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September, 2009:

Is the fixed-penalty fine for smoking offences effective?


The smoking ban has been extended to include 48 covered public transport interchanges (“New bans and fines failing to deter smokers”, September 2).

However, there are not enough tobacco control officers, or staff from the other departments, to issue the fixed-penalty tickets. If there are not enough officers to patrol the new restricted areas, smokers will continue to light up.

It would appear that the issuing of tickets is fairly rare. Therefore, the new rule is not deterring smokers because there is little chance of them being caught and having to pay the penalty.

Most smokers do not care about the extended ban.

I think the problem has been made worse, because smokers are unclear about the rules.

From my observations, it would appear that only a few posters have been put up in bus terminals telling smokers that, from September 1, smoking is banned. However, it is not made clear which are the restricted areas and where smoking is allowed.

This makes it really hard for smokers to follow the rules, because the instructions are unclear, and so people continue to smoke where they should not.

It is also difficult for officials to take action against someone when they receive a complaint from a member of the public. After all, it does not take that long to smoke a cigarette and stub it out.

Education is the key to getting people to obey the rules and not light up in no-smoking areas. This is far more important than imposing penalties.

Gladys Ho, Tsuen Wan

The smoking ban was extended to transport interchanges from the beginning of this month. I am a non-smoker and support it.

It means passengers do not have to put up with second-hand smoke when queuing up for a bus. However, I have my doubts about how effective it has been.

Before the ban was fully extended, some government departments were saying it would mean an increased workload on their staff.

A law can only be effective if it has suitable penalties and enough people to enforce that law.

If departments cannot, or will not, take action to fine people who break the law, then it will fail to have the desired deterrent effect.

The relevant departments have been designated the roles of enforcers of this particular law, and they should do their jobs.

Mak Ka-chun, Yuen Long

Unions see red over enforcing smoking ban

Ng Yuk-hang, SCMP

More than a dozen unions have pledged to the Food and Environmental Hygiene Department that they will enforce the smoking ban, its chief said yesterday, though union leaders disputed that claim.

Director of Food and Environmental Hygiene Cheuk Wing-hing said that he had met the heads of 13 of the department’s unions, representing more than 5,400 civil servants, and that all leaders had said they would implement the law. The department has 16 unions.

His claim comes after seven representatives from the department’s two staff unions marched to the Legislative Council’s complaints division on Tuesday to file a complaint about being made to enforce the ban. A union leader present at yesterday’s meeting with Cheuk said that some unions had made clear their opposition towards enforcing the ban.

But Cheuk said that it was only “individual groups” who were unwilling to perform their new duty.

“Civil servants in their right mind will implement the new law,” he said.

A failure to perform duties could lead to disciplinary action or even termination of employment.

The smoking ban was extended on Tuesday. Among the new provisions, 700 staff from the department, 2,200 from the Leisure and Cultural Services Department and 430 from the Housing Department are responsible for handing out fixed-penalty tickets of HK$1,500 to those who smoke in places under their management.

Wong Wah-hing, chairman of the hawker control team sub-union at the Government Frontline Employees’ Union, said that a number of unions had told Cheuk that they were against the smoking ban. “We have too many things to do and do not have enough manpower,” he said.

Li Mei-siu, chairwoman of the Food and Environmental Hygiene Department’s Staff Rights Union, which also expressed unwillingness to perform the new duty, was not invited to the meeting.

Days before the ban was extended, Li demanded an increase of manpower and subsidies to assist in performing the extra task.

Cheuk said yesterday that such demands were “not up to the spirit of the times” and “would not win acceptance from citizens”.

“We cannot agree on increasing manpower, especially when we are talking about slimming the civil service at this time,” he said.

He said there were 104 wet markets and cooked-food centres, so increasing staffing would mean a boost of several hundred people.

“The public should not be misled by a group with unknown membership,” he said.

Li said her union represented about 90 staff, but they were voicing concerns for over 200 staff, who in a survey done last year expressed worries over personal safety in the course of enforcing the smoking ban.

The department gave verbal warnings yesterday to offenders, but did not issue any fixed-penalty tickets. Cheuk said it was because both staff and citizens needed time to adjust to the new law, and that “enforcement would be stepped up in about a month”.

The leisure department had given 435 verbal warnings as of 5pm yesterday. Its head, Betty Fung Ching Suk-yee, said that enforcement had been smooth. She hoped that staff would be “co-operative” and active in enforcing the new law.

The Tobacco Control Office issued 14 tickets yesterday. The Housing Department issued none.

Staff too busy to enforce smoking ban, say unions

Regina Leung, SCMP

Two unions representing government workers said on Wednesday their members were too busy to hand out fixed-penalty tickets to people violating Hong Kong’s anti-smoking laws.

