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Tobacco use in children and young people

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Introduction

The younger an individual starts to smoke, the more harm is likely to be caused, with early smoking associated with heavier smoking, increased dependency, a lower chance of quitting and higher mortality. Childhood smoking can also cause serious risks to respiratory health, impairing lung growth and initiating premature lung function decline1,2,3,4.

A 2011 study5 estimated that more than 200,000 11-15 year olds in the UK start smoking each year. Whilst prevalence rates have declined since this time, young people's smoking remains a concern. 77% of smokers aged 16 to 24 in 2014 began smoking before the age of 186

Across the population, people living in the most deprived areas of England in 2016 were more than four times more likely to smoke than those in the least deprived areas7. Children of smokers are two to three times more likely to smoke themselves, leading to an inter-generational cycle6. Smoking rates are also disproportionately high amongst certain groups of young people, such as looked after children and those with mental health concerns8. Supporting young people to choose not to smoke will therefore have both health and equality benefits.

The Tobacco Control Plan (2017) set out the Government's aim to reduce the prevalence of smoking among both adults and children and included a national ambition to reduce rates of regular smoking among 15 year olds in England to 3% or less by the end of 2022.

Facts and figures

Nationally, the proportion of children who have ever smoked has declined significantly over the past 25 years. The 2018 NHS Digital survey of smoking, drinking and drug use among young people estimated that 16% of school pupils aged 11-15 had ever smoked (this includes having tried smoking). The estimated proportion who had ever smoked in 1996 was 49%.

Regular smokers are defined as someone smoking at least one cigarette per week. The proportion of regular smokers has also reduced, with 2.1% of 11-15 year olds estimated to be regular smokers in 2018, compared to 13% in 1996. The proportion of regular smokers increases with age, with 5.3% of 15 year-olds in 2018 estimated to be regular smokers, down from a high of 30% in 1996 (figure 1). In 2018 the average (mean) number of cigarettes smoked per week by regular smokers aged 11-15 was 24.7.

 Figure 1: Trend in estimated percentage of regular smokers (15 year olds), England 1982-2018

Line chart showing how the percentage of regular male and female smokers in England has declined considerably since the mid-1990s.
Source: NHS Digital, Smoking, drinking and drug use among young people: England, 2018

Local data about the nature and extent of young people's smoking is currently limited. The most recent national survey to estimate local prevalence, the What about YOUth? Survey, took place in 2014, and many sources still draw on this. The Schools Health Education Unit (SHEU) in Blackpool also undertakes a healthy lifestyle survey, which generates useful information about children and young people's behaviour (including smoking), however this does not generate local prevalence estimates.

Data from the What about YOUth? Survey, 20149 showed:

  • Blackpool had significantly more regular smokers than the regional and national average (figure 2)
  • The proportion of occasional smokers was similar to the national average
  • The proportion of current smokers ranged from 15% in Brighton and Hove down to 3.4% in Redbridge
  • Blackpool had the 4th highest proportion (13.4%) of 15 year olds who smoked in the country (figure 3)

Figure 2: Percentage of current smokers (15 year olds), 2014/15

Stacked bar chart showing that the 2014/15 proportion of regular smokers at age 15 in Blackpool is double national and regional levels at 11.1%.
Source: PHE, Health behaviours in young people - What About YOUth? Profile

Figure 3: Percentage of current smokers (15 year olds) comparison of upper tier local authorities, 2014/15

Bar chart shows that Blackpool had 4th highest percentage of 15 year old smokers among local authorities in the 2014/15 What About Youth survey.
Source: PHE, Health behaviours in young people - What About YOUth? Profile

 A Healthy Lifestyle Survey10 has been carried out bi-annually by the Schools Health Education Unit (SHEU) in primary schools (children aged 8-11 years) and secondary schools (children aged 12-15 years) in Blackpool since 2015. The 2019 survey found that:

    • 98% of pupils aged 8-11 years said that they had never smoked, 2% said they had tried smoking once or twice (96% and 3% in 2017). 
    • Less than 0.5% of pupils aged 8-11 years said they had smoked at least one cigarette in the 7 days before the survey
    • 88% of pupils aged 8-11 years said that they wouldn't smoke when they were older (82% in 2017); 10 % said 'maybe' (13% in 2017) and 2% said they would smoke when they were older (4% in 2017)
    • 76% of pupils aged 12-15 years said they had never smoked (75% in 2017)
    • 6% of pupils in Year 8 reported having smoked in the last seven days (4% in 2017), whilst 15% of pupils in Year 10 reported having smoked in the last seven days (14% in 2017)
    • The proportion of Year 10 females surveyed who smoked in the preceding seven days was 13% (20% in 2017), for Year 10 males the proportion was 16% (15% in 2017 and 13% in 2015)
    • 6% of 12-15 year olds reported being able to smoke anywhere in their home (8% in 2017), and 7% reported being able to smoke in certain rooms (13% in 2017)

Electronic Cigarettes / Vapes and the Use of Other Tobacco Products

Electronic cigarettes, or vapes, deliver nicotine through a vapour rather than through tobacco smoke. Whilst e-cigarettes are  considered to be of lower harm to individuals than tobacco-based cigarettes, there remain concerns about possible long-term effects, and the introduction of young people to nicotine, particularly if they had not previously smoked cigarettes. In 2015 it became illlegal to sell e-cigarettes containing nicotine to under 18s or to purchase them on behalf of under 18s, and this was followed in 2016 by the UK adoption of the EU Tobacco Products Directive, introducing a regulatory framework for e-cigarettes that also prohibited their advertising or promotion through a range of media outlets12.

2021 guidance by the National Institute for Health and Care Excellence (NICE) recommends that young people are discouraged from using e-cigarettes due to the potential higher chance of smoking in the future, and the recommended approach to treating tobacco dependence for those aged 12 to 17 is to consider Nicotine Replacement Therapy (NRT) (together with behavioural support)13.

The NHS Digital Survey of smoking, drinking and drug use among young people in 2018 found that 90% of 11-15 year olds were aware of e-cigarettes (from 83% at age 11 to 92% at age 15). 75% reported having never used e-cigarettes, 2% were regular e-cigarette users and 4% occasional e-cigarette users. These figures suggest a slight upwards trend in use from the 2014 survey, when 78% reported never having used e-cigarettes, 1% were regular users and 3% occasional users. Among 15 year olds, 59% reported never using e-cigarettes, 41% had tried them, whilst 11% were current users (4% regular, 7% occasional users). A higher proportion of males reported both current use and having ever used e-cigarettes. Of those who had never smoked cigarettes, 1% were current e-cigarette users and 86% had never used e-cigarettes.

Local comparisons from the What About YOUth? survey in 2014/15 suggest that the proportion of 15 year olds who reported having tried e-cigarettes was higher in Blackpool than national or regional levels (figure 4). More recently, the SHEU Healthy Lifestyle survey found that, in Blackpool in 2019, 39% of 12-15 year old respondents reported having ever used an e-cigarette (35% in 2015 and 34% in 2017). Reported regular e-cigarette use has remained relately stable across the three SHEU surveys (7% in 2015, 6% in 2017 and 2019).

Young people's use of other tobacco products, such as smoking shisha through use of a hookah or waterpipe also remains a public health concern. These products also carry health risks and tobacco legislation applies to them too. There are a number of initiatives that have been carried out to raise awareness of these risks and the legislation which applies to these products.

2014/15 What About YOUth? Survey findings suggest that 9.5% of 15 year olds in Blackpool had tried other tobacco products, compared to 15.2% nationally.

Figure 4: What About YOUth? Survey - Use of tobacco products by children age 15 years: 2014/15

Bar charts showing that in 2014/15 survey Blackpool had higher level of current smokers and those that had tried e-cigarettes than across England and North West.
Source: PHE, Health behaviours in young people - What About YOUth? Profile

Second hand smoke (SHS) - the impact on children

Since the introduction of the smoke free legislation, the major source of tobacco smoke exposure for young children is smoking in the home and in vehicles by parents and other household members. Maternal smoking is usually the largest source of SHS because of the cumulative effect of exposure during pregnancy and close proximity to the mother during early life. For further information on smoking during pregnancy visit the JSNA Smoking in Pregnancy page.

