A realistic look at youth smoking in seven European cities
The EU-funded SILNE-R aimed to identify new opportunities for policies to prevent youth smoking in Europe. “Several measures have already been taken in European countries to prevent youth smoking. However, there is need for more efforts, and for more evidence to support these efforts,” outlines Dr Anton Kunst, project coordinator. Successful anti-smoking strategies identified Despite efforts made by tobacco control NGOs, not all countries in the study – Belgium, Germany, Ireland, Italy, the Netherlands, Portugal and Finland – have adopted all the policy measures that have been shown to be effective in the past. SILNE-R therefore identified strategies that individual NGOs can apply to stimulate national and local policymakers to implement effective policies. Where countries or regions did adopt effective policies, implementation may be partial and poor and the effectiveness may be limited. “We therefore aimed to assess how policies could be implemented in such a way as to have a maximal impact on preventing youth smoking,” emphasises Dr Kunst. Eliminating effects of variation across Europe “To negate the differences we found between NGOs, we identified various strategies where they could increase their influence on policymaking,” explains Dr Kunst. Examples include using scientific evidence, involving national media, establishing lasting contacts with ministries and marginalising the tobacco industry. Where policies have failed, for example, to make school premises smoke-free, the strategy could be improved in several ways. SILNE-R formulated appropriate solutions, in this case: clear communication to staff and students, empowerment of staff members who enforce the smoking bans, and progressive sanctioning of students who violate the rules. The why and how for tackling the problems “We applied a methodology that is new in this field of enquiry: the ‘realist analysis’,” reports Dr Kunst. Key to this approach is that researchers didn’t just ask the question WHETHER an intervention is effective, they also asked WHY it is (not) effective and HOW effectiveness could be increased. As Dr Kunst points out, “this opens up a new, promising area of research. However, it takes time to explore and apply new methods of empirical research, but with some perseverance we finally managed to get novel results based on these methods.” The qualitative, comparative research angle the team employed also came with a price. In-depth interviews were held with adults and focus group discussions with young people. Contrary to previous studies, they did this for the seven countries simultaneously. As a result, all transcripts had to be translated into one common language for training interviewers, with subsequent analysis of a huge number of transcripts. Next steps SILNE-R has already produced more than 40 manuscripts, many already published by international scientific journals, but many others are still in the pipeline. “This post-project year we will be working hard to complete the remaining papers and get all papers published,” Dr Kunst stresses. Dr Kunst says he would like to see an extension of the project work to the entire EU. “In the current project, we focused on learning from ‘spearhead’ countries with advanced tobacco control policies.” However, these countries are mostly found in northern and western parts of Europe. “Having realised that tobacco consumption is now especially high in countries in other parts of the EU, we would like to assess the situation in these countries using the methods that we have developed,” he concludes.
Keywords
SILNE-R, policies, Europe, youth smoking, NGO, tobacco control, realist analysis
