The European Conference on Young People and Tobacco was held over four days in October 1995, in Edinburgh, Scotland. The conference explored potential and existing methods for generating European level collaboration on tobacco control and prevention activities aimed at young people. To this end practitioners, researchers and representatives of the target group came together to share their experience and to apply their collective minds to a number of issues. Ideas were generated as to how barriers to effective action might be overcome; as to how research and practice could be more fully integrated for the benefit of programmes on young people and tobacco; and as to how the European Network on Young People and Tobacco might proceed beyond its pilot phase.
The themes of the conference reflect the key aims of the network: to facilitate communication amongst researchers and programme managers; and to contribute to the harmonisation of efforts across Europe to reduce smoking prevalence amongst young people. In staging the conference, the European Network on Young People and Tobacco was pursuing these objectives and involving its constituency in both exploring issues raised during its pilot phase and the future role of the network.
Conference deliberations were set in the European context by Mrs Soledad Blanco of the Europe Against Cancer Programme and in the Scottish context by the Minister for Health at the Scottish Office, Lord James Douglas-Hamilton. The former opened the programme on Thursday and the latter on Friday.
Most of the delegates worked directly in the area of young people and tobacco control and were invited to attend because they could contribute knowledgeably to the debate. Each country was invited to propose a core group of delegates made up of a researcher, a policy maker and a programme manager. Additional representation was sought from youth organisations in each country. In the event a cross section was achieved, with fourteen countries sending delegates and a total of seventy-two people taking part.
Over two and a half days of formal input, delegates listened to more than twenty presentations and took part in several workshops, as well as viewing exhibitions and resources. Periods of light relief included a reception at Edinburgh Castle, hosted by Lord James Douglas-Hamilton, a traditional Scottish ceilidh and tours of Edinburgh and the surrounding countryside.
In designing the programme, the Steering Committee of the European Network on Young People and Tobacco intended to reflect the process by which tobacco prevention programmes are designed. Session 2, therefore, began with new research information on smoking prevalence among young people in Europe, presented by Dr Candace Currie, from the World Health Organisation (WHO) study on the Health Behaviours of School Children. Professor Keith Tones offered theoretical insights suggesting that the issue of young people and tobacco required a 'Radical Analysis and Sophisticated Solutions'. Barriers to intervention were given particular emphasis, being the theme of the final presentation of this session by Dr Karen Slama and the theme of the following workshop sessions. Research, its role and perspective, was considered in Session 4, new ideas for programmes were presented in Session 5 and strategies for reaching wider target groups in Session 6. Conference then considered examples of integration and collaboration at school, city, country and European level, followed by discussion on how research and interventions could be more fully integrated. The final day was devoted to developing ideas for strategies at European, national and regional level and to discussing the future role, remit and funding of the European Network on Young People and Tobacco.
This report is in three sections. The Executive Summary contains an overview of the conference, its aims and objectives, and conclusions and recommendations. Each session of the conference is summarised, and the key points from the presentations and discussion extrapolated. The second part of the report contains the proceedings of the conference with summaries of the presentations and workshops. Part 3 contains presentations of current projects.
The aims of the European Conference on Young People and Tobacco were to do the following:
The conference built on the work of a series of European conferences on young people, health education and smoking prevention which were supported by the Europe Against Cancer Programme: Glasgow 1990, Dublin 1990, Seville 1993, Montpellier 1993, Frascati 1994, Empoli 1994 and Dublin 1994. Two particular interests underpinned the planning of the Edinburgh conference:
Other aims for the conference reflect the goals of the European Network on Young People and Tobacco itself:
Delegates were asked to consider several key topics in workshop groups during the conference. These related directly to those areas which the conference organisers aimed to tackle:
Three workshop sessions in total were devoted to these questions where they were considered at several levels:
The conclusions reached by the conference are set out below, followed by specific recommendations on the work to be undertaken by the Network.
Session 3 was devoted to considering the barriers to effective prevention. Five main areas were identified where barriers might exist: lack of knowledge, funding, and support; constraints within organisational structures; and inadequate intervention strategies. Delegates identified factors which, in their experience, contributed to the current situation in each of these areas.
Lack of knowledge and expertise
Lack of support
The theme of session 8 was the integration of research and tobacco control interventions. Delegates identified ways in which the current situation in their countries could be improved under four headings: intersectoral collaboration, programme preparation, programme evaluation, and programme diffusion. Their conclusions were as follows:
The European Network on Young People and Tobacco was seen as having a valuable role in addressing the barriers to effective intervention, and in promoting the integration of research and programme delivery. In session 9, delegates discussed what they wanted from the network. This led to several areas being identified where the network could expand its activities.
