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Smoking in Young People

Introduction

Trying smoking as a teenager is a significant risk factor for becoming a regular, long-term smoker and for developing one or more health problems associated with smoking. Those most at risk of smoking at a young age are girls (although girls tend to try their first cigarette at an older age than boys), , those with a White British or Mixed ethnic background, those whose friends also smoke and those who also engage in drinking alcohol, using drugs, and truanting. Smoking in all ages disproportionately affects those affected by deprivation and is the main factor accounting for gap in healthy life expectancy between the wealthy and the most deprived.

What do we know?

Smoking is the main cause of preventable ill health and premature death in adults in England and is the main factor accounting for the gap in healthy life expectancy between people who live in the wealthiest parts of our community and the most deprived (NICE, 2015).

Most smokers start smoking in their teens and continue to smoke long into adulthood. Starting smoking earlier in life usually means smoking for longer and this increases the risk of the health problems associated with smoking (NHS, 2016, WHO, 2016). There is evidence to suggest that young people become addicted to nicotine very quickly and that those who try a cigarette at a young age were more likely to become regular smokers (ASH, 2015, NICE, 2015).

Data collected through the 'What about YOUth?' (WAY) survey was used to measure smoking prevalence among 15 year olds in England for the first time in 2014. The survey collected local questionnaire data from 15 year olds who were randomly selected from the National Pupil Database (NPD). The questionnaire covered a range of topics related to the welfare and wellbeing of young people including smoking, emotional wellbeing, diet, physical activity, drugs, alcohol and bullying. Smoking prevalence data are reported through the Public Health Outcomes Framework and can be benchmarked against other Local Authority areas.

In 2014 the survey found that 24% of 15 year olds in England had ever smoked and 8% were current smokers. Girls were more likely to smoke than boys, but tended to try a cigarette for the first time at an older age. The average age of first trying a cigarette was 13-14 years. Those from deprived areas were more likely to smoke than those from privileged areas. When analysed by ethnicity, those who described their ethnicity as White or Mixed were most likely to have smoked, and those from Asian ethnicity groups were least likely to have smoked. The survey also found regional differences in smoking patterns: those living in London were the least likely to smoke and those in the North East were most likely to smoke (Ipsos MORI, 2015).

In each category (current, regular and occasional smokers) prevalence in Reading was not significantly different to the England averages or the South East averages. Prevalence of current smoking and regular smoking were not significantly different from the averages for Local Authority areas with similar levels of deprivation, but prevalence of occasional smoking was significantly lower than in these areas (see Table 1 below).

Table 1: Estimated prevalence of current, regular and occasional smoking amongst 15 year olds (with confidence intervals)

Category

Reading

England

South East

Reading's 2010 Deprivation Decile (fifth less deprived)

Current Smokers

8.2% (6.5%-9.9%)

8.2% (8.1%-8.3%

9% (8.6%-9.4%)

9% (8.5%-9.5%)

Regular Smokers

6.1% (4.6%-7.6%)

5.5% (5.4%-5.6%)

5.8% (5.5%-6.1%)

5.6% (5.2%-6.0%)

Occasional Smokers

2.1 % (1.2%-3%)

2.7% (2.6%-2.8%)

2.7% (2.6%-2.8%

3.4% (3.1%-3.7%)

 

Source: Public Health Outcomes Framework (indicators 2.09-2.09ii)

In comparison with Local Authority areas with similar levels of deprivation, prevalence in Reading did not appear significantly different to the average (see Public Health Outcomes Framework indicators 2.09-2.09ii), but there was a mixed picture across areas in the decile.

Figure 1: Percentage of Current Smokers (15 year olds) 2014 - Local Authority Areas in 2010 IMD Deprivation Decile - Fourth less deprived image1

Source: Public Health Outcome Framework (Indicators 2.09-209ii)

The Smoking, Drinking and Drug Use (SDD) surveys monitor smoking, drinking and drug use amongst secondary age pupils in England. 2014 survey results showed that 18% of those surveyed reported ever trying a cigarette ("even just one puff"), this is the lowest prevalence of smoking amongst young people since the survey began in 1982. The SDD survey also found that girls were more likely to smoke than boys and also indicated that rising age was associated with being a regular smoker and with trying smoking (figure 2).

Figure 2: Smoking behaviour by age (England) image2

Source: Smoking, Drinking and Drug Use Among Young People in England - 2014, HSCIC

Smoking in young people was also associated with drinking alcohol, taking drugs, truanting from school and having friends who smoked (NatCen, 2015).