Their comments follow the extension on Tuesday of anti-smoking laws to include 48 public transport interchanges, bus terminals, wet markets, beaches and housing estates.

Some 2,200 staff from the Leisure and Cultural Service Department, 700 from the Food and Environmental Hygiene Department and 430 from the Housing Department are responsible for enforcing the new penalties.

But the Leisure Service Staff General Union and the Food and Environmental Hygiene Department’s Staff Rights Union, said its members could not perform these extra duties because they did not have sufficient manpower.

However, Director of Food and Environmental Hygiene Cheuk Wing-hing said most of his staff had assured him they would not ignore their new duties.

“There is no truth to the allegations that our staff will refuse to do this work. There are 12 staff unions – which represent about 5,400 staff – involved in this enforcement work,’’ he said.

“All of them have pledged to stand firmly by their duties and will execute departmental guidelines when enforcing the new laws,” said Cheuk.

Cheuk said his staff had already issued six verbal warnings to offenders since the ban was extended to wet markets and public transport interchanges.

He said the department would provide training to enforcement officers.

Leisure and Cultural Services Department director Betty Fung Ching Suk-yee also said her staff had issued 800 verbal warnings to offenders on Tuesday.

Fung said the department understood union concerns about staff having too much work.

The extension of the smoking ban is part of the tough anti-smoking laws first introduced in early 2007.

They are controversial – with some organisations, such as karaokes, pubs and restaurants, arguing they will hurt their businesses.Smoking kills around 6,000 people in Hong Kong each year and passive smoking is estimated to kill around 1,000, experts say.

New bans and fines failing to deter smokers

Ng Yuk-hang and Austin Chiu, SCMP

Smokers continued to puff away at wet markets, transport interchanges and housing estates yesterday despite the introduction of a HK$1,500 fixed-penalty fine for offenders, instead of a summons.

The smoking ban was also extended yesterday to cover 48 covered public transport interchanges.

At Kowloon Tong public transport interchange, smokers stubbed out their cigarettes on a no-smoking sign that covered an astray on a litter bin.

At Lai Kok Estate in Sham Shui Po, some senior residents were seen smoking outside the designated smoking area. Housing Department staff, who can now issue fixed-penalty tickets, were nowhere to be seen.

At Hung Hom wet market, the South China Morning Post called the management office after finding some seafood vendors smoking. A staff member appeared moments later, but by then the smokers had finished their cigarettes.

One customer, who had been a regular shopper at the market for five years, said she regularly saw seafood vendors smoking and gambling during the lunch break. “I just hope the ban can stop them from producing secondhand smoke,” she said.

Director of Health Dr Lam Ping-yan said smoking control efforts would be more effective if they concentrated on education instead of issuing penalty tickets.

A total of 2,200 staff from the Leisure and Cultural Services Department, 700 from Food and Environmental Hygiene and 430 from the Housing departments are now responsible for handing out fixed-penalty tickets to those who smoke in places under their management.

As of 4pm yesterday, the Tobacco Control Office had issued six tickets – three in indoor public places, one in an amusement game centre and two in public leisure areas.

Leisure and cultural services officers gave 498 verbal warnings. “As the smokers were co-operative, there was no need to issue fixed-penalty tickets,” a spokeswoman said.

A Housing Department spokesman said one ticket had been issued by 6pm. He said only the department’s housing managers and housing officers were responsible for handing out penalty tickets, and other staff would need to report to them to follow up when they spotted someone violating the ban.

As of 2pm, the Food and Environmental Hygiene Department had made two verbal warnings.

Meanwhile, seven representatives from the two Food and Environmental Hygiene Department staff unions yesterday marched to the Legislative Council’s complaints division to file a complaint about being made to enforce the ban.

Though the staff were unwilling to hand out fixed-penalty tickets, Food and Environmental Department Staff Rights Union chairwoman Li Mei-siu said they had no choice because they feared their contracts would not be renewed.

A spokesman from the Food and Environmental Hygiene Department said it had contacted 12 major staff associations yesterday. He said they affirmed they would perform their duties diligently and would not turn a blind eye to offenders.

Australia’s Preventative Health Taskforce recommends plain packaging & a raft of other TC measures

General Messages
by Ms. Kylie Lindorff

The Australian Government’s Preventative Health Taskforce’s ‘National Preventative Health Strategy’ was released on Tuesday 1st September and contains recommendations on tobacco, alcohol and obestity.

Highlights of the tobacco section include:
– Increasing the price of cigarettes to $20AUS a pack by 2013
– Introducing plain packaging for tobacco products
– Continuing social marketing campaigns
– Further restrictions on promotion of tobacco products such as point of sale bans and use of new media
– Expanding Quitline services
– Expanding health professional training
– Expanding programs for those with mental illness, Indigenous peoples and low SES groups

The summary and full report can be found at:….

