Young People and Smoking

1. Young People and Smoking Professor Amanda Amos Public Health Sciences University of Edinburgh

2. Key questions What are current patterns and trends in youth smoking? What do we know about why young people start and continue to smoke? Which interventions are effective in preventing and/or reducing youth smoking? What are the implications for tobacco control policy and practice at national and local levels? UnpackUnpack

3. 1. What are the current patterns and trends in youth smoking?

6. Scottish Smoking Prevention Targets Ambitious new targets set but still behind the best in the worldAmbitious new targets set but still behind the best in the world

7. 2. What do we know about why young people start and continue to smoke? 

8. A role model- female icon of 20th century learning to smoke Niagara. Rarely like this more a process can take several years from first puff or only a few weeks, but at least half don�t go on to become regular smokers. In rest of talk will be looking at the range of factors that influence whether a young person starts to smoke and continues. But at heart are key factors: Adolescence- period of considerable change and challenge for young people as negotiate the transition form childhood to adulthood. During which trying out a range of behaviours, including smoking, which help project type of adult image they aspire to and perceive may also help deal with difficult aspects of adolescence and transition. What smoking, cigarettes and being a smoker means to them (and others) and its functional value in this period of transition. Move from anti- in primary to more positive in secondary school. Dependence- both nicotine which develops at low levels of consumption and much more rapidly than young people think, and psycho-social aspects- what they think it does for them. A role model- female icon of 20th century learning to smoke Niagara. Rarely like this more a process can take several years from first puff or only a few weeks, but at least half don�t go on to become regular smokers. In rest of talk will be looking at the range of factors that influence whether a young person starts to smoke and continues. But at heart are key factors: Adolescence- period of considerable change and challenge for young people as negotiate the transition form childhood to adulthood. During which trying out a range of behaviours, including smoking, which help project type of adult image they aspire to and perceive may also help deal with difficult aspects of adolescence and transition. What smoking, cigarettes and being a smoker means to them (and others) and its functional value in this period of transition. Move from anti- in primary to more positive in secondary school. Dependence- both nicotine which develops at low levels of consumption and much more rapidly than young people think, and psycho-social aspects- what they think it does for them.

9. In rest of talk will be looking at the range of factors that influence whether a young person starts to smoke and continues. But at heart are key factors: Adolescence- period of considerable change and challenge for young people as negotiate the transition form childhood to adulthood. During which trying out a range of behaviours, including smoking, which help project type of adult image they aspire to and perceive may also help deal with difficult aspects of adolescence and transition. What smoking, cigarettes and being a smoker means to them (and others) and its functional value in this period of transition. Move from anti- in primary to more positive in secondary school. Dependence- both nicotine which develops at low levels of consumption and much more rapidly than young people think, and psycho-social aspects- what they think it does for them. In rest of talk will be looking at the range of factors that influence whether a young person starts to smoke and continues. But at heart are key factors: Adolescence- period of considerable change and challenge for young people as negotiate the transition form childhood to adulthood. During which trying out a range of behaviours, including smoking, which help project type of adult image they aspire to and perceive may also help deal with difficult aspects of adolescence and transition. What smoking, cigarettes and being a smoker means to them (and others) and its functional value in this period of transition. Move from anti- in primary to more positive in secondary school. Dependence- both nicotine which develops at low levels of consumption and much more rapidly than young people think, and psycho-social aspects- what they think it does for them.

10. Becoming a smoker Not always uni-directional progression Variable length and time Dependence/addiction can be rapid Extends into late teens Young people v adult v our understandings: being a smoker addiction quitting In rest of talk will be looking at the range of factors that influence whether a young person starts to smoke and continues. But at heart are key factors: Adolescence- period of considerable change and challenge for young people as negotiate the transition form childhood to adulthood. During which trying out a range of behaviours, including smoking, which help project type of adult image they aspire to and perceive may also help deal with difficult aspects of adolescence and transition. What smoking, cigarettes and being a smoker means to them (and others) and its functional value in this period of transition. Move from anti- in primary to more positive in secondary school. Dependence- both nicotine which develops at low levels of consumption and much more rapidly than young people think, and psycho-social aspects- what they think it does for them. In rest of talk will be looking at the range of factors that influence whether a young person starts to smoke and continues. But at heart are key factors: Adolescence- period of considerable change and challenge for young people as negotiate the transition form childhood to adulthood. During which trying out a range of behaviours, including smoking, which help project type of adult image they aspire to and perceive may also help deal with difficult aspects of adolescence and transition. What smoking, cigarettes and being a smoker means to them (and others) and its functional value in this period of transition. Move from anti- in primary to more positive in secondary school. Dependence- both nicotine which develops at low levels of consumption and much more rapidly than young people think, and psycho-social aspects- what they think it does for them.

11. Will look at key influences at three levels. Scottish report.Will look at key influences at three levels. Scottish report.

14. HBSC 2005/6 �gender and social inequalities 15 year old girls (34%) more likely than boys (25%) to report that had first smoke at 13yrs or younger, and significantly higher in girls from low affluent families Regular smoking significantly higher in low affluence girls and boys Regular smokers twice as likely to get free school meals

16. Social worlds- 15 year olds Spend 5 or more evenings with friends- 68% smokers v 32% non-smokers Hang around the street- 87% smokers v 50% non-smokers Do sport: �males 68% smokers v 82% non-smokers - females 35% smokers v 56% non-smokers Truanted more than 10 times- 27% v 5% Expect to go to university- 19% smokers v 49% non-smokers

18. Some policy and practice implications Address all three levels of influence Congruent with adolescent girls� and boys� experiences of smoking (eg role, meanings) and wider social worlds eg media, peer education, schools Integrate within wider health promotion to support youth in transitions Link with addressing inequalities

19. 3. Which interventions are effective in preventing/reducing youth smoking? The prevention challenge is to make cigarettes and smoking: Less aspirational/desirable (meaning, role) Less acceptable (meaning and context) Less accessible (context) Deal with addiction (cessation) UnpackUnpack

20. Aspirational Stop all tobacco marketing- point of sale, packaging Meaning, role, skillsMeaning, role, skills

23. Aspirational Stop all tobacco marketing- point of sale, packets Reduce positive media images of smoking Meaning, role, skillsMeaning, role, skills

27. Sen and the City Lost in Translation Scarlett Johanssen Jack Nicholson The Departed best film 2006Sen and the City Lost in Translation Scarlett Johanssen Jack Nicholson The Departed best film 2006

28. Aspirational Stop all tobacco marketing- point of sale, packets Reduce positive media images of smoking Health promotion campaigns and programmes at national and local levels Meaning, role, skillsMeaning, role, skills

29. Health promotion Comprehensive, well resourced, sustained- most effective National level- well designed mass media campaigns are effective Local level - educational setting (school, college) can be effective (eg ASSIST) - community setting (eg youth) ?? New media- promising (eg EC Help campaign)

30. Acceptability- social norms Reduce adult smoking Media campaigns- adults and young people Smokefree public places Smokefree homes and cars

31. Access and availability Price- highly price sensitive Size of pack (10s??) Enforce age of sale Illegal/smuggled Social sources- family and friends 2006 15 year olds � 82% bought from shops- mostly corner shops. Only 10% vending machines. 2006 15 year olds � 82% bought from shops- mostly corner shops. Only 10% vending machines.

32. Addiction Cessation support and young people Challenges �reach and effectiveness Guidelines on ways of working with young people No clear evidence on effectiveness

33. 4. What are the implications for tobacco control policy and practice? Comprehensive Evidence based But also innovation Tailored Partnership working Resourced Evaluation Research and understanding Not just tobacco