5722.pdf

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extracted text
Finnish strategy
TO PROMOTE HEALTH
AND NON-SMOKING
AMONG YOUNG PEOPLE

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MINISTRY OF SOCIAL AFFAIRS
AND HEALTH

PUBLICATIONS

1997:22

PUBLICATIONS OF MINISTRY OF SOCIAL AFFAIRS AND HEAL! rl 1997:22

FINNISH STRATEGY
TO PROMOTE HEALTH
AND NON-SMOKING
AMONG YOUNG PEOPLE

MINISTRY OF SOCIAL AFFAIRS AND HEALTH
Department for Promotion and Prevention
Helsinki 1997

Photo on the front cover:
itstock/Lehtikuva
Layout (except the cover):
Leenamaija Laine, Studio d-Light Oy

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ISSN 1236-2050
ISBN 952-00-0353-3

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PRESENTATION LEAF

Publisher
Ministry of Social Affairs and Health/Finland

Authors (in case of organs: name,
chairman and secretary)
Consensus Development Conference
on Promotion of Non-Smoking Lifestyles
among Young People held 27-28.8,1996

Date

1.7.1997

Art of the publication
Consensus Statement

Principal
Ministry of Social Affairs and Health
Date of appointing the organ

The title of the publication
Finnish Strategy to Promote Health and Non-Smoking among Young People
Parts of the publication
Recommendations

Summary
The Concensus Conference proposed 38 measures to promote healthy and smokefree lifestyles
among young people in Finland. The aim of these measures is to create healthy and smokefree environments for young people, to improve co-operation and communication between
parents, other adults and young people in families, at schools and during their leisure
activities and in this way to promote and to support healthy and non-smoking growth of
young people.
Key words
Education, health education, health promotion, preventive health policy, schools,
smoking, young people
Other data

Title and number of the series

ISSN
1236-2050

ISBN
952-000353-3

Total number of pages

Price

Confidentiality

Distributor
Ministry of Social Affairs
and Health/Finland

Language
English

Publisher
Ministry of Social Affairs
and Health/Finland

3

CONTENTS

Introductions.......................................................................................................................................

5

Towards a policy of consensus: reasons and recommendations for actions................................

8

Legislative measures.........................................................................................................................

10

Actions by authorities........................................................................................................................

11

Developing professional skills..........................................................................................................

13

Actions to support families and parenthood...................................................................................

14

Actions supporting the work of schools and educational institutions..........................................

16

Actions aimed at leisure time...........................................................................................................

18

Other actions......................................................................................................................................

20

Implementation of the recommendations for action......................................................................

20

4

INTRODUCTION

Finland is one of the first countries which has
introduced comprehensive legislative and ad­
ministrative actions to reduce and prevent smok­
ing. In Finland the Tobacco Acts of 1976 and 1995
have been the main elements of the health-ori­
ented tobacco policy based on health education,
pricing policy, protection, restrictions and re­
search.
The key provisions of the Finnish Tobacco Act
include:
a total ban on direct and indirect tobacco ad­
vertising and sales promotion of tobacco prod­
ucts and smoking;
the ban on sales of tobacco to young people
under 18 years;
a requirement for smokefree air in all public
and business premises, workplaces, child day
care centres and schools, including yards;
obligatory health warnings and content label­
ling on retail packs of tobacco products;
- the vending machines under continuous su­
pervision, and
the ban to establish smoking rooms in the
buildings in which people under 18 years mainly
stay or which they use.
The proprietors of indoor premises may allow
smoking in a smoking room in so far as no tobac­
co smoke can enter those premises where smok­
ing is prohibited.

The Finnish smokefree policy has been very
successful. The proportion of daily smokers has
been decreasing since the 1960’s. In 1996 22% of
Finnish population smoked daily (18% women,
27% men). These figures are the lowest in Eu­
rope. However, the situation has not been so
positive among young people. In Finland they
tend to begin smoking earlierthan in most Euro­
pean countries. In 1995 26% of boys and 24% of
girls aged under 18 smoked daily.This is why we
need new measures and activities to discourage
onset of smoking among young people.
The Finnish Ministry of Social Affairs and
Health initiated the action to prepare a plan for
a Finnish strategy to promote health and smoke­
free lifestyles among young people. In 1996, an
expert group was appointed to propose recom­
mendations for smoking prevention. The mem­
bers of the group represented NGOs, child day
care centres, student organizations, medical ex­
perts, schools, communities, the church, re­
searchers, sports associations, media, and ad­
vertisers. The Ministry of Social Affairs and
Health with co-partners organized a consensus
conference in August 1996. Its aim was to criti­
cally assess and discuss the 38 recommenda­
tions prepared and proposed by the consensus
group. After a two-day lively discussion by the
500 conference participants the recommenda­
tions were finalized.