The Government has not yet responded to the strategy’s recommendations and isn’t expected to until the end of 2009. Until then, they are simply recommendations to which the government has not committed and are not legally binding.

Health groups will be lobbying hard to encourage the government to implement all the recommendations in the report.

Congratulations to the Taskforce’s tobacco working group for their very hard work in producing a comprehensive, progressive set of recommendations.

Kylie Lindorff
Policy Manager
VicHealth Centre for Tobacco Control
and Quit Victoria
100 Drummond Street
Carlton Victoria Australia 3053
Ph: 61.3.9635 5518 Fax: 61.3.9635 5030
Mobile: 61 (0)409 974 547

Is enough being done to police the smoking ban?


I do not think the law is working. Sometimes, while I am having a meal in a restaurant, I see people smoking. If I ask waiters to ask that person to stop smoking, they often refuse to do so. The reason for their refusal is understandable.

Waiters do not want to displease their patrons, and asking a customer not to smoke poses a dilemma for them.

I agree with Brad Foreman (Talkback, August 27) about learning from no-smoking laws overseas.

Owners of bars and restaurants are the only people who can supervise their premises effectively. It would be easier to implement the smoking ban if compliance was a requirement to obtain a licence. The bar owners would become the enforcers.

Sze Wah-mei, Kwun Tong

Smokers may face five days in jail

Kelly Chan, SCMP

Five days’ detention for people who defy the smoking ban at indoor public places or fire-risk areas has been ordered by the Ministry of Public Security.

The move is part of a 50-day campaign to prepare a safe environment for the 60th anniversary of the founding of the People’s Republic of China on October 1.

The draconian detention measure in a country that boasts the world’s largest smoking population became a talking point after a man caught smoking in a shopping mall in Chongqing was jailed for five days by police on Saturday.

Yuzhong district police caught the 56-year-old Hubei native smoking during a patrol, the Chongqing Evening News reported. He was the first in Chongqing to be detained for smoking in a shopping mall.

The fire department considered the mall to be a major fire hazard, as it was full of flammable materials, while the firefighting facilities were insufficient.

A Yuzhong district fire department official said the man’s detention was intended to act as a deterrent to smokers in the mall, and to prevent a fatal disaster.

The man’s son complained that the punishment was harsh. He believed a 500 yuan (HK$565) fine would have been appropriate because his father had not fought with police and did not know of the policy.

Wang Dezhi , deputy director of the Chongqing fire prevention department, said the punishment complied with an instruction from the Ministry of Public Security last month.

The fire bureau, which is under that ministry, held a teleconference on August 20. Its director, Chen Weiming, announced a 50-day campaign to prepare a safe environment for the 60th-anniversary celebrations.

Leading officials ordered local fire departments to implement strict and heavy penalties for six actions that could lead to a blaze.

The penalties included five days’ detention for people who smoke or use a naked flame in places with a risk of fire and explosions.

The conference also called on local firefighters and police to check all government offices, venues for National Day celebration activities, and premises with a risk of fire or explosions, such as petrol stations and shopping malls and restaurants.

Fires in poorly managed shopping malls are common on the mainland.

In January last year, an inferno killed three firefighters and two members of the public in a building housing a wholesale mall, a hotel and a trade office in Urumqi , capital of Xinjiang .

Twelve floors of the building were engulfed in flames for 68 hours until only the burned-out shell was left.

The Chinese Association of Tobacco Control said there were about 350 million smokers on the mainland – 30 per cent of the population aged over 15. China is the biggest manufacturer and consumer of tobacco in the world.

Unions tell staff not to enforce smoking ban

Paggie Leung, SCMP

A government department’s staff union has made a last-minute appeal to its members not to enforce the city’s smoking ban – which is being extended today – but to perform only their original duties.

“We’ve issued a statement to our members, urging them to do our original duties,” said Gary Cheung Siu-wing, chairman of the Leisure Service Staff General Union.

Saying that enforcing the smoking ban was not among their original duties, Cheung said there were not enough employees to complete even their normal work. Hence, they had no time to perform the extra duty.

Today’s extension broadens the ban to include 48 covered public transport interchanges; and offenders will receive a fixed penalty of HK$1,500 instead of a summons.

Starting from today, 2,200 staff from the Leisure and Cultural Service Department, 700 from the Food and Environmental Hygiene Department and 430 from the Housing Department will be responsible for handing out fixed-penalty tickets to those who smoke in premises and venues under their management – such as libraries, wet markets, beaches and housing estates.