Progressing its role as a forum for the exchange of information
Delegates saw the Network's main role as facilitating the exchange of information, experience and skills on research, good practice, funding sources, and useful contacts. Maintaining the newsletter was considered important and through it new data, research, funding information and programme innovations could be disseminated. The newsletter was valued by participants, as was access to the database of information held by the Network. Some improvements to the newsletter and database were suggested:
The following topics emerged as examples of issues which could usefully be explored:
In pursuing this role, the Network could:
Developing a role in the funding process
The following strategies were suggested, although it was recognised that in order to do this successfully, the network would have to build up its profile and credibility.
The Network, as an international project, could ease the funding difficulties of preventive programmes by supporting applications, particularly those involving collaboration amongst various countries.
A spectrum of skills, information, resources and support was offered:
Based on the conclusions of the conference in the above areas, a series of formal recommendations was developed for the European Network on Young People and Tobacco.
Delegates formally agreed that the Network should continue and that its aims should be:
The opening sessions set the context for the conference. Tobacco control activity in Europe, and within the Europe against Cancer programme, was outlined by Mrs Soledad Blanco. Dr Anne Charlton and Cecilia Stephens then described the inception and progress to date of the European Network on Young People and Tobacco. Lord James Douglas-Hamilton, the Scottish Health Minister, officially welcomed delegates and presented the tobacco control policies currently in place in Scotland.
Key points
in future large scale projects involving government agencies and non-governmental agencies will have priority for European funding
Dr Currie's presentation was in four sections: the background to the Health Behaviours of School Children (HBSC) Survey; new data on young people and smoking and the implications of the findings; the advantages and limitations of cross - national data; and the future plans of the HBSC team.
Dr Currie was followed by Professor Tones who challenged many of the assumptions behind smoking prevention interventions, and argued for the need to look beyond our current understanding of the social and personal influences on smoking to the factors which create them. Such an analysis led him to re-appraise existing programmes, and to conclude that vertical programmes may be less effective than horizontal programmes. The latter are built on interagency collaboration, address social issues at several policy levels, and offer consciousness raising education and general life skills. It is such approaches that hold the key to future success.
In the final presentation of this section, Dr Slama explored the barriers to tobacco control action and how these might be tackled, preparing the delegates to consider this issue in the afternoon workshops.
Key points
Workshops were held to explore participants' experience, in their own work, of the barriers to effective prevention. Delegates were asked to consider the contribution of low knowledge levels, inadequate funding, lack of support, structural issues and unclear intervention strategies. Delegates then identified ways in which the European Network on Young People and Tobacco could help address these issues.
Key points
The outcomes of the workshops are incorporated above in the section outlining the conclusions of the conference. A brief summary is included here:
Session 4: The role and perspective of research
This session was introduced by Dr Hein de Vries, of ABC Cancer Prevention Research Programme, University of Limburg, with a presentation on the role of research as a key tool in intervention planning. This was followed by short presentations from four researchers whose work illustrated how research can inform interventions. Dr Anne Charlton discussed findings on young women and self esteem, suggesting that this research was a clue to young women's smoking and could underpin intervention planning. Dr Manuel Nebot presented research on the diffusion process of an intervention developed for schools. Dr Alison Bullock described some preliminary findings into young people's out of school activities, designed to inform the planning of out of school preventive work and Dr Erkki Vartiainen reviewed the evaluation results of various types of interventions. Finally, Dr Hein de Vries made a brief presentation of a demonstration project being undertaken in the Netherlands.
Key points
the social influence approach combined with booster sessions is also appropriate for high risk groups attending vocational schools
Mme Danielle Grizeau, of the French Committee on Health Education chaired this session which explored alternative methods of engaging with young people on health issues. Role play, games, peer education projects and smokefree clubs have all been used but because some methods appeal to some young people and not others, a variety of approaches are required. Three projects were presented to the conference as methods which have been or could be employed in smoking prevention with young people.
Key points
In order to explore the theme, "Up until now smoking interventions have failed to understand the viewpoint of the young smoker", presentations were made to conference by young people, youth workers and health education practitioners. Siri Kohl, a young woman from Germany representing a group of young people who advise the Berlin Senate, put forward the young person's perspective on smoking education. Becky Saunders and Merlynne Francique both discussed smoking education in the context of the philosophy and methods of youth work. Finally, Niklas Oden from A Non-Smoking Generation, Sweden described their peer education approach.. Several young people from Edinburgh City Youth Cafe contributed to the discussion. The session was chaired by Henk Stegeman.
Key points
mass media campaigns may need to include both lifestyle messages and harder hitting images of the harmful effects of smoking
Professor Albert Hirsch chaired this session and gave the opening presentation on structures for international co-operation on tobacco control. Five presentations followed, each giving an example of a coalition operating at a particular level. Marleen Lambert from Belgium described a national coalition; Dr Donatello Alesso described a coalition of cities - the Network of Smokefree Cities; Per Bge and Joergen Falk described a coalition between two organisations working together on a programme for schools in Denmark; Dr Katerina Sokou discussed research undertaken in schools in Greece and David Rivett of the World Health Organisation described the work of the European Network of Health Promoting Schools.
Key points
Dr Hein de Vries opened this session by summarising the key points of his presentation on the role and perspective of research and by outlining the task that participants were to complete in small groups. Delegates were divided into groups by country and asked to discuss:
The ideas put forward by the delegates are incorporated in the above section on the conclusions of the conference.
Key points
Dr Anne Charlton chaired this session which explored how conference delegates saw the future development of the European Network on Young People and Tobacco. Dr Charlton introduced the deliberations by reviewing the key lessons of the conference and outlining several key questions for consideration in workshop groups:
A number of manuals were presented to conference during this session. Dr Annie Sequier outlined a co-production between France and Portugal. Dr Carla Arciti presented a bi-lingual guide for teachers produced in English and Italian. A group of Smokebuster club co-ordinators introduced a collaborative project being undertaken by four national clubs, under the leadership of the Ligue Nationale contre le Cancer, France, to develop a practical guide to smoking prevention with children.
A series of formal recommendations (see above) was derived from the conclusions reached by delegates in session 9. These were put to conference and accepted as the way forward for the European Network on Young People and Tobacco.
Delegates were asked to complete an evaluation form at the end of the conference. Twenty six were completed and returned. Overall comments were very favourable and grading scores out of ten at seven and above. In terms of the presentations, delegates thought the standard was very high, in general, although some complained that more visual aids would have helped in some cases. Some presentations were difficult to understand, especially if they were overlong and too theoretical. The balance between discussion and didactic plenary sessions was weighted too heavily towards the latter. Many delegates commented that they would have preferred more discussion time and a less packed programme.
Similar comments were made about workshop sessions which people felt were too short for adequate discussion of major issues. Presentations made within the workshops were felt to distract from the subject being discussed as they were not always directly relevant. Most people appreciated the opportunity to interact and share ideas, although some would have preferred working in smaller groups. More workshops would have been appreciated.
Despite comments on the structure of the workshops and presentations, the main aims of the conference were achieved, although some in more detail than others. The role of the Network was given considerable attention and specific recommendations were drawn up, but plans for collaborative action were less well formulated. Barriers to action were identified, but no plan emerged to tackle these.
Workers from youth organisations were outnumbered by health promotion experts and researchers. This was unfortunate especially in the light of Alison Bullock's finding that youth clubs could be a setting for preventive interventions as a considerable number of young people attend them. Specific examples of existing work in these settings with young people themselves, rather than the theoretical framework and training initiatives presented, would have been useful.
Young people, as the target group, were represented at the conference by several young people from the Edinburgh area and by Siri Kohl and Rebecca Kwee from Germany. Delegates were attentive to their contributions and eager to find out the young people's views on smoking prevention. In turn, the young people responded articulately to questions directed at them and made their contributions confidently. Vicky Haylott, Ian Etherington and David Scott of Edinburgh City Youth Cafe were spontaneous in their responses and supported appropriately by the conference organisers. The consensus of the discussion was that adults need to give young people an integral role in the development and delivery of programmes, as well as listening to their views. Young people themselves and youth workers were considered, by the young people, to be more effective educators than parents or teachers. The young people from Edinburgh City Youth Cafe were inspired by the experience and intimated their intention to organise a conference for young people on health issues.
However, young people as the target group were under-represented at the conference. An alternative method of accessing young people's views, rather than asking them to react to adult views, is required. Not all young people are able to express themselves confidently in an adult setting like a conference of experts. Unfortunately, because only a handful of young people were present and most of them were unable to make prepared contributions, the debate on whether the views of the young smoker are considered in smoking prevention did not really take off. It was dominated by adult concerns about what kind of messages young people thought were appropriate rather than offering young people a chance to set the agenda.
A conference or seminar, specifically for young people, where they have the opportunity to develop their views using participative methods, may elicit a wider range of opinions and responses. Young people could then feed their conclusions into an adult setting and even establish the agenda to be discussed by the adults.
The goals of this particular conference did not explicitly include involving the target group or integrating their views. However, within a further conference on the subject of young people and tobacco there could be room for considering, and incorporating, mechanisms to ensure that smoking prevention programmes are led by young people's experience.