School-based prevention programs
School-based prevention programs are popular and enjoy strong political support. Educators and public-health professionals have long believed that, because most of current adult smokers began experimenting with cigarettes before they were 18 years of age, we should prevent youth experimentation and smoking initiation. And what better place to reach youth than the schools?
New evidence raises serious questions about the wisdom of existing school-based smoking prevention programs (read about it). Although some short-term follow-up studies of these programs have reported lower youth smoking, the review of long-term effectiveness convincingly shows that they are not effective. They may increase students’ knowledge of the dangers of smoking but they do not lead to lower youth smoking in the long run. Existing school guidelines were developed before the current evidence that school-based and youth-access programs were ineffective at actually decreasing smoking. The logical appeal of these programs, combined with their lack of effectiveness in actually decreasing smoking, explains why the tobacco industry has long supported these youth smoking prevention strategies.
What, then, should the schools be doing to help decrease smoking? The schools can, at minimal cost, use tobacco as an ideal example to teach critical thinking with real world problems: the science of addiction, the effects of second-hand smoke, the role of marketing in selling cigarettes and politics in protecting the tobacco industry, and cost of use. Understanding these issues relates to science, social science, mathematics, and economics. Integrating tobacco issues into the curriculum in this way will help schools focus on what they should be doing and do best: teaching kids critical thinking skills.
Existing school-based smoking prevention programs do not work, but there are other effective strategies to reduce youth smoking. As with adults, concern about the effects of second-hand smoke on nonsmokers is a more powerful cessation message for youth than concern about the effects of active smoking. Smoke free environments decrease the likelihood that adolescents will be smokers by approximately 25% and increase the odds that they will stop smoking if they have started experimenting. Increased cigarette prices that come with tax increases also decrease youth smoking. Banning advertising and promotion of tobacco products also decreases tobacco uses among adolescents.
Youth access programs
It seems logical that making it more difficult for teenagers to obtain cigarettes would reduce the likelihood that a teen would become a smoker. The broad political appeal of this logic has led to the widespread enactment of so-called "youth access" laws, which make it illegal to sell cigarettes to teenagers. Although these laws do make it difficult for teens to buy cigarettes they do not decrease youth smoking. Youth access interventions are not associated with consistent positive effects on youth smoking prevalence. Furthermore, there is no evidence that increased compliance is associated with decreased prevalence (read about it). One reason why these policies may not affect youth smoking although they do affect the ease with which children can purchase cigarettes is that as teens find it harder to buy cigarettes they may simply shift to these other sources.
Although some tobacco control advocates have argued for attempting to restrict access to these other sources, doing so with a high level of effectiveness is a practical impossibility and could reinforce the tobacco industry’s efforts to present tobacco control advocates as unreasonable and extremist. It would also shift the focus of tobacco control efforts further away from the tobacco industry and its marketing practices.
Some have argued that youth access programs should be part of a comprehensive tobacco control program, even absent of evidence of effectiveness in reducing teen smoking, because they are politically popular and useful for coalition building. This argument ignores the fact that youth access programs consume limited resources for tobacco control and have created an opportunity for the tobacco industry to build coalitions with local merchants, expanding the industry’s political base. In addition, youth access programs reinforce the tobacco industry’s central marketing message that kids should smoke because it will make them appear more "adult."