Smoking, Drinking and Drug Use among Young People in England 2018 [NS]

Extensive research has demonstrated the harmful effects that smoking has on health. Smoking contributes to a variety of health conditions, including cancers and respiratory, digestive and circulatory diseases, whilst also impairing the development of teenage lungs. Moreover, smoking causes more preventable deaths than any other single cause; in 2017, 77,800 preventable deaths in England were estimated to be attributed to smoking:

Tobacco use remains one of the most significant public health challenges in the UK. One of the national ambitions in the government’s new tobacco control plan published in 2017, is to reduce the number of 15 year olds who regularly smoke to 3% or less by 2022.  This ambition will be measured via the Smoking, Drinking and Drugs survey.

All pupils were asked about their cigarette smoking behaviour. Pupils were categorised in three ways based on the responses given:

• Regular smokers (defined as usually smoking at least one cigarette per week).
• Occasional smokers (defined as usually smoking less than one cigarette per week).
• Non-smokers.

The term ‘current smoker’ used in this report includes regular and occasional smokers.

‘Ever smoked’ includes ‘current smokers” plus ‘ex-smokers” and those who have ‘tried smoking once’.

This part includes information on smoking prevalence, patterns of cigarette consumption, and factors associated with regular smoking.

Pupils who have ever smoked, by year

In 2018, 16% (confidence interval 15-17%) of 11-15 year old pupils had ever smoked, down from 19% of pupils in 2016, and is the lowest level ever recorded by this survey. 

There has been a steady decline since 1996, when 49% of pupils had smoked at least once.

Smoking status of pupils who have ever smoked

The 16% of pupils who had ever smoked consisted of regular smokers (2% of pupils), occasional smokers (3%), those who used to smoke (3%), and those who have tried smoking (8%).

Regular and current (regular plus occasional) smoking prevalence are covered further in the following sections.

Pupils who have ever smoked, by sex and age

Prevalence of pupils having ever smoked was similar for boys (16%) and girls (17%).

The proportion of pupils who had ever smoked increased with age from 2% of 11 year olds, to 31% of 15 year olds.

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Pupils who are current smokers, by year

In 2018, 5% (confidence interval 4-6%) of pupils were classified as current smokers. Though not significantly different from the surveys in 2014 and 2016 (6%), the proportion has generally declined over time since 1996, when 22% of pupils were current smokers.

Pupils who are current smokers, by sex and age

Prevalence of current smoking was the same for boys and girls (5%).

The proportion of current smokers increased with age: from less than 1% of 11 year olds to 11% of 15 year olds.

Pupils who are current smokers, by region

Current smoking prevalence varies across regions and was lowest in London (3%).

Pupils who are current smokers, by ethnicity

Current smoking prevalence was highest amongst white pupils (6%).

Factors associated with current smoking

A logistic regression model was used to explore which characteristics  might be associated with current smoking. This identifies associations, not causes; in other words, factors which identify pupils with an increased or decreased likelihood of being smokers. See Appendix B for more information on the regression model used.

The 8 factors (explanatory variables) shown below had a significant association with current smoking. The size of the circles represents an estimate of the relative contribution to the model (table 1.10 shows the odds ratios for each possible value of each variable in the model).

It was estimated that e-cigarette use had the strongest association, followed by drug use, and having friends who smoke. 

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Pupils who are regular smokers, by year

In 2018, 2% (confidence interval 1.8-2.5%) of pupils were classified as regular smokers. Though not significantly different from the 2016 survey, the proportion has generally declined over time since 1996, when 13% of pupils were regular smokers.

The government's tobacco control plan aims to reduce the number of 15 year olds who regularly smoke to 3% or less. In 2018, 5% of 15 year olds were regular smokers, down from 30% in 1996.

Pupils who are regular smokers, by sex and age

Prevalence of regular smoking was the same for boys and girls (2%).

The proportion of regular smokers increased with age: from less than 1% of 11 and 12 year olds, to 5% of 15 year olds.

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Smoked cigarettes in the last week, by sex and age

This measure differs from regular smoking as it may include some occasional smokers who had smoked in the last week, and may exclude some regular smokers who did not smoke in the last week.

4% of pupils said they had smoked in the last week; 3% of boys and 4% of girls, which is not a statistically significant difference.

The proportion increased with age, from under 1% of 11 year olds, to 8% of 15 year olds.

Total cigarettes smoked in the last week (regular smokers)

Almost half (45%) of regular smokers said that they had smoked more than 20 cigarettes in the last week.

Mean cigarettes smoked in last week (regular smokers)

In 2018, mean consumption of cigarettes in the last week by regular smokers was 24.7, which has fallen gradually since 2007 when it was 44.1.

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The Health Survey for England (HSE) is an annual survey carried out in the respondent’s home.  We would expect the estimates from HSE to be lower than SDD as children seem to be less likely to admit to risky behaviours such as smoking, drinking and drug taking when completing surveys at home.  This is evident in the 2017 HSE results which are much lower than those from SDD, with 1% of 11-12 year olds saying they had every smoked, and 11% of 13-15 year olds. 

Estimates for Scotland are available from the Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS).  SALSUS is also carried out in schools under exam conditions but it only covers 13 and 15 year olds.  SALSUS showed that 2% of 13 year olds and 7% of 15 year olds in Scotland were regular smokers compared to 1% and 7% respectively from SDD in England in 2016.  SALSUS was run more recently in 2018 but the results are not due to be published until later this year.

Estimates from Wales are available from the Healthy Behaviours in School Children Survey (HBSC).  HBSC is also carried out in schools under exam conditions, and like SDD covers children in years 7 to 11. In 2017/18 the survey showed that 4% of pupils smoked at least once a week, and it was 9% for year 11 pupils only.  This compares to 2% and 5% respectively (regular smokers) from SDD in England in 2018.