5

Smoking among young people seems to be
related to environmental factors. Smokefree en­
vironment and role models play an important role
in onset of smoking. In their daily life children and
young people seem to need strong support and
presence of the parents and adults. This may be
one of the most important elements in promot­
ing health and smokefree lifestyles among young
people. The active role of the whole society as a
“couch” of smokefree life is also needed.
The recommendations are now in their prac­
tical stage. In implementation the actors are
mainly the same which participated in their prep­
aration. The idea is to initiate a comprehesive and
interactive process promoting knowledge about
and action for non-smoking at several levels. It
is stressed that the onset of smoking among
young people is in the beginning a psychosocial
problem, not a health problem.
The special network nominated by the Min­
istry of Social Affairs and Health will follow and
evaluate the process. In 2000 the network will
organize a follow-up conference on the issue.

Daily smokers (%) aged 14-18 -years
in 1977-1997 by sex

The Adolescent Health and Lifestyle Survey 1997.

Tampere School of Public Health
University of Tampere

Terttu Huttu-Juntunen
Minister of Social Affairs and Health

6

Consumption of cigarettes
per person aged 15 or over, 1950-1996

Proportion of daily smokers (%)
aged 15-64 years in 1960-1996 by sex

Males %

Females %

8

?

1950 94: Wholesale trade purchases and imports.
1995-96: Tobacco products delivered for
taxable consumption.

National Public Health Institute 1996

Statistics Finland.
Tobacco statistics 1996.

7

TOWARDS A POLICY OF CONCENSUS:
REASONSAND RECOMMENDATIONS FOR ACTIONS

Smoking is today the greatest preventable health
problem in Finland and the other industrialized
countries. In Finland, almost all regular smokers
have started smoking before the age of 20, in con­
sequence of which the exposure to the detrimen­
tal substances of tobacco becomes very high. Two
out of three of those who have started smoking at
an early age will catch a tobacco-related disease.
One out of two regular smokers will die premature­
ly from a tobacco-related disease. Every fourth of
those who started smoking before the age of 16
will lose his/her capacity for work as a result of a
serious tobacco-related disease prior to the retire­
ment age. On a global level, three million people
die every year due to smoking.
If smoking is started before the age of 18, it
will usually result in an addiction continuing into
adulthood. Smoking causes considerable health
problems as early as in childhood and increases
the risk of many serious diseases when grown up.
School-age smokers are more often ill and suf­
fer more often from ill health than non-smokers.
At the same time they also suffer more often than
non-smokers from abdominal pains, headaches,
tension, nervousness, insomnia and tiredness.
Smoking among schoolchildren is also associat­
ed with other unhealthy lifestyles ■ early experi­
ments with alcohol drinking in order to get drunk
and bad food habits. Almost all young abusers of
medical and narcotic drugs also smoke. Smokers
are on average less successful at school than
non-smokers. Learning how to smoke and how to
roll cigarettes also tends to make it easier to start

8

using cannabis products. The cheapness of rollyour-own tobacco, which is made possible by the
low excise duty, almost tempts people to use it.
Adults, in the same way as young people,
smoke more often the lower their education.
Those with a lower education also smoke in
quantitative terms more than those with a high­
er education, and smoking is clearly more usual
among vocational school pupils than among
those attending higher secondary school. As re­
gards smokers at vocational schools, they have
usually started smoking at comprehensive
school. Young people’s choices concerning edu­
cation often depend on their family background
apart from their success at school.
The differences in smoking among social
groups increased from the end of the 1970’s to
the middle of the 1980’s and have thereafter re­
mained unchanged. It can be concluded from the
indirect information concerning social group de­
pendence of smoking among young people that
their situation resembles that of the adults.
Therefore it can be assumed that socioeconom­
ic differences in morbidity and mortality (e.g. cor­
onary diseases and lung cancer) will remain un­
changed or even increase in the near future.
Smoking experiments and smoking among
young people increased at the end of the 1980’s,
but in the beginning of the 1990’s their level fell
to that of the beginning of the previous decade.
Young people in Finland start smoking very ear­
ly. Here the pattern deviates from the usual West­
ern one so that boys usually begin experiment­

ing with smoking at an earlier age than girls. In
1994 52 % of Finnish girls aged 13 and 70 % of
boys of the same age had experimented with
smoking. The corresponding figures for those
aged 15 were 77 % (girls) and 81% (boys). In Fin­
land those aged 15 smoke daily more often than
their peers in the other countries from which sta­
tistical data are available.
Smoking among young people is possible be­
cause of sufficient pocket money and the re­
duced control by the parents: children break
away from the sphere of parental control quite
early. Those young people who start smoking
associate smoking with images of adulthood and
success.
Finnish schools are very worried about smok­
ing among pupils. Although the statutory restric­
tions on smoking have increased since the end
of the 1970’s , there are still problems related to
control. In 1995 every fourth pupil aged 14 and
half of the pupils aged 16 at higher secondary
schools and vocational institutions said that ob­
servance of the restrictions on smoking is not su­
pervised at all in their school. On the other hand,
when pupils said that there is supervision, it was
most often said to be “rather strict” but seldom
“very strict". In 1995 20 % of Finns aged 14 -16
were daily smokers, and about half of them re­
ported to be smoking every day on the school
premises.
These recommendations summarize the pol­
icy lines and the means to promote health and
non-smoking among young people. These meas­

