Smoking (Young People)
This chapter considers smoking in young people aged under
19. Smoking in pregnancy, and tobacco control and
smoking in adults are considered separately.
Tobacco remains the main cause of preventable
morbidity and premature death in England and Bedford Borough.
Beyond the well-recognised effects on health, tobacco also plays a
role in perpetuating poverty, deprivation and health inequalities.
Smoking is the most important cause of premature death and a major
factor to the mortality divide between the most deprived areas in
Bedford Borough and Bedfordshire as a
Nationally some 80% of people start smoking as
teenagers and it can be presumed that this will be the same for
smokers who live in Bedford Borough. ONS 2013 mid year
population estimates, the estimated 5-19 population was 30,000-
this is representative of 18.6% of the total estimated population
of Bedford Borough.
Facts, Figures, Trends
Young people smoking and prevention
In 2008, the Department of Health highlighted
that the evidence base for working with young people was still
developing. However an effective tobacco control approach to
smoking in young people should incorporate education methods that
de-normalise smoking as a habit, young people specific treatment
services and enforcement of regulations.
In 2010 a national survey carried out for the
NHS Information Centre of 7,296 pupils from 246 schools in England,
found that 27% of pupils had tried smoking at least once. The
proportion of pupils who had ever smoked was 53% in 1982, and the
proportion continues to decline. (NHS Information Centre, 2010)
Nationally in 2010, 12% of 15 year-olds stated
that they were regular smokers with girls being more likely to
smoke than boys. 5% of pupils (age 11 to 15) reported being regular
smokers (at least once a week). However prevalence of regular
smoking increased with age: from 0.5% of pupils aged 11 years old
to 12% of 15 year-olds with girls being more likely to smoke than
boys Those young people who do experiment run the risk of addiction
and of becoming long term smokers. The earlier young people
become regular smokers, the greater their risk of developing lung
cancer or heart disease if they continue smoking into adulthood
(NHS Information Centre, 2010).
There is evidence that 11 to 16 year olds who
smoke can also experience high rates of drinking and drug
dependence on cigarettes, showing signs of addiction within four
weeks of starting to smoke. The 2010 survey found that in line with
previous years, there were strong overlaps in smoking, drinking and
drug taking behaviour. 7% of all pupils said that they had smoked
cigarettes in the last week; including 5% who had also drunk
alcohol or taken drugs recently: 2% had smoked cigarettes and drunk
alcohol recently, 1% had smoked cigarettes and taken drugs
recently, and 2% had done all three recently. Just 2% of smokers
had neither drunk alcohol or taken drugs recently.(NHS Information
The 2010 survey also suggests the following factors are
associated with a young person who begins to smoke:
Sex and age: Once other factors were controlled
for, the girls were more likely than boys to be regular smokers
(odds ratio=2.08). Age was also associated with regular smoking;
with each additional year of age, the odds of a pupil becoming a
regular smoker increased by 1.65 times.
Drinking and drug use: There
is a relationship between regular smoking and having drunk alcohol.
Young people who have taken drugs in the last year have greater
odds of being a regular smoker than young people who have never
Influence of friends and
family: young people are far more likely to start smoking
if influenced by family and friends to do so.
Truancy and exclusion from
school: truancy and exclusion is associated with young
people who smoke.
Socio economic indicators:
pupils who receive free school meals, an indication of family
deprivation, are more likely than others to be regular smokers
Children who are looked after have very high
rates of smoking. These young people have very high rates of
smoking. Data from England in 2003 show that one in three (32%)
looked after young people, aged 11 to 17 were current smokers.
Seven in every 10 (69%) children in residential care were smokers,
compared with just over one in five of those in foster care (22%).
The study reported that these children began to smoke very young –
nearly one in three(32%) had started smoking at age 10 or younger
There is some evidence that young people with
a range of mental health conditions, including schizophrenia,
depression and ADHD are more likely to smoke.155 UK data showed
that young people with a diagnosis of depression were over five
times more likely to be smokers than those without depression (BMA,
In the autumn term of 2012 a survey was
commissioned and co-ordinated by NHS Bedfordshire. Questionnaires
were distributed and subsequently collated from a sample of
secondary aged pupils, aged 12 to 15 in Bedford Borough. A total of
1383 took part from 12 Middle and Upper schools or Academies in
Bedford Borough. . This is only a small representation of the whole
pupil population in Bedford Borough. However within this 75% said
they had never smoked and 9% of Bedford Borough pupils said they
smoked at least one cigarette in the last week. The data will be
used to inform planning and support.
