Impact on outcomes
Possible gaps in evidence
Impact on short term and intermediate outcomes
There is review level evidence supporting:
- the integration of information about the health effects of tobacco use, as well as the legal and economic and social aspects of smoking into the classroom 
- combined activities such as prevention linked in with development of whole-school/organisation-wide smoke-free policy – see above for details; 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 [1,2]
- media campaigns co-ordinated with other activity e.g. school interventions and other activity – see above for details – and in partnership with other organisations [3,4]
- informing the public about the adverse health effects of passive smoking through media campaigns; media campaigns can be used to inform the public about the adverse health effects of passive smoking which can strengthen public support for bans and legislation [3,5]
- the general benefits of media
- campaigns on smoking cessation (albeit these are not clear whether directly through cessation or through SHS) / the effectiveness of mass media campaigns – although whether this is of SHS or cessation or prevention campaigns and its specific outcomes (e.g. whether it changes smoking behaviour - where smoking takes place, results in cessation or prevention/delayed onset of smoking) is unclear
- comprehensive tobacco control programmes which include mass media campaigns being effective in changing smoking behaviour in adults e.g. on smoking behaviour/prevalence and on increases in abstinence (but studies were from a heterogeneous group of studies of variable methodological quality and definitions used) [but recognised that intensity and duration of mass media campaigns may influence effectiveness and that this may be difficult to quantify ; one review noted how media presence or placement is as important as the messages themselves and how sufficient placements in the right locations are required to help change beliefs, attitudes and behaviours e.g. with timely news coverage generating community conversation which works towards norm changes [3,4].
- media/social marketing campaigns (among other interventions) as well as changes in social norms and physical environment [5,7]
- advanced notice by smoking cessation services of any media/public relations activities introduced in connection with the legislation, as a result of increased interest in and demand for smoking cessation  connected with the introduction of smoke-free legislation and linked to media activity 
- media campaigns generally (i.e. not necessarily focusing on second-hand smoke directly)  and those which involve: adding peer group support and lottery incentives to mass media-based self-help interventions (increasing abstinence levels [3,8]; posters or printed media to increase awareness of campaigns [3,8]; advertisements depicting suffering as a result of tobacco use (promoting smoking cessation or reinforcing decision to quit); dissonance-arousing messages specifically targeting girls (positive short-term effects on quit rates); graphic mass media messages about the negative consequences of smoking among adults (which have a positive effect on quit attempts among young people); [3,8]; television (when messages recalled, associated with increased quit rates) [3,8]; internet-based interventions (on quit rates), especially if appropriately tailored to users and frequent automated contacts with users occur (but note that trials did not show consistent effects) [3,8,9] – see Logic Model 3 Smoking Cessation Services for further detail
- However, one (Cochrane) review did conclude that although there was often high awareness of community interventions programmes, increased knowledge of health risks, changes in attitudes to smoking, more quit attempts, and better environmental and social support for quitting in intervention communities, this rarely led to higher quit rates and reductions in community smoking levels, with smoking rates remaining similar between intervention and control communities even in the largest and best-designed/conducted trials 
Gaps in the evidence include:
- the lack of UK evidence on the effectiveness of multi-component interventions (e.g. combining school-based with mass-media or family-based interventions) 
- the longer-term effectiveness of new media (e.g. text messaging and podcasts to deliver personalised advice to smokers) 
- the impact of mass media smoking cessation messages on people who smoke and who are pregnant, socio-economically disadvantaged or from a minority ethnic group 
- inability (from a Cochrane review) to determine the comparative effectiveness or that one intervention reduced parental smoking and prevented childhood exposure to tobacco smoke more effectively than others although some were identified that reported the effectiveness of intensive support provided in clinical settings (the effectiveness of parental education and smoking cessation support programmes to try to reduce children’s SHS exposure has not been demonstrated) 
- media campaigns focusing specifically on second-hand smoke
- the role of the mass media in the lowered exposure to SHS i.e. whether this is directly from enforcement of and maintained compliance with smoke-free legislation, or whether from education and social marketing activities with increased awareness and understanding and social environment (norms) changes or reduced smoking rates and frequency
1. NICE (2010). Public Health Guidance 23 – School-based interventions to prevent the uptake of smoking among children. NICE, London.
2. Bauld, L., Brandling, J., Templeton, L., (2009). Facilitators and barriers to the delivery of school-based interventions to prevent the uptake of smoking among children: A systematic review of qualitative research. For National Institute for Health and Clinical Excellence (NICE): Public Health Programme Guidance 23. NICE, London;
3. 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. www.nice.org.uk/PH10
4. Gutierrez, K., (2007). Mass Media Interventions to Stimulate and Promote Smoking Cessation: Expert Opinion Paper. For NICE: Public Health Programme Guidance 10. NICE, London.
5. 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
6. 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
7. NICE (2007). Public Health Intervention Guidance 5 – Workplace health promotion: how to help employees to stop smoking. NICE, London.
8. 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.
9. Civljak M, Sheikh A, Stead LF et al. Internet-based interventions for smoking cessation. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD007078. DOI: 10.1002/14651858. CD007078.pub3
10. Secker-Walker R, Gnich W, Platt S, et al. Community interventions for reducing smoking among adults. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD001745. DOI: 10.1002/14651858.CD001745.
11. Priest N, Roseby R, Waters E, et al. Family and carer smoking control programmes for reducing children’s exposure to environmental tobacco smoke. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD001746. DOI: 10.1002/14651858.CD001746.pub2
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