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Rates of tobacco smoking are substantially higher among young people accommodated in residential homes than in the general youth population. Public health guidance from the National Institute for Health and Care Excellence (NICE) recommends that all smokers should be identified, advised to quit, and offered treatment for tobacco dependence during health-care consultations. Opportunities to address tobacco dependence are available for young people in residential care through the annual statutory health review assessment (HRA). However, little is known about the extent to which HRA is used to address tobacco dependence among this population. We aimed to assess smoking-related recording and clinical practice during the HRA.


A retrospective review of the statutory health assessment forms of all young people accommodated in residential homes by an English local authority in the East Midlands between June 1, 2013, and May 31, 2014, was conducted. Practice was assessed with standards developed from statutory and NICE guidance relating the recording of smoking-related information during annual health assessments. Descriptive statistics were used to summarise the characteristics of the young people and the level of smoking-related recording. Associations between categorical variables were analysed with χ2 tests, and one-way ANOVA was used to assess continuous data. Ethics approval was provided by the Families, Young People & Children Clinical Audit, Standards, Effectiveness and Research Group of Leicestershire Partnership NHS Foundation Trust, and data were accessed under Section 251 of the NHS Act.


31 young people were included in the review, of whom 30 (97%) had completed a statutory HRA. Inquiries about smoking were made in 23 (77%) instances. 12 (52%) of those who had participated in the HRA and who were asked about smoking were identified as smokers. Nine (75%) of these smokers engaged in discussions about their smoking and were offered treatment for tobacco dependence: two (22%) accepted a referral for treatment. The reasons for declining support for smoking cessation were documented in two (17%) cases.


Opportunities to address tobacco dependence among young people in residential homes are being missed during the HRA. Further research should explore clinician practice and attitudes to addressing tobacco dependence during the HRA and the perceptions of these young people in relation to receiving smoking cessation advice and the treatment offered.


This study was funded by a UK Centre for Tobacco and Alcohol Studies PhD studentship.

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