curriculum Guid-ance 5: Health Educationdocument (NationalCurriculum Council, 1990) and no smoking-specific intervention available for children under8 years of age. In Liverpool, few schools approachthe topic until Year 6 (Ord and Ashton, 1991), bywhich time almost one-quarter of children havealready tried to smoke (Walters and Whent, 1995).

Because it is easier to establish positive healthattitudes than change negative ones (Jurset al.,1990), the necessity of implementing a smokingeducation program early in the school curriculumis paramount. This proactive approach to smokinghas many advocates (Baric and Fisher, 1979;Schinke and Gilchrist, 1983; Michell, 1989; Oeiet al., 1990; Cohenet al., 1990; Amos, 1992; Bushand Iannotti, 1993; Glynn, 1993; Kelderet al.,1994) and is further endorsed by drug educators(Ives and Clements, 1996; Jackson, 1996). It isbased on the premise that smoking patterns beginprior to experimentation, with the development ofattitudes and beliefs that in turn can influencebehaviour (Leventhal and Cleary, 1980). Thisdevelopmental process begins in early childhoodbetween the ages of 5 and 8 years (Health EducationAuthority, 1991) when exposure to cigarettesenables children to learn the nuances of smokingfrom significant others, enables them to becomeinformed about the nature of the habit, and where,ultimately, they cultivate their attitudes, beliefs andperceptions of smoking behaviour (Leventhal andCleary, 1980; Flayet al., 1983; Conradet al.,1992; Royal College of Physicians, 1992).

Although this allusion to the necessity andimportance of looking at young children ‘‘in viewof the recognized influence of the early yearson attitude and habit formation’’ (Schneider andVanmastright, 1979, p. 72) has been espoused byprominent researchers in current smoking studies(Leventhal and Cleary, 1980; Oei and Burton 1990;Stanton and Silva, 1991; Bowenet al., 1991;Young, 1992; Bhatiaet al., 1993; OPCS 1993;Fidler and Lambert, 1994), a paucity of pertinentresearch prevails. In fact, there has been no smok-ing research conducted on children 4–8 years of

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age in Liverpool and relatively few at the national(Fidler and Lambert, 1994; Somerset Health Educa-tion Authority, 1994) or international levels(Tucker, 1987; Oei and Burton, 1990; Bhatiaet al., 1993).

The dearth of research on this particular agegroup has also resulted in a lack of awarenessabout young childrens’ attitudes toward smokingand to what extent they partake in the habit. This,in turn, has ramifications for the development ofeffective smoking interventions, which need to bebased on an accurate understanding of the beliefsand knowledge of the target group (Tones, 1990,as cited in Oakleyet al., 1995, p. 1029). Researchefforts involving primary school children are there-fore necessary before health educators and healthpromoters can put into practice their general beliefthat the elimination of smoking-related diseasescan only be achieved via primary prevention:deterring children from starting to smoke.

Study design

The research study presented here was devised toaddress the issue of smoking in local young chil-dren, specifically before the habit manifests itself,to highlight the necessity of early intervention and,ultimately, to fill a significant gap in the smokingliterature. The aim was to yield insights into theacquisition of attitudes and beliefs by examiningthe knowledge and perceptions that Liverpoolprimary schoolchildren (4–8 years of age) of vary-ing socio-economic backgrounds have about smok-ing. This will provide a foundation on which todevelop an effective intervention model for healthpromotion aimed at combating the increasing pre-valence of smoking among local children.

Sample

All primary schools in the city of Liverpool wereinvited to participate in the study and, of thoseresponding, 12 were chosen. Selection was basedon various social and economic indicators: unem-ployment statistics from the 1991 Census,Liverpool lung cancer standardized mortality ratiosand the Index of Well-being (Shepton, 1994), to

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Table I. Subject profile information

Year group Gender Age

N % Girls Boys Years N

Reception430 24 208 222 4 113

5 317Year 1438 25 214 224 5 109

6 3257 4

Year 2461 26 204 257 6 105

7 3558 1

Year 3446 25 210 236 6 1

7 958 350

Total1775 100% 836 939 1775

ensure that schools were representative of thediverse socio-economic backgrounds found inLiverpool.