ures were agreed upon as a result of the multi­
faceted and critical debate at the national discus­
sion forum in Jyvaskyla in August 1996. It is a
great challenge to reduce smoking among young
people, and it calls for the contribution of all
parties: homes, schools, non-governmental or­
ganizations, business life, media, authorities,
experts and the young themselves. The task is
not an easy one, but we can be hopeful since we
have succeeded in reducing smoking among the
adult population in Finland. It is essential that we
work systematically for several years and initiate
interactive processes promoting knowledge
about and action for non-smoking at several lev­
els. The objective of these recommendations is
to make Finnish society understand the problems
relating to smoking among young people, take a
serious attitude towards them and to implement
the proposed action.

9

LEGISLATIVE MEASURES

Tobacco is a plant containing toxic chemical com­
ponents; products made from it would not be
granted a selling licence if they were put on the
market today. Non-smoking is one of the most
significant factors promoting young people’s
health. Support for non-smoking is a means to
prevent many serious illnesses, also abuse of al­
cohol and other substances and drugs.
A factor influencing the learning of health­
promoting issues, adopting the knowledge,
changes in attitudes and behaviour is the whole
social environment of young people, where the
school plays an important role. Non-smoking
among school staff is a basic factor contributing
to the effect of messages concerning the advan­
tages of non-smoking.

Recommendation 1:

The Ministry of Social Affairs and Health
should prepare an amendment to the Act on
Measures to Reduce Smoking according to
which schools and educational situations
shall be totally smoke-free.

In spite of the great health hazards involved in
smoking the interest shown by society and poli­
ticians in prevention of smoking has not been
sufficient, since smoking among young Finns is
more common compared with the other Europe­
an countries. Marketing and sales promotion of
tobacco products is considered as an ordinary
business activity, and the decision-makers are
not willing to interfere in it. Tobacco products,
used as they are meant to, involve a great health
hazard though.

10

Recommendation 2:

The Ministry of Social Affairs and Health
should prepare an amendment to the Act on
Measures to Reduce Smoking according to
which the sanction for a repeated violation
of the prohibition against selling tobacco
products to young people under the age of
18 shall be the loss of the right to sell to­
bacco products.

There is clear and binding evidence of the effect
of the prices of tobacco products and purchasing
power on their consumption: the consumption of
tobacco products is the more common and seri­
ous the greater amount of cigarettes children
have money to buy. The price is considered to
affect more children’s and young people’s smok­
ing than that of adults. When nicotine addiction
is a factor, children and young people try to ob­
tain nicotine according to what they can afford,
e.g. by changing over to cheap cigarettes or cig­
arettes which they themselves roll. The present
low taxation of cheap cigarettes and cigarette
tobacco makes it possible for children’s experi­
ments with smoking to develop an addiction even
when their limited purchasing power would oth­
erwise protect them. It is difficult to raise tobac­
co prices and the tax on tobacco since it is a prod­
uct which affects the cost-of-living index.

Recommendation 3:

The Ministry of Finance should in collabo­
ration with the Ministry of Social Affairs
and Health prepare an amendment to the
Act on Excise Duty on Tobacco in order to
raise the taxation of tobacco products
clearly over the minimum level determined
by the European Union and to determine
the tax on all tobacco products to be of the
same amount per consumer unit as that of
factory-made cigarettes.

Recommendation 4:

Tobacco should be excluded from the costof-living index.

The salesand marketing of ten-cigarette packets
have increased remarkably in recent years. Ac­
cording to a study, among those aged 14, about
half of those experimenting with their first ciga­
rettes and a third of those who had experiment­
ed a little more often had last bought a ten-ciga­
rette packet. Smoking experiments among young
people are started with the same cigarette
brands as are the most popular among daily
smokers.
Also the easy access to tobacco products is
a factor encouraging young people to initiate and
continue smoking. The mail-order and vending
machine business allowed by the present legis­
lation facilitate obtaining tobacco products.

Recommendation 5:

The Ministry of Social Affairs and Health
should prepare an amendment to the Act on
Measures to Reduce Smoking standardiz­
ing the size of cigarette packets to 20 ciga­
rettes.

Recommendation 6:
The Ministry of Social Affairs and Health
should prepare an amendment to the Act on
Measures to Reduce Smoking prohibiting
the sales of tobacco products from vending
machines and by mail-order.

Although tobacco advertising is prohibited by
law in Finland, it is conveyed to the country
through foreign media. Finland should not accept
the mixed European practice concerning tobac-

co advertising that reduces the credibility of our
own legislation. Rescinding the Finnish national
legislation which prohibits tobacco advertising
cannot be accepted under any circumstances.

