Good news: smoking rates in England fell to a record low last year, with one in 12 smokers quitting and the number of adult smokers down to 15.5 per cent. The number of young people smoking also sharply declined, falling 6.5 per cent among 18-24 year olds since 2010. And encouragingly, fewer children are even trying smoking; the percentage of eight- to 15-year-olds who ever smoked fell from 18 per cent of boys and 20 per cent of girls in 1997 to six per cent of boys and three per cent of girls in 2016.
Stevie Benton, communications manager at smoking charity ASH, says there are several reasons for the drop in smoking rates in young people. “The key has been a comprehensive strategy over a number of decades – no one single policy has made the difference. Dramatically curtailing the marketing of tobacco in the UK has been a vital part of the story. Measures such as standardised plain packaging, prohibitions on advertising, promotion and sponsorship, and POS display restrictions have taken away the power of seductive and glossy brands that tobacco companies used to entice smokers. Rising tobacco prices and minimum pack sizes have made cigarettes less accessible to children. Declining adult smoking rates also make a difference.”
However, complacency isn’t an option. Despite the fall in the number of young smokers, every day hundreds of under-16s start smoking. The habit is the cause of death in 50 per cent of lifetime smokers, and it’s widely known that starting young makes it harder to quit.
For pharmacy teams to help young smokers, it’s important to understand what it is about this unhealthy habit that makes them start in the first place. Having family or friends who smoke is the biggest deciding factor for young people, says NHS Digital’s Smoking, drinking and drug use among young people report, with almost all young smokers having a friend who smoked. Regular smokers are also much more likely to have a family member who smokes (83 per cent) and the proportion of pupils who smoke increases with the number of smokers living in their household. And according to ASH, at least 23,000 young people in England and Wales start smoking by age 15 as a result of smoking in the home.
A PHE spokesperson agrees saying that “surveys of young people show that the greater the number of friends and family who smoke, the more likely that young person is to become a smoker”. Adding: “Young people who are excluded from school or experiment with drugs and alcohol are more likely to smoke.”
If a young person lives in a community where there is easier access to cheaper illicit tobacco, then they are also more likely to try smoking and continue with the habit, explains PHE.
“For many smokers, smoking is an addiction forged in childhood, not an informed adult choice – and the tobacco industry has deliberately targeted children for decades. There is also some evidence that because teenage brains are still developing they are more susceptible to developing addiction,” says Stevie. “We also know that kids from disadvantaged backgrounds are more likely to smoke, and to take it up at a younger age. Other factors, such as peer pressure and a desire
to fit in, are also relevant.”
Encouraging customers who are parents to quit the habit has the potential to help reduce childhood smoking. “Reducing overall smoking around children helps because it removes the ‘role model’ factor. Parents quitting also reduces the accessibility of tobacco to children because it isn’t lying around in the home,” Stevie adds.
Exposure to second-hand smoke is another influencing factor in determining whether children start smoking. Some 63 per cent of young regular smokers were exposed on every or most days in the last year, compared with 12 per cent of non-smokers.
‘Towards a smokefree generation’ is the Government’s new Tobacco Control Plan, published in July 2017. The Government’s aim is for a smoking prevalence rate of five per cent or less by 2030.
By 2022, it aims to reduce prevalence among adults from 15.5 per cent to 12 per cent or less, and to reduce the percentage of 15-year-old smokers from eight per cent to three per cent or less. The plan aims to cut smoking in pregnancy rates from 10.7 per cent to six per cent or less.
The plan calls for a shift from national to local action in order to achieve these goals.Specific commitments included in the plan are to provide access to training for all health professionals on how to help patients quit smoking and to promote links to smoking cessation services. The Government also plans to maximise the availability of safer alternatives to smoking.
Smoking is an addiction largely taken up in childhood, with around three-quarters of smokers starting before the age of 18. The outcome is that young people become addicted before they understand the health risks smoking brings. In fact, children show signs of addiction to tobacco within four weeks of starting smoking.
A US study found that smoking just one cigarette in early childhood doubles the chance of a teenager becoming a regular smoker by the age of 17. What’s more, the younger someone is when they start smoking, the greater the risk to their health because of links with heavier smoking and high levels of addiction.
“Smoking is disastrous for health and damages the whole body. Smoking causes cancer, heart disease, lung disease, eye problems, circulation problems, infertility and much more. Smokers die an average 10 years younger, while also suffering worse general health,” says Stevie.
Risks to respiratory health are serious in young smokers. Children who smoke are between two and six times more susceptible to coughs, wheezing and shortness of breath. Smoking affects lung development and this can increase risk of COPD in later life and the risk of lung cancer and heart disease increases in children who become regular smokers. Bronchitis, pneumonia, asthma and sudden infant death are all more common in children whose parents smoke.
According to the World Health Organization, teenage smokers are three times more likely to drink alcohol, eight times more likely to use cannabis and 22 times more likely to use cocaine than non-smokers.
Standardised plain packaging for tobacco products was implemented in May 2017. “The evidence we have from Australia, where standardised plain packaging was implemented in 2012, is that it makes smoking less appealing. It will take a few years to see the impact on youth smoking rates, just as the advertising ban took a few years to have an effect on smoking rates,” says Stevie Benton, communications manager at smoking charity ASH.
A Cancer Research UK study found that young people are less likely to try cigarettes with a printed health message ‘smoking kills’ on each cigarette. The study found that the health warning meant young people were three times less likely to want to try them than standard cigarettes. They also put off smokers. The study also found that green coloured cigarettes were less appealing than standard coloured ones.
Dr Crawford Moodie, lead author, says: “The study shows how cigarettes can be an important communication tool and that altering their appearance, with a health warning or an unappealing colour, can make them less desirable.”
There are lots of ways that pharmacy staff can help support young smokers.
“Getting teens to stop smoking is very difficult, but the sooner people start seeing quitting as the norm, rather than smoking, the sooner they will quit successfully,” says Stevie. “Even if the first attempt – or several attempts – are unsuccessful, encourage them to keep going. Nicotine replacement therapy (NRT) has an indication from age 12 plus. The highest successful quit rates come from a combination of on-going support and access to NRT.”
According to ASH research, England is one of the best places worldwide to give up smoking. The ban on smoking in public places has resulted in two million fewer smokers, while electronic cigarettes have had a huge impact, with 2.9 million adults now using them.
Gul Root, PHE’s lead public health pharmacist, said: “Staff in lots of pharmacies are already helping people to quit smoking by providing opportunistic advice, engaging them in NHS stop smoking services or selling nicotine replacement therapies. For young people, pharmacy teams can be even more proactive and discuss the health harms associated with smoking if they are aware, or suspect, that the young person smokes. There are free training materials and resources for stopping smoking available to pharmacy teams from NICE and the National Centre for Smoking Cessation which will help them to effectively advise young people to stop smoking.”
The number of young people smoking has sharply declined, falling 6.5 per cent among 18-24 year olds since 2010