ERPHO Fingertips uses Tellus4 2009 data and
suggests 3% of Bedford Borough pupils aged 10 to 15 are smoking.
Second Hand Smoke - Passive smoking
Breathing other people’s cigarette smoke
is known as passive smoking. Many potentially toxic gases are
present in higher concentrations in side stream smoke than in
mainstream smoke and nearly 85% of the smoke in a room results from
side stream smoke. Exposure to second-hand smoke (SHS) has
immediate and long term health effects. (ASH, 2007)
The impacts of exposure to tobacco smoke on
children’s health are far reaching; they start in the womb and
continue into adult life. The overwhelming majority of children in
the UK are exposed to SHS. Over 80 per cent of children under the
age of 10 from the most affluent backgrounds display biological
markers of exposure, and this rises to more than 95 per cent of
children from the least affluent backgrounds - (Royal College
of Physicians, 2005)
In the UK the report by the Government
appointed Scientific Committee on Tobacco and Health (2004) found
that passive smoking is a cause of respiratory disease, cot death,
middle ear infections and asthma in children. Infants and children
are particularly vulnerable to the health effects of SHS with most
of their exposure coming from parents within the home.
Estimated figures are that 2 million children
in UK are exposed to second-hand smoke which is mainly from
home – [Royal College of Physicians, 2005].
In Bedford Borough 17.7% in 2011/12 of
new born babies were living in a home with at least one smoker
(compared with 18.6% in 2010/11)
21.18% of newborn babies were
living with a smoker in the 20% most deprived wards in Bedford
Borough in 2011/12.
Asthma is the most common chronic disease of
childhood. There is now compelling evidence that passive smoking is
a risk factor for the induction of new cases of asthma as well as
for increasing the severity of disease among children with
established asthma. In the UK, it is estimated that between 1,600
and 5,400 new cases of asthma occur every year as a result of
parental smoking.6 Another major study has shown that passive
smoking has a negative effect on the respiratory systems of
children of all ages. As well as impacting on children’s health
parental smoking can cause damage to family finances and wellbeing,
it also has a strong influence on the likelihood of their children
becoming smokers (BMA Board of Science, Breaking the
cycle of Children’s exposure to tobacco smoke,
Teenagers smoking in pregnancy
In the Infant Feeding Survey (2005) early
results showed teenage mothers were the only age group where
smoking rates in pregnancy increased between 2000 and 2005. In
2005, 45 per cent of teenage mothers smoked throughout their
pregnancy, showing a five percentage point increase between 2000
Lone parenthood, poor education, young age and
low socioeconomic status all increase the risk of maternal smoking.
The 2004 Families and Children Study showed that half of lone
Current activity and services:
Stop Smoking support is available across
Bedford Borough for young people at;
- GP practices
- Some Upper Schools
- Community venues
Numbers of under 18’s accessing the local
service through any of the above are low. For 2013/14, 31
first time attended, 27 set a quit date resulting in 10 who
succeeded in quitting which equates to 37% conversion rate from
setting a quit date. In 2012/13 of the under 18’s accessing the
service 31 set a quit date, and 9 succeeded in quitting (29%
conversion rate). Of the 31 under 18’s. This indicates the
challenges of supporting this group.
Prevention - Kick Ash Bedfordshire
The Kick Ash programme is an award winning
young person led smoking prevention programme. Year 10 (15
yr. old) pupils in upper school are trained to work as mentors to
support year 8 pupils (13 yr. old) and year 5/6 pupils (10/11 yr.
old) in partner middle schools. The mentors act as smoke free
role models and help other young people to recognise what may
influence their decision to smoke and how to combat that.
The programme is in line with NICE guidance
[NICE] and guided by the ‘diffusion of innovation’ (Rogers, E 1995)
and ‘social learning’ theories (Bandura. A, 1977).
- A multi-component approach that includes
prevention, cessation, enforcement and advocacy in line with NICE
(National Institute for Clinical Excellence) guidance.
- Multifaceted to include a peer mentoring
programme and mentors year 10 students elect to be part of a
specialist interest group and work with Bedford Borough Stop
Smoking Service, a communication lead and Trading Standards.
