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6. Implications of the research evidence and recent experience in Scotland for future preventive initiatives.
Key points
- There is good evidence to support the implementation of an on-going, intensive, multi-stranded media campaign. Targets should include girls and young women in disadvantaged circumstances and young people in their late teens.
- Given the equivocal research evidence and the inconsistency of current approaches in Scottish schools, a reappraisal of drugs education in schools is needed.
- Drugs education should continue to be an integrated part of the curriculum with clear consistent messages. The message on tobacco should be uncompromising: never smoke.
- Informing parents about tobacco, alcohol and other drugs and their responsibilities in this regard should be an integral part of drugs education
- The Ambitious, Excellent Schools and the Health Promoting School programmes provide the frameworkP within which a comprehensive approach to tobacco, alcohol and other drugs should be developed.
- Effective support and management of pupils with behavioural problems is relevant to smoking prevention.
- Universities and further education institutions should play a bigger part in discouraging young people from smoking or misusing alcohol or other drugs
- Any plans for future smoking prevention initiatives based on community development principles should ensure that they take full account of the unsuccessful Breathing Space campaign.
- Further consideration of smoking cessation services for young people is needed in the light of the poor results of the recent pilot programme.
- In the long term, increasing smoking cessation among adults who are or will be parents is likely to contribute to the prevention of smoking among young people.
- Where parental smoking cessation is not attained, stopping smoking in the home may also contribute to the prevention of smoking among young people.
6.1 In Chapter 4, we summarised evidence that comprehensive, campaigns, combining well-enforced regulations, educational programmes and support for individuals and communities can reduce smoking rates if sustained over several years. This is what we recommend for Scotland. In Chapter 3 we set out a comprehensive series of recommendations designed to reduce the availability and affordability of tobacco products for young people. In the light of the further evidence we have gathered and presented in Chapters 4 and 5, we set out in this Chapter what else we think should be done to prevent young people from starting to smoke and becoming addicted smokers?
Media
6.2 There is moderately good evidence from other countries that carefully developed, targeted, intensive and long-lasting media campaigns can discourage some young people from smoking. Successive previous campaigns in Scotland have shown that anti-smoking ads can achieve high levels of viewer awareness. We therefore recommend that an on-going, multi-stranded media campaign, building on the previous work by Health Scotland and the Health Education Board for Scotland, is designed and implemented to discourage smoking by young people of any age. One strand should have a strong focus on developing messages and using media that reach and have credibility with girls in our more disadvantaged communities. Another should target young people in their late teens. The campaign should draw on the evidence for effectiveness in the source literature summarised in this report and should be integrated as far as possible both with other anti-smoking measures and with other media-based health information for young people. This recommendation is consistent with the Final Recommendations of the pan-European meeting on Tobacco, Youth Prevention and Communication in Rome, 2003, agreed by over 200 public health and media experts from 32 countries (see Box).
Key conclusions from the Pan-European meeting on Tobacco, Youth Prevention and Communication, 2003
Youth prevention campaigns have to be part of a comprehensive tobacco control policy and not be conducted in isolation. Media campaigns play a key role to build knowledge, change attitudes and behaviour in support of a tobacco-free society.
Pan European youth smoking prevention campaigns should promote the visibility of tobacco control. Campaigns should contribute to change the social norm from smoking to non-smoking in the European Union.
To reach young people we need to do campaigns which target both adults and youngsters. We need to speak to young people as adults but use the media of their generation.
Education
Schools
6.3 The research evidence does not provide a sound foundation for confidently advocating a particular approach to smoking or drugs education in schools. Furthermore, although the recent review of drugs education in Scottish schools has shown that almost all schools are providing some form of drugs education, it has also revealed a picture of inconsistency in all aspects of its delivery. Given the recent adoption of the Ambitious, Excellent Schools programme, we think this is an ideal time to take stock.