Cheung doubted if they had the legal right to issue the tickets, because over 90 per cent of them still had not got the new departmental warrant card. “Because it’s an extra duty … we need to have the warrant card before we can enforce the new ban,” Cheung said.

But a spokesman from the Tobacco Control Office said staff were empowered to enforce the law whether or not their new warrant cards were ready.

Also opposing the extra duty is the Food and Environmental Hygiene Department’s Staff Rights Union. Its chairwoman, Li Mei-siu, said it would stage a demonstration in Central today before filing a complaint with the Legislative Council’s complaints division. She said staff would not be able to enforce the ban because of their existing workload and concerns about personal safety.

“It’s not our role to do smoking control,” she said. “The government has ignored our safety and requested us to do the extra job without giving us more manpower and resources.”

For its part, the Food and Environmental Hygiene Department said its staff – in the foreman, hawker control officer and health inspector grades, as well as market assistants – had received training and attended experience-sharing sessions. It had also issued operational manuals and enforcement guidelines.

Mok King-po, the convenor of a coalition of Housing Department staff unions, said its members would accept the new role but more manpower and training should be given.

“I also want to call on all citizens to co-operate with us, which is very important,” Mok said.

Last week, the food and hygiene department issued a guideline to frontline staff, saying they should perform their original duties before enforcing the ban. The Leisure and Cultural Services Department also said that enforcing the smoking ban would not override the current core duties and work priorities of its staff.

Adolescent Maturity and the Brain: The Promise and Pitfalls of Neuroscience Research in Adolescent Health Policy


Longitudinal neuroimaging studies demonstrate that the adolescent brain continues to mature well into the 20s. This has prompted intense interest in linking neuromaturation to maturity of judgment. Public policy is struggling to keep up with burgeoning interest in cognitive neuroscience and neuroimaging. However, empirical evidence linking neurodevelopmental processes and adolescent real-world behavior remains sparse. Nonetheless, adolescent brain development research is already shaping public policy debates about when individuals should be considered mature for policy purposes. With this in mind, in this article we summarize what is known about adolescent brain development and what remains unknown, as well as what neuroscience can and cannot tell us about the adolescent brain and behavior. We suggest that a conceptual framework that situates brain science in the broader context of adolescent developmental research would help to facilitate research-to-policy translation. Furthermore, although contemporary discussions of adolescent maturity and the brain often use a deficit-based approach, there is enormous opportunity for brain science to illuminate the great strengths and potentialities of the adolescent brain. So, too, can this information inform policies that promote adolescent health and well-being.

Keywords: Adolescent, Health policy, Neuroscience, Neuroimaging, Judgment

In the last decade, a growing body of longitudinal neuroimaging research has demonstrated that adolescence is a period of continued brain growth and change, challenging longstanding assumptions that the brain was largely finished maturing by puberty [1–3]. The frontal lobes, home to key components of the neural circuitry underlying “executive functions” such as planning, working memory, and impulse control, are among the last areas of the brain to mature; they may not be fully developed until halfway through the third decade of life [2]. This finding has prompted interest in linking stage of neuromaturation to maturity of judgment. Indeed, the promise of a biological explanation for often puzzling adolescent health risk behavior has captured the attention of the media, parents, policymakers, and clinicians alike. Although such research is currently underway, many neuroscientists argue that empirical support for a causal relationship between neuromaturational processes and real-world behavior is currently lacking [4].

Despite the lack of empirical evidence, there has been increasing pressure to bring adolescent brain research to bear on adolescent health-and-welfare policy. For example, in the policy process, adolescent brain immaturity has been used to make the case that teens should be considered less culpable for crimes they commit; however, parallel logic has been used to argue that teens are insufficiently mature to make autonomous choices about their reproductive health [5]. This apparently conflicting use of neuroscience research evidence highlights the need for brain scientists, neurocognitive psychologists, and adolescent health professionals to work together to ensure appropriate translation of science for policy. Failing to proactively define or engage in a discussion about the role of neuroimaging research in policy may catalyze a course of action many adolescent health professionals would not endorse.

In this review, we begin by outlining historical attempts to use developmental benchmarks as measures of adolescent maturity. (When we refer to “maturity” we do not intend to suggest the end of development, but rather use this as shorthand for the achievement of adult-like capacities and privileges.) We then briefly summarize what is known about adolescent brain development, and what is unknown. (For in-depth reviews of adolescent brain development, and more nuanced discussions of research findings, which are beyond the scope of this review, see [6] and [7]). We provide an overview of what neuroimaging research can and cannot tell us about the adolescent brain and behavior. We then highlight the current use of the brain sciences in adolescent health policy debates. Finally, we outline a strategy for increasing the utility of brain science in public policy to promote adolescents’ well-being.

