NHS Health Scotland
  Outcome Indicators

2.1. Activity: Combination of tobacco control interventions e.g. smoking prevention, mass media, protection & control measures


Impact on outcomes

Possible gaps in evidence


Impact on short term and intermediate outcomes

There is review level evidence supporting:

  • a comprehensive approach embracing individual, social, community and societal issues rather than a single intervention/programme, as the different elements of a comprehensive approach may act synergistically whereas no single interventions/ programme can prevent young people from taking up smoking
  • media campaigns co-ordinated with other activity  e.g. smoking cessation services, policy change, school interventions, and other activity to help people to stop using tobacco (national mass media campaigns, supported by local activities, can play an important role in changing society’s attitudes towards tobacco use)
  • the importance of multi-faceted approaches and of initiatives aiming to bring about sustained individual and social change (which takes time but it is important to take a strategic perspective, developing relationships with target groups and stakeholders and encouraging full community engagement)
  • multi-channel mass media campaigns combined with other interventions; media campaigns and concurrently implemented tobacco control programmes (although some studies were inconclusive); mass media interventions as part of a complex set of interventions contributing to a reduction in smoking (but it is difficult to establish their independent role and value). [Media campaigns and concurrently implemented tobacco control programmes (or policies) are associated with a reduction in the net smoking prevalence of between 6–12%..; as well as a reduced cigarette use prevalence, the contribution of individual components to the overall effectiveness of these interventions cannot be attributed; mass media interventions on their own or when combined with a school-based programme are effective in preventing the uptake of smoking in young people]
  • the importance of campaigns being a part of comprehensive tobacco control programmes in order to generate significant changes in smoking prevalence (with the various elements working synergistically to de-normalise tobacco use and support smokers in quitting and remaining smoke-free)
  • combined activities such as prevention linked in with development of whole-school/organisation-wide smoke-free policy  i.e. delivering interventions that aim to prevent the uptake of smoking linked in with the whole-school/organisation-wide smoke-free policy; conversely, the development of a whole-school/organisation-wide smoke-free policy linking in with prevention activity
  • the combination of requesting proof of age/ID, active enforcement, and other youth prevention strategies – Overall, the factors … work best when combined with broader tobacco control initiatives produced by tobacco control bodies
  • mass-media and point-of-sales measures combined with other prevention activities as part of a comprehensive tobacco control strategy – these would include price and regulation policies, education programmes, cessation support services and community programmes  e.g. multi-faceted interventions (active enforcement, multi-component educational strategies, and increased taxing and restrictions on smoking in public places respectively) are most effective for reducing youth’s ability to access tobacco, particularly when combined with ongoing and active enforcement of minimum age restrictions
  • raising awareness is not sufficient to change behaviour– media campaigns and other measures need to be supported by wider measures. 

Gaps in the evidence include:

  • the lack of UK evidence on the effectiveness of multi-component interventions e.g. school-based with mass media or family-based interventions


References :
Naidoo, B. Warm, D. Quigley, R. and Taylor, L. (2004) Smoking and public health: A review of reviews of interventions to increase smoking cessation, reduce smoking initiation, and prevent further uptake of smoking.  London: H.D.A.   www.nice.org.,uk

NHS Health Scotland (2006)  External evaluation of the NHS Health Scotland/ASH Scotland Young People and Smoking Cessation Pilot Programme

National Institute for Health Care Excellence (NICE, 2008). Public Health Guidance 10 – Smoking cessation services in primary care, pharmacies, local authorities and workplaces, particularly for manual working groups, pregnant women and hard-to-reach communities.  London: NICE. Available from (external link) : www.nice.org.uk/PH10

National Institute for Health Care Excellence (NICE , 2008). Public Health Guidance 14 – Preventing the uptake of smoking by children and young people: mass-media and point-of-sales measures to prevent the uptake of smoking by children and young people. London: NICE. Available from ( external link) :  www.nice.org.uk/PH14 .

National Institute for Health Care Excellence (NICE, 2010). Public Health Guidance 23 – School-based interventions to prevent the uptake of smoking among children. London: NICE. Availaable from (external link): www.nice.org.uk/PH23 .

Scottish Executive (2006). Towards A Future Without Tobacco. Scottish Executive, Edinburgh.

Scottish Government (2008). Scotland’s Future is Smoke Free: A Smoking Prevention Action Plan. Scottish Government, Edinburgh.

Sowden, A.J. (1998). Mass media interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews, 4, Art. No: CD001006; doi:10.1002/14651858.CD001006

Stead, L.F. and Lancaster, T. (2005). Interventions for preventing tobacco sales to minors. Cochrane Database of Systematic Reviews, 1, Art. No: CD001497; doi:10.1002/14651858.CD001497.pub2 www2.cochrane.org/reviews/en/ab001497.html

Thomas, R.E. and Perera, R. (2006). School-based programmes for preventing smoking. Cochrane Database of Systematic Reviews, 3, Art. No: CD001293; doi:10.1002/14651858.CD001293.pub2

Thomas RE, Baker P, Lorenzetti D. (2007) Family-based programmes for preventing smoking by children and adolescents

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