Recommendations on preventing uptake

People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care.

Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

This guideline should be read alongside the NICE's guidelines on patient experience in adult NHS services and babies, children and young people's experience of healthcare, which have guidance on giving information to people and discussing their views and preferences.

In this guideline, we use the following terms for age groups:

  • children: aged 5 to 11

  • young people: aged 12 to 17

  • young adults: aged 18 to 24

  • adults: aged 18 and over.

Unless otherwise stated, the recommendations on preventing uptake are for children and those aged 24 and under.

At the time of publication (November 2021), no nicotine-containing e-cigarettes were licensed as a medicine for stopping smoking by the Medicines and Healthcare products Regulatory Agency (MHRA) and commercially available in the UK market. All nicotine-containing e‑cigarettes in the UK that are not licensed as a medicine by the MHRA are regulated by the Tobacco and Related Products Regulations (2016), and cannot be marketed by the manufacturer for use for stopping smoking.

These recommendations aim to prevent children, young people and young adults from taking up smoking. They cover anti-smoking mass-media and digital campaigns, measures to prevent tobacco being sold to and bought for children and young people, and prevention interventions in educational settings.

1.1 Organising and planning national, regional or local mass-media campaigns

These recommendations are for commissioners and organisers of mass-media campaigns.

1.1.1 Develop national, regional or local mass-media campaigns to prevent the uptake of smoking among young people under 18. Work in partnership with: the NHS, national, regional and local government and non-governmental organisations, children and young people, media professionals, healthcare professionals, public relations agencies and local anti-tobacco activists. [2008]

1.1.2 Integrate regional and local campaigns to prevent smoking in children and young people with any national communications strategy to tackle tobacco use. [2008]

1.1.3 Think about targeting campaigns towards groups that epidemiological data identify as having higher than average or stagnant rates of smoking. Base the campaigns on research that identifies and helps to understand the target audiences. [2008]

1.1.4 Base campaign messages on strategic research and qualitative before-and-after testing with the target audiences. Repeat the messages in various ways and regularly update them to keep the audience's attention. [2008, amended 2021]

1.1.5 Use a range of media channels to get unpaid press coverage and generate as much publicity as possible. Reach specific audiences by:

  • using regional and local channels

  • using the full range of media used by children and young people. [2008, amended 2021]

1.1.6 Share effective practice in campaigns to prevent smoking in children and young people, including effective local and regional media messages, locally, regionally and nationally. [2008]

1.1.7 Run campaigns to prevent smoking in children and young people for 3 to 5 years. [2008]

1.1.8 Use process and outcome measures to ensure campaigns are being delivered correctly and effectively. For recommendations on the principles of evaluation, see NICE's guideline on behaviour change: general approaches. [2008]

1.2 Campaign strategies to prevent uptake and denormalise tobacco use

These recommendations are for local authorities, trading standards bodies, organisers and planners of national, regional and local mass-media campaigns, and commissioners and planners.

1.2.1 Assess whether an advocacy campaign is needed to support policy related to illegal tobacco sales. [2008, amended 2021]

1.2.2 If an advocacy campaign is needed, base it on good practice. Use a range of strategies to reduce the attractiveness of tobacco and contribute to changing society's attitude towards tobacco use, so that smoking is not considered the norm by any group. This could include:

  • generating news by writing articles, commissioning newsworthy research and issuing press releases

  • using posters, brochures and other materials

  • using digital media. [2008]

1.2.3 As part of an advocacy campaign, provide a clear, published statement on how to deal with underage tobacco sales. [2008]

1.2.4 Do not develop or deliver mass-media or access-restriction campaigns in conjunction with (or supported by) tobacco organisations. Actively discourage use of enforcement and related campaigns developed by tobacco organisations. [2008]

1.3 Helping retailers avoid illegal tobacco sales

These recommendations are for local authorities and trading standards bodies.

1.3.1 Provide retailers with training and guidance on how to avoid illegal sales. This includes encouraging them to:

  • ask for proof of age from anyone who appears younger than 18 who attempts to buy cigarettes, and get it verified (examples of proof include a passport or driving licence, or cards bearing the nationally accredited 'PASS' hologram)

  • inform Trading Standards of each tobacco sale refused on the grounds of age. [2008]

1.3.2 Make it as difficult as possible for young people under 18 to get cigarettes and other tobacco products. In particular, exercise a statutory duty under the Children and Young Persons (Protection from Tobacco) Act (1991) to prevent underage sales by:

  • prosecuting retailers who persistently break the law

  • making test purchases each year, using local data to detect breaches in the law and auditing the breaches regularly to ensure consistent good practice across all local authorities. [2008]

1.3.3 Work with other agencies to:

  • identify areas where underage tobacco sales are a particular problem

  • improve inspection and enforcement activities related to illegal tobacco sales. [2008]

1.3.4 Run campaigns for retailers to publicise legislation prohibiting underage tobacco sales. These could include:

  • details of possible fines that retailers can face

  • details of where tobacco is being sold illegally

  • successful local prosecutions

  • health information. [2008]

1.3.5 Ensure efforts to reduce illegal tobacco sales by retailers are sustained. [2008]

1.4 Coordinated approach to school-based interventions

This recommendation is for schools, commissioners, local authorities, careers services or integrated youth support services, and local tobacco control alliances.

