Smoking in young people

Early smoking initiation is linked to risk of cancer and mortality later in life. The number of regular young smokers is largely decreasing, though some young people are experimenting with e-cigarettes.

This indicator was published in March 2020.

In May 2021 we updated our graphs and charts where new data had been published, and we reviewed our policy recommendations by nation.

Background

  • Smoking remains the UK’s single greatest cause of preventable illness and avoidable death, with 100,000 people dying each year from smoking-related diseases.1
  • Smoking is detrimental to the health of young people throughout their lives, with earlier initiation linked to increased levels of smoking and dependence, a lower chance of quitting, and higher mortality.1
  • Smoking has been found to cause 16 types of cancer and is linked to at least six further types of the disease.2 Smoking also reduces lung function, increases the risk of a young person developing asthma, decreases their exercise tolerance and may impair their growth.3
  • Most adult smokers have had their first cigarette or were already addicted to nicotine by the age of 184 and 90% of lifetime smoking is initiated between the ages of 10 and 20 years in the UK.5 It is therefore important to ensure a continued reduction in the proportion of young people that smoke, to safeguard their health and that of future generations.
  • E-cigarettes are a relatively new product – they aren’t risk free and their long-term impact is not known. The general advice is to discourage young people who have never smoked from using e-cigarettes.6
  • Smoking: This indicator measures the proportion of 15-year olds that smoke regularly (one or more cigarettes per week) in England, Wales and Scotland and draws on various data sources. English data is available from the Smoking, Drinking and Drug Use Survey,7 Welsh data is available from the Health Behaviour in Schools Survey9 and Scottish data is taken from the Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS)8. Comparable data is not available for Northern Ireland; however, the Northern Ireland Young Persons’ Behaviour and Attitudes Survey collects information on the proportion of 11-16-year olds that smoke regularly.10
  • E-cigarette use: This indicator measures the proportion of young people who have ever tried e-cigarettes, young people who are regular smokers of e-cigarettes (at least once a week) and the proportion of regular cigarette smokers that have ever tried e-cigarettes. Directly comparable data for the four countries in the UK is not available as age-ranges included in the surveys differ and the way e-cigarette use is measured differs in each of the four countries. However, we draw on various sources of data to provide a general picture of e-cigarette use for young people between the ages of 11-16 where possible. English data is available from the Smoking, Drinking and Drug Use Survey,7 Welsh data is available from the Health Behaviour in Schools Survey9 and Scottish data is taken from the Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALUS)8 and data for Northern Ireland is available from the Northern Ireland Young Persons’ Behaviour and Attitudes Survey.10

Key findings

The proportion of 15-year olds who smoke regularly has fallen across England, Scotland, Wales and the proportion of 11-16 year olds who smoke regularly has fallen in Northern Ireland – but since 2014 this trend has plateaued for females in Wales and has reversed among males in Wales and Scotland.

  • England: Regular smoking among males and females aged 15 in England has fallen steadily since 2011, from 11.0% for both sexes to 4.9% and 5.3% in 2018 respectively.7 15-year olds living in the most deprived areas in England were more than twice as likely to report that they smoked regularly compared with those living in the least deprived areas in 2014.29
  • Scotland: 8% of 15-year old males and 6% of 15-year old females were reported to be regular smokers in 2018. These figures have dropped from 25% for males and 27% for females in 1998. However, this trend has reversed for males since the last survey in 2015; the proportion of 15 year old males who are regular smokers has increased by 1% for the first time between 2015 and 2018.8 11% of 15-year olds living in the most deprived areas reported smoking regularly in Scotland in 2013, compared to 7% of 15-year olds living in the least deprived areas.8
  • Wales: 9% of both females and males aged 15 were reported to be regular smokers in 2018. These figures have dropped from 22.0% and 29.0% in 1998 respectively.9 However since 2013/14 the trend has plateaued at 9% for females in Wales and has reversed for males, with a 2 percentage point increase since the 2013/14 survey.9
  • Northern Ireland: The proportion of 11-16 year olds who had ever smoked cigarettes declined from 36.6% in 2000 to 12% in 2016. In addition, 33.3% of those who had ever smoked cigarettes reported smoking at least once a week in 2000. This figure has dropped to 9% in 2016, which suggests that there has been a decline in current smokers aged 11-16 over the past 16 years.10

E-cigarette smoking

The proportion of young people who have ever-tried e-cigarettes according to the latest data available from England, Wales, Scotland and Northern Ireland is similar for all four countries between 20-25%.The proportion of young people who use e-cigarettes regularly where data is available is much lower than those who have ever tried e-cigarettes. Where data is available (England and Scotland) young people who are regular cigarette smokers are more likely to have tried e-cigarettes compared to those that do not smoke regularly.

