Smoking is the most important cause of preventable ill health and premature mortality in the UK.
NICE guidance sets out the risk to children and young people who can become addicted to nicotine very quickly. They also tend to continue the habit into adulthood as around two-thirds of people who have smoked took up the habit before the age of 18.
The earlier children start to smoke on a regular basis the greater-than-average risk of developing lung cancer or heart disease. Children and young people who smoke are two to six times more susceptible to coughs, increased phlegm and wheezing than their non-smoking peers. The habit can impair the growth of their lungs and is also a cause of asthma-related symptoms in childhood and adolescence.
Children and young people are also more susceptible to the effects of passive smoking, particularly if there is a parent at home who smokes. Bronchitis, pneumonia, asthma and cot death are significantly more common in infants and children who have one or two parents who smoke (Royal College of Physicians, 2005).
See also the section on Smoking among Adults in the JSNA.
Key inequalities and risk factors
There is a lack of data about children and young people’s smoking behaviour and attitudes in Bracknell Forest and it would be valuable to collect quantitative and qualitative data to help design specific interventions aimed at preventing smoking initiation at a young age.
Other research indicates that children and young people start to smoke and then continue for a number of reasons connected to their personal or social circumstances:
- Age - Smoking prevalence in young people increases with age
- Gender - The Health and Social Care Information Centre 2014 survey (NHS Digital) on smoking, drinking and drug use by young people in England indicates that girls are more likely to smoke than boys
- Family influences - Propensity to smoke amongst young people is increased if peers of the same age, siblings, parents or other members of the same household smoke (ASH, 2016)
- Education - Young people who played truant from school or who had been excluded from school in the previous 12 months were almost twice as likely to smoke regularly compared to those who had never been truant or excluded. Poor educational attainment or ‘disengagement’ from school and education is also highlighted (Morgan et al. 2006)
- Substance misuse - There is a strong association between smoking and other substance use. Secondary school pupils who smoked regularly in 2013 were 5 times more likely to have drunk alcohol in the week prior to the survey. Regular smokers were 15 times more likely to have used drugs in the month prior to the survey cmopared with non-smokers
- Mental health – young people with emotional disorders were more likely to smoke
- Deprivation - Children and young people are also more likely to smoke if they live in more deprived households (NHS Digital, 2014). ASH report (2016) that in poorer communities, young people are more exposed to smoking behaviour, more likely to try smoking and, once hooked, they find it harder to quit.
The National Treatment Agency JSNA Support Pack has Key data for planning effective tobacco control in 2016-17 which outlines the key inequalities and risk factors in the most detail.
Facts, figures, trends
The Tobacco Control Plan set out the Government's aim to reduce smoking among both adults and children and included a national ambition to reduce rates of regular smoking among 15 year olds in England to 12% or less by the end of 2015. HSCIC 2014 survey data (NHS Digital) shows that since 2001, the rate of regular and occasional smoking amongst 11-15 year olds has fallen:
According to the HSCIC 2014 survey (NHS Digital), fewer than one in five 11 to 15 year olds (18 per cent) said that they had smoked at least once. This was the lowest level recorded since the survey began in 1982, and continues the decline since 1996 when 49% of pupils had tried smoking. In addition, the proportion of 11-15 year olds who reported smoking regularly (at least one cigarette per week) also fell from 10% in 2001 to 3% in 2013 and 2014.
Smoking take up
According to Cancer Research UK evidence, it is estimated that an average of 136,500 children aged 11-15 started smoking between 2012 and 2014 in the UK which is more than 370 per day. The number of new childhood smokers each year is falling, probably due in part to successful tobacco control policies designed to protect children. Below are key findings from the HSCIC 2014 survey (NHS Digital) (accessed 29 April 2016).
Smoking behaviours, by age and sex
In 2014, of all 6,085 boys and girls between the ages of 11 and 15 who were surveyed, 18% had ever smoked and 82% had never smoked. Trends have been positive over time:
Of all children surveyed between the ages of 11 and 15, 2% of boys and 3% of girls described themselves as occasional smokers, 2% of boys said they smoked regularly as did 4% of girls. At age 15, the proportion of 15 year old boys and girls who describe themselves as regular smokers was 6% and 9%, representing a 2% drop for boys and a 1% increase for girls on HSCIC 2013 survey figures (NHS Digital).
