Ecological Exploration of Knowledge and Attitudes Towards Tobacco and E-Cigarettes Among Primary School Children, Teachers, and Parents in Wales: A Qualitative Study

Abstract

Experimentation with e-cigarettes has grown rapidly among UK adolescents. To date, this topic has been primarily researched in secondary schools, with less understanding of development of attitudes and behaviours at an earlier age. This research reports qualitative data from interviews with pupils, parents, and teachers at 4 case study schools in Wales (N = 42). It draws on Bronfenbrenner’s Ecological Systems Theory to consider how the intersection of systems surrounding primary school-age children and their interaction with these systems, shape knowledge, and attitudes towards e-cigarettes and tobacco. Findings indicate that consistent messaging on smoking from school and family was reflected in strong disapproval among pupils and clear understanding of harms. This was less evident for e-cigarettes, where messages were mixed and inconsistent between home and school, with concerns over what to tell children about e-cigarettes in light of mixed messages and absence of official guidance. Implications of findings for policy and teaching are discussed.

School staff perceptions of the nature and consequences of students’ use of e‐cigarettes

“…[15][16][17] Very little is known about the vaping activities of primary school children and this is an area in need of much greater attention in the face of international evidence suggesting increasing prevalence of e-cigarette use among younger children. 18 The aim of the present study was to extend the limited data available on Australian students' vaping behaviours by assessing the nature and consequences of e-cigarette use in primary and secondary schools. Given the lack of prior work with primary school aged children in particular and the ethical and access issues associated with discussing this topic with young children, an exploratory approach was adopted that involved surveying staff working in schools.…”

Changes in childhood experimentation with, and exposure to, tobacco and e-cigarettes and perceived smoking norms: a repeated cross-sectional study of 10–11 year olds’ in Wales

“…As fewer children experience exposure to secondhand smoke in their daily lives, they are perhaps less likely to hold a strong attitude toward hypothetical exposure. Notably, while disapproval of secondhand smoke remained lowest among those exposed to tobacco smoke (mirroring qualitative research that children who are exposed to it express a strong dislike of it ( 33 )), recent change over time in tolerance of secondhand smoke was not observed among children of smokers, perhaps indicating that this change was driven primarily by children with relatively low exposure to secondhand smoke.…”

“…However, causality remains contested, with residual confounding remaining a likely partial explanation for these trends ( 32 ). Youth smoking rates and attitudes in favour of smoking continued to decline during the emergence of e-cigarettes ( 11 ), while our analyses of survey data and qualitative data on primary school pupils in Wales from the present study indicate that parental vaping is associated with perceived smoking norms only where it occurs alongside smoking ( 33 , 34 ). Indeed, children whose parents used e-cigarettes were more likely to perceive these as devices adults used to stop smoking, with perceiving e-cigarettes as a means of giving up smoking associated with lower reported susceptibility to smoking ( 33 , 34 ).…”

“…The main exception was the percentage of children reporting family rules restricting smoking in the home, which after increasing from 2007 to 2014, showed no further change since 2014. However, in our qualitative research ( 33 ), children talked of not having restrictions in their home because it was something that just did not happen, and was understood to be unacceptable without a need for formal rules. Hence, questions about smoking rules in the home may be losing their validity as indicators of whether smoking happens in the home as smoking in children’s home becomes more de-normalised.…”

“…However, taken together with the tendency for the lack of increase in formal rules on smoking, greater acceptance by children of people smoking around them may reflect a tendency for more limited communication with children regarding tobacco, and a perception that smoking is not an issue which affects children anymore. In our linked qualitative research, many non-smoking parents expressed a view of smoking as an adult issue, and a preference not to discuss tobacco with their children until they began to encounter it later in adolescence ( 33 ). Anecdotally, during survey recruitment, some schools who declined to participate also expressed a view that tobacco was not really an important issue for children in their school anymore.…”