National Institute for Health and Clinical Excellence (NICE)
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New NICE public health guidance on preventing the uptake of smoking by children and young people

The National Institute for Health and Clinical Excellence (NICE) has today (23 July 2008) issued new public health guidance on mass-media and point-of-sales measures to prevent the uptake of smoking by children and young people.

Delaying or preventing the uptake of smoking can have a major effect on both short and long term health. Most adult smokers started smoking before they were 18 years old. Children and young people who smoke are two to six times more susceptible to coughs, increased phlegm and wheezing than their non-smoking peers. Smoking can also impair the growth of their lungs and is a cause of asthma-related symptoms in childhood and adolescence.

This guidance is aimed at those who have a responsibility or a role in improving health and wellbeing of children and young people under 18. This includes those working in the NHS, local authorities, voluntary and community sectors, as well as the private sector, in particular the retail industry and mass-media services.

Mass media
Recommendations are aimed at organisers and planners of national, regional and local mass-media campaigns, as well as local and regional commissioners and planners responsible for improving the health and wellbeing of children and young people under 18. The recommendations include:

• the development of national, regional or local mass media campaigns which are developed in partnership with national, regional and local government and nongovernmental organisations, the NHS, children and young people, media
professionals, healthcare professionals, public relations agencies and local anti-tobacco activists.

• Use a range of strategies as part of any campaign to reduce the attractiveness of tobacco. This may include writing articles, producing posters, brochures and other materials to promote the campaign

• Convey well researched messages that:

o elicit a strong, negative emotional reaction while providing sources of further information and support
o use personal testimonials that children and young people can relate to
o empower children and young people to refuse offers of cigarettes
Point of sales

• National government should support enforcement of existing legislation by:

o encouraging national organisations and local authorities to provide education and training programmes for trading standards officers
o encouraging and providing all local authorities with support to enforce legislation and undertake regular audits

• Local authorities and trading standards bodies should ensure retailers are aware of legislation prohibiting under-age tobacco sales and providing training and guidance on how to avoid illegal sales.

Andrew Dillon, NICE Chief Executive and Executive Lead for the guideline said: “Smoking is still the main cause of preventable disease and premature death in England and treating smoking-related diseases costs the NHS an estimated £1.5 billion a year. We have already published three sets of public health guidance on smoking cessation, but our remit in this case was to look at how to approach children and young people specifically. These recommendations have been developed to complement existing activities, with the aim of supporting a comprehensive tobacco control strategy.”

Professor Catherine Law, Chair of the Public Health Interventions Advisory Committee (PHIAC) at NICE and Professor of Public Health and Epidemiology, UCL Institute of Child Health said
: “Mass media campaigns are an effective approach in delaying uptake of smoking amongst children and young people. This delay can have a major effect on long term health. Children who smoke become addicted to nicotine very quickly and research shows the earlier you start smoking the harder it is to give up in later life. If starting is delayed or prevented there is the potential to reduce the number of early deaths attributed to smoking and improve health throughout life.”

Professor Simon Capewell, PHIAC member at NICE and Chair of Clinical Epidemiology, University of Liverpool said: “We know that around two-thirds of people who have smoked took up the habit before the age of 18 and because the risk of disease is related to the length of time a person has smoked, they face an even greater-than-average risk of developing lung cancer or heart disease. The recommendations on mass media campaigns in this guidance will help children and young people understand the health consequences of smoking and support them in refusing cigarettes.”

Mr Dale Robinson, PHIAC member at NICE and Corporate Manager - Health & Environmental Services at South Cambridgeshire District Council said:
“As well as looking at mass media interventions, this guidance also makes particular recommendations for places that young people buy cigarettes. These recommendations include the national government working with agencies to ensure that retailers, including publicans, are aware of legislation on under-age tobacco sales, including the fact that it covers vending machines. The guidance also advises local agencies to work together to identify areas where under-age tobacco sales are a particular problem and then offer practical advice to retailers on how to avoid selling cigarettes to children.”

Notes to Editors

About the guidance

1. The mass-media and point-of-sales measures to prevent the uptake of smoking by children and young people guidance is available at:

2. Children and young people refer to those under the age of 18.

3. Mass-media interventions use a range of methods to communicate a message. This can include local, regional or national television, radio and newspapers, and leaflets and booklets. It can also include new media. In this document, ‘new media’ refers to communication via the Internet or mobile phone. On the Internet, it can involve anything from real-time streaming of information and podcasts, to discussions with experts and the use of social networking sites. (An example of real-time streaming of information is the ‘breaking news’ text that appears along the bottom of the screen during some TV news programmes.) The aim of mass-media interventions is to reach large numbers of people without being reliant on face-to-face contact.
Point-of-sales interventions take place at the point where tobacco could be sold. Primarily, they aim to deter shopkeepers from making illegal sales.

4. Related NICE public health guidance includes:

• Smoking cessation services in primary care, pharmacies, local authorities and workplaces, particularly for manual working groups, pregnant women and hard to reach communities.

• Behaviour change at population, community and individual levels.

• Workplace health promotion: how to help employees to stop smoking.

• Brief interventions and referral for smoking cessation in primary care and other settings.

About NICE

5. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

6. NICE produces guidance in three areas of health:

public health – guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector

health technologies – guidance on the use of new and existing medicines, treatments and procedures within the NHS

clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.