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?
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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
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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
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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
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In Jersey it became illegal to smoke in a motor vehicle carrying
young people under the age of 18 from 1st 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
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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
Vulnerability: The received
vulnerability of second- hand
smoke on young people
Threat
appraisal
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
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• 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
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• 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
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Evaluation
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• 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
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• 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/SecondHandSmokeConsultation
.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.