Recommendation 7:

For the purpose of protecting young peo­
ple’s health Finland should impose a total
ban on tobacco advertising in the EU, and
in particular a ban on tobacco advertising
through sports, culture and other sponsor­
ing. It must always be possible to have
stricter legislation at the national level
than that defined in the proposed directive
on ban on tobacco advertising.

ACTIONS BY THE AUTHORITIES

The present action to promote young people’s
health is not enough but new resources, new
ways and a strong commitment to promote non­
smoking are needed. The State and the local au­
thorities must develop concrete health policy
strategies to support non-smoking. Develop­
ments in non-smoking among young people
should be reported in the Public Health Report
given by the Council of State to Parliament at
regular intervals.
Adults cannot bring up today’s young people
after the same models as were used in their
youth, but adults have to be available and
present. A young person shall be accepted as a
sensible, conscious and responsible learner who
is supported and guided in making choices and
solutions concerning his or her own life. Those
grown-ups who are working with young people
must be aware of the significance of their own
example, of the prevailing youth culture and the
health risk involved in smoking. These grown-ups
must also develop their mutual collaboration in

11

promoting health in municipalities and agree on
the general objectives and policies to prevent
smoking among young people.
The bans and restrictions of the Act on Meas­
ures to Reduce Smoking are society’s message
that smoking is not considered acceptable. On
the other hand, a weak control of the observance
of the Act can strengthen young people’s idea
that these or other collectively agreed rules of the
game are not meant to be followed.
The present experience indicates that the ban
on the sale of tobacco products to young persons
under 18 has not been implemented as presup­
posed in our legislation.

The enforcement of the ban on sales of tobacco
products presupposes an active work and infor­
mation between health care, schools, trade and
other actors. The municipal health officers must
inform, support and educate the staff of shops
and kiosks regarding the enforcement of the ban
on sales and the health criteria of the restrictions.
The present signs in shops indicating the ban on
sales and health risks of tobacco products drawn
up in cooperation with tobacco industry do not
fulfil the requirements of the legislation. Health
officers should utilize the expertise of the non­
governmental organizations working to promote
health in the enforcement of the ban on sales and
in related information.

Recommendation 8:
Recommendation 10:

The Ministry of Social Affairs and Health
should collaborate with the supervisory
authorities and agencies representing re­
tail trade in preparing uniform and clear
directives on the enforcement and supervi­
sion of the ban on selling tobacco products
to young persons under 18.

It is widely accepted that carefully planned pur­
chase tests directed at all retail sale premises at
regular intervals is the most effective way of su­
pervising the observance of the sales ban. The
importance of supervision can be increased by
combiningthe supervision with guidance and in­
formation.

Recommendation 9:
The municipal supervisory authorities
should intensify the observance of the ban
on sales of tobacco products to those un­
der 18 by increasing supervision and devel­
oping the supervision methods (e.g. test
purchases) in cooperation with the Minis­
try of Social Affairs and Health.

12

The authorities should supervise that those
selling tobacco products furnish their sales
premises with signs indicating the ban on
sales of tobacco products to persons aged
under 18 and the health risks of these prod­
ucts. Furthermore, the signs should invite
young people to be prepared to present
their identity cards.

As the restrictions on tobacco advertising have
increased, the appearance of tobacco packets
has become a more and more important factor
conveying images and arousing interest. The
package as such advertises the product. The
Finnish authorities should prepare measures
aiming at the sale of tobacco products in uniform
packages bearing the same colour. Finland
should also advocate this actively in the Health
Council of the European Union. Visible and col­
ourful presentation of tobacco products on sales
premises, easy access and purchasing encourage
children to buy them. Placing tobacco products
clearly on view and demonstrations of these
products weaken the health message concerning
the risks of smoking conveyed by other means.

Recommendation 11.

The Ministry of Social Affairs and Health
and the central organizations of retail trade
should prepare a recommendation with a
view to placing tobacco products on sales
premises out of sight for children.

Tobacco advertising considerably increases chil­
dren’s interest in experiments with smoking. Fur­
thermore, some TV programmes show much
smoking. Maybe the most difficult thing to tack­
le is the conveyance of tobacco advertising from
abroad e.g. through various sponsored sports
and cultural events. In some cases tobacco in­
dustry also tries to influence the illustration of
news and events shown in the media. In spite of
the total ban on tobacco advertising the Finnish
TV channels conveyed in March 1996 about four
hours of tobacco advertising in the context of
sports programmes.

It is possible to increase professional under­
standing and skills to reduce smoking among
young people through research and developing
the action based on it. Research is the basis and
point of departure for health promotion, as well
as a means to assess the outcome of the meas­
ures taken. Forthe time beingthere is not enough
systematic material to constitute the basis for
future research and development.