Consent was obtained from head teachers, par-ents and the children themselves. Table I providesdetails of the subjects who participated in thestudy. The sample is fairly evenly distributed; eachyear group comprises approximately one-quarterof the total sample.

Letters of introduction, consent forms and par-ental questionnaires were sent home with eachchild. The purpose of the parental questionnairewas 2-fold. Firstly, it was designed as a validitycheck, enabling cross-comparisons to be made withthe subjects, to ensure that responses were truthfulin nature. Secondly, the information was neededto confirm that the proven link between socialclass and rates of smoking did exist within thesample population (Marsh and McKay, 1994). Asexpected, the highest proportion of smokers inthe parental sample was found among manuallabourers, the unemployed and homemakers. Suchfindings are in accordance with the figures pub-lished by the Health Education Authority (Waltersand Whent, 1995) and effectively illustrates why

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the Mersey region, with a rate of unemploymentthat is twice that of the national average, hassmoking-related lung cancer rates 30% higher thanthe national average (Mersey Regional CancerRegistry, 1993).

Although the correlation between smoking andsocial class was firmly established in the parentalsample, no statistically significant differences werefound in the childrens’ attitudes, beliefs and behavi-our toward smoking based on social class.

Several studies of note have had similar findings(Oakley et al., 1992; Glendinninget al., 1994;Reid et al., 1995). However, as previous researchhas confirmed, parental smoking habits can influ-ence the future smoking behaviour of children(Charlton and Blair, 1989; WHO and Chollat-Traquet, 1992) and adult smoking prevalence islinked to deprivation (Marsh and McKay, 1994),therefore it is suggested that social class is animportant intervening variable which can indirectlyshape childrens’ perceptions and behaviour towardsmoking.

MethodsAs the collection of information from childrenrequires ‘a special approach’ (Oakleyet al., 1995)involving diverse skills and different researchmethods (Mahonet al., 1996), a singular methodo-logy would not suit the requirements of this study’saims and objectives. Consequently, a consolidationof the methods that best measure attitudes, beliefsand perceptions with the tools that best accommod-ate children as subjects was deemed to be the bestmethodological design. Hence, the multi-methodapproach known as triangulation, the utilizationof both quantitative and qualitative methods toinvestigate human behaviour from a variety ofperspectives, was adopted (Cohen and Manion,1994). Using both the quantitative and qualitativeparadigms in this research allows for a ‘holistic’depiction of the children under study and enablesthe weakness of one method to be compensatedby the strength of the other. Additionally, theoutcomes from each approach can be used to cross-validate the research findings, thereby enhancingvalidity and confidence in the results (Breitmayeret al., 1993).

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Although some social scientists argue that themethodological integration of divergent paradigmsis infeasible due to fundamental philosophicaldifferences, others like Steckleret al. (1992, p. 4)adopt a more pragmatic approach and suggest thatcombining qualitative and quantitative methods isnot only possible but necessary because:

...social interventions, such as health educationand health promotion programs, are complexphenomena which require the application ofmultiple methodologies in order to properlyunderstand or evaluate them.

For the purpose of this study, the multiplemethods selected consisted of a questionnaire, theDraw and Write investigation technique (Williamset al., 1989), and semi-structured interviews. Inthe subsequent evaluation of the results, the rich,detailed ‘process’ information gathered from thequalitative methods of Draw and Write and semi-structured interviews not only substantiated thefactual ‘outcome’ data of the questionnaires butalso enriched them as well (Jick, 1983).

