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A BREATH OF FRESH AIR FOR SCOTLAND IMPROVING SCOTLAND'S HEALTH: THE CHALLENGE TOBACCO CONTROL ACTION PLAN
CHAPTER 3: PREVENTION AND EDUCATION
The Challenge
3.1 A reduction in smoking levels in Scotland requires us to take action to minimise the number of 'new recruits' to the smoking habit. The
Improving Health in Scotland: the Challenge6 announced our determination to focus action on what it called teenage transition, the vitally important move from childhood to adulthood during which attitudes, opinions and habits can be formed for life.
3.2 The decision to start smoking can be influenced by a variety of social and cultural factors. Inevitably, our choices are influenced by what we see around us, the behaviour and views of our families, friends and members of our community as well as the addictive nature of nicotine itself. We are influenced also by the access that we have to cigarettes and the images that we see in the media, be that through direct advertising or subtle association with a particular lifestyle or role model.
3.3 The review report points to new evidence about the speed with which young people, particularly young girls, can develop nicotine dependence. More than 80% of adult smokers start smoking in their teens and most are addicted before they are 20. Some will manage to kick the habit early, but many will continue to smoke for decades, unable to give up and increasingly at risk of serious illness and early death. There is also a strong correlation between poverty, social exclusion and other risk factors such as poor diet and the misuse of drugs and alcohol, and early smoking.
Current activity
3.4 Smoking prevention is a key priority for NHS Health Scotland and it currently devotes some 1.5 million per annum across a range of programmes to it. The review report examines in detail prevention efforts to date, including mass media campaigns, school-based initiatives and community-based programmes. It notes the contribution of the Scottish Health Promoting Schools, that 96% of schools in Scotland now provide education on tobacco and highlights the high levels of awareness amongst young people of recent advertising campaigns developed by NHS Health Scotland.
3.5 The marketing and promotion of tobacco products has, in the past, done much to counteract public health messages. For this reason, the ban on tobacco advertising, steps to increase smoke-free provision in the workplace and public places and the new health warnings on cigarette packets are significant. However, as described in Chapter 6, we will continue to work - including at UK level where necessary - to see how much further we can push the boundaries.
3.6 In spite of the advances made, we are concerned at the lack of real progress in recent years particularly in closing the inequalities gap and in reducing smoking levels in young people, particularly girls. For this reason, we believe that a radical re-think of traditional approaches to prevention and education activity is necessary. We need to maximise the benefits from the limited resources available for health education and prevention and do more to challenge influences which promote smoking and smoking behaviour. In particular, discouraging young people from starting to smoke needs to be given the utmost priority.
Future direction
3.7 We believe a national communications strategy is needed. A multi-faceted approach is necessary in order to influence both the general public and specific target groups. Young people must remain our principle target and they themselves hold the key to the success of any prevention messages. We need to understand more about the way in which they make choices about their lifestyle and involve them in shaping the strategies and messages we need to put across in order to make a difference.
3.8 Clearly we recognise the continuing importance of raising awareness of both the immediate and longer-term dangers of smoking. We need to ensure that these messages continue to get across, particularly to those who still believe that it is always easy to stop. However, despite the power and importance of such messages, the Executive believes that warnings alone will not be sufficient to make the kind of impact we need. We do need to track awareness of the dangers of smoking amongst young people and ensure that these don't decline but the reality is that awareness of the risks does not always translate into a decision to avoid developing a smoking habit.
3.9 Our approach to prevention and education will be founded on the commitment to involve young people and develop messages that relate to their lives. We will conduct further research into the pressures that young people are under to start smoking and work with them to design programmes which help them to recognise and resist these pressures. We will also involve young people directly in the development of a strategy which demonstrates that smoking isn't the norm amongst the people they aspire to be and that the decision to adopt a smoke-free lifestyle will be more rewarding in both the short and longer term.
3.10 These messages will carry the greatest weight if they are integrated across a variety of different channels and settings. Schools programmes, community education and media advertising must work together over a long period of time. We will explore a range of channels and options for getting our messages across and be prepared to experiment with electronic and direct marketing where young people judge this to be appropriate. We also believe that interventions are likely to be most effective when they are linked to other supportive action rather than being delivered in isolation. For example, in socially deprived communities, prevention can be coupled with support and advice given in other settings such as debt counselling.
3.11 Of course, we also need to ensure that our commitment to integration doesn't start and finish with our approach to education and communication. However sophisticated our message, it will not deliver change unless we also act to restrict availability, provide cessation services where they are most needed and provide a route out of poverty and social exclusion for our most disadvantaged members of society.
Actions
2. In consultation with the new Ministerial Working Group, we will commission a review of current national communication and education programmes and build any learning into the development of a coherent, integrated long-term communications strategy to guide future prevention activity at national and local levels. 3. In partnership with NHS Health Scotland, we will commission further research with young people to provide a clearer picture of the factors that lead them to start or resist smoking and track awareness of the dangers of smoking and passive smoking amongst key target groups. |
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