Smoking - children and young people

Child and adolescent smoking causes serious risks to respiratory health both in the short and long term. Children who smoke are 2 – 6 times more susceptible to coughs, wheeziness and shortness of breath than those who do not smoke (Royal College of Physicians, 1992).

Smoking impairs lung growth and causes lung function to start to decline which may lead to an increased risk of chronic obstructive lung disease later in life. The earlier children start to smoke on a regular basis, and the longer the habit persists into adult life, the greater the risk of developing lung cancer or heart disease (British Medical Association, 2007).

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).

What do we know?

Preventing young people from taking up smoking is key to reducing smoking related harm in the UK. Two thirds of adult smokers begin smoking before the age of 18. It is estimated that every year more than 205,000 children in the UK start smoking (Cancer Research UK, 2013).

Almost one in five 11-15 year olds report having smoked a cigarette at least once. This is the lowest level recorded since 1982. Eight percent of 15 year olds report smoking regularly. 22% had used e-cigarettes at least once and 10% smoked waterpipe tobacco (Shisha) at least once.

Despite this, the prevalence of regular smoking amongst 15 year olds in the UK has been decreasing as illustrated in Figure 1.

Figure 1. Prevalence of regular smokers aged 15 in England (SDD survey)

Figure 1

Regular smoking is associated with other risky behaviours including drinking alcohol, taking drugs and truancy. Young people who smoke are more likely to have either a family member or friend who smokes.

Beliefs about smoking behaviours vary according to young people’s own smoking behaviour; smokers are more likely to believe that people of their age smoke to cope with stress or because it gave them a good feeling , while non-smokers are more likely to believe that people of their age smoke in response to peer pressure.

Perceptions of the need for support and advice with regard to smoking are low among Slough young people. 2.9% of primary school children and 8.75% of secondary school young people stated they would like more knowledge and support with regard to smoking (Good Childhood Index Pilot, 2013).

(Source: Survey of Smoking, Drinking and Drug Use among Young People in England 2014 and What About Youth – WAY survey 2014).

Facts, Figures and Trends

According to the What About Youth (WAY) Survey 2014/15 in Slough the percentage of 15 year olds that are current smokers is 4%, this is half the national average of 8%. Of those who currently smoke, around two thirds smoke regularly (defined as more than 1 cigarette per week) and one third smoke less regularly than this

Using modelled estimates from the Undestanding Society Survey, however, smoking amongst 15 year olds in Slough is estimated to be more prevalent with an estimated 6.5% currently smoking, similarly split (4.3% reguar smokers and 2.2% occasional).

The WAY Survey also found that although the prevalence of smoking cigarettes in teens in Slough is lower than the national average, the prevalence of use of other tobacco products is higher than the national average at 16.3% of those aged 15.

In addition to other tobacco products, we find that 10% of 15 year olds in Slough have tried e-cigarettes. This is a recent phenomenon and as such no data on e-cigarette use has been collected before.

Though overall in Slough, the estimated rate of teens smoking is lower than the national average there are areas in Slough in which the rate is much higher than the national average, including Upton and Central wards as illustrated below in Figure 2.

Figure 2. Modelled prevalence of people aged 11-15 who are regular smokers by electoral ward (2009-2012)

National and local strategies (current best practices)

NICE Guideline PH 14( 2008) - Preventing The Uptake Of Smoking By Children And Young People.

Recommendations focus on how to communicate 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.

NICE Guidelines PH23 (2010) School-based interventions to prevent smoking.

The guidelines recommend interventions that are 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:

  • ensuring smoking prevention interventions in all schools are linked to a local tobacco control strategy
  • developing a whole-school smoke-free policy in consultation with young people and integrating it into wider healthy school strategies and policies
  • integrating information about all aspects of smoking (eg health effects, legal and social aspects) into the curriculum
  • delivering interventions to prevent smoking through PSHE sessions, seeking to enhance self-esteem, resisting pressure from others to smoke and involving parents and carers
  • considering offering evidence-informed peer-led interventions, such as ASSIST – A Stop Smoking in School Trial (Campbell et al, 2008)
  • working in partnership with others, such as education training providers, school nursing and public health teams to design and deliver evidence-informed training for school staff.

What is this telling us?

Preventing children and young people from taking up smoking is key to reducing the burden of smoking-related diseases. As well as this, tackling smoking in young people in Slough is key to reducing health inequalities.

While smoking cigarettes is estimated to be slightly less common in young people in Slough than the national average, the use of other tobacco products (including water-pipe or shisha) is much higher. While this form of smoking is often seen as “safer” than smoking cigarettes in fact they pose the same risks (Source: WHO review).

We also need to be aware of the increasing use of e-cigarettes in young people. Because this is a relatively new phenomenon, the research is in its early stages. There are, however, early indications that e-cigarettes may be a gateway product to use of cigarettes (Source: Leventhal et al 2015 JAMA).

What are the gaps?

Awareness of the risks of smoking waterpipe tobacco or shisha needs to be raised among young people and children in Slough.

In addition, more work is needed to target the most vulnerable children and young people to prevent them from taking up or to help them to stop smoking cigarettes.

What are the key inequalities?

Children and young people are more likely to smoke if they have poor educational attainment or are ‘disengaged’ from school (Morgan et al. 2006);have used alcohol or drugs (Goddard 1992) or have mental or emotional health problems (Office for National Statistics 2005).

Although children and young people in the UK are generally exposed to declining levels of second-hand smoke in the home, those who live in the most deprived households have the highest levels of exposure (Health and Social Care Information Centre, 2013).

Recommendations

  • PSHE leads in schools to continue to raise awareness of the risks of smoking cigarettes and the risks of passive smoking.
  • High risk teens, including those involved with pupil referral units or youth justice to be priority for smoking interventions.
  • PSHE leads in schools to raise awareness of risks of other tobacco products and potential risks of e-cigarettes.

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