- The programme adopts a community development
approach and is based on the principles of partnership and
community empowerment and is lead by young people for young
- Young mentors are recruited who represent a
wide cross section of students from varying social
In 2013-14 1 Bedford Upper School piloted the
Kick Ash programme. 37 year 10 students became Kick Ash mentors
within this school and also worked with 1 of their local
feeder middle schools to deliver an interactive PSHE session to
year 8’s aimed at ‘creating a lifesaving shift in young people’s
attitudes towards the tobacco industry’.
Mentors also spent their year as part of Kick Ash collecting
hundreds of pledges from fellow students and members of the
community who committed to being ‘proud to be smokefree’.
Stop Smoking Service users are provided with a
feedback questionnaire prior to discharge. User feedback is then
used to inform future service development, if required.
A range of methods of public engagement have
been used on the tobacco control agenda, the most recent being a
scoping around local peoples views on illicit tobacco, this was
conducted using both telephone and face to face interviews in
National & Local Strategies
Following the publication of the Public Health White Paper the
Government published a Tobacco Control Plan for England (March
2011). The national ambition for 15 year olds is to reduce
rates of regular smoking among 15 year olds in England to 12% or
less by the end of 2015.
Currently there is no available data to indicate Bedford
Borough prevalence in under 16’s.
Further information from Department of Health
was published in ‘Improving outcomes and supporting transparency –
A public health outcome framework for England’ 2013-2016".
- NICE PH Guidance 23; School-based
Interventions to Prevent the Uptake of Smoking Amongst Children and
Young People 2010
- NICE PH Guidance 14; Preventing the
uptake of smoking by children and young people 2008
- NICE PH Guidance 10; Smoking Cessation Services
NRT is licenced to support 12 to 18year olds
in attempts to stop smoking. [Healthy Lives, healthy people;
a tobacco control plan for England] and should be offered according
to the NICE guidelines PH 10:
“Explain the risks and benefits of using NRT
to young people aged from 12 to 17, pregnant or breastfeeding
women, and people who have unstable cardiovascular disorders. To
maximise the benefits of NRT, people in these groups should also be
strongly encouraged to use behavioural support in their quit
What are the unmet needs/service gaps?
Within some schools there is a lack of
understanding of the importance of their role in supporting young
people to stop smoking, how to raise the issue and make the most of
- Continue implementation of
Kick Ash scheme. Supporting the engagement of 2 schools per year
into the programme.
- Revisit schools to increase
the number of staff able to support students in house and ensure
students are aware of services available to them.
- Encourage local people to
make their homes and cars smoke free with the support of partners
within local services.
- Continue to provide training
and refresher sessions on Brief Interventions particularly to front
line staff, ensuring that ‘every contact counts’.
- Look to find alternative
access points to the service for local youngsters such as social
- Consider enhanced access
routes to support complex clients in partnership with local
- Work alongside maternity and
PH sexual health to increase numbers of pregnant teenage smokers
accessing the service.
- Robust data collection and monitoring of Stop
Smoking Service users
National Centre for Social Research and National Foundation for
Educational Research, Smoking, drinking and drug use among
young people in England 2010, A survey carried out for
the NHS Information Centre. Available at:
(last accessed 6 August 2013)
Public Health England – fingertips –
Health and Wellbeing Indicators
ASH - Second hand Smoke
Rogers. E, Diffusion of innovation
Theory, 1995, available at:
Bandura. A, 1977, Social Learning
Healthy Lives, healthy people; a tobacco
control plan for England (March 2011)
Public Health Outcomes Framework 2013 to
NICE PH Guidance 23; School-based Interventions
to Prevent the Uptake of Smoking Amongst Children and Young
NICE PH Guidance 14; Preventing the uptake of
smoking by children and young people 2008
NICE PH Guidance 10; Smoking Cessation Services
BMA Board of Science, Breaking the cycle of
Children’s exposure to tobacco smoke , 2007. Available
(last accessed 6 August 2013)
Royal College of Physicians , 2005 Going
smoke-free: the medical case for clean air in the home, at work and
in public Places
Scientific Committee on Tobacco and Health
(SCOTH) Department of Health, 2004 - Secondhand smoke: Review
of the evidence since 1998
Health and Social Care Inofrmation Centre,
Infant Feeding Survey, 2005. Available at:
(last accessed 6 August 2013)
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