Reducing the prevalence of smoking in youth in Western countries: an international review

Abstract

This paper appraises the major options for the achievement of national targets for the reduction of teenage smoking in Western countries, which has changed little in recent years. The criteria for appraisal include efficacy, cost to the health sector, reach (that is, replicability), and impact (the combination of reach and efficacy). The major interventions appraised include school health education, media and school programmes for youth, media and community programmes for all age groups, prevention of sales to teenagers, restrictions on smoking in schools, advertising bans, fiscal policy, and media advocacy. Interventions aimed primarily at youth are likely to have a delaying effect only, and sophisticated school programmes, though potentially valuable, have proved difficult to implement effectively on a large scale. Priority should therefore be given to broad-based interventions aimed at the community as a whole, including mass campaigns for all age groups, fiscal policy, restrictions on smoking, and bans on advertising. Mass campaigns may be more effective than schools at reaching high risk groups. A continuous programme of media advocacy is essential to secure both the initial allocation and the retention of the resources required for an effective national programme. CR - Copyright © 1995 BMJ