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Smoking (Young People)

Introduction

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 whole.    

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 Centre).

 

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 taken drugs

 

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 (BMA, 2007)

 

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, 2007)

 

Schools

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. (ERPHO, 2013)

 

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, 2007)

 

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 and 2005.

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 mothers smoked.

 

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 people. 
  • Young mentors are recruited who represent a wide cross section of students from varying social groups.    

 

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’. (http://www.operationsmokestorm.com)     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’.

 

Local Views

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 2012. 

 

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 2008

 

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 attempt”.

 

 

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 every contact.  

 

Recommendations

  • 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 media.
  • Consider enhanced access routes to support complex clients in partnership with local services.
  • 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

 

References

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:  https://catalogue.ic.nhs.uk/publications/public-health/surveys/smok-drin-drug-youn-peop-eng-2010/smok-drin-drug-youn-peop-eng-2010-rep2.pdf (last accessed 6 August 2013)

Public Health England – fingertips – Health and Wellbeing Indicators   