Tackling shisha smoking – the role of politicians, public health and local residents in designing a health promotion campaign to influence behaviour change in Barnet. Chimeme Egbutah Public Health Strategist, London Borough of Barnet Tuesday 20th June 2017

What is Shisha? Undertaken all over the world by: North Africans, middle eastern, south asian Young people and adults Male and female Mollases tobacco – flavoured tobacco Herbal shisha – no more safer. Still at risk of CO and other toxins

The growing problem of shisha in Barnet Since 2013, Barnet has seen an increase in the number of shisha premises. 23 active premises operating shisha. Such establishments are often accompanied by non-compliant practices such as health and safety breaches, non tax duty paid tobacco products, and poor compliance with Smokefree legislation Hotspots of shisha premises in the southern central part of the Borough, mostly Finchley Church End ward and West Finchley ward,

Member mandate Borough with the largest number of children and young people (96,716) Family Friendly Borough by 2020 Chair of Health and Wellbeing Board saw this as an issue along high streets, attraction to Barnet young people 10 secondary schools in walking distance to shisha bars Prosecutions was sporadic – more needed to be done! Need a health promotion and education campaign to raise awareness of the health harms of shisha Chair of the HWBB set the tone and requested that. Directive approach Number of low prosecutions Year No of compliant shisha premises/ Total No of shish premises % of compliant premises 2013 9/13 69% 2014 7/14 50% 2015 9/23 39%

The Public Health Problem – Myth Busting FACTS Evidence shows that shisha smoking is at least as harmful as smoking cigarettes Contains a significant number of carcinogenic toxins and contains far more tar, carbon monoxide and nicotine than cigarettes. Associated with several cancers, coronary artery disease, and deterioration of lung function Health and Safety risks to staff working within premises MYTHS One of your 5 a-day Smoking shisha is seen as safer than smoking cigarettes There is no risk associated with sharing a mouthpiece Second hand smoke not harmful Social acceptance - Okay to smoke in doors, peers, family Smoking shisha is low cost

Aims of the project Educate and inform local residents and businesses about the risks of smoking shisha by dispelling the myths that surround its use, presenting the health facts and highlighting true health implications. Engage and inform key partners who work with young people in the borough of the health harms and myths of smoking shisha.

Phases of Project Strong communications input through out lifetime of the project Task and Finish Group – jointly chaired Target audience of Young People ( Year 8+) General Barnet Population Shisha Premises

Imagery Colour scheme Skull, Poison and Lungs Truth/Myth-buster box Shisha pipe Visual appeal Logo Amount of text Toolkit will allow schools to under take the audit themselves with guidance and to pick and choose which elements of the framework they would like to concentrate on Looking to use the framework within other settings including children centres and within the early help team in the Council.

Targeting Young People Blackburn and Darwin Video: ‘The Truth Behind The Smoke’ (see video) Barnet Video with Cut Films: ‘More Than One Choice’

Differences in opinion Public Health Clear evidenced based messaging Maintaining budget Building on co- production from previous experience Placing posters across the borough Communications Promote across the borough Focus group imagery Video and tweets Use of geo-targeting Political Fear of offending local community Video – too hard hitting and ‘dark’ Placing posters across the borough Evidence based messaging

Communicating messages Use of term “Hookah” instead of ‘shisha’ Glamorising shisha smoking Checking….and double checking messages Target group and audience Co-production with young people *Political Environment – timing of campaign “SHISHA SMOKE contains as much addictive nicotine as cigarettes” “SHISHA SMOKE contains tobacco and can give you cancer” “SMOKING SHISHA could increase your risk of cancer”

Final Product

Final Product (2) The shisha campaign website was viewed 1,799 times for an average of 3 minutes and 28 seconds. Six sheet posters had over 17 million opportunities to see. Bus shelter panel posters had over 10 million opportunities to see. 300 school teachers saw the shisha campaign article in the school circular. 13 secondary schools and youth centres (3075 children and teachers) 79% of participants stated that the workshop has made them consider not smoking shisha in the future 80% of young people aged 13 – 25 were exposed to the digital advertising We have raised the reputation of Barnet as a council which cares about the health and wellbeing of its residents. Media coverage in March 2017 BBC London covered a piece on the campaign Campaign up for 3 awards (won 1 for the Cut Film – “More than one choice”) Cllr fear gone as began to see the reception the campaign had Media – press and print End of June receiving an award

Acknowledgments & thanks Cut Films (Roy Castle Lung Cancer Foundation) Barnet Communications Team Barnet Public Health Team Barnet Environmental Health (RE)