A 2019 survey conducted by Action on Smoking and Health (ASH) found that 90% of young people aged 11-18 said that people are never allowed to smoke inside their house, with 7% living in houses where people can smoke (3% didn't know). 87% of young people said they never travel in a car when someone is smoking. A 2019 YouGov poll conducted for ASH also found that 89% of adults supported a smoking ban within cars carrying under 18s, and 64% supported banning smoking in cars regardless of passenger age14.

National and local policies

The Tobacco Free Lancashire Strategy 'Towards a Smokefree Generation 2018-2023' has been developed in line with the Tobacco Control Plan for England, setting out the ambition to achieve a smokefree generation by:

  • preventing children from taking up smoking in the first place
  • stamping out inequality, for example smoking in pregnancy
  • supporting smokers to quit

Further information about the authorities' response to smoking and tobacco use can also be found on the Blackpool JSNA Smoking page.

NICE guideline [NH209] 'Tobacco: preventing uptake, promoting quitting and treating dependence' (November 2021) covers support to stop smoking for everyone over the age of 12. It also provide guidance on ways to prevent children, young people and young adults aged 24 and under from taking up smoking.

Action on Smoking and Health (ASH) have also compiled a selection of resources for young people and schools.

Services

Blackpool's NHS Tobacco Addiction Service provides support to Blackpool residents as part of the wider Fylde Coast pathway. The service treats smoking as an addiction first and foremost, helping smokers to understand that the highly addictive nature of nicotine (contained within tobacco) is one of the main reasons why it is so hard to stop smoking. The service is open to anyone aged 12 and over who lives or works in Blackpool and wants to give up smoking. 

For further information about the service visit the Blackpool JSNA Smoking page.

References

[1] Action on Smoking and Health (ASH) (2019) Young people and Smoking, September 2019.

[2] Leonardi-Bee J., Jere M., Britton J. (2011) Exposure to parental and sibling smoking and the risk of smoking uptake in childhood and adolescence: a systematic review and meta-analysis. Thorax. 66(10):847-855.

[3] Seddon C. (2007) Breaking the cycle of children’s exposure to tobacco smoke. British Medical Association.

[4] Royal College of Physicians (2005) Going smoke-free: The medical case for clean air in the home, at work and in public places. A report by theTobacco Advisory Group.

[5] Hopkinson, N., Lester-George, A., Ormiston-Smith, N., Cox, A., & Arnott, D. (2013) Child Uptake of Smoking by area across the UK. Thorax, 69(9):873-875.

[6] Department of Health (2017) Towards a Smokefree Generation: A Tobacco Control Plan for England. (Accessed 18th February 2022).

[7] Office of National Statistics (ONS) (2018) Likelihood of smoking four times higher in England's most deprived areas than least deprived (Accessed 18th February 2022).

[8] Meltzer, H, Lader, D, Corbin, T, Goodman, R & Ford, T (2004) The mental health of young people looked after by local authorities in England, London: TSO

[9] HSCIC, Health and Wellbeing of 15-year-olds in England - What about YOUth? (WAY?) Survey, 2014. Health and Social Care Information Centre, December 2015

[10] Blackpool Council/SHEU. Supporting the Health and Wellbeing of Young People in Blackpool, 2019

[11] With the exception of Covid-19 affected 2021.

[12] Action on Smoking and Health (ASH) Use of e-cgiarettes among young people in Great Britain, June 2021.

[13] National Institute for Health and Care Excellence (NICE). Tobacco: preventing uptake, promoting quitting and treating dependence. NICE Guidance [NG209], November 2021.

[14] Action on Smoking and Health (ASH). Secondhand Smoke, March 2020