QuestionnaireA developmentally appropriate questionnaire wascreated, with the aim of obtaining information onchildrens’ knowledge and experience of smokingto provide baseline data (see Appendix). Using thereview findings of previous research that examinedthe different factors that influence the smokingbehaviour of older children, the questionnaire wasdesigned to collect demographic information, per-sonal smoking behaviour, parental, sibling and peersmoking behaviour, current and future intention tosmoke, and attitude toward smoking.

This questionnaire was subjected to extensivepiloting to establish content validity. The revisedversion was administered to 1701 children in12 schools. Each of the 12 questions on thequestionnaire was read aloud by the researcher tochildren in groups of two, who were asked to tickthe box that best described what they believed tobe the correct answer. Accuracy and confidentialitywere stressed. All questionnaire responses werecoded and entered on a computer database for

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statistical analysis consisting mainly of tests ofsignificance (χ2).

Draw and Write investigation technique

The Draw and Write investigation technique,which requires children to draw pictures andwrite a response in accordance to specificinvitations read aloud in the classroom by theresearcher, was conducted with 976 children insix of the 12 original schools. Drawing hasproven to be an effectual method for delvinginto the belief systems of young children (Prid-more and Bendelow, 1995) and the value of thisparticular tool lies in the fact that it simulates day-to-day school activity, it meets the requirements ofa large-scale survey, it is a child-centred approachthat enables all subjects to partake at their ownlevel and it provides insight into children’sthinking at differing levels of cognitive develop-ment (Williams et al., 1989).

The smoking-specific investigation used in thestudy (Wetton, 1990) employed four differentinvitations for the purpose of discovering whatperceptions and beliefs children had regardingsmoking. After administration, coding categorieswere developed for use in analysing the responseswhich was based on frequency of responses.

Interviews

A subsample of 50 children from the six schoolspartaking in the Draw and Write investigationtechnique were asked to participate in semi-structured confidential interviews which exploredthe underlying attitudes and beliefs children haveabout smoking. Children were asked to commenton various pictures, respond to several questionsand give their opinion on a multitude of smoking-related statements. Many of the issues exploredin great detail during the interview stemmedfrom recurring themes in the Draw and Writemethod. Each interview, approximately 30 minin length, was tape recorded and transcribed.Content analysis was conducted and themesindicating trends in the attitudes, beliefs andperceptions children of varying ages have aboutsmoking were identified.

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Results

The results of this study, involving the analysis ofdata from the use of three diverse methods withina large sampling frame were extensive, thus onlya summary of the findings is detailed below. Adetailed account is available in an interim researchreport entitled Attitudes, Beliefs and SmokingBehaviour of Liverpool Primary Schoolchildren(Porcellatoet al., 1996).

Summary of questionnaire results

The results of the questionnaire were divided intothree sections: smoking experience, attitude towardsmoking and intention to smoke in the future.

Smoking experience

The majority of children in the sample (94%) hadnever tried to smoke a cigarette (N5 1583).These children were labelled ‘non-triers’. A smallproportion of children (6%) tried at least one puffof a cigarette and were subsequently labelled‘triers’. A large number of triers (70%) were boys(P , 0.001) and over 60% had parents who smoke(P , 0.001). The children in the study were alsoasked questions about the smoking habits of theirparents, siblings and peers. Almost half of theparents in the sample, 47% of mothers and 48%of fathers, were smokers, whereas less than 10%of siblings and peers smoked, respectively.

Attitude toward smoking

As one component in the assessment of attitudetoward smoking, children were asked if theythought smoking was good or bad for people.From the data collected, 91% of children believedsmoking was bad for people, less than 3% thoughtit was good and 6% of children did not know. Ofthe children who had a positive disposition towardsmoking (N5 42), 70% had parents who smoke(P , 0.05) and 60% were 4–5 years of age (P,0.001). Twice as many boys (N 5 28) as girlsthought smoking was good for people (P, 0.05).This statistical significance suggests a gender biasin the smoking experiences of the children inthis study.

