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

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, replica bility), and impact (the combination of reach and efficacy). The major inter ventions appraised include school health education, media and school pro grammes for youth, media and com munity programmes for all age groups, prevention of sales to teenagers, re strictions on smoking in schools, adver tising bans, fiscal policy, and media advocacy. Interventions aimed primarily at youth are likely to have a delaying effect only, and sophisticated school pro grammes, though potentially valuable, have proved difficult to implement effec tively on a large scale. Priority should therefore be given to broad-based inter ventions 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 advo cacy is essential to secure both the initial allocation and the retention of the resources required for an effective national programme. (Tobacco Control 1995; 4: 266-277)