activityapartfromsleeping [93]
.TheTVisthereforebeausefulmeansofinluencing childrenandadolescentswithregardtoacceptablesocialbehaviour,culturalnorms,issues
ofdailylivingandhealth-relatedmatters [94]
.Infact,severalmassmediacampaignshave beenruninthepastinattemptstoinluencesmokingbehaviouramongyoungpeople
[95] .
Speciicprogrammeshavebeenusedforsomeschools [34,79,96,97]
.Informationpro- grammespreparedspeciicallyforthemassmediahavebeenverymuchlesscommon
[98,99] ,althoughsuchcampaignscanactuallyleadtoatransientreductioninsmoking
prevalenceseealsoFig. 12.7
[98]
. AnanalysisrecentlypublishedbytheCochraneGroup
[100] warnsthattheresultsof
differentcampaignscannotbeevaluatedfromasingleviewpointbecausethebaselinesitu- ationinonestudyisnotnecessarilycomparablewiththatinanotherstudyorcampaign.
Generalisationoftheinformationobtainediscomplicatedbyawiderangeofindividual factorsarisingoutofthecharacteristicsofacommunityandthelocationoftheparticular
school [101]
. Similarly, according to a meta-analysis of other school-based prevention programmesonly1621outof131studiesanalysedtheirdataonastatisticallysound
basis [102]
,thecommonfailingbeingthatchangesinthecontrolgroupwerenotconsis- tentlyincludedintheanalysis.Furthermore,thelevelofimpartialityofthemediaagencies
orperiodicalswasnotalwaysclearlydeined. AccordingtooneanalysisfromtheUSAoftheimpactofmagazinearticlesonhealth
educationtopicsovertheperiodfrom1950to1983,itisclearthatprintmediamayinfact inluence the initiation rate in the general population
[25] . The number of educational
articlesontheharmfuleffectsofsmokingcorrelatedwithsmokingcessationinadultsbut notwithsmokinginitiationinadolescentsbecausethislattergroupwasnotthetargetread-
ershipforthesemagazines,andgreateremphasisonthisaspectneedstobemadeinfuture [25]
.Withoutdoubt,broad-basedPRcampaignsofthistypeareappropriateinstruments foreducationalpurposesinthosecountrieswithahighsmokingprevalence,e.g.Southern
andSoutheasternEurope. AccordingtotheanalysispublishedbytheCochraneGroup
[100] ontheinluenceof
massmediainterventionsonsmokingbehaviouramongyoungpeople,sixmassmediacam- paignsweresuitableforpreventingsmokinginitiationinthistargetpopulation,andtwoof
thesesixmediainterventionsalsocausedareductioninsmokingprevalenceamongadoles- cents
[103–105] .Overall,eficacyhasbeenassessedasonlymoderatelypositivetodate.
Fig. 12.6
Effectofinitiation policiesonthenumberof
smokersintheUnitedStates
within50years.aStatus quo;b50reduction;
c100reduction;d
100reductionplus25 delayedinitiation
[90] 60
50 40
30 20
10 1993
2003 2013
2023 2033
2043
Smokers [Millions]
a b
c d
Insummary,mediacampaignstoencouragesmokingcessationanddiscouragesmoking initiationcanbeusefulandeffectiveprovidedthattheyarenotinluencedbythetobacco
industry.However,thecampaignsmustutilisepreviouslyvalidatedmaterialandthepro- grammesthemselvesmustbedesignedspeciicallytoincludechildrenasthetargetaudience.
Whereverpossible,programmesshouldbescreenedonchildren’sTVchannelsattheright timeofdayandtheyshouldbeofanappropriatedurationtoensureacceptancebychildren.
12.11 Role of Government and Community in Primary Prevention
Centralgovernmentishardlyinvolvedintheregulationofcigarettesalesinthevarious countrieswithinandoutsideEurope,notevenwhentheissueatstakeistheprotectionof
youngpeoplefromthehazardsofsmoking.OneexceptionistheUKgovernmentwithits “Smokingkills”campaignthathasbeenrunningnowfor10years
[106] :£100millionhas
beenallocatedtoachievethreemaingoalswithinthenext3years.Oneofthesegoalsisto reducesmokingamongadolescents16-yearsoldfrom13to9orlessbytheyear
2010,withafallto11bytheyear2005.Thisislinkedtoabundleofmeasures,suchas minimaltobaccoadvertisinginshops,toughenforcementonunder-agesales,proof-of-age
100 90
80 70
60 50
40 30
20 10
1950 1953 1956 1959 1962 1965 1968 1971 1974 1977 1980 1983
Year Percentage of population lines
80 70
60 50
40 30
20 10
Magazine articles bars
Smoking causes lung cancer
Smoking is hazardous to nonsmokers health
Fig. 12.7
Population beliefs on the harmfulness of smoking left axis, and annual number of articlesonsmokingandhealthindexedinTheReader’sGuidetoperiodicalLiteraturerightaxis
[25] .Intheearly1950s,therewerelessthan20magazinearticlesonsmokingandhealtheachyear.
