Smoking and mental health - NCSCT

Population strategies to prevent smoking in mental disorders 6
SSS. 55 Given that SSS are extremely cost-effective it is therefore important to
improve the availability, awareness, access and uptake of SSS among smokers
making a quit attempt, to maximise the chances of success.
6.2.9 Preventing smoking uptake through school-based interventions
Cigarette smoking is a behaviour that generally begins in adolescence, and
particularly during the years spent in secondary education. In England, only 9%
of 11 year olds have ever tried a cigarette, whereas, by age 15, 55% have done so
and 15% are regular smokers. 56 Schools have therefore been a focus of efforts to
influence smoking behaviour and prevent smoking uptake. However, most of the
published evidence evaluating the effectiveness of such school-based
interventions is from the USA, and it is not clear whether these findings are
applicable to the UK, where the context of the health and education systems, and
extent of tobacco control policy implementation, is different. 57,58
The available evidence suggests, however, that school-based health promotion
programmes to inform adolescents about the prevalence and health risks of
smoking, and programmes to teach young people social and personal skills such
as decision-making, stress that management and assertiveness have limited
impact on smoking uptake. 57,58 Interventions to make adolescents aware of peer,
family and media influences on their behaviour, correct their overestimates of
smoking prevalence in their peers and society as a whole, and encourage them to
make public commitments not to smoke, have been reported to have positive
short-term and longer-term effects on youth smoking prevalence, but these
findings have not been confirmed in higher-quality studies. 58 The UK ASSIST
study has demonstrated that a peer-led education programme reduces uptake of
smoking in young people in the short term, 59 although it is not clear whether
this effect is sustained. It has been suggested that more comprehensive
approaches, which tackle wider societal issues and involve intervention with
students’ families and the communities in which they live, may also be
effective. 57,60,61
6.2.10 Harm reduction
The potential importance of promoting nicotine substitution for people who
smoke and otherwise cannot or do not want to quit smoking has been
highlighted by the RCP as a potential means to decrease some of the harmful
effects of smoking, 62 and to increase the likelihood of future quit attempts (see
section 5.3). Harm reduction, ideally comprising complete substitution of
smoked tobacco with an alternative source of nicotine, offers substantial
potential to prevent smoking-related disease and provides an alternative for
smokers obliged to comply with smoke-free regulation. Section 5.3 summarises
© Royal College of Physicians 2013 115