A Historical Perspective on Development and Maturity

Throughout history there have been biological benchmarks of maturity. For example, puberty has often been used as the transition point into adulthood. As societal needs have changed, so too have definitions of maturity. For example, in 13th century England, when feudal concerns were paramount, the age of majority was raised from 15 to 21 years, citing the strength needed to bear the weight of protective armor and the greater skill required for fighting on horseback [8]. More recently, in the United States the legal drinking age has been raised to 21, whereas the voting age has been reduced to 18 years so as to create parity with conscription [9]. Similarly, the minimum age to be elected varies by office in the U.S.: 25 years for the House of Representatives, 30 years for the Senate, and 35 years for President. However, individuals as young as 16 can be elected Mayor in some municipalities. The variation evident in age-based definitions of maturity illustrates that most are developmentally arbitrary [9]. Nonetheless, having achieved the legal age to participate in a given activity (e.g., driving, voting, marrying) often comes to be taken as synonymous with the developmental maturity required for it.

Age-based policies are not exceptional; policies are frequently enacted in the face of contradictory or nonexistent empirical support [10]. Although neuroscience has been called upon to determine adulthood, there is little empirical evidence to support age 18, the current legal age of majority, as an accurate marker of adult capacities. Less clear is whether neuroimaging, at present, helps to inform age-based determinations of maturity. If so, can generic guidelines be established, or is individual variation so great as to preclude establishing a biological benchmark for adult-like maturity of judgment?

Brain Development in Adolescence

Current studies demonstrate that brain structures and processes change throughout adolescence and, indeed, across the life course [11]. These findings have been facilitated by imaging technologies such as structural and functional magnetic resonance imaging (sMRI and fMRI, respectively). Much of the popular discussion about adolescent brain development has focused on the comparatively late maturation of the frontal lobes [12], although recent work has broadened to the increasing “connectivity” of the brain.

Throughout childhood and into adolescence, the cortical areas of the brain continue to thicken as neural connections proliferate. In the frontal cortex, gray matter volumes peak at approximately 11 years of age in girls and 12 years of age in boys, reflecting dendritic overproduction [7]. Subsequently, rarely used connections are selectively pruned [6] making the brain more efficient by allowing it to change structurally in response to the demands of the environment [13]. Pruning also results in increased specialization of brain regions [14]; however, the loss of gray matter that accompanies pruning may not be apparent in some parts of the brain until young adulthood [2,15,16]. In general, loss of gray matter progresses from the back to the front of the brain with the frontal lobes among the last to show these structural changes [3,6].

Neural connections that survive the pruning process become more adept at transmitting information through myelination. Myelin, a sheath of fatty cell material wrapped around neuronal axons, acts as “insulation” for neural connections. This allows nerve impulses to travel throughout the brain more quickly and efficiently and facilitates increased integration of brain activity [17]. Although myelin cannot be measured directly, it is inferred from volumes of cerebral white matter [18]. Evidence suggests that, in the prefrontal cortex, this does not occur until the early 20s or later [15,16].

The prefrontal cortex coordinates higher-order cognitive processes and executive functioning. Executive functions are a set of supervisory cognitive skills needed for goal-directed behavior, including planning, response inhibition, working memory, and attention [19]. These skills allow an individual to pause long enough to take stock of a situation, assess his or her options, plan a course of action, and execute it. Poor executive functioning leads to difficulty with planning, attention, using feedback, and mental inflexibility [19], all of which could undermine judgment and decision making.

Synaptic overproduction, pruning and myelination—the basic steps of neuromaturation—improve the brain’s ability to transfer information between different regions efficiently. This information integration undergirds the development of skills such as impulse control [20]. Although young children can demonstrate impulse control skills, with age and neuro-maturation (e.g., pruning and myelination), comes the ability to consistently use these skills [21].

Evidence from animal studies suggests that the neural connections between the amygdala (a limbic structure involved in emotional processing, especially of fear and vigilance) and the cortices that comprise the frontal lobes become denser during adolescence [22]. These connections integrate emotional and cognitive processes and result in what is often considered to be “emotional maturity” (e.g., the ability to regulate and to interpret emotions). The evidence suggests that this integration process continues to develop well into adulthood [23]. Steinberg, Dahl, and others have hypothesized that a temporal gap between the development of the socioemotional system of the brain (which experiences an early developmental surge around puberty) and the cognitive control system of the brain (which extends through late adolescence) underlies some aspects of risk-taking behavior [24,25]. This temporal gap has been compared with starting the engine of a car without the benefit of a skilled driver [25].

