Drug Education News

News and views from the Drug Education Forum

School based interventions to prevent the uptake of smoking among children

As I noted at the end of last week NICE are consulting on evidence papers around school based efforts to prevent young people from smoking. You can download the papers from here, but I thought it might be helpful to provide a summary of what they found, which you can find below.

One of the things I found interesting was that (in contrast to what NICE believe is effective in mass media campaigns) fear based approaches are seen as a barrier to providing prevention programmes in schools. Read the rest of this entry »

Filed under: NICE, tobacco

School-based interventions to prevent smoking: consultation on the evidence

NICE have published the evidence papers for the guidance they are developing on school based tobacco interventions.

There are 4 papers they are consulting on:

  • A cost effectiveness review;
  • A qualitative review;
  • An effectiveness review; and
  • An economic modelling report.

They say:

The aim of this consultation is to enable stakeholders to consider the evidence gathered and to provide the opportunity to comment, in particular on:

  • major gaps in the evidence gathered, including papers in the published literature that we have not been able to identify
  • queries around the interpretation of the evidence, both of single studies and the reviewed material as a whole
  • the applicability of the evidence and its usefulness for the development of guidance
  • issues relating to equality
  • issues relating to cost-effectiveness

Filed under: consultation, NICE, tobacco

Behaviour Change

Looking around the NICE website I notice they’ve produced guidance on behaviour change which you can get here.

They highlight the neeed to:

Plan carefully interventions and programmes aimed at changing behaviour, taking into account the local and national context and working in partnership with recipients. Interventions and programmes should be based on a sound knowledge of community needs and should build upon the existing skills and resources within a community. 

Equip practitioners with the necessary competencies and skills to support behaviour change, using evidence-based tools. (Education providers should ensure courses for practitioners are based on theoretically informed, evidence based best practice.)

Evaluate all behaviour change interventions and programmes, either locally or as part of a  larger project. Wherever possible, evaluation should include an economic component.

There’s a slide set that goes with the guidance that may be of interest:

Filed under: Health, NICE

School-based interventions to prevent the uptake of smoking among children

NICE are consulting on the scope for guidance they are developing on “education interventions” which prevent children and young people from starting smoking.

Their current draft has two key questions: 

  • Which school-based interventions are effective and cost-effective in preventing children and young people from taking up smoking?
  • What factors aid the delivery of effective school-based interventions to prevent the uptake of smoking? What are the barriers to successful delivery?

They also set out expected outcomes:

  • A reduction in smoking prevalence;
  • Self-reported or biochemical validation of non-smoking status;
  • A reduction in the prevalence of experimentation with smoking;
  • Changes in knowledge and attitudes related to smoking tobacco; and
  • As a secondary outcome, improved social skills (including refusal skills), an ability to cope with stress or peer pressure, improved self-esteem and self-efficacy.

Having been to the stakeholder’s event they held today here are some things that came out from the questions put to the people from NICE: 

  • At the moment the guidance will take in non-formal education and FE colleges, but will exclude children being home educated. [I think it would be helpful if they were explicit about this in the scope.]
  • When they talk about “educational interventions” this doesn’t mean they will restrict themselves to teaching or class room activity. In other words they will also look at things like smoking policy, peer mentoring etc.
  • They currently aren’t looking at delay of onset as one of the expected outcomes.

My initial thoughts are that our response will be looking to have informal education and Further Education explicitly included in the scope of the guidance, and to argue that home schooling should be part of the remit. I also wonder whether it would be helpful to look at the information, advice and guidance that Connexions provides to young people, particularly those who are not in education, employment or training.

I think we should also be asking that they include changes in skill sets as a primary outcome and that delaying onset should also be seen as an outcome from smoking prevention activities.

We may want to ask NICE to consider whether the biochemical validation – drug testing – needs to be carried out in ways that are compatible with the guidance schools work to on drug testing.

I also think we should ask NICE to think about who the guidance will be aimed at. The referral from the Department of Health talks about local authorities and primary care, but I think that could be usefully extended to school and college leaders (governors and head teachers), and youth services.

Should you want to join the Forum in having your say on the scope then there is a form to fill in.

Any thoughts need to be with NICE by 5 pm on 20th October.

Filed under: NICE, tobacco

The Evidence for Vivid Communication

Following up on what NICE said in their response to the Forum’s submission on preventing young people from taking up smoking I thought I should look at what evidence they’ve found for “vivid communication”.