6.4 Despite these disappointing findings, the Working Group was in no doubt that the education system has a vital role to play in helping to prevent children and young people from smoking and the hazardous use of alcohol and other drugs. Drugs education should be a fully integrated part of the curriculum. This conclusion is consistent with that of a recently published authoritative report by the UK Advisory Council on the Misuse of Drugs, Pathways to Problems, which among other things, extensively reviewed the effectiveness of tobacco, alcohol and drugs education in schools 99. The aim should be to convey clear, consistent messages that are begun in primary school and continued right through secondary school. With respect to tobacco, given its addictiveness and its harm to smokers, their babies, children and those around them, the message should be uncompromising: never smoke. This should be delivered from an early age and continued right through school.
6.5 We therefore recommend that a comprehensive reassessment and reform of education on tobacco, alcohol and other drugs in Scottish schools is carried out by a working group whose members have expertise in drugs education research and delivery and in the design and integration of complex educational programmes across the curriculum.
6.6 Given the importance of parents' influence upon whether or not their child will smoke, we also recommend that an integral part of drugs education in school should be to inform parents about tobacco, alcohol and other drugs and their responsibilities in this regard. This should mainly be done by sending parents clear, consistent information at regular points during their child's progress through school. In addition, to reduce their children's exposure to second-hand smoke, we recommend that at the relevant stages, parents are encouraged by midwives, health visitors, general practitioners and hospital doctors, nursery staff and teachers to create a smoke-free home and not smoke when their children are present.
6.7 We endorse the concept of the Health Promoting School and recommend that schools continue to develop an holistic approach to the health and well-being of their pupils. The aim should be to ensure that the school ethos, policies, services and extra-curricular activities all foster the health and well-being of all the pupils. This should include having and applying a school no smoking policy covering everyone using the school grounds. Staff have an important influence as role models.
6.8 Given the association between smoking (and other drug use) with mental health problems, truancy and juvenile offending, we recommend that all schools have effective systems for the assessment, support and care for such pupils, including the ability to liaise effectively with social services where necessary.
Higher and further education and training
6.9 Given the clear evidence that many young people start to smoke or progress from occasional to regular smoking (and drink heavily or use other drugs) once they leave school, we recommend that Universities, Colleges of Further Education and other major training providers, student associations and the National Union of Students should be invited to explore how they could better enable students or trainees to avoid starting to smoke or misuse alcohol or other drugs while attending their institution. This could be developed within the framework of The Health Promoting University.
Community-based initiatives
6.10 Our review of the research found that most community-wide initiatives were not successful and in those that showed some impact it was unclear which elements contributed to the effect. The Breathing Space initiative in Wester Hailes, Edinburgh, was not successful. Given the absence of a successful model, we cannot as yet endorse this approach for country-wide action. Future plans for a community-based smoking prevention initiative should fully consider and seek to avoid the reasons behind the lack of success of Breathing Space84, 85.
6.11 There remains, nevertheless, an urgent need to find ways of interrupting the drift into nicotine addiction and lifelong smoking by so many young people in Scotland, particularly in disadvantaged circumstances. We therefore recommend further research studies to test innovative, carefully designed ways of protecting and dissuading young people in disadvantaged circumstances from starting to smoke or becoming regular smokers. We also recommend that all community-based youth organisations should adopt clear no-smoking policies and use the opportunities open to them to reinforce the message about the addictiveness and harm to health of smoking.
Smoking cessation services for young people
6.12 In the light of the recent poor outcome of the pilot smoking cessation services for young people in Scotland 98 we recommend that active consideration is given to developing other approaches within a carefully designed evaluation framework.
Smoking cessation services for adults
6.13 We have shown that young people are more likely to smoke if their parents smoke and if they live in areas where smoking is more common. We are optimistic that the current policies on the provision of opportunities and support for smoking cessation, against the background of the legislation on smoking in public places will reduce the number of present and future parents who smoke. In the medium to long-term, this should result in fewer children and young people starting to smoke. In addition, if parents who are unable to stop smoking ensure they at least do not smoke in the home, this could also contribute to the prevention of smoking among young people.
Consultation and implementation
6.14 Given that implementation of the recommendations in this report would largely affect young people, we recommend that a representative sample of young people should be consulted to seek their views on the recommendations
6.15 We recommend that the proposals in this report are used by the Scottish Executive as the basis for developing a fully resourced five year Action Plan, with built in performance measures, subject to monitoring by the Scottish Ministerial Group for Tobacco Control.
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