Recommendation 13:

An expert group appointed by the Ministry
of Social Affairs and Health should assess
the research and development concerning
smoking among young Finns and give a
proposal for long-term continued action
taking into account future needs.

DEVELOPING PROFESSIONAL
SKILLS
Recommendation 12:

The Ministry of Transport and Communica­
tions should start negotiations with repre­
sentatives of the Finnish mass media in
order to bring about uniform directions and
policies to prevent the conveyance of ma­
terial containing tobacco advertising and
promoting smoking. To begin with, the
prevalence of tobacco advertising and
smoking in the media should be studied.

In the education of health care personnel smok­
ing issues have been outshadowed by the in­
struction focused on treatment of illnesses. In an
international study carried out in 42 countries it
was found out that students of medicine were
astonishingly ignorant of tobacco-related diseas­
es, and that the curricula lacked information on
them. In consequence, health care personnel of­
ten neglect to try to persuade people to stop
smoking, even though that would be very impor­
tant from the point of view of care. This defect can
be remedied by means of education. Education
is important also in terms of tobacco policy, since
health care personnel’s influence on people's
opinions in health issues is vital.

13

Recommendation 14:

Recommendation 16:

Institutes of social welfare and health care
studies, polytechnics, faculties of medicine
and other units providing health care edu­
cation should develop an education pack­
age concerning prevention of smoking, to­
bacco-related diseases and withdrawal
methods. The need for such education
should be studied by surveying the present
volume of education relating to tobacco.

Employees engaged in social service,
health care, education, youth work and
sports provision should not smoke during
working hours.

A young person cannot adopt health values in an
environment where health is not valued, where
health messages are in conflict with the prevail­
ing patterns of behaviour or where the circum­
stances make it difficult to pursue healthy life
habits. Young people observe and adopt health
values from their environment without being con­
scious of it and often in such situations that the
grown-ups do not at all understand as being ped­
agogic. Non-smoking among child day care work­
ers, teachers, social and health care personnel
and their attitude to smoking are significant fac­
tors when bringing up children to be non-smok­
ers. Therefore non-smoking should be consid­
ered as a factor influencing the appraisal of suit­
ability when choosing employees for the abovementioned sectors.

Recommendation 15:

Vocational education for child care, educa­
tion, social and health care, youth work and
sports provision should include instruction
in skills and knowledge which promote non­
smoking. Those graduated from these insti­
tutes should be themselves non-smokers.

14

ACTIONS TO SUPPORT
FAMILIES AND PARENTHOOD
The prerequisites for health-promoting lifestyles
are created in one’s early childhood. The founda­
tion for a child’s mastery of life, self-esteem and
mental health is laid in the family. Also the child’s
health habits are determined by the habits and
culture of the family. In connection with family
training for parents expecting a child parents
should also be trained for parenthood, family life,
child care and upbringing. This so called parents’
school model shall be followed also at child
health clinics. At the same time they shall
strengthen the parents' capacity to strive for an
active health-promoting cooperation with the
other growth and school environment of the
child. The public discussion should by every pos­
sible means support the parents in their chal­
lenging task to bring up their children to value
healthy life habits and non-smoking.
The parents function as the first role model
of non-smoking for the child, and this model must
be strengthened when people are growing into
parenthood. Maternity and child health clinics
shall emphasize the idea of a smoke-free home.
One significant risk factor contributing to repeat­
ed infections in children is tobacco smoke in the
home. When treating children with repeated in­
fections the parents’ attention must be drawn to
this circumstance. The importance of parents’
own attitude in supporting the child’s healthy
growth and development, as well as the impor­
tance of mutual interaction as a means of up­
bringing must be stressed. Health education is

just as important for those who are expecting
their first child, and smoking parents must be
encouraged to stop smoking. Also parents of the
first child starting school need special informa­
tion and guidance.

Recommendation 17:

A study of health promotion work done in
homes, obstacles to it and its possibilities
should be initiated. Its outcome would pro­
vide the basis for an action programme to
help parents to bring up their children in a
way promoting health.

Recommendation 18:
One objective of family training and mater­
nity and child health clinics should be to
promote parents’ non-smoking and a
smoke-free home.

Recommendation 19:

Health care centres should provide those
expecting a child and parents of small chil­
dren an opportunity to take part in with­
drawal from tobacco and to get nicotine
substitution therapy free of charge.

Recommendation 20:
Measuring the carbon monoxide expired by
parents should be introduced as a tool and
as a part of the ordinary health examina­
tions at maternity clinics.

Behaviour that preindicates future smoking and
other risk behaviour and exclusion can be ob­
served as early as in small children, and detect­

ing that will make it possible to help these chil­
dren at an early stage.

Recommendation 21:
Social welfare and health care and the edu­
cational system should collaborate in
working up and developing identification
and prevention methods to anticipate fu­
ture risk behaviour and exclusion and take
them into standard use for the purpose of
prevention.