I’m not quite sure what the NICE team mean by vivid, but let’s hope it’s not the same as fear based as as that doesn’t seem to be as effective as other forms of advertising.

The paper they’ve put together has this to say:

In a review (+) examining the effects of anti-smoking advertising on teenagers, Wakefield and colleagues suggest that although there is some research to suggest that graphic health effects ads, social normative ads, and tobacco industry manipulation ads can positively influence teenagers (increased knowledge about the harms of smoking, lower intentions to smoke and lower perceived prevalence of smoking), the findings are far from consistent (Wakefield et al. 2003). Their review suggests that shock/ fear messaging as well as normative messaging is associated with an increased intention not to smoke, while tobacco industry manipulation ads require a sophisticated target audience in order to be effective.

Another international review found that:

ads that portray health effects can be effective, but they must engage viewers emotionally. Ads that include social disapproval, or refusal skills can also be effective with youth, but have mostly been studied in controlled community settings. The results of one social approval/refusal skills ad campaign included in the review was found to be ineffective when implemented on a large scale, but effective when tested in community trials.

They point to a UK based piece of research which found:

In terms of fear appeals ads, interviewees did not see themselves as targets of these messages and, as a consequence, did not feel it necessary to respond to these threats. In terms of social norms ads, many interviewees said that the advertisements spoke to them at their level and were realistic in terms of social pressure without preaching or telling them what to do. Actors that were slightly older than the target audience also were more effective. In terms of industry manipulation ads, many respondents found them attractive, slick, and sophisticated; however many rejected the idea that the industry might be manipulating their own behaviour by encouraging them to smoke or to smoke certain brands. Using a qualitative research design, the authors concluded that no single anti-smoking message appeal is likely to have universal appeal and that young people’s responses to message appeals are mediated by the values they attach to smoking.

Filed under: advertising, NICE, tobacco,

Preventing the Uptake of Smoking by Children – Response from NICE

I’ve just had the response from NICE to our submission to their consultation on the guidance they’re doing on preventing the uptake of smoking by children.

We said:

The Drug Education Forum believes that public health campaigns are more effective when carried out in conjunction with effective education campaigns.

We understand the reason that educational interventions were not included in the scope of this guidance, however we hope that it will be made clear that there should be an expectation that public health campaigns aimed at children should run alongside educational interventions. In our view this should mean that those that develop public health campaigns should produce materials and resources that are available to schools to use in PSHE lessons.

NICE replied:

Smoking education in schools is the subject of other NICE guidance currently in development, see http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11976

This guidance emphasizes the importance of a comprehensive strategy for tackling tobacco use.

We said:

“be informed by research that identifies and understands the target audiences”


“include advertisements that elicit an emotional reaction (for example, fear)”

The Drug Education Forum is well aware of young people’s often stated claim that they would find harder messages around drugs (including tobacco) would have a deterrent effect on their use. However, there is no evidence, we are aware of, for campaigns carried out in this way leading to changes in children’s behaviour.

There does seem to be some evidence (see Boomerang Ads from Drug and Alcohol Findings 2005) that harder messages can have the unintended consequence of making drugs more attractive to young people.

The Drug Education Forum does not believe that fear is the most effective reaction to be trying to achieve with public health campaigns aimed at children. To support this view we would cite the findings in the review of effectiveness carried out to inform this guidance, which says:

“A UK-based (++)6 qualitative study found that social norms messages were more effective than fear messages at encouraging more committed smokers to consider their smoking behaviours and reinforcing awareness of the dangers of smoking in less committed smokers.” [page 6]

NICE will also want to make it clear that where campaigns are targeted at children and young people they need to be in line with the Advertising Standards Authority guidance. We would particularly point to CAP Code clauses 9.1 and 9.2 (Fear and distress) and 47.2 (Children), and CAP (Broadcast) TV Advertising Standards Code rules 7.3.6 (Children – Distress).

They replied:

Thank you for this considered response. There is published evidence which indicates that vivid communications are successful with young people. This evidence can be found in the review of the mass media campaigns available on the NICE website at: http://www.nice.org.uk/guidance/index.jsp?action=folder&o=40004

Thank you.