Taking these percentages and applying them to the mid-2014 population estimates for Bracknell Forest, the number of children aged 11-15 is estimated at 7,092 and their smoking behaviour is estimated as follows:
Of young people who smoke, girls are more likely to smoke packet cigarettes (27%) and boys are more likely to smoke hand rolled cigarettes (39%). Of the 7,092 estimated 11-15 year olds, 5,845 never smoked.
There is a social element to smoking with occasional smokers more likely to smoke more cigarettes on Friday and Saturdays compared to any other day.
Electronic cigarettes deliver nicotine in a vapour rather than in smoke and compared to tobacco products, electronic cigarettes are significantly safer.
The current national evidence is that in the UK regular e-cigarette use is almost exclusively confined to those young people who smoke, and youth smoking prevalence is continuing to fall. Data on e-cigarettes was first reported in the HSCIC 2014 survey (NHS Digital) which showed 88% of young people are aware of them, 22% had used them and 1% use them regularly.
E-cigarette use among pupils who had never smoked was 11% and whilst there is consensus that e-cigarettes are the most popular quitting tool in the country with more than ten times as many people using them than using local stop smoking services. There is no evidence that use of electronic cigarettes leads to a take-up of smoking, but as an ongoing concern this will be the subject of greater research over time.
Equal proportions of regular smokers and occasional smokers have tried e-cigarettes (32%). Of the 187 regular smokers, 25% used to use e-cigarettes, 17% regularly use them and 15% occasionally use them. Of the 147 occasional smokers, 14% used to use them, 13% regularly use them and 16% occasionally use them.
In 2001, a total of 10% of both male and female pupils aged 11-15 stated that they were regular smokers. By 2014, this has decreased to 3% or an estimate of 213 young people using mid-year 2014 estimates for Bracknell Forest. The downward trend is across all ages for both boys and girls. These statistical estimates do not take into account other inequalities or risk factors such as deprivation.
The greatest decline in smoking has been amongst older pupils:
The proportion of 14 year olds who smoked regularly fell from 13% in 2006 to 4% in 2014 and among 15 year olds, 8% smoked regularly in 2014, compared with 20% in 2006.
Reasons for smoking
the HSCIC 2014 survey report (NHS Digital) states that the most prevalent reason why pupils believed their peers smoked was to look cool in front of their friends (85%). Smokers were more likely to believe that people of their age smoked because of its effects, for example, to cope with stress or because it gave them a good feeling. Non-smokers were more likely to believe people of their age smoked in response to social pressures.
Frequency of pupils’ exposure to second-hand smoke
The HSCIC 2012 survey (NHS Digital) included data on exposure to second-hand smoke. Two-thirds (67%) of pupils reported being exposed to second hand smoke, of these 43% experienced second hand smoke in their own home (55% in other people’s homes) and over a quarter (26%) experienced second hand smoke in their family car (30% in other people’s cars). The HSCIC 2014 survey (NHS Digital) reported exposure to second hand smoke had fallen to 64%, although a larger proportion (59%) were exposed to second hand smoke in their own home and one third (34%) experienced second hand smoke in their family car.
Influence of peers and family
The HSCIC 2014 survey (NHS Digital) looked at influence of peers and family and showed that the likelihood of smoking at a younger age increased if peers of the same age, family members or members of the same household smoke:
- 97% of pupils who described themselves as regular smokers and 94% of occasional smokers reported that their friends were also smokers compared to 51% non-smokers
- 82% of pupils who described themselves as regular smokers and 69% of occasional smokers reported that their family were also smokers
- 66% of young regular smokers and 33% of occasional smokers said that their families knew and the proportion of pupils who report that their families try to stop them smoking or persuade them not to smoke has remained consistently high (over 90% since 2000).
These are consistent with the findings from the HSCIC 2012 survey (NHS Digital).
