Alcohol misuse: tackling the UK epidemic - London

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be expensive given the amount consumed, the availability of single cigarettes from friends or unscrupulous
retailers, and the relative availability of cheap cigarettes on the black market. 105
For this reason there can
be no guarantee that increasing the cost of cigarettes will reduce adolescent smoking. Unless tobacco tax
closes the price gap between products, an increase in the price of premium brands can only lead to an
increase in consumption of cheaper brands, including hand-rolling tobacco.
Managing the availability of cigarettes, alcohol and drugs does not directly tackle the attitudes of
adolescents to these substances. This makes it unlikely that adolescents will modify their behaviour where
these substances are still available. Attempts to limit the availability of cigarettes and alcohol also fail to
take into account the maturity and autonomy that adolescents often feel lies behind their decision to
smoke or drink. It has been found that adolescent smokers believe that they are old enough to make up
their own minds about smoking and, as a result, tend to hold negative opinions about the importance and
effectiveness of tobacco control. 105
Regulating the advertising and marketing of cigarettes and alcohol
Advertising and marketing are likely to be relevant in adolescents’ decisions to start smoking or
drinking. 104,105
The Teenage Smoking Attitudes Survey of 1998 found adolescents’ awareness of cigarette
advertising and sponsorship of sport to be well established. 89
The Centre for Social Marketing study found
not only that peer activity and social norms support drinking and intoxication, but that active marketing
and retailing strategies positively encourage and enable the process. In the wider environment perceived
general population norms and marketing activity generate a sense of acceptability and encouragement of
drinking among adolescents. 71
Calls for tighter regulation of advertising, broadcasting, sponsorship and packaging of both alcohol and
cigarettes have wide support. Alcohol Concern has recently made detailed recommendations for
controlling the promotion of alcohol and for promoting responsible drinking. 109
Appropriate, clear
labelling may also help promote healthy behaviour among adolescents. Health warnings against excessive
alcohol consumption could be incorporated into alcohol advertisements while lower cost, low alcohol and
non-alcoholic drinks are promoted. 110
Educating adolescents about the dangers of tobacco, alcohol and drugs misuse
School-based education, has been the most common method used to prevent the uptake of adolescent
smoking, drinking and drug use. For example, educating adolescents about the risks of smoking is one of
the key tactics currently used by the government to reduce the prevalence of regular smoking. Similarly,
the Scottish plan for action on alcohol gives priority to public information and education, with less
emphasis on control policies and treatment. 72
This approach can have several drawbacks, the most obvious being that school-based programmes often
fail to reach the most vulnerable adolescents who may be excluded from, or non-attenders at, school.
Education programmes for adolescents may also be provided too late since attitudes towards smoking may
already be established. Where education is provided, it has therefore been suggested that policy makers
should consider targeting children as young as four to eight years of age. 104
The approaches traditionally used in school-based education have also been questioned. A review of
recent studies, mostly from the US and Canada, found that evidence for the effectiveness of school-based
programmes in preventing the uptake of smoking is limited. 104
The Schools Health Education Unit found
that the proportion of adolescent smokers wanting to give up had not risen between 1983 and 2001,
despite anti-smoking campaigns and health education programmes. This suggests that anti-smoking
information is not effective for these adolescents or that the other ‘smoking’ influences are too great for
anti-smoking campaigns and health education programmes to overcome. 65
British Medical Association Adolescent health