NHS Health Scotland
Outcome Indicators

4.1. Activity: Combination of ‘education and social marketing activities’ and ‘implementing and ‘maintained compliance with, monitoring and enforcing the ban on smoking in enclosed public places’ and ‘taxation’.


Impact on outcomes

Possible gaps in evidence


Impact on short term and intermediate outcomes

There is review level evidence supporting:

  • delivering interventions that aim to prevent the uptake of smoking linked in with the whole-school or organisation-wide smoke-free policy; conversely, the development of a whole-school or organisation-wide smoke-free policy linking in with prevention activity (e.g. preventing the uptake of smoking) [1]
  • media campaigns co-ordinated with other activity  e.g. smoking cessation services, telephone quitlines, tobacco control policy change, school interventions, and other activity to help people to stop using tobacco [2,3]
  • 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) [2]
  • multi-channel mass media campaigns combined with other interventions in increasing tobacco use cessation [2,4]; media campaigns and concurrently implemented tobacco control programmes associated with a reduction in net smoking prevalence (although some studies were inconclusive) [2,4]; 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) [5].
  • 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) [3]
  • workplace interventions in the context of environmental support (workplace smoking restrictions and educational campaigns) being effective in facilitating smoking cessation [2,6]
  • “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” [7]
  • a comprehensive tobacco control strategy, defined by the US Surgeon General and World Health Organisation, as encompassing price and regulation policies, education programmes, cessation support services and community programmes [7].

Gaps in the evidence include:

  • the longer-term effectiveness of new media [2] and of workplace interventions [2,8]

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

2. NICE (2008). Public Health Programme 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.  NICE, London.          

3. Gutierrez, K., (2007).  Mass Media Interventions to Stimulate and Promote Smoking Cessation: Expert Opinion Paper. For NICE: Public Health Programme Guidance 10. NICE, London.         

4. Jepson, R., Harris, F., Rowa Dewar N., et al on behalf of: Cancer Care Research Centre; Centre for Social Marketing, University of Stirling; Alliance for Self Care Research, University of Abertay; Centre for Reviews and Dissemination, University of York (2006). A Review of the Effectiveness of Mass Media Interventions which both Encourage Quit Attempts and Reinforce Current and Recent Attempts to Quit Smoking. For NICE: Public Health Programme Guidance 10. NICE, London.       

5. Bala M, Strzeszynksi L, Cahill K. Mass media interventions for smoking cessation in adults. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004704. DOI: 10.1002/14651858.CD004704.pub2

6. Bell, K. McCullough, L., De Vries K. et al, on behalf of British Colombia Centre for Excellence for Women’s Health, Vancouver (2006). Workplace policies for Smoking Cessation: Final Draft. For National Institute for Health and Clinical Excellence (NICE): Public Health Programme Guidance 10. NICE, London

7. 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. NICE, London.

8. NICE (2007).  Public Health Intervention Guidance 5 – Workplace health promotion: how to help employees to stop smoking. NICE, London.

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