Quitting information and advice
The HSCIC 2014 survey (NHS Digital) stated that older children would seek out information from a wide variety of sources. Existing smokers were significantly more likely than non-smokers to think that social media, friends, FRANK and youth workers were helpful sources of information about smoking. Non-smokers were more likely than smokers to mention teachers.
Boys were significantly more likely than girls to mention GPs, police in schools, relatives other than parents and siblings, or radio. Girls were more likely than boys to mention newspapers or magazines. This has a significant implication for how promotions and public health interventions are planned and delivered.
Dependence on smoking, by length of time as a regular smoker
The HSCIC 2012 survey (NHS Digital) records 46% of young people who have smoked for under one year say they would find it difficult to stop for one week, compared to 82% for those who have smoked more than one year. These rates are similar for those who said it would be difficult to quit altogether. 40% of young people who have smoked more than one a year would like to give up and 75% have tried to give up.
Young people in year 9 and above were surveyed for the 2013 Bracknell Forest survey of children and young people and in terms of frequency of smoking:
When asked why they smoke, of the 38 young people who said they smoke at least sometimes, 23% said it helps to keep their weight down, 22% said they don’t like the way they feel if they don’t smoke, 20% said because their friends smoke, 17% said because their family smoke, 16% said it gives them confidence. 28% said ‘other’.
More than one response was possible for these questions so percentages add up to more than 100%. It is also important to note that due to the small survey sample size, results may not be an accurate reflection of the true frequency and reasons for smoking across young people in Bracknell Forest.
Care, support and management
Local NHS Stop Smoking services - design and deliver targetted personal as well as whole family communication, support and signposting to young people. The NHS stop smoking service serving Bracknell Forest is smokefreelife Berkshire which offers advice, information and support in person and online and in group and one-to-one settings as well as training to professionals and providers.
Want to know more?
Healthy Lives, Healthy People: A Tobacco Control Plan for England (Department of Health, 2011) - government strategy to reduce smoking through the new public health system to reduce smoking rates, tackling tobacco use through a multi-faceted and comprehensive approach at both national and local level.
Local tobacco control profile (Public Health England) – Key statistics, data and information for a range of measures relevant to smoking and young people.
Not Good Enough: PHSE in schools (Ofsted, 2013) – outlines changes needed to PHSE lessons which if limited to highlighting the health risks associated with smoking about which young people are already aware do little to prevent the establishment of regular smoking habits in school age children.
PHSE Programme of Study (PSHE Association, accessed 29 April 2016) – a range of resources for PHSE teachers across key stages 1-5 to add value to PHSE schemes of work.
Preventing the uptake of smoking by children and young people (NICE, 2008) - guidance for those responsible for the health and wellbeing of children and young people aged below 18. The recommendations focus on communicating effectively to children and young people about smoking and point-of-sales measures, that should be combined with regulation, education, cessation support and other activities as part of a comprehensive strategy.
School-based interventions to prevent smoking (NICE, 2010) - recommends interventions relevant to a range of educational settings (maintained and independent primary, secondary and special schools; colleges and academies, pupil referral units, secure units, further education colleges, 'extended schools' where childcare or informal education is provided outside school) as well as staff and pupils in those settings.
Smoking, drinking and drug use among young people in England in 2014 (NHS Digital, 2014) – a suite of surveys covering numerous aspects of smoking, drinking and drug use among young people in England, in particular, prevalence, behaviours, types of alcohol and drugs taken, how often, access to substances, pupil attitudes and predictors of smoking, drinking and drug taking among secondary school age children. Different surveys focus on different aspects.
Tobacco control: JSNA support pack –Good practice prompts for planning comprehensive interventions in 2016-17 and Key data for planning effective tobacco control in 2016-17 for planning, developing, delivering and assessing smoking intervention programmes.
This page was created on 27 February 2014 and updated on 7 June 2016. Next review date March 2017.
Cite this page:
Bracknell Forest Council. (2016). JSNA – Smoking. Available at: jsna.bracknell-forest.gov.uk/developing-well/children-and-young-peoples-health/smoking-children-young-people (Accessed: dd Mmmm yyyy)
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