Tobacco Control Strategy - Creating a Tobacco-Free Generation

Chapter 4 Creating an Environment Where Young People do not want to smoke

Current Position

It is estimated that around 15,000 young people between the ages of 13 to 24 in Scotland start to smoke each year^[11]. If we are to achieve our vision of a tobacco-free Scotland, we must create an environment where future generations of young people choose not to smoke.

In 2007 we raised the legal age for tobacco sales from 16 to 18 and our 2008 smoking prevention action plan, Scotland's Future is Smoke Free contained a range of measures to reduce the attractiveness, availability and affordability of tobacco products. Some of these were introduced through the Tobacco and Primary Medical Services (Scotland) Act 2010, such as the establishment of the first Tobacco Retail Register in the UK, a ban on automatic tobacco vending machines and a ban on the display of tobacco and smoking-related products in shops. Following the successful defence of the display and vending machine bans against legal challenges from the tobacco industry, these measures will now be implemented.

Smoking rates for 13 and 15 year olds in Scotland are at the lowest since reporting began in 1982^[12] and we are on track to achieve our 2014 targets for smoking rates among 13 and 15 year olds^[13]. While we welcome this progress, there is still more to be done. The uptake of smoking over the age of 16 remains a concern with smoking rates rising from 13% among 15 year olds^[14] to around 24% among 16-24 year olds^[15]. We therefore need to do more if we are to achieve our vision where no young people start to smoke.

Challenge

Evidence shows that the younger an individual starts to smoke, the more likely they are to be an adult smoker, the heavier they are likely to smoke during adulthood and the more likely they are to fall ill and die early as a result of smoking^[16].

We know that most smokers take up smoking as a young person. Around two-thirds of smokers in the UK started smoking under the age of 18 and over a third (39%) started under the age of 16^[17]. We also know that young people from the most deprived areas progress to regular smoking more rapidly than those in the least deprived areas^[18]. Smoking rates are also disproportionately high amongst certain groups of young people, such as, looked after children and young offenders^[19]. Supporting young people to not smoke will therefore have both health and inequality benefits.

There is no single reason why a young person starts to smoke. Evidence suggests that there are three levels of influence associated with a young person starting to smoke - individual, societal and environmental - and that effective smoking prevention approaches must address all of these^[20].

We also know that health behaviours do not exist in isolation. The most recent Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) results show that around 4% of 13 year olds and 19% of 15 year olds had tried cannabis and that around 44% of 13 year olds and 77% of 15 year olds had tried alcohol^[21]. Action to support young people to negotiate decisions about tobacco must also take account of the potential interactions between smoking and other health-damaging behaviours.

Approach

To create an environment that supports young people to choose not to smoke we will build on our 2008 action plan by continuing to ensure that young people are aware of the health harms of tobacco use and continuing efforts to reduce the availability, attractiveness and affordability of tobacco to young people.

World Health Organization Framework Convention on Tobacco Control

The Framework Convention on Tobacco Control (FCTC) is the first ever public health treaty brokered by the World Health Organization. Article 5.3 states that: "In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law."

Scotland is signed up to the FCTC as part of both the United Kingdom and the European Union. Whilst Scotland has a strong record in this regard, consideration should be given to how Scotland could further enhance its reputation as a world leader.

Action: We will commission an audit of the implementation of Article 5.3 of the Framework Convention on Tobacco Control in Scotland, with a view to providing the Scottish Government with options for ensuring the continued protection of public health policy from undue interference from the tobacco industry.

Lead: Scottish Government

Awareness and Support

Ministerial Working Group on Tobacco Control

We want all Scotland's young people to develop the knowledge and skills to support positive mental and physical health behaviours which will be sustained into adult life. This asset-based approach should be a key feature of all services working with families, children and young people.

