1 Recommendations

This guidance was amended in November 2014 to reflect the ban on the sale of tobacco from vending machines, which came into effect in October 2011 in England.

The changes made were:

  • Recommendation 4 and 5 were amended to remove mentions of vending machines.

This document constitutes the Institute's formal guidance on mass-media and point-of-sales measures to prevent the uptake of smoking by children and young people.

Mass-media and point-of-sales measures should be combined with other prevention activities as part of a comprehensive tobacco control strategy. Such a strategy is defined by the US Surgeon General, World Health Organization and others as encompassing price and regulation policies, education programmes, cessation support services and community programmes. It should be sufficiently extensive and sustained to have a reasonable chance of success.

The evidence statements that underpin the recommendations are listed in appendix C. A brief description of the interventions is given below, immediately before the list of recommendations.

When implementing the recommendations, careful consideration should be given to the potential impact on health inequalities.

Interventions

  • Mass-media interventions use a range of methods to communicate a message. This can include local, regional or national television, radio and newspapers, and leaflets and booklets. It can also include new media. In this document, 'new media' refers to communication via the Internet or mobile phone. On the Internet, it can involve anything from real-time streaming of information and podcasts, to discussions with experts and the use of social networking sites. (An example of real-time streaming of information is the 'breaking news' text that appears along the bottom of the screen during some TV news programmes.) The aim of mass-media interventions is to reach large numbers of people without being reliant on face-to-face contact.

  • Point-of-sales interventions take place at the point where tobacco could be sold. Primarily, they aim to deter shopkeepers from making illegal sales.

Recommendations

Mass media

Recommendation 1: campaign development

Who is the target population?

Children and young people under 18.

Who should take action?

  • Organisers and planners of national, regional and local mass-media campaigns.

  • Local and regional commissioners and planners (including regional tobacco programme managers) with a remit to improve the health and wellbeing of children and young people under 18. This includes those working in the NHS, local authorities and tobacco control alliances.

What action should they take?

  • Develop national, regional or local mass-media campaigns to prevent the uptake of smoking among young people under 18. The campaigns should:

    • be informed by research that identifies and understands the target audiences

    • consider groups which epidemiological data indicate have higher than average or rising rates of smoking

    • be developed in partnership with: national, regional and local government and non-governmental organisations, the NHS, children and young people, media professionals (using their best practice), healthcare professionals, public relations agencies and local anti-tobacco activists.

  • The campaign(s) should not be developed in conjunction with the tobacco industry.

Recommendation 2: campaign messages

Who is the target population?

Children and young people under 18.

Who should take action?

  • Organisers and planners of national, regional and local mass-media campaigns.

  • Local and regional commissioners and planners (including regional tobacco programme managers) with a remit to improve the health and wellbeing of children and young people under 18. This includes those working in the NHS, local authorities and tobacco control alliances.

What action should they take?

  • Convey messages based on strategic research and qualitative pre- and post-testing with the target audiences. These could include messages that:

    • elicit a strong, negative emotional reaction (for example, loss, disgust, fear) while providing sources of further information and support

    • portray tobacco as a deadly product, not just as a drug that is inappropriate for children and young people to use

    • use personal testimonials that children and young people can relate to

    • are presented by celebrities to whom children and young people can relate (taking care to avoid credibility and other problems)

    • empower children and young people to refuse offers of cigarettes

    • include graphic images portraying smoking's detrimental effect on health as well as appearance (for example, its effect on the appearance of skin and teeth).

  • Repeat the messages in a number of ways and regularly update them to keep the audience's attention.

Recommendation 3: campaign strategies

Who is the target population?

Children and young people under 18.

Who should take action?

  • Organisers and planners of national, regional and local mass-media campaigns.

  • Local and regional commissioners and planners (including regional tobacco programme managers) with a remit to improve the health and wellbeing of children and young people under 18. This includes those working in the NHS, local authorities and tobacco control alliances.

What action should they take?

  • Use a range of strategies as part of any campaign 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. Strategies could include:

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

    • using posters, brochures and other materials to promote the campaign

    • using opportunities arising from new media.

  • The campaign(s) should not be delivered in conjunction with (or supported by) the tobacco industry.

  • National campaigns should exploit the full range of media used by children and young people, including television advertising.

  • Regional and local campaigns should build on, and be integrated with, a national communications strategy to tackle tobacco use. Regional campaigns should use regional press and radio (local campaigns should use local press and radio) to reach specific audiences and to get unpaid coverage in the press. They should also use regional and local networks (as appropriate) to generate as much publicity as possible.

  • Effective practice, including effective local and regional media messages, should be shared locally, regionally and nationally.

  • Campaigns should run for 3–5 years.

  • Use process and outcome measures to ensure campaigns are being delivered correctly and effectively. For recommendations on the principles of evaluation, see Behaviour change: the principles for effective interventions (NICE public health guidance 6).

Illegal sales

Recommendation 4

Who is the target population?

Children and young people under 18.

Who should take action?

National government.

What action should they take?

  • Support better enforcement of existing legislation by:

    • working with the Local Better Regulation Office to make illegal tobacco sales a higher priority for local authorities, thereby increasing inspection and enforcement activities

    • encouraging and providing all local authorities with support to:

      • enforce legislation to prevent under-age tobacco sales, in accordance with their statutory role and best practice

      • undertake regular audits of test purchasing to ensure consistent practice and enforcement

    • encouraging national organisations and local authorities to provide education and training programmes for trading standards officers

    • working with government agencies and national organisations to ensure retailers and others, such as publicans, are aware of legislation on under-age tobacco sales

    • ensuring magistrates are aware of the:

      • potential damage that smoking can do to children and young people and hence, the need to deter non-compliance among retailers

      • range of measures available to deter retailers from making under-age tobacco sales, including the use of fines up to level four on the standard scale and the granting of either a 'restricted premises' or 'restricted sales order' (Criminal Justice and Immigration Act, due to come into force March 2009).

  • Ensure enforcement efforts are sustained over a number of years.

Recommendation 5

Who is the target population?

Retailers.

Who should take action?

Local authorities and trading standards bodies.

What action should they take?

  • Ensure retailers are aware of legislation prohibiting under-age tobacco sales by:

    • providing training and guidance on how to avoid illegal sales

    • encouraging them to:

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

      • complete the 'Age restricted products refusal register' for each tobacco sale refused on the grounds of age

    • running campaigns to publicise the legislation. These could include details of possible fines that retailers can face, where tobacco is being sold illegally and successful local prosecutions, as well as health information.

  • 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 under-age sales by:

    • prosecuting retailers who persistently break the law

    • undertaking test purchases each year, using local data to detect breaches in the law and auditing them regularly to ensure consistent practice across all local authorities.

  • Work with other agencies to identify areas where under-age tobacco sales are a particular problem.

  • Work with the Local Better Regulation Office to improve inspection and enforcement activities related to illegal tobacco sales.

  • Assess whether an advocacy campaign is needed to support enforcement. Any such campaign should be run in accordance with best practice and provide a clear, published statement on how to deal with under-age tobacco sales.

  • Actively discourage use of enforcement and related campaigns developed by the tobacco industry.

  • Ensure efforts to reduce illegal tobacco sales by retailers are sustained.