Thehighestpeakinmagazinecoveragewas75articles,whichoccurredsurroundingthereleaseof the1964SurgeonGeneral’sreport.Thepercentageofthepopulationbelievingthatsmokingis
hazardoustonon-smoker’shealthwasbelow50in1974,buthadapproached70bytheearly 1980s
cards,andstrongrulesonthesitingofcigarettevendingmachines.“Wewantchildrento beablegointoshopswithoutbeingfacedwithtobaccoadvertsorpromotionalmaterials”
[106] .Toensuretheachievementofthesegoals,theWhitePaperdescribesdetailedmea-
suresthataretobeimplementedbycentralandlocalgovernments. Sincetobaccoconsumptionisasociallydeterminedphenomenon,changesinthesocial
environmentandsocialnormscouldbecomeimportant [107]
.Itisentirelyconceivable that a change in norms, values and behavioural patterns would increasingly discredit
tobaccoconsumption,andthatthiswouldthenbefurthermirroredinthesocialenviron- ment.Thisobjectivecanbeassistedbycharitableorganisationsinmanycountriesdedi-
catedtothestruggleforasmoke-freeenvironment–agoalthatwouldalsoincludeschools. Schoolcurriculum-basedsmokingpreventionprogrammesmightwellprovehighlyeffec-
tive [108]
andlocalcommunitiesshouldhelptocreateapositivenon-smokerimage [109]
. Acombinedschool-andcommunity-basedtobacco-usepreventionprogrammeclearlyhas
thepotentialtoreducesmokinginitiationrates,asdemonstratedbystudiesin28-year-old non-smokers
[72] .AnalysisofthedatabytheCochraneGroupalsoindicatesapositive
result [110]
. Arestrictiononthesaleoftobaccoproductstominorsisanimportantaspectofpreven-
tion.Salestominorsmustbereducedinaccordancewiththefollowingstipulatedrecom- mendations of the WHO: a minimum age 18 years, b licence system for tobacco
retailers,cthreatofpenaltiesforillegalsaleoftobaccogoods,throughtorevocationof licence,dstatutoryprohibitiononsalestominors,enosalesinhealthservicebuildings,
schoolsorsportsfacilitiesandfnosalesfromcigarettevendingmachinesorself-service stores
[34,111] .
12.12 Concluding Remarks
Theissuessurroundingprimarytobacco-usepreventionprogrammesdesignedtodeter
•
studentsfromsmokingintheiryouthneedtoberevisited.Childrentrytobaccojustas theytryalcoholorillicitdrugs.Eventhoughitmaysoundsurprising,thesefactscannot
bealteredovernightbecauseadolescentstypicallywanttodiscoverwhattheworldhas tooffer.Consequently,thisexperimentationphasecanonlybesuppressed.
Attemptstolimittobaccoconsumptionbyusingschool-basedprogrammes,massmedia
•
campaignsorrestrictionsontobaccosalestominorshavebeeneffectiveprincipallyin thecontextofresearchstudies.However,someofthestudiesconductedtodateare
highlycomplexandwouldbeimpracticalinareal-lifesetting.Theeasewithwhich minorscanobtainillicitdrugsdemonstratesthefutilityofseekingtopreventthesupply
ofthesesubstances.Theonlypossibleguaranteeofsuccessmightbethroughtheworld- widecoordinationofsuchefforts
[97] .
Advertising encourages smoking initiation and sustains smoking see
•
Chap. 13 ,
whereasadvertisingbansreducethenumberofsmokers,althoughthefactorsinvolved insmokingbehaviourareverydificulttoidentifyindividually.Theburdenofprooffor
theeffectivenessofadvertisingbans,however,lieswithpublichealthauthorities.