It was used with a group of young women (14-16). It got them thinking.
They could see that they all had very different smoking patterns. One was
a chain smoker and quite proud of it, others only smoked in the pub (sic).
(Health Promotion Adviser)

Our department was asked to come in and run a school group. They were
only 13. The booklets were way over their heads. What they really wanted
was a bit of attention. They were low achievers and they got two adults.
We look at self-esteem, now and the smoking gets tagged on.(Health
Promotion Adviser)

It's useful to work through it page by page. It gets them thinking and ready
to stop. (Teacher)

We found they didn't want to carry it around with them as they didn't
want their parents to know they smoked, so we reproduced the smoking
diary very, very tiny. (Health Promotion Adviser)

I think it's best used one to one, then you can go through it a bit at a time
and help them to make a sort of plan for giving up. But it's very difficult
for them, they want to stop just like that. When it doesn't work they say it's
too difficult. The stages of change model just does not seem to apply to
them. (Health Promotion Adviser)

These more detailed responses also highlighted just how challenging is the task of
encouraging teenagers to give up smoking. Although all respondents expressed
opinions as to what might be effective cessation strategies for teenagers, perhaps
the majority view could be summarised by one stark comment, "I wish I knew".
This is not to say that respondents were pessimistic and negative, they were just
unsure about what, if anything, worked. One or two health educators commented
that perhaps the reasons that young people gave for smoking were changing. In
particular, it seemed that the idea that smoking is "cool" is disappearing, but it is
being replaced by the equally strong belief that smoking is a support for "troubled"
young people. If this was an accurate reflection of changing attitudes they thought
new approaches would have to be developed to deal with them.

However, there was widespread agreement about key elements of any approach.
Most stressed the need for wide-ranging strategies incorporating several agencies.
To have any chance of success strategies needed to

• be flexible and varied
• be supported by trusted, non-judgmental, non-patronising adults
• encourage peer support, buddy systems, group work
• develop and support young-people-led initiatives and programmes
• make available (when wanted) accurate information on a range of issues -
money, health, exploitation etc.
• provide positive role models
• use fun, lively methods such as quizzes, competitions