Adolescent Neuropsychology: Linking Brain and Behavior

As detailed above, across cultures and millennia, the teen years have been observed to be a time of dramatic changes in body and behavior. During adolescence, most people successfully navigate the transition from dependence upon caregivers to self-sufficient adult members of society. Where specifically, along the maturational path of cognitive and emotional development, individuals should be given certain societal rights and responsibilities continues to be a topic of intense interest. Increasingly, neuroscience has been called on to inform this question.

Impulse control, response inhibition, and sensation seeking

Among the many behavior changes that have been noted for teens, the three that are most robustly seen across cultures are: (1) increased novelty seeking; (2) increased risk taking; and (3) a social affiliation shift toward peer-based interactions [13]. This triad of behavior changes is seen not only in human beings but in nearly all social mammals [13]. Although the behaviors may lead to danger, they confer an evolutionary advantage by encouraging separation from the comfort and safety of the natal family, which decreases the chances of inbreeding. The behavior changes also foster the development and acquisition of independent survival skills [13].

Studying the link between behavioral changes and brain changes has been greatly facilitated by recent advances in neuroimaging technology and behavioral assessments. One challenge has been to identify the fundamental units of emotion and cognition and how they combine to determine more complicated “real-world” behaviors. For instance, younger adolescents are less likely than older adolescents to wait a given period of time to receive a larger reward [26]. This tendency can be studied using experiments in which the subject is asked questions such as whether they would rather receive $800 now or $1,000 in 12 months. By varying the amount of monetary difference and/or time between the transactions, an “indifference point” can be calculated to quantify an individual’s tendency to prefer the “here and now” to some future reward. There is an extensive literature characterizing effects of age, gender, intelligence quotient (IQ), and other variables on this phenomenon, which is termed “delay discounting” [26,27]. However, more recent work has demonstrated that delay discounting is determined in part by the more fundamental traits of impulse control and future orientation, each with their own neural representations and developmental trajectories [28]. Furthermore, future orientation itself is a multidimensional construct involving cognitive, affective, and motivational systems.

Studies using fMRI are beginning to contribute to this parsing of behavior into more fundamental units by characterizing different neural representations and maturational courses for separate but related concepts such as impulse control and sensation seeking. Whereas sensation seeking changes seem to reflect striatal dopamine changes related to the onset of puberty, impulse control, as discussed previously, is more protracted and related to maturational changes in the frontal lobe [21].

“Hot” and “cold” cognition

Perhaps because of the relative ease of quantifying hormonal levels in animal models, it is tempting to attribute all adolescent behavioral changes to “raging hormones.” More nuanced investigations of adolescent behavior seek to understand the specific mechanisms by which hormones affect neural circuitry and to discern these processes from nonhormonal developmental changes. An important aspect of this work is the distinction between “hot” and “cold” cognition. Hot cognition refers to conditions of high emotional arousal or conflict; this is often the case for the riskiest of adolescent behaviors [29]. Most research to date has captured information in conditions of “cold cognition” (e.g., low arousal, no peers, and hypothetical situations). Like impulse control and sensation seeking, hot and cold cognition are subserved by different neuronal circuits and have different developmental courses [30]. Thus, adolescent maturity of judgment and its putative biological determinants are difficult to disentangle from socioemotional context.

What We Do Not Know About Brain Development in Adolescence

In many respects, neuroimaging research is in its infancy; there is much to be learned about how changes in brain structure and function relate to adolescent behavior. As of yet, however, neuroimaging studies do not allow a chronologic cut-point for behavioral or cognitive maturity at either the individual or population level. The ability to designate an adolescent as “mature” or “immature” neurologically is complicated by the fact that neuroscientific data are continuous and highly variable from person to person; the bounds of “normal” development have not been well delineated [5].

Neuroimaging has captured the public interest, arguably because the resulting images are popularly seen as “hard” evidence whereas behavioral science data are seen as subjective. For example, in one study, subjects were asked to evaluate the credibility of a manufactured news story describing neuroimaging research findings. One version of the story included the text, another included an fMRI image, and a third summarized the fMRI results in a chart accompanying the text. Subjects who saw the brain image rated the story as more compelling than did subjects in other conditions [31]. More strikingly, simply referring verbally to neuroimaging data, even if logically irrelevant, increases an explanation’s persuasiveness [32].

Despite being popularly viewed as revealing the “objective truth,” neuroimaging techniques involve an element of subjectivity. Investigators make choices about thickness of brain slices, level of clarity and detail, techniques for filtering signal from noise, and choice of the individuals to be sampled [5]. Furthermore, the cognitive or behavioral implications of a given brain image or pattern of activation are not necessarily straightforward. Researchers generally take pains to highlight the correlative nature of the relationship; however, such statements are often misinterpreted as causal [5]. Establishing a causal relationship is more complicated than it might, at first, seem. For example, there is rarely a one-to-one correspondence between a particular brain region and its discrete function; a given brain region can be involved in many cognitive processes, and many types of cognitive processes may be subserved by a particular brain structure [33].