The Local Tobacco Control Alliance have also regularly conducted an annual Smoking & Drinking Amongst Young People in West Berkshire, Reading & Wokingham survey. In 2015/16, two Reading schools participated in this, with a total of 1693 completed questionnaires being received from pupils aged 11-17 years. The results from this survey mirror much of the patterns that are being reported nationally and, it provides an important source of local intelligence, particularly around the supply of cigarettes and alcohol to young people.

In addition to smoking by young people, second-hand smoke is particularly dangerous for children and young people. In 2010 the Royal College of Physicians (RCoP) described second-hand smoke as a major hazard to the health of children who live with smokers with most harm occurring in the home. There is evidence that there are associations between second-hand smoke and increase risk of Sudden Infant Death Syndrome (SIDS), respiratory infections, asthma and wheezing, middle ear infection and bacterial meningitis.

National and Local Strategies

Healthy Lives, Healthy People: A Tobacco Control Plan for England was published by the Department of Health in 2011 and sets out the government's strategy to reduce smoking prevalence in adults to 18.5% or less, smoking amongst 15 year olds to 12% or less and smoking during pregnancy to 11% or less by the end of 2015 by: stopping the production of tobacco; making tobacco less affordable; effectively regulating the sale of tobacco products; helping tobacco users to quit; reducing exposure to secondhand smoke; and communicating effectively for tobacco control.

Quality Standards developed by the National Institute for Health and Care Excellence (NICE) are designed to draw together existing guidance on high priority issues, providing comprehensive recommendations that are not restricted to healthcare settings but can be applied across sectors. NICE Quality Standard QS82 addresses reducing and preventing tobacco use and makes the following recommendations particularly related to smoking amongst young people:

  • Schools and colleges deliver combined interventions to stop children and young people taking up smoking by improving their social competence and awareness of social influences.
  • Schools and colleges do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking.
  • Trading standards identify and take action against retailers that sell tobacco products to people under 18.

What is this telling us?

Most smokers take up smoking in their teens and those who try a cigarette as teenagers are more likely to become regular smokers. The earlier a person starts smoking, the longer they are likely to be a smoker and the greater the risks to their health.

Rates of smoking amongst 15 year olds in Reading are similar to national, regional and the 2010 deprivation decile averages, with 8.2% describing themselves as current smokers and 6.1% describing themselves as regular smokers. National prevalence data from the SDD suggests average prevalence of regular smoking of 4% in 14 year olds and 2% in 13 year olds and 0% in 11 and 12 year olds. Applying these to the ONS mid-year population estimates to 2014 suggests almost 200 young people aged 11-15 years old in Reading were regular smokers in 2014.

Those most at risk of smoking at a young age are girls (although girls tend to try their first cigarette at an older age than boys), those who are economically deprived, those with a White British or Mixed ethnic background, those whose friends also smoke and those who also engage in drinking alcohol, using drugs, and truanting.

What are the key health inequalities?

Smoking in all ages disproportionately affects those affected by deprivation and is the main factor accounting for gap in healthy life expectancy between those living in the wealthiest areas of our community and the most deprived (NICE, 2015).

Links to other sections in the JSNA

Cancer

Cardiovascular Disease

Children & Young People

Common causes of death & disability

Deprivation by Ward and Lower Super Output Area

Drugs & Alcohol

Smoking

Smoking in Pregnancy

References

Action on Smoking and Health (ASH), 2015. ASH Fact Sheet: Young People and Smoking. Available at: http://ash.org.uk/files/documents/ASH_108.pdf (Accessed 9th June 2015).

Ipsos MORI, 2015. Health and Wellbeing of 15 year olds in England: Findings from the What about YOUth? Survey 2014. Health and Social Care Information Centre (HSCIC).

NatCen Social Research and the National Foundation for Educational Research, 2015. Smoking, drinking and drug use among young people in England in 2014. Health and Social Care Information Centre (HSCIC).

NICE, 2015. Smoking: Reducing and Preventing Use. Quality Standard [QS82].

NHS, 2016. Under-18s Guide to Quitting Smoking. Available at: http://www.nhs.uk/Livewell/smoking/Pages/Teensmokersquit.aspx (Accessed 9th June 2016).

Royal College of Physicians, 2010. Passive Smoking and Children. London, RCP.

World Health Organisation, 2016. Tobacco Free Initiative. Available at: http://www.who.int/tobacco/research/youth/health_effects/en/ (Accessed 9th June 2016).
   

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