Filed under: NICE, tobacco, ,

School-based interventions to prevent the uptake of smoking

NICE have been asked to look at school-based interventions to prevent the uptake of smoking by the Department of Health.

They are looking for national organisations to register as skakeholders in developing the guidance, and their email to me said:

By registering as a stakeholder, you will be invited to:

  • Attend the initial stakeholder meeting to discuss the draft scope on Friday 3rd October 2008
  • Comment on the draft scope, which is currently being developed and which sets out what the guidance will, and will not cover. ( The consultation period on the draft scope with last 4 weeks between 22nd Sept – 17th Oct 2008 )
  • Review the stakeholder list and suggest other relevant organisations that may be interested in contributing to the development of the guidance
  • Comment on and submit additional evidence for consideration of the draft synopsis of evidence
  • Comment on the draft recommendations

If you want a reminder of how NICE do their consultation then this presentation may help.

Filed under: NICE, tobacco

Response to Preventing the uptake of smoking by children: consultation on the draft guidance

The Drug Education Forum have made the following comments on the draft guidance from NICE on preventing the uptake of smoking by children.

Recommendation 1:

“be informed by research that identifies and understands the target audiences”

“include advertisements that elicit an emotional reaction (for example, fear)”

The Drug Education Forum is well aware of young people’s often stated claim that they would find harder messages around drugs (including tobacco) would have a deterrent effect on their use.  However, there is no evidence, we are aware of, for campaigns carried out in this way leading to changes in children’s behaviour.

There does seem to be some evidence (see Boomerang Ads from Drug and Alcohol Findings 2005) that harder messages can have the unintended consequence of making drugs more attractive to some young people.

The Drug Education Forum does not believe that fear is the most effective reaction to be trying to achieve with public health campaigns aimed at children.  To support this view we would cite the findings in the review of effectiveness carried out to inform this guidance, which says:

“A UK-based (++)6 qualitative study found that social norms messages were more effective than fear messages at encouraging more committed smokers to consider their smoking behaviours and reinforcing awareness of the dangers of smoking in less committed smokers.” [page 6]

NICE will also want to make it clear that where campaigns are targeted at children and young people they need to be in line with the Advertising Standards Authority guidance.  We would particularly point to CAP Code clauses 9.1 and 9.2 (Fear and distress) and 47.2 (Children), and CAP (Broadcast) TV Advertising Standards Code rules 7.3.6 (Children – Distress).

contribute to changing society’s attitude towards tobacco use so that smoking is not considered the norm by any group’

We endorse this as a critical challenge for the outcome of the guidance; as peer and family norms are powerful influences on children and young people.

Filed under: consultation, NICE, tobacco,

More NICE guidance under development

Not too many details as yet, but there are two that may be of interest to readers of this blog:

  1. Alcohol use disorders in adults and adolescents
    Guidance relating to the prevention and early identification of alcohol use disorders in adults and adolescents
  2. Looked after children
    Guidance on looked after children

As a reminder here’s the presentation the Forum had from NICE a few meetings back:

Filed under: NICE

Child nicotine patches approved

The BBC report:

Children as young as 12 should receive nicotine patches if they have a serious smoking problem, the official NHS advisory body in England says.The recommendation comes in a set of guidelines by the National Institute for Clinical Excellence (NICE).

These are intended to advise health authorities on helping people give up smoking.

Children have been offered patches in trials, but this is the first time it has become official English policy.

Brief interventions and referral for smoking cessation in primary care and other settingsI the report is referring to this guidanceBrief interventions and referral for smoking cessation in primary care and other settings – the press release, which accompanies it says:

Young people aged 12-17 should be offered information, advice and support on how to stop smoking. NRT may be used for young people over 12 years who show clear evidence of nicotine dependence and as part of a supervised regime.

It builds on earlier advice which says:

It is recommended that people who are under the age of 18 years, pregnant or breastfeeding, or who have unstable heart conditions, should discuss the use of NRT with a doctor or nurse before starting treatment.

Filed under: NICE, tobacco, ,

About this blog

This blog tries to pick up relevant media and research stories about drug education. It mainly focuses on information in England as this is the geographical remit for the Drug Education Forum. We welcome comments that are on topic.

del.icio.us links

DrugScope’s Search Engine

March 2017
M T W T F S S
« Jul    
 12345
6789101112
13141516171819
20212223242526
2728293031  

Archives