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Future intention to smoke

An additional means of drawing out children’sattitudes toward smoking was accomplished byasking the children if they thought they wouldsmoke when they grew up. A large proportion ofthe children (77%) did not intend to smoke inadulthood, whilst 10% were uncertain about theirfuture smoking habits. Of the 13% who intendedto smoke, the majority were from Reception andYear 1 (P , 0.001). Statistically significant genderdifferences (P, 0.001) were also apparent asboys were twice as likely to want to smoke in thefuture than girls. At least 60% of the children whointend to smoke when older had parents whosmoke (P, 0.001).

Summary of Draw and Write findings

The children in a subsample of six schools (N5976) were invited to partake in a Draw and Writesession that involved four different inquires. In thefirst inquiry, the children were asked todrawsomeone who smokes and write how they thinkthat person feels and where they think the smokegoes. For the majority of the children in the sample(60%), smoking had negative associations, whilstonly a minority (less than 30%) felt it had positivecharacteristics. Smokers were generally describedas feeling ‘sick’, ‘bad’, ‘horrible’ or ‘dizzy’(Figure 1).

In Inquiry 2, the children were asked todraw aperson who had been smoking for a long, longtime and write how they could tell from the insideof the body that this person had been smoking fora long time. Of the four inquiries, this one provedto be the most difficult to answer, in particular forthe young children who had difficulty understand-ing the concept of ‘inside the body’. Cancer anddamage to specific organs such as the lungs andheart was mentioned by 22% of children, themajority in Year 2 and 3. As depicted in Figure 2,most of the children relied heavily on visiblesigns of smoking (smoke, cigarettes, ashtray) andphysical appearance (wrinkles, yellow fingers,black teeth).

In Inquiry 3, the children were asked todraw ayoung person who just started to smoke and write

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Fig. 1. Examples of responses for Inquiry 1 across year groups.

the answer to three questions: how old do youthink this person is? where did this young personlearn to smoke?and why does this young personwant to smoke?Figure 3 gives details aboutchildrens’ perceptions of smoking acquisitionacross year groups. Familial references account forat least 40% of the responses regardless of age.The older children, however, specifically mentionmother, father or both parents, whereas the young-

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sters tend to use the more universal term of ‘home’to convey the same notion.

A further point of difference between the yeargroups lies in their interpretation of the questionasked. Children in Reception tended to interpretthe questionwhere has your young person learnedto smoke?literally and thus cited specific locationswith much greater frequency than their oldercounterparts. In addition, the peer group which

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Fig. 2. Examples of responses for Inquiry 2 across year groups.

plays a minimal role in the eyes of the 4–5 yearolds (less than 1%) is one the most frequentresponses given by those children in Year 3.

With reference to why young people want tosmoke, children in Reception were most likely tostate ‘because they want to’ or ‘because they likeit’, whereas the 7 and 8 year olds were more likelyto cite self image and copying others, particularlyfriends, as the reason. At least half of the youngchildren drew a young smoker who was less than10 years of age, whereas the majority of the older

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age group depicted a young smoker between theages of 11–20 years.

In Inquiry 4, the subjects were instructed todraw themselves in a room full of smokers andwrite how the feel and what they would say.Invariably, almost the entire sample denoted nega-tive feelings in the presence of individuals whosmoke (Figure 4). However, of the children whoenjoyed being in the company of smokers, themajority were children from Reception. Withrespect to what the subjects would say to smokers,

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Fig. 3. Frequency of responses to the question: where has your person learned to smoke?

the most popular response by almost 80% of thechildren, regardless of age, was asking a smokerto stop or quit smoking, or leave the room. Somechildren (6%) said they would reprimand thesmokers or question their rationale for smoking(4%) and a few stated they would leave the roomthemselves (2%).

Summary of interview resultsDominant themes to emerge from content analysisof the interviews included negative attitudes towardsmoking, knowledge about smoking and familialinfluences.