  • England: In 2018, 25% of 11-15-year-old pupils reported ever having used e-cigarettes, which is a similar figure when compared to the 2016 data.7 2% of 11-15-year olds reported using e-cigarettes regularly, at least once a week.11 Most regular smokers aged 11-15 (92%) reported having ever used e-cigarettes. This compared to just 14% of pupils who had never smoked.12
  • Scotland: In Scotland, 26% of 13- and 15-year olds reported ever having used an e-cigarette in 2018.8 However, only a small proportion used e-cigarettes regularly (defined as once a week or more): 2% of 13-year olds and 3% of 15-year olds. Most regular smokers (83%) reported having ever used e-cigarettes. This compared to just 21.5% of pupils who had never smoked.8
  • Wales: 25% of school pupils aged 11-16 were reported to have ever tried an e-cigarette in 2018. However, only 3% of 11-16 year reported using e-cigarettes regularly.9
  • Northern Ireland: Two percent of 11-16-year olds had ever used an e-cigarette in 2016.12 Only 6.4% of 11-16-year olds reported using e-cigarettes on a regular basis in 2016.10

Timeline of anti-smoking legislation

See references 12-17

2002

Publication of the Tobacco Advertising and Promotion Act

2003

Direct and indirect advertising or promotion of tobacco products is banned in the UK

2006

Scotland bans smoking in public premises via the introduction of the Prohibition of Smoking in Certain Premises (Scotland) Regulations 2006. The Smoke-free (Premises and Enforcement) Regulations in England are published as well as the Health Act, which devolves regulation-making powers regarding smoking to the Welsh Government

2007

In March, Wales and Northern Ireland ban smoking in public places with England following in July 2007

2009

Publication of another Health Act, including provisions to enable the introduction future regulations on the promotion of tobacco products

2011

The sale of tobacco from vending machines is banned in the UK

2012

All large shops and supermarkets in England, Wales and Northern Ireland are required by law to hide cigarettes, tobacco products and displays from public view

2013

Large shops in Scotland are required by law to hide cigarettes, tobacco products and displays from public view

2015

Other businesses and smaller shops in England, Wales, Northern Ireland and Scotland are required to hide cigarettes, tobacco products and displays from public view. Drivers in England and Wales are banned from smoking in a car if a child under the age of 18 is also in the vehicle

2016

Smoking in a car with a child present is also banned in Scotland

2017

Cigarettes are required to be sold in plain packaging across the UK. A consultation is launched in Northern Ireland to ban smoking in cars when a child under the age of 18 is present. The consultant closed a few months later but results and next steps have not been published

What does good look like?

Meeting Government targets to create a tobacco free generation, by 2030 in England19, 20 and 2034 in Scotland.21 We welcome the publication of tobacco control plans in England22 and Scotland.23

A ban on smoking in cars with young children present in Northern Ireland.

Continued support for local authorities to offer stop smoking services, in light of a sustained reduction in budget for these services from central Government.24 Young people’s smoking is partially predicted by family members’ smoking; it is therefore paramount that adults are supported to stop smoking, so that young people in their family are not encouraged to smoke. Furthermore, as 90% of lifetime smoking is initiated between the ages of 10 and 20,3 so targeted support for young people to quit smoking must be easily accessible so that they do not continue to smoke into adulthood.

As per NICE guidance, targeted mass-media campaigns to discourage young people from smoking should be initiated.25

In April 2019, Wales trialled a smoking ban on the sidelines of some children’s sports pitches.26 Some other sports grounds have a similar policy in place, such as Healthy Norwich’s ‘Smoke free Sidelines’ initiative that was launched in 2017. This was found to have an effect on the visibility of smoking among spectators at youth football matches.27 Governments in the UK should consider a ban to eradicate smoking among adults at the sidelines of children’s sports events.

Increased data collection on e-cigarette use among young people in the UK, and evidence-based legislation to discourage young people’s uptake as necessary.

Comprehensive and consistent data collection on cigarette smoking behaviour by young people in Northern Ireland.

Policy recommendations

  • UK Government should prohibit all forms of marketing of e-cigarettes to children and young people, for example by marketing sweet flavours.
  • UK Government should resource Local Authorities to extend bans on smoking in public places to locations with a high child footfall (e.g. school grounds, leisure centres, parks, hospitals).
  • We welcome the First Minister’s commitment to consulting on a complete ban on the advertising and marketing of vaping products / electronic cigarettes and urge Scottish Government to implement a ban without delay.
  • Local Authorities should extend bans on smoking in public places to locations with a high child footfall (e.g. school grounds, leisure centres, parks, hospitals).
  • Welsh Government should set targets to become a tobacco free generation (defined as a smoking prevalence of <5%). England and Scotland have set similar targets to be achieved by 2030.
  • Welsh Government should prohibit all forms of marketing of e-cigarettes to children and young people, for example by marketing sweet flavours.
  • We welcomed the extension of smoke-free areas in 2019 to cover hospitals, schools and near playgrounds. Welsh Government should deliver the provisions in the Public Health (Wales) Act relating to smoking and clearly set out how these will be implemented and enforced. Bans on smoking in public places should be considered in other locations with a high child footfall (e.g. outside leisure centres and parks) again with clear guidance on enforcement.
  • Northern Ireland Executive should set targets to become a tobacco free generation (defined as a prevalence of <5%) in the successor Tobacco Control Strategy, when the current one expires in 2022.
  • Northern Ireland Executive should must prohibit all forms of marketing of e-cigarettes to children and young people, for example by marketing sweet flavours.
  • Relevant authorities should extend bans on smoking in public places to locations with a high child footfall.