Action: We will establish a Prevention Sub-Group of the Ministerial Working Group on Tobacco Control. The Sub-Group will be responsible for overseeing the implementation of the preventative actions in this Strategy, and for advising the Scottish Government on new actions to prevent the uptake of smoking among young people. The Sub-Group will ensure alignment with wider national prevention priorities and collaborations.

Lead: Scottish Government

Investing in Prevention Programmes

Following the successful defence of the Tobacco and Primary Medical Services (Scotland) Act 2010 against legal challenges from the tobacco industry, we are now seeking to reclaim the costs incurred through defending this legislation.

Action: We will reinvest any recovered costs in prevention programmes designed to support young people to choose not to smoke.

Lead: Scottish Government

In building awareness and support among young people, it is important to recognise the range of factors that tobacco can impact on. In addition to health benefits, there are considerable, social, financial and environmental advantages that come from choosing not to smoke. This approach should also explicitly recognise the role of the tobacco industry in creating and perpetuating what the World Health Organization recognises as a world-wide tobacco epidemic.

Engaging Young People

Children and young people have a right to access health-related information and education, including in relation to harmful substances such as tobacco^[22]. In communicating with young people around the impacts of tobacco, it is important that information is delivered in a style and format that reflects the needs of the target audience. Young people's use of media will vary according to age and social background. It is important for all communication activity to respond to this, particularly in addressing health inequalities.

If we are to change attitudes to smoking, we need to involve young people in the development of policies, services and communications activity designed to address tobacco use. Young people need to be given the opportunity to play an active role in tobacco control and policy makers and service providers need to listen to their views about what actions might be helpful to support young people not to use tobacco.

Action: Following the success of the Youth Commission on Alcohol, we will commission Young Scot to deliver a Youth Commission on Smoking Prevention. The Commission will recruit young people aged 12-21 from a range of backgrounds to provide the Scottish Government and local delivery partners with a series of recommendations and solutions which support young people to choose not to use tobacco.

Lead: Young Scot

Educational approaches

Curriculum for Excellence identifies health and wellbeing as a priority area for learning establishments. It provides flexibility for teachers, schools, colleges and local authorities to identify opportunities for young people to learn and develop in creative and interactive ways across traditional curricular topics. Curriculum for Excellence provides a real opportunity for young people to develop the skills for learning, skills for work and skills for life in a way which enhances their ability to make positive choices about their health and wellbeing. We want to support teachers by ensuring they have easy access to up-to-date, high quality resources.

Action: We will work with learning establishments and partner agencies to identify good practice and high quality resources which will be shared on the GLOW schools intranet site.

Lead: Scottish Government/Education Scotland/NHS Heath Scotland

Furthermore, we expect schools and local authorities to work closely with local partners from health, justice and the Third Sector to fulfil the potential offered by the Curriculum for Excellence.

Action: We will publish a National Action Plan for Health and Wellbeing in Curriculum for Excellence by autumn 2013.

Lead: Scottish Government

In line with the spirit of Curriculum for Excellence, local tobacco control plans should set out prevention activity and support for young people to stop smoking which takes account of the potential interactions between tobacco and wider health behaviours such as cannabis and alcohol use. This should include joint working between tobacco cessation services and Alcohol and Drug Partnerships where appropriate.

Action: Local tobacco control plans should take account of the potential interactions between tobacco and wider health behaviours. These plans should explicitly focus on vulnerable young people such as looked after children and young offenders.

Lead: NHS Boards/Local Authorities/ADPs/Third Sector

Evidence suggests that peer approaches are effective in delivering information about smoking harms and changing behaviours. The peer-led ASSIST programme developed by Cardiff and Bristol Universities has been evaluated as a useful smoking prevention initiative amongst young people in Wales which could have a positive impact on inequalities^[23].

Action: We will undertake a pilot of ASSIST, which will consider its suitability for Scotland and potential for further adaptation to other risk-taking behaviour.

