Alcohol misuse: tackling the UK epidemic - London

In the past, education strategies have often included scare or shock tactics, based on the assumption that
adolescents started to smoke because they lacked knowledge about the adverse effects associated with
smoking. 104
However, a study of adults in Britain found no evidence to suggest that smokers deny the health
risks of smoking: 111
a study of adolescent smokers in the UK and US found that most respondents perceived
themselves as mature, informed, autonomous and knowledgeable adults at low risk from the long-term
consequences of smoking. 105
Health promotion messages and advice on smoking cessation generally focus upon the negative aspects of
continuing to smoke and contrast these with the benefits of giving up; yet many smokers perceive a
number of benefits from smoking, and health and social problems with the process of cessation. 112
The
1998 Teenage Smoking Attitudes Survey found that smokers were more likely than non-smokers to
perceive benefits from smoking – such as its perceived calming effects and role in image and slimming. 89
Another study of adolescent smokers’ perceptions found that they identified many benefits of smoking,
enjoyed the physiological effects and social benefits and perceived it to relieve stress, reduce boredom and
boost self-image and identity. 105
It has been suggested that perceived benefits of alcohol consumption, based on personal positive
experiences, also play an important role in the drinking behaviour of adolescents. Therefore, like smoking
policy, alcohol education may need an increased focus on positive outcomes. 113
Though acknowledgement of the attractive, pleasurable aspects of smoking and drinking and even drug
use may be seen as unacceptable and irresponsible, it could provide an opportunity to relate better to
adolescents. 112
Understanding adolescents’ attitudes and behaviours before implementing education
policies is likely to increase the effectiveness of interventions. It is the perception that adults do not
understand adolescent choices that may sometimes limit the impact of health education. Where education
is used to encourage prevention there is evidence that peer-led programmes are more effective than
teacher-led programmes. 114
More methodologically sound evaluations of interventions undertaken in schools are needed to judge the
efficacy of health education programmes and promote good practice.
Education promoting the development of social skills
Health education policy in schools has recently begun to move away from the traditional emphasis on risk,
towards an emphasis on social and environmental factors which influence smoking, drinking and drug
use. The government’s present drug strategy for example seeks to teach people from the age of five
upwards ‘the skills needed to resist pressure to misuse drugs’. 102
Evidence for the effectiveness of these
strategies is scarce. Adolescents may reject such approaches if they feel that their behaviour is determined
by personal choice. 105
Moreover, these programmes are unlikely to reduce initial experimentation if, as
some evidence suggests, 84
people who try drugs possess similar or greater levels of attributes such as selfesteem
as the general population.
Nevertheless, reviews of the existing evidence suggest that programmes which combine components on
short-term health, information on social influences and training on how to resist pressure, seem to be
more effective than traditional knowledge-based interventions. 104
The Health Development Agency has
found that interactive programmes, which foster the development of interpersonal skills, may reduce
alcohol use. 114
While life skills programmes may not prevent initial experimentation, they may help to
prevent misuse and could be targeted at those most likely to develop problems. 84
The use of mass media
Mass media campaigns have become increasingly popular and are seen as a particularly appropriate
method for delivering health messages to adolescents. There are methodological problems with many of
the studies of media interventions but some support seems to be provided for their effectiveness. 104
There
British Medical Association Adolescent health 23