NHS Health Scotland
Outcome Indicators

2.2. Activity: Smoking prevention

Impact on outcomes

Possible gaps in evidence


Impact on short term and intermediate outcomes

There is review level evidence supporting:

  • school-based smoking policies that support both prevention and smoking cessation activities and that apply to everyone using the premises (although there is evidence that the extent and enforcement of smoke-free school policies can act as a facilitator or barrier to school-based smoking prevention)
  • school-based interventions for school-based interventions for preventing uptake of smoking among children (significant effect for, and cost-effective, although lack of evidence for long-term effects; there is other evidence re the particulars of interventions which can act as facilitators/barriers to the effective delivery of school-based interventions including the importance of reinforcement of a message such as interventions that directly address peer smoking norms though involving young people delivering/facilitating the successful implementation of school-based prevention interventions )
  • information on smoking (the health effects of tobacco use, and the legal and economic and social aspects of smoking) being integrated into the curriculum
  • educational establishments working in partnership with outside agencies to design, deliver, monitor and evaluate smoking prevention activities. However, it also noted the particulars of what works with regard to educational activities and variation in effectiveness and noted that aspects of the delivery context (e.g. delivery mechanism, programme content) act as barriers or facilitators to effective delivery
  • the continued use of school-based ‘peer’ or ‘social-type’ interventions in preventing smoking in children. (Interventions that directly address peer smoking norms through involving young people in delivery can facilitate the successful implementation of school-based prevention interventions.)  
  • another review supported the following interventions, which are arguably closest to ‘smoking prevention’ interventions:
  • family interventions may help to prevent adolescent smoking (i.e. helping family members to strengthen non-smoking attitudes and promote non-smoking in children and other family members)

Gaps in the evidence include:

  • the long-term effects of school-based smoking prevention programmes due to the lack of follow-up post-education
  • the lack of UK evidence on whether it is more effective to provide interventions focused on smoking prevention alone or risky behaviours in general which include smoking

There is review level evidence acknowledging the mixed evidence or lack of evidence of effectiveness of:

  • interventions based on information alone (i.e. little evidence that these are effective; half of the best quality studies found short-term effects on children’s smoking behaviour but the highest quality and longest trial – the Hutchinson Smoking Prevention Project – found no long-term effects from 65 lessons over 8 years).
  • the relative effectiveness of different approaches to quitting is mixed

…but nevertheless supported:

  • the school nurse being the most effective for provision of smoking cessation, in the context of a school culture which encourages (rather than punishes or ignores) the pupil’s self-identification as a smoker, and intensive 1:1 support for a range of behavioural/emotional issues, including smoking (but not targeting smoking exclusively); this recommendation is, however, in spite of the lack of evidence of relative effectiveness
  • health education and promotion activity continuing in schools, beyond aged 12-14 where it most commonly occurs

There are policy documents reporting:

  • mixed results of school-based programmes; some evidence of lower smoking rates in schools that build a supportive school ambience with the school ethos and policies in line with ‘no smoking’ policy
  • that comprehensive campaigns, combining well-enforced regulations, educational programmes and support for individuals and communities can reduce smoking rates if sustained over several years

…and recommending that:

  • such campaigns should be developed for use in Scotland


NICE (2010). Public Health Guidance 23 – School-based interventions to prevent the uptake of smoking among children. NICE, London.

A Scottish Perspective on this piece of NICE Guidance is available at www.healthscotland.com/scotlands-health/evidence/NICE.aspx

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 PRA, Lorenzetti D. Family-based programmes for preventing smoking by children and adolescents. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD004493. DOI: 10.1002/14651858.CD004493.pub2

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.

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

Naidoo B et al. (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.  

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