Lead: Scottish Government

While schools are central to dissemination of information about tobacco to young people, we recognise that learning does not, and should not, only take place within the school environment. Youth groups and organisations are effective not only in reinforcing the messages delivered through traditional education, but in also meeting the needs of vulnerable young people.

Action: We will work with the youth sector to support smoking prevention programmes.

Lead: Youthlink Scotland/Youth Scotland/Scottish Youth Parliament/Young Scot/ASH Scotland/Fast Forward'

In order to support young people to make decisions about tobacco use and other health behaviours, we also need to support those around them. It is important that parents, carers and key professionals, such as youth workers, and those working with looked after children and young offenders, have the right information about smoking harms. A key part of this is the consistent enforcement of local smoking policies to create smoke-free environments in which young people can live.

Action: In support of the Scottish Government Parenting Strategy, we will work with service providers in the statutory and Third Sector to assist parents, carers and professionals address the smoking habits and associated health behaviours of young people.

Lead: Scottish Government/Local Authorities/ADSW/CCPS/NHS Health Scotland/Third Sector

16-24 Year Olds

In recognition of the high smoking rates of those over 16, service providers, universities, colleges and training providers should consider how they can support 16-24 year olds to negotiate decisions about tobacco and the potential interactions with other health behaviours.

Action: In conjunction with relevant bodies, including higher and further education and vocational training providers, we will explore what measures can be developed to support young people between 16-24 in making decisions about smoking and other health behaviours.

Lead: Scottish Government/NHS Health Scotland/NHS Boards/Young Scot/ASH Scotland

Attractiveness

It has long been recognised that marketing and promotion of tobacco products undermine public health messages about the dangers of smoking. Tobacco advertising and promotion was banned in the UK in 2002. Tobacco sponsorship came to an end in 2005. However, opportunities remain for further action.

Standardised Packaging of Tobacco Products

In our 2008 tobacco control strategy, Scotland's Future is Smoke-Free, we committed to consider tobacco packaging with the UK Government and the devolved administrations in Wales and Northern Ireland. We have since worked together to deliver a UK wide consultation on standardised tobacco packaging between April and August 2012. This sought to explore whether standardised packaging would have an additional public health benefit, over and above existing tobacco control initiatives alongside any competition, trade and legal implications.

Following careful consideration of the consultation responses and the available evidence, the Scottish Government has come to the view that standardised packaging has a key role to play in achieving our vision of a tobacco-free generation.

Action: The Scottish Government will await the UK Government and the other Devolved Administrations' responses to the recent consultation before deciding on the most appropriate legislative option for introducing the standardised packaging of tobacco products.

Lead: Scottish Government

Implementation of the Tobacco and Primary Medical Services (Scotland) Act 2010

Following the successful defence of the Act against legal challenges from the Tobacco Industry, the display ban which includes significantly stricter incidental and requested display regulations than the rest of the UK and the ban on automatic tobacco vending machines will now be implemented.

Action: The bans on the sale of tobacco from automatic tobacco vending machines and the display of tobacco and smoking-related products in large shops will come into force on 29 April 2013. The ban on the display of tobacco and smoking related products in all other shops will come into force on 6 April 2015.

Lead: Scottish Government

Media Representation

We remain concerned that representations of tobacco and smoking in the media, including digital media, can create a false impression that smoking is glamorous, the normal thing to do and can be one of the factors that influence a young person to take up smoking.

Action: We will maintain pressure on the UK Government to address the representation of tobacco use in the media and welcome the commitment in their most recent tobacco strategy to bring together media regulators and the entertainment industry to consider what more can be done.

Lead: Scottish Government

Availability

Illicit Tobacco

Illicit tobacco products undermine the effectiveness of high tobacco prices to reduce smoking rates and improve public health. In 2009, the Enhanced Tobacco Sales Enforcement Programme (ETSEP) was introduced to enable the Scottish Government and Trading Standards officers throughout Scotland to work with HMRC to tackle the availability of illicit cigarettes and the sale of tobacco products to people under the age of 18.