Negative attitudes

This pattern of negativity that dominants theresearch findings can be seen in the manner inwhich the subjects’ perceived smokers. Despiteage, children were twice as likely to expressnegative feelings about individuals who smoke.Comments attesting to the ‘stupidity’ of smokers‘because it’s not good for you’ are paramount Allthe subjects emphatically stated that smoking wasbad for people and could not think of any benefitsfor indulging in the habit. Negative perceptionswere also evident about the social desirability of

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young smokers. Most of the sample were inclinedto believe that smokers generally made less thanfavourable friends because of the moral taboosattached to the smoking habit.

Knowledge about smoking

An aspect that became obvious from the analysisof Draw and Write, and which is recurrent through-out the interviews, is the fact that this sample ofchildren has well-informed perceptions of smokingfounded in a comprehensive and principally accur-ate knowledge base. The entire sample knew cigar-ettes could be purchased at shops and many wereaware of a minimum age of purchase. Almostwithout exception, those interviewed believed thatnon-smokers outlived smokers and knew of thesignificant health risks involved. Parents wereimplicated as the main source of informationregarding health consequences. Those interviewedalso made inferences that implied an understandingof concepts such as addiction, cessation and passivesmoking.

Although the attitudes, beliefs and perceptionschildren hold about smoking are generally sound,they do have some misconceptions about the habit

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Fig. 4. Examples of responses for Inquiry 4 across year groups.

which emanate, it would seem, from their beliefthat smoking is an adult activity. Questions probingthe appropriateness of smoking in relation to agerevealed that a significant proportion of the samplethought it was ‘OK’ to smoke ‘‘when you’re atadult age because adults are bigger than kids’’.

Familial influences

The premise that one learns to smoke ‘from theirfamilies’ was central to the core of childrens’

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beliefs about smoking. In the opinion of most ofthe children interviewed, parents occupy the roleof primary educator with regard to smokingacquisition and are not seen to relinquish theposition until parental influence gives way topeer influence with the progression of age. Thistransition from family to friend was also seen inchildrens’ perceptions of why people want tosmoke. A significant number of children in theolder age group felt that young smokers would

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originate from families where smoking was preval-ent. A girl in Year 3 hypothesized that ‘‘theycouldn’t have bought the ciggys from the shop sothey might have got them off their mum’’.

Discussion

The overall research findings of this triangulatedstudy lead us to conclude that primary schoolchil-dren in Liverpool, age 4–8 years, generally havea negative disposition toward smoking and, for themost part, have yet to establish regular patternsof smoking behaviour. Moreover, they appear topossess a fairly sophisticated understanding of thenature of smoking in conjunction with a strongbelief that the habit is an intrinsic part of adulthood.Although their perceptions are generally accurate,many also harbour misconceptions about the realityof health risks in adulthood. The identification ofsuch factors has generated greater insight into whatchildren think about smoking and, moreover, lendscredence to those who espouse the implementationof smoking intervention strategies much earlier inthe school curriculum, prior to the manifestationof the habit.

Negative disposition toward smoking

The disdain for smoking and smokers as a predom-inant theme in the resultant data of the diversemethods strongly supports the work of previousresearchers who have conducted similar investi-gations on older children (Oei and Burton, 1990;Bhatia et al., 1993). There is also noteworthyconsistency with the results from the SomersetHEA Best of Health Project and Somerset HealthAuthority Study (1994) looking at childrens per-ceptions of smoke, smokers and smoking uponwhich the Draw and Write inquiries (Wetton, 1990)were based. Such congruency suggests that thismethodology is valid for assessing childrens’ per-ceptions about smoking. When such anti-smokingsentiment abounds, it would seem to be the idealopportunity to introduce health education measuresthat could maintain and build upon such negativity,and subsequently enable schoolchildren to resisttaking up the habit as they enter adolescence.

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Influence of family

According to the research findings obtained fromall three methods, the family plays an integral rolein the smoking perceptions of young children.Parents in particular are accorded special signific-ance by children, who see them as the mainsource of information with regard to health-relatedbehaviours as well as one of the primary inspira-tions for young people wanting to smoke.