1.4.1 Ensure smoking prevention interventions in schools and other educational establishments are:

  • part of a local tobacco control strategy

  • evidence-based

  • linked to the school or educational establishment's smokefree policy

  • consistent with regional and national tobacco control strategies

  • integrated into the curriculum. [2010]

See also NICE's guideline on behaviour change: general approaches.

1.5 Whole-school or organisation-wide smokefree policies

These recommendations are for everyone working in and with primary and secondary schools and further education colleges.

1.5.1 Develop a whole-school or organisation-wide smokefree policy in consultation with young people and staff:

  • Include smoking prevention activities (led by adults or young people).

  • Include staff training and development.

  • Take account of children and young people's cultural, special educational or physical needs. (For example, by providing material in alternative formats such as pictures, large print, Braille, audio and video.) [2010]

1.5.2 Ensure the policy forms part of the wider strategy on wellbeing, relationships education, relationships and sex education (RSE), health education, drug education and behaviour. [2010]

1.5.3 Apply the policy to everyone using the premises (grounds as well as buildings), for any purpose, at any time. Do not allow any areas in the grounds to be designated for smoking (with the exception of caretakers' homes, as specified by law). [2010]

1.5.4 Widely publicise the policy and ensure it is easily accessible so that everyone using the premises is aware of its content. (This includes making a printed version available.) [2010]

See also NICE's guidelines on alcohol interventions in secondary and further education, social and emotional wellbeing in primary education and social and emotional wellbeing in secondary education.

1.6 Adult-led interventions in schools

These recommendations are for everyone working in and with primary and secondary schools and further education colleges.

1.6.1 Integrate information about the health effects of tobacco use, as well as the legal, economic and social aspects of smoking, into the curriculum. For example, classroom discussions about tobacco could be relevant when teaching subjects such as biology, chemistry, citizenship, geography, mathematics and media studies. [2010]

1.6.2 Include accurate information about smoking in the curriculum, including its prevalence and its consequences. Tobacco use by adults and peers should be discussed and challenged. Aim to:

  • develop decision-making skills through active learning techniques

  • include strategies for enhancing self-esteem and resisting the pressure to smoke from the media, family members, peers and the tobacco industry. [2010]

1.6.3 As part of the curriculum on tobacco, alcohol and drug misuse, discourage children, young people and young adults who do not smoke from experimenting with or regularly using e-cigarettes. Talk about e‑cigarettes separately from tobacco products. [2021]

1.6.4 When discussing e‑cigarettes, make it clear why children, young people and young adults who do not smoke should avoid e‑cigarettes to avoid inadvertently making them desirable. [2021]

1.6.5 Provide additional 'booster' activities to support classroom education on tobacco until school leaving age. Activities might include school health fairs and guest speakers. [2010]

1.6.6 Ensure smoking prevention interventions are delivered by teachers and higher-level teaching assistants who are both credible and competent in the subject, or by external experts. The latter should be trained to work with children and young people on tobacco issues. Interventions should be:

  • entertaining, factual and interactive

  • tailored to age and ability

  • sensitive to family origin, culture and gender

  • non-judgemental. [2010]

1.6.7 Involve children and young people in schools in the design of interventions to prevent the uptake of smoking. [2010]

1.6.8 Encourage parents and carers to become involved. For example, let them know about classwork or ask them to help with homework assignments. [2010]

For a short explanation of why the committee made the 2021 recommendations and how they might affect practice, see the rationale and impact section on adult-led interventions in schools.

Full details of the evidence and the committee's discussion are in evidence review F and G: e-cigarettes and young people.

1.7 Peer-led interventions in schools

This recommendation is for everyone working in and with secondary schools and further education colleges.

1.7.1 Consider evidence-based, peer-led interventions aimed at preventing the uptake of smoking. They should:

  • link to relevant parts of the curriculum

  • be delivered both in class and informally, outside the classroom

  • be led by young people nominated by the students themselves (the peer leaders could be the same age or older)

  • ensure peer leaders receive support from adults who have the appropriate expertise during the course of the programme

  • ensure young people can consider and, if necessary, challenge peer and family norms on smoking, discuss the risks associated with it and the benefits of not smoking. [2010, amended 2021]

See also NICE's guideline on alcohol interventions in secondary and further education.

  • National Institute for Health and Care Excellence (NICE)