Action: We will continue to support strong national and local alliances to tackle the availability of illicit tobacco through the Enhanced Tobacco Sales Enforcement Programme.

Lead: SCOTSS/COSLA/Local Authorities/Scottish Tobacco Control Alliance/HMRC/NHS Boards

Tobacco Retail Register

The establishment of the Scottish Tobacco Retailer Register (the first in the UK) in 2011 made it illegal for anyone who is not registered to sell tobacco products. Over 11,000 retailers have registered and it is already proving a useful tool in enabling enforcement agencies to target activity. It will be important to review and evaluate the effectiveness of the Register with a view to considering further steps to regulate the supply of cigarettes.

Action: We will undertake a review of the Scottish Tobacco Retailer Register in 2015 by which time the Register will have been in force for three years.

Lead: Scottish Government

Enforcement - Underage Sales

While legislation and tough penalties are in place to prevent the sale of tobacco to people under the age of 18, young people still report purchasing cigarettes. In 2010 around half of 13 and 15 year olds who said they regularly smoke had successfully bought cigarettes from a shop^[24]. Furthermore, despite the introduction of legislation to address proxy sales, it is most common for regular smokers to report getting someone else to buy them cigarettes from a shop, with 54% of 13 year olds and 55% of 15 year olds reporting this^[25]. This shows that there is still much more to do in enforcing the existing legal framework and, potentially, the need to consider other options for ensuring compliance. As with all actions in the Strategy, activity should focus on areas of deprivation where smoking rates are highest and the consequences are most severe.

Action: We will continue to support strong national and local alliances to tackle underage purchases through the Enhanced Tobacco Sales Enforcement Programme and also more rigorous enforcement of existing tobacco sales laws.

Lead: SCOTSS/COSLA/Local Authorities/Scottish Tobacco Control Alliance

Responsibility for selling any age-restricted product should not be taken lightly and we will explore where legislation on age-restricted goods can be further harmonised. We are consulting on possible changes to alcohol licensing which will have a bearing on how this is done. Currently the grounds for refusing a personal alcohol licence includes a reference to the list of relevant offences as set out in the Licensing (Relevant Offences) (Scotland) Regulations 2007. One option may therefore be to include the offence of selling tobacco products to persons under 18 in the list of relevant offences.

Action: We will consider how best to ensure that any offences under tobacco sales legislation can be taken into account by Police and Licensing Boards when granting a personal alcohol licence under the Licensing (Scotland) Act 2005.

Lead: Scottish Government

The Alcohol etc. (Scotland) Act 2010 set out a requirement for an age verification policy, set at 25, in relation to the sales of alcohol. Many retailers have since adopted schemes such as Challenge 25 or Think 25 which they have also applied to sales of tobacco. We welcome this and will encourage all retailers who sell tobacco to do the same.

Action: We will work with retailers to encourage the extension of the alcohol age verification policy to the sale of tobacco products.

Lead: Scottish Government

Affordability

Taxation

The price of tobacco products is one of the most important factors in determining consumption. Research shows that young people and adults from lower income groups are sensitive to changes in price^[26]. Tobacco taxation is therefore an effective way of reducing tobacco consumption among young people and tackling inequalities amongst adult smokers.

Action: We will maintain pressure on the UK Government to ensure duty on tobacco products remains above inflation.

Lead: Scottish Government

Further Measures

Over the lifetime of this Strategy, it will be important to consider what further measures can be taken to reduce the attractiveness, availability and affordability of tobacco. This should include monitoring and, where necessary, acting to close down, any new tobacco marketing and promotion activities identified during the lifetime of the Strategy.

Action: The Scottish Government will look to the Prevention Sub-Group of the Ministerial Working Group on Tobacco Control to provide advice on further options for reducing the attractiveness, availability and affordability of all tobacco and smoking-related products.

Lead: Prevention Sub-Group of the Ministerial Working Group on Tobacco Control