A child always reflects the “health” of its family,
growth conditions and living environment. Al­
though the responsibility for bringing up children
and young people has to a greater extent been
shifted to the day care centre, school and other
groups outside the family, the home and the par­
ents always bear the main responsibility. The
parents’ significance and role is further of crucial
importance for the child's healthy development.
Day care centres must give the children the ba­
sic facilities for adopting non-smoking and oth­
er health-promoting habits and lifestyles.

Recommendation 22:

Within child care non-smoking should be
promoted by means of play and various
activities. The facilities of the day care per­
sonnel to promote non-smoking among
families should be increased by means of
supplementary training.

A considerable risk factor with a view to chil­
dren’s smoking and other development is after­
noons spent without grown-up control. Children
are influenced by circumstances that are beyond
the parents’ control. In Finland children are ex­
pected to grow functionally independent earlier

15

than their psychosocial development would al­
low. In cases where the parents are in full-time
employment schoolchildren should have an or­
ganized programme during afternoons - in the
same way as in many other countries. The pro­
gramme should be planned so as to contain rec­
reational and stimulating activities for children
under the care of grown-ups.

Recommendation 23:
There should be organized afternoon activi­
ties for schoolchildren on school premises
or elsewhere after school hours. They could
be organized by e.g. schools, parishes,
municipal youth and sports services, and
other hobby organisations.

ACTIONS SUPPORTING THE
WORK OF SCHOOLS AND
EDUCATIONAL INSTITUTIONS

The health behaviour adopted in youth is often
retained throughout the life, and thus health
should be a quality factor in the educational sys­
tem at its all levels. Basic knowledge and skills
relating to health shall be integrated into all com­
prehensive and vocational education. With the
reformed curricula the share of health education
has been reduced considerably in schools and
educational institutions. Their curricula and
teaching methods shall promote and strengthen
non-smoking, which is integrated into the in­
struction even from the lower level of the com­
prehensive school.
A young person seeks situations according to
what he or she has learned to value. Health pro­
motion does not consist of teaching individual
facts or learning things by heart, but young peo­
ple must get a positive overall view of health and

16

its prerequisites, which is supported by the so­
cial environment. Guided by it young people can
learn how to master health issues and make so­
lutions concerning health. Control of social pres­
sures undermining health can be promoted in
education and upbringing by giving special atten­
tion to creating a positive picture of oneself and
to strengthening one’s self-esteem. Instruction in
social skills (communication, expressing oneself,
social intercourse) shall be an integral part of the
education and upbringing.

Recommendation 24:

An action programme for non-smoking
should be drawn up for each school and
educational institution in cooperation with
school and student health care. The pro­
gramme should be a registered strategy
agreed upon jointly - also with the pupils
contributing. It should manifest the atti­
tude towards smoking, measures to pre­
vent from onset of smoking, policies in dif­
ferent situations, continuous monitoring
and evaluation.

Recommendation 25:
Health education in schools and educa­
tional institutions should be strengthened,
and prevention of smoking should be
linked to young people’s mastery of life and
the school’s teaching of manners. The Na­
tional Board of Education should in col­
laboration with experts develop opera­
tional models within the curricula of
schools and educational institutions. These
models should include means of which all
young people can be taught matters relat­
ing to prevention of smoking

Although promotion of non-smoking and health
concerns the whole school or educational insti­
tution, teachers need many-sided help from pro­
fessionals in different fields. In this context rep­
resentatives of school and student health care
play the most central role.
School and student health care are part of the
statutory public health work of a municipality.
Their goal is to promote a healthy growth and
development of pupils and students as well as
the health of the whole community. Such action
requires from the school health personnel be­
sides an active contribution, initiatives and con­
stant presence also cooperation with the school
and educational community.
With the economic recession the resources of
school and student health care have decreased,
since the time spent by public health nurses and
physicians on it has been reduced in recent
years. The recommendation is that there should
be a maximum of 750 pupils/ students per one
public health nurse employed on a full-time ba­
sis in school or student health care. If the public
health nurse is responsible for several schools or
institutions, the number of pupils/students
should be lower, since time has to be reserved for
contribution according to school or educational
institution.

Recommendation 26:
Health care centres should guarantee the
public health nurses and doctors working
in school and student health care enough
time for taking care of the pupils’/students’
health and for promotion of non-smoking in
collaboration with the other school and
educational community. The facilities of
school and student health care should be
situated in connection with the school or
educational institution.

Young people often say that they are interested
in stopping smoking and talk about numerous
attempts to do so, but find the nicotine addiction
problematic. Besides the addiction, also the re­
warding and strengthening factors related to
smoking guarantee in the end that experiments
with smoking often lead to lifelong smoking.
More research findings are needed concerning
how to make young people stop smoking, its
methods and outcome.