Some neuroscientists lament that the technology has been used too liberally to draw conclusions where there is little empirical basis for interpreting the results. For example, a 2007 New York Times Op-Ed piece reported the results of a study in which fMRI was used to view the brains of 20 undecided voters while they watched videos of presidential candidates; they had previously rated the candidates on a scale of 1 to 10 from “very unfavorable” to “very favorable” [34]. The results of the brain scans were interpreted as reflecting the inner thoughts of the participants. For instance, “[w]hen viewing images of [Senator Clinton], these voters exhibited significant activity in the anterior cingulate cortex, an emotional center of the brain that is aroused when a person feels compelled to act in two different ways but must choose one. It looked as if they were battling unacknowledged impulses to like [Senator] Clinton” [34]. The editorial drew a swift response from several neuroscientists who believed that, in addition to subverting the standard peer review process before presenting data to the public, the investigators did not address the issue of reverse inference [35]. In neuroimaging terms, reverse inference is using neuroimaging data to infer specific mental states, motivations, or cognitive processes. Because a given brain region may be activated by many different processes, careful study design and analysis are imperative to making valid inferences [36,37]. In symbolic logic terminology, reverse inference errors are related to the “fallacy of affirming the consequent” (e.g., “All dogs are mammals. Fred is a mammal. Therefore, Fred is a dog.”).

In sum, neuroimaging modalities involve an element of subjectivity, just as behavioral science modalities do. A concern is that high-profile media exposures may leave the mistaken impression that fMRI, in particular, is an infallible mind-reading technique that can be used to establish guilt or innocence, infer “true intentions,” detect lies, or establish competency to drive, vote, or consent to marriage.

The adolescent brain in context

Neuroimaging technologies have made more information available about the structure and function of the human brain than ever before. Nonetheless, there is still a dearth of empirical evidence that allows us to anticipate behavior in the real world based on performance in the scanner [5]. Linking brain scans to real-world functioning is hampered by the complex integration of brain networks involved in behavior and cognition. Further hindering extrapolation from the laboratory to the real world is the fact that it is virtually impossible to parse the role of the brain from other biological systems and contexts that shape human behavior [6]. Behavior in adolescence, and across the lifespan, is a function of multiple interactive influences including experience, parenting, socioeconomic status, individual agency and self-efficacy, nutrition, culture, psychological well-being, the physical and built environments, and social relationships and interactions [38–42]. When it comes to behavior, the relationships among these variables are complex, and they change over time and with development [43]. This causal complexity overwhelms many of our “one factor at a time” explanatory and analytic models and highlights the need to continually situate research from brain science in the broader context of interdisciplinary developmental science to advance our understandings of behavior across the lifespan [44].

Adolescent Maturity and Policy in the Real World: Scientific Complexity Meets Policy Reality

The most prominent use of neuroscience research in adolescent social policy was the 2005 U.S. Supreme Court Case, Roper vs. Simmons, which has been described as the “Brown v. Board of Education of ‘neurolaw,”’ recalling the case that ended racial segregation in American schools [45]. In that case, 17-year-old Christopher Simmons was convicted of murdering a woman during a robbery. Ultimately, he was sentenced to death for his crime. Simmons’ defense team argued that he did not have a specific, diagnosable brain condition, but rather that his still-developing adolescent brain made him less culpable for his crime and therefore not subject to the death penalty. Amicus briefs were filed by, among others, by the American Psychological Association (APA) and the American Medical Association (AMA) summarizing the existing neuroscience evidence and suggesting that adolescents’ still-developing brains made them fundamentally different from adults in terms of culpability.

The AMA brief argued that: “[a]dolescents’ behavioral immaturity mirrors the anatomical immaturity of their brains. To a degree never before understood, scientists can now demonstrate that adolescents are immature not only to the observer’s naked eye, but in the very fibers of their brains”’ [46]. (Notably, the brief submitted by the AMA et al., implied a causal link among brain structure, function, and behavior in adolescence [5]). The neuroscientific evidence is thought to have carried significant weight in the Court’s decision to overturn the death penalty for juveniles [47].