What can health professionals do about this?

  • Make every contact count. Use clinical consultations as an opportunity to sensitively explore whether young people smoke cigarettes or e-cigarettes, where appropriate. RCPCH’s Young People’s Special Interest Group recommends using the HEADSSS assessment framework to explore pertinent psychosocial issues with young people.
  • Offer and signpost young people and their parents/carers where appropriate, to evidence based smoking cessation interventions in the local area. There is NICE guidance which covers stop smoking interventions and services delivered in primary care and community settings for everyone over the age of 12.28

Contributing authors

  • Grace Brown, RCPCH Policy & External Affairs Division
  • Dr Ronny Cheung, RCPCH State of Child Health Clinical Lead
  • Rachael McKeown, RCPCH State of Child Health Project Manager
  • Dr Rakhee Shah, RCPCH State of Child Health Clinical Advisor

Royal College of Paediatrics and Child Health (2020) State of Child Health. London: RCPCH. [Available at: stateofchildhealth.rcpch.ac.uk]

References

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(1)

Peto R et al. 2012. Mortality from smoking in developed countries 1950-2010. University of Oxford. UK: pp.512-523.

(2)

Action on Smoking and Health (ASH). 2019. Smoking and Cancer. Available from: ASH (pdf)

(3)

National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. 2012. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Available from: NCBI

(4)

Jarvis M. 2004. Why people Smoke. BMJ.

(5)

Department of Health and Social Care. 2013. Chief Medical Officer annual report 2012: Children and young people’s health. Available from: GOV.UK

(6)

Public Health England. 2019. Vaping in England: evidence update summary February 2019. Available from: GOV.UK

(7)

NHS Digital. 2019. Smoking, Drinking and Drug Use among Young People in England 2018. Data from Part 1 Table 1.3, available from: NHS Digital

(8)

Scottish Government. Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS). Available from: Scottish Government website

(9)

World Health Organization. Health Behaviour in School-Aged Children (HBSC). Available from: HBSC

(10)

Information Analysis Directorate. 2017. Young Persons’ Behaviour and Attitude Survey 2016. Available from: Department of Health, Northern Ireland (pdf)

(11)

NHS Digital. 2019. Smoking, Drinking and Drug Use among Young People in England 2018. Data from Part 4, available from: NHS Digital

(12)

Northern Ireland Statistics and Research Agency. 2017. Young Persons’ Behaviour & Attitudes Survey 2016: Top-Line Results. Available from: Northern Ireland Statistics and Research Agency (pdf)

(13)

Politics.co.uk (date unavailable) Tobacco Advertising. Available from: Politics.co.uk

(14)

Action on Smoking and Health. 2017. ASH Briefing on Standardised Tobacco Packaging. Available from: ASH

(15)

Health and Safety Executive. Advice on smoking at work. Available from: HSE

(16)

Action on Smoking and Health Wales. 2016. Tobacco point of sale displays. Available from: ASH Wales | Cymru

(17)

Scottish Government. Guidance on the display and pricing of tobacco products and smoking related products in Scotland, for tobacco retailers and Local Authority Trading Standards Officers. Available from: Scottish Government website (pdf) 

(18)

Department of Health (2017) Regulations restricting smoking in private vehicles when children are present. Available from: Department of Health Northern Ireland

(19)

Department of Health & Social Care & Cabinet Office (2019) Advancing our health: Prevention in the 2020s – consultation document. UK Government: 22 July 2019. Available from: GOV.UK

(20)

Public Health England (2019) PHE Strategy 2020-2025. Available from: GOV.UK

(21)

Scottish Government (2018) Raising Scotland’s tobacco-free generation: Our tobacco control action plan 2018. Scottish Government: Population Health Directorate: 20 June 2018.

(22)

Department of Health and Social Care (2017) Smoke-free generation: Tobacco control plan for England. 18 July 2017.

(23)

Scottish Government (2018) Raising Scotland’s tobacco-free generation: Our tobacco control action plan 2018. Scottish Government: Population Health Directorate: 20 June 2018.

(24)

Action on Smoking and Health. 2020. Many ways forward. Available from: ASH (pdf)

(25)

National Institute for Health and Care Excellence. 2014. Smoking: preventing uptake in children and young people. Available from: NICE

(26)

Action on Smoking and Health Wales. 2019. Campaign to stop parents from smoking on the sidelines kicks off with live ITV broadcast. Available from: ASH Wales | Cymru

(27)

Norfolk Smokefree Sidelines, Healthy Norwich, University of East Anglia. 2018. Smokefree Sidelines Evaluation. Available from: University of East Anglia (pdf)

(28)

National Institute for Health and Care. 2018. Stop smoking interventions and services. Available from: NICE

(29)

NHS Digital. 2015. Health and Wellbeing of 15-year-olds in England – Main findings from the What About YOUth? Survey 2014. Available from: NHS Digital

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