Recommendation 27:

Health centres should organize activities to
support those pupils/students who want to
stop smoking (e.g. withdrawal groups).
Young people’s knowledge of the risks of
smoking as well as confidential discus­
sions about smoking should be promoted
e.g. by means of measuring expired carbon
monoxide as part of ordinary health exami­
nations.

According to Finnish studies teachers are in need
of more information in almost all areas of health
education: targets, contents, methods and in
general issues relating to young people’s health
behaviour and smoking habits. The professional
facilities of teachers shall include the ability to
discuss health issues with their pupils/students.

Recommendation 28:

Teachers and school and student health
personnel should be provided joint supple­
mentary training for the purpose of devel­
oping the content and working methods of
health promotion, school and student
health care and curricula for health edu­
cation.

17

Today’s society poses young people more and
more challenges relating to adulthood. Every
young person matures individually gathering ide­
as, advice, influences etc. from various quarters.
Also healthy life habits have different values and
emphases in different individuals’ lives. The
starting point for health education promoting
non-smoking shall be the young person, his or
her life situation and living environment. Studies
have shown that the best results in promoting
non-smoking among young people have been
achieved when a programme at population level
directed to both young people and adults has
been integrated into health education pro­
grammes of schools and educational institutions.

Recommendation 29:
The educational system, social welfare,
health care, temperance work and non-gov­
ernmental organizations should collabo­
rate in developing and implementing
health education programmes aimed at
non-smoking for young people and adults.
They should take into account expert rec­
ommendations, local conditions, young
people’s needs, lifestyles and cultures.

Follow-up is an efficient means to influence non­
smoking and other lifestyles. In addition to the
national follow-up an efficient prevention re­
quires intense and well-timed local and school­
based monitoring, when the action can be direct­
ed according to problems and their impact can be
followed.

18

Recommendation 30:

Non-smoking among young people should
be followed by means of a national system
which produces sufficiently quickly and fre­
quently information about the prevalence
ofsmoking per school, educational institu­
tion and municipality.

ACTIONS AIMED AT LEISURE TIME

Children remain primarily in the sphere of influ­
ence of the parents until the age of ten years.
After that leisure-time activities, friends, idols
and other reference groups become very influen­
tial. Young people taking part in organized group
activities use according to studies intoxicating
substances to a minor extent than other young
people.
Being together with other young people, lei­
sure time interests, habits and hobbies consid­
erably mould the lifestyles of young people and
the culture formed by them. An adult participant
must accept that young people themselves are
the real experts in youth culture. Influential indi­
viduals play an important role in youth groups.
It would be important to seek out the local opin­
ion-leaders among the young and to motivate
them to maintain health-supporting models of
action.
Information is necessary for making choices
supporting health. However, in particular in pu­
berty smoking can be fascinating because it can
be seen as a game with risks and can channel
young people’s defiance towards authority.
Therefore it is important to organize various
kinds of stimulating activities for young people.
Society must offer children and young people
various kinds of leisure time activities. The State
and the local authorities shall increase their fi­
nancial support to children’s and young people’s
school clubs and leisure-time activities. Further­

more, they must seek new flexible solutions to
ensure an efficient use of new and existing
premises for such activities.
In Finland more than 350,000 children and
young people aged 3 -18 participate annually for
three months in organized sports club activities.
It is possible to lay foundation for health-promot­
ing choices even in such a short time. Hobby or­
ganizations should develop their activities so as
to better promote healthy life habits and under­
line non-smoking as one basic principle in their
action.
According to a sports study those children
and young people who are not participating at
the moment are also interested in sports club
activities. If sports and leisure time organizations
working with young people would have enough
resources they could double their number of
members.
Non-smoking shall be extended to all levels
of young people’s leisure-time and to their circle
of friends. Since coaches and hobby instructors
serve as models for children and young people
their non-smoking should be promoted. It should
be stressed within the framework of their train­
ing that it is not recommended that instructors
and children’s parents smoke in connection with
hobby activities - neither indoors nor outdoors.
The premises and the surrounding area should
be totally smoke-free. The State, local authorities
and parishes should aim at making the premis­
es and outdoor facilities owned by them smokefree.
Confirmation classes, in particular camp
classes have become a rite of becoming adult.
Issues relating to smoking have however caused
much trouble in the youth work of parishes and
for instance in confirmation classes. The teach­
ers in confirmation classes have not given much
attention to matters that are essential for non­
smoking and other health matters for young peo­
ple. Parishes and churches should assume more
responsibility for non-smoking and healthy life­
styles among young people.

Recommendation 31:

The State and the local authorities should
make it possible for sports and other hobby
organizations to provide a greater selection
of health-promoting leisure-time activities
on children’s and young people’s condi­
tions.

Recommendation 32:
One condition for granting financial sup­
port by the State and municipalities to
hobby and sports organizations should be
promotion of young people’s health and
non-smoking.

Recommendation 33:

The churches and parishes should specify
their targets regarding health promotion
and promotion of non-smoking in confirma­
tion classes and other activities targeted to
young people.