The results of the study illustrating that childrenwho reported having parents who smoke, siblingsand friends who smoke are more likely to havetried a cigarette, more likely to want to smoke inthe future and more likely to think that smokingis good rather than bad are consistent with thefindings of Shuteet al. (1981), who found thatparents and siblings exert a powerful effect on thebehaviour and desires of pre-school and first gradechildren. In concurrence are the results of a uniquesmoking study from Oxfordshire conducted byFidler and Lambert (1994) who examined theinfluence of the adult role model of smoking onchildren aged 3–5 years of age and found thatparents who smoke do influence their childrens’total perception of smoking. Furthermore, Oeiet al.(1990) also found a highly significant relationshipbetween the smoking habits of children and theirparents in their study on the smoking behaviourof 9-year-old children, as did Charlton (1996)on her work about children, smoking and thefamily circle.

In light of the influential nature of familialrelationships, it is somewhat distressing to notethat over half of the children in this study live ina home with at least one or more smokers, themajority of whom smoke more than six cigarettesper day, as compared to 47.5% of children wholive in a house where no one smokes at all. Thisknowledge brings home the message that anyhealth promotion measures must stretch beyondthe confines of the school and must ‘bridge theinterface between school and home’ if attemptsare to be even remotely effective. Smoking inter-vention models must be developed to help dispelthe incongruence children experience with regard

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to what they perceive to be true, that smoking isbad, and the reality they encounter at home, parentssmoking and enjoying it.

Smoking as an adult activity

Invariably, almost all the children in the studybelieved that smoking was bad. However, a signi-ficant number of children believed that it was ‘OK’to smoke ‘‘when you’re at adult age because adultsare bigger than kids’’. According to some, smokingwas an appropriate activity ‘‘when you are oldenough to buy cigarettes’’ as ‘‘...their lungs havegrown a bit bigger’’. Similarly, others were of theopinion that ‘‘only big grown ups smoke and littleones can’t’’ because ‘‘it could kill children becausethey haven’t got as big lungs’’, ‘‘because childrenare only little, we don’t understand’’. Such miscon-ceptions could perhaps be dispelled if young chil-dren were educated about the ubiquitous effects ofsmoking on all individuals, at all levels.

The influence of age

Further highlighted in this research is the signific-ance of age in relation to perceptions, knowledge,attitudes and beliefs, and behaviour toward smok-ing. It is apparent that many of the responses givenby the children are in effect shaped by theircognitive development. As such, any interventionstrategy developed must be developmentally appro-priate, whereby cognitive ability is synchronizedwith age level, comprehensive in nature and morethan just knowledge based because these youngchildren are generally well informed aboutsmoking.

Moreover, the research findings of this studyhave enabled the identification of those childrenwith a positive disposition toward smoking whocould potentially be at ‘risk’ of engaging in thehabit in the future. As children from Receptionaccounted for the greatest proportion of subjectswho reported that they had tried to smoke, whointend to smoke in the future and who viewsmoking positively, these 4–5 year olds becomean important cohort. Since the rationale for thesefindings in the Reception year group is not yetunderstood and the differences in childrens’

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responses based on year group are as yet unclear,further exploration of such variables is merited.According to Flay (1993, p. 372),

Without a full understanding of [the acquisition]process, plus an equally full understanding ofbehaviour change processes in general, it isimpossible to design very effective preventionprograms.

In light of this premise, a longitudinal study of theReception birth cohort will be conducted. Byutilizing the research design of the cross-sectionalwork to track these subjects over the next fewyears, as they approach the age of experimentation,it will be possible to construct individual profileswhich reflect the developmental progression ofeach child and their respective behaviour changesover time. Such information, which will enablestrategies to be tailored accordingly, is fundamentalto the creation of an effective smoking interventionmodel for health education aimed at deterringyoung local children from starting to smoke.

Acknowledgements

This research study has been funded by the RoyCastle Lung Cancer Foundation.

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