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5.20 Approaches to youth smoking prevention

Under the broader rubric of 'prevention' just described, what can be done and is there evidence that it works? Reviews of the literature repeatedly concur that effective youth smoking prevention requires a comprehensive multifaceted approach,216 involving a range of well-researched, coordinated and complementary strategies which reinforce each other.13, 217-224 As in tobacco control generally, the impact of each strategy when used in isolation is likely to lead to an underestimate of their combined impact because of synergistic effects.1, 9 One-off or single focus interventions targeting young people are unlikely to have lasting results.223, 225

The imperative for sustained effort and funding has been reinforced in some states of the USA, where the initial successes of large scale and comprehensive campaigns and intense tobacco control activity of the 1990s has diminished, mirrored in the halted decline of teenage smoking.226 The efficacy and acceptability of programs targeting young people is also enhanced by their involvement in intervention planning and development,227 and is supported by the United Nations' Convention of the Rights of the Child.228 In the tobacco control literature, youth participation in intervention design is not often explicitly referred to, and as noted by Williams et al, there is a lack of controlled studies measuring the impact of youth involvement.223

Identifying best practice evidence-based youth smoking prevention strategies is hindered to some extent by the fact that only a small proportion of prevention interventions implemented in Australia and overseas have been rigorously evaluated, if at all.98 Guidance for effective prevention thus needs to be drawn both from understanding of the factors influencing uptake, as well as the efficacy of prevention efforts that have been evaluated or bear some evidence of positive effect. Table 5.3 maps some of the key uptake factors identified earlier in this chapter that are amenable to intervention as identified from the literature.

Table 5.3
Core components of comprehensive youth smoking prevention

Influences to smoke	Intervention approaches that can address this
Family environment (see Section 5.7)	Adult campaigns and cessation interventions Parent/home components of school-based interventions Information and resources directed at parents regarding youth smoking
Smoking behaviour of peers, and peer attitudes and norms (see Section 5.8)	Mass media campaigns targeted at young people (and flow on effect of adult campaigns) Peer influence strategies incorporated into school interventions, youth resources Peer education approaches
Intentions, attitudes and beliefs (see Section 5.6)	Youth directed mass media campaigns School-based programs Targeted resources, internet and technology strategies Interactive technology strategies Strategies to denormalise smoking (including smoke free public places)
Educational environment (see Section 5.9)	School curriculum and programs School smokefree policy Complementary initiatives that are protective against smoking (e.g. physical activity, school connectedness)
Accessibility to and availability of tobacco products (see Section 5.11)	Sales to minors interventions Point of sale stock regulations Removing display at point of sale in retail outlets Licensing
Affordability (see Section 5.12)	Pricing and taxation
Tobacco advertising and promotion targeted at young people (see Section 5.15)	Advertising and promotion bans Health warnings on packaging and advertising Plain packaging of tobacco products/packets Monitoring and advocacy around new tobacco industry tactics to target young people
The portrayal of smoking in the popular media (see Section 5.15)	Advocacy and publicity Exposing young people to deceptive tobacco industry marketing approaches (including smoking in movies)
Tobacco products created to appeal to new users (see Section 5.16)	Advocacy and regulation to curb packaging, flavourings that appeal to young people

5.20 Approaches to youth smoking prevention

5.1 Introduction

5.2 Stages in the uptake of smoking

5.3 Factors influencing uptake by young people—overview

5.4 Physiological aspects

5.5 Individual personality traits and psychiatric influences

5.6 Intentions, attitudes and beliefs

5.7 The home environment

5.8 The smoking behaviour of peers, and peer attitudes and norms

5.9 The educational environment: achievements, aspirations and 'school connectedness'

5.10 Other drug use

5.11 Accessibility of tobacco products to young smokers

5.12 Affordability of tobacco products

5.13 Opportunity to smoke

5.14 Cultural background

5.15 Tobacco advertising and promotion targeted at young people

5.16 Products and packaging created to appeal to new users

5.17 Factors influencing uptake of smoking later in life

5.18 Uptake—a concluding note

5.19 What is meant by prevention?

5.20 Approaches to youth smoking prevention

5.21 Mass media strategies/campaigns

5.22 Interactive technology and multimedia

5.23 School-based interventions

5.24 Peer influence and education

5.25 Parent/family/home targeted interventions

5.26 Reducing tobacco access and supply

5.27 Reducing product appeal

5.28 Promotion and visibility of tobacco

5.29 Denormalising smoking

5.30 Taxation and pricing of tobacco products

5.31 Harnessing predictors of uptake to prevent smoking

5.32 Preventing smoking in more 'at risk' groups

Acknowledgments

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