Recommendation 34:
The State, the local authorities and par­
ishes should prohibit smoking in outdoor
facilities and sports grounds possessed
and administered by them.

Recommendation 35:

Tobacco products should not be sold in ca­
fes or kiosks in connection with hobby fa­
cilities.

19

OTHER ACTIONS
As regards those doing their national service the
attitude of foremen towards smoking and group
pressure have traditionally favoured smoking.
The time in military service and its atmosphere
should support non-smoking and good health.

Recommendation 36:
The Defence Forces should designate non­
smoking and health promotion as one im­
portant educational target.

Action according to the recommendations put
forth above needs to be supported by systemat­
ic nation-wide information over several years. It
is known that repeated messages in mass media
can strengthen the health education taking place
in the field and add to its weight.

Recommendation 37:

There is great need for long-term informa­
tion in favour of non-smoking society in
Finnish society.

,?o

"

IMPLEMENTATION OF
THE RECOMMENDATIONS
FOR ACTION

The consensus panel proposes an immediate im­
plementation of these recommendations. Fur­
thermore, it proposes that the Ministry of Social
Affairs and Health appoint, for a minimum of five
years, a steering group for the implementation of
the recommendations to monitor and assess the
action taken.

Recommendation 38:

The Ministry of Social Affairs and Health
should see to it that a follow-up meeting
will be organized after three years, as welt
as draw up a report concerning the imple­
mentation of the proposed action.

MINISTRY OF SOCIAL AFFAIRS AND HEALTH
PUBLICATIONS
ISSN 1236-2050

1997:

1

Trends in Social Protection in Finland.
ISBN 952-00-0263-4

2

Sosiaaliturvan tutkimus- ja kehittamistoiminnan neuvottelukunta.
Tutkimuspoliittinen tavoiteohjelma.
ISBN 952-00-0266-9

3

Vakuutusvalvonta Suomessa.
ISBN 952-00-0277-4

4

Att inte 13ta sig hindras.
ISBN 952-00-0278-2

5

From disability to ability.
ISBN 952-00-0279-0

6

Riktlinjerna for halso- och sjukvSrden.
ISBN 952-OO-O288-X

7

Lapsi, perhe ja ruoka. Imevais- ja leikki-ikaisten lasten, odottavien ja imettavien
aitien ravitsemussuositus. 3. uud. p.
ISBN 952-00-0289-8

8

Suomen kansallinen ymparistdterveysohjelma.
- ilmestyy Komiteanmietintbna 1997:8
ISBN 952-00-0235-9

9

Forsakringstillsyn I Finland.
ISBN 952-00-0236-7

10

Suomalainen strategia nuorten terveyden ja savuttomuuden edistamiseksi.
ISBN 952-00-0238-3

11

Pekingista Suomeen. Suomen hallituksen tasa-arvo-ohjelma.
ISBN 952-00-0290-1

12 Frin Peking till Finland. Finlands regerings jamstalldhetsprogram.
ISBN 952-00-0293-6
13 Tuomo Martikainen, Petri Uusikyla.
Reforming Health Policy in Finland. A Critical Assessment.
ISBN 952-00-0297-9

14 Guidelines on Health Care in Finland.
ISBN 952-00-0300-2
15 Insurance Supervision in Finland.
ISBN 952-00-0314-2

16 Sosiaali- ja terveysministerion kansainvalisen toiminnan ulottuvuuksia ja
tulevaisuuden linjauksia.
ISBN 952-00-0317-7
17 Ennaltaehkaisevaa etsimassa. Kuntaprojektin tutkimuksia. Loppuraportti.
ISBN 952-00-0320-7

18 Poverty and Social Exclusion in Finland in the 1990s.
ISBN 952-00-0322-3
19 Varpu Marjaana Seppanen.
Turvaverkon vankina? Pitkaaikaistyottdmat ja toimeentulotuki.
ISBN 952-00-0335-5
20 From Beijing to Finland. Equality Programme of the Finnish Government.
ISBN 952-00-0348-7

21 De Beijing jusqu’en Finlande. Le programme d’egalite du gouvernement finlandais.
ISBN 952-00-0349-5
22 Finnish Strategy to Promote Health and Non-Smoking among Young People.
ISBN 952-00-0353-3
23 Onko sosiaalipolitiikaIla vaikutusta? Vertaileva tutkimus tulonsiirtojen vaikutuksista
lapsiperheiden, vanhusten ja tyottbmien toimeentuloon seka tuloeroihin ja kdyhyyteen

Suomessa ja OECD-maissa. Toim. Kari Salavuo.
ISBN 952-00-0355-X

22

Correspondence to
Olli Simonen
Government Counsellor
Ministry of Social Affairs and Health
P.O. Box 197
FIN-00531 Helsinki
e-mail olli.simonen@stm.vn.fi

23

ISBN 952-000353-3
ISSN 1236-2050

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