In a dissenting opinion in that case, Justice Antonin Scalia reflected on a 1990 brief filed by the APA in support of adolescents’ right to seek an abortion without parental consent (Hodgson v. Minnesota). In this case, the APA argued that adolescent decision making was virtually indistinguishable from adult decision making by the age of 14 or 15. Scalia pointed out this seeming inconsistency: “[The APA] claims in this case that scientific evidence shows persons under 18 lack the ability to take moral responsibility for their decisions, [the APA] has previously taken precisely the opposite position before this very Court. Given the nuances of scientific methodology and conflicting views, courts—which can only consider the limited evidence on the record before them, are ill equipped to determine which view of science is the right one” [48]. Although one can make the case that the “cold cognitive” context in which abortion-related decisions are made encourages more mature judgment than the “hot cognitive” context of a murder, Scalia’s comments highlight the peril of leaving nonscientists to arbitrate and translate neuroscience for policy.

The Supreme Court used neuroimaging research to protect juveniles from the death penalty based on reduced capacity and consequently reduced culpability. A year after Roper vs. Simmons was decided, the same logic was extended to limit adolescent sexual behavior. In 2006, the State of Kansas used its interpretation of adolescent neuroscience research to expand the state’s child abuse statute to include any consensual touching between minors under the age of 16 years. Although scientists may be reticent to apply their research to policy, in some cases, policy makers are doing it for them.

Some argue that one must only look to the use of early-life brain science to anticipate what happens when brain science is overgeneralized [49]. In the early 1990s, there were several high-profile studies that suggested that there was rapid growth brain growth and plasticity in the first 3 years of life and, therefore, that “enriched” environments could hasten the achievement of some developmental milestones [50]. This research was used to perpetuate the idea that videos, classical music, and tailored preschool educational activities could give a child a cognitive advantage before the door of neural plasticity swung shut forever [49]. One could imagine that such a perspective would discourage the allocation of resources for school-aged children and adolescents because, if this were true, after early childhood it would simply be “too late.” The use of neuroscientific research to support “enriched” environments demonstrates that if neuroscientists do not direct the interpretation and application of their findings (or the lack of applicability), others will do it for them, perhaps without the benefit of their nuanced understanding. A proactive approach to research and research-to-policy translation that includes neuroscientists, adolescent health professionals, and policy makers is an important next step.

Toward a Policy-Relevant Neuroscientific Research Agenda

Public policy is struggling to keep up with burgeoning interest in cognitive neuroscience and neuroimaging [51]. In a rush to assign biological explanations for behavior, adolescents may be caught in the middle. Policy scholar Robert Blank comments, “We have not kept up in terms of policy mechanisms that anticipate the implications beyond the technologies. We have little evidence that there is any anticipatory policy. Most policies tend to be reactive” [51]. There is a need to situate research from the brain sciences in the broader context of adolescent developmental science, and to find ways to communicate the complex relationships among biology, behavior, and context in ways that resonate with policymakers and research consumers.

Furthermore, the time is right to advance collaborative, multidisciplinary research agendas that are explicit in the desire to link brain structure to function as well as adolescent behavior and implications for policy [52].

Ultimately, the goal is to be able to articulate the conditions under which adolescents’ competence, or demonstrated maturity, is most vulnerable and most resilient. Resilience, it seems, is often overlooked in contemporary discussions of adolescent maturity and brain development. Indeed, the focus on pathologic conditions, deficits, reduced capacity, and age-based risks overshadows the enormous opportunity for brain science to illuminate the unique strengths and potentialities of the adolescent brain. So, too, can this information inform policies that help to reinforce and perpetuate opportunities for adolescents to thrive in this stage of development, not just survive.


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Do graphic health warning labels have an impact on adolescents’ smoking-related beliefs and behaviours?



To assess the impact of the introduction of graphic health warning labels on cigarette packets on adolescents at different smoking uptake stages.


School-based surveys conducted in the year prior to (2005) and approximately 6 months after (2006) the introduction of the graphic health warnings. The 2006 survey was conducted after a TV advertising campaign promoting two new health warnings.


Secondary schools in greater metropolitan Melbourne, Australia.


Students in year levels 8-12: 2432 students in 2005, and 2050 in 2006, participated.


Smoking uptake stage, intention to smoke, reported exposure to cigarette packs, knowledge of health effects of smoking, cognitive processing of warning labels and perceptions of cigarette pack image.


At baseline, 72% of students had seen cigarette packs in the previous 6 months, while at follow-up 77% had seen packs and 88% of these had seen the new warning labels. Cognitive processing of warning labels increased, with students more frequently reading, attending to, thinking and talking about warning labels at follow-up. Experimental and established smokers thought about quitting and forgoing cigarettes more at follow-up. At follow-up intention to smoke was lower among those students who had talked about the warning labels and had forgone cigarettes.


Graphic warning labels on cigarette packs are noticed by the majority of adolescents, increase adolescents’ cognitive processing of these messages and have the potential to lower smoking intentions. Our findings suggest that the introduction of graphic warning labels may help to reduce smoking among adolescents.