How do we stop young people smoking? Sensible advice about the health risks is no use on its own, so a new study of what really influences young people is welcome.

Lloyd and Lucas have carried out studies in Sussex and London and produced a thorough, serious study, full of charts and tables, but also terse one-liners from young people. They have considered risk and protective factors, and come up with some useful proposals.

Smoking, they argue, cannot be seen in isolation, as behaviour that can be classified as a problem and dealt with on its own. It must be seen in the context of family, school and the wider community. Children from “intact” families are less likely to smoke than those from “reconstituted” families. Having parents who smoke is an obvious risk factor, but good communication between parents and children is a protective one. Young people who communicate well with their parents are less likely to use smoking as a form of rebellion.

In school, Lloyd and Lucas identify the variations one would expect relating to social class and academic expectations, with the children of high achievers less likely to smoke. What is important, the book shows, is the culture within a school. Peer group pressures, and particularly the influence of the best friend, are crucial in encouraging or deterring smoking. The aim should therefore be to prevent the playground becoming a recruiting ground for smokers. Banning everyone, including staff and visitors, from smoking on the premises, imposing sanctions and offering counselling for those found smoking are all effective measures.

People commonly say that teenage girls take up smoking to suppress their appetites and stay thin. However, Lloyd and Lucas argue that, for young teenagers, feeling attractive and feeling thin are not necessarily closely related, and that concerns about weight do not directly influence smoking. Teenage smokers see these as adult preoccupations. Those who are interested in sports do not see smoking as preventing them from achieving a level of performance that they are satisfied with. Their view is that it is better to be a slim, fit smoker than an overweight, unfit non-smoker.

What, then, will discourage children from smoking? In primary schools the message about the link between smoking and disease seems to be effective, if presented in the context of human biology and health. From Year 5 (nine to 10-year-olds) onwards, it is more useful to examine how the real psychological benefits of smoking can be obtained through other means, than to examine social or health consequences. In the early secondary years, smoking is best seen as a sign that a child has a problem with self-esteem and assertiveness and coping with peer pressures. Later, in Years 9 and 10, emphasis should be on examining the reasons why parents and other adults smoke, and the influence of best friends.

These programmes also need support from wider social policy. Such steps as banning tobacco advertising and smoking in public places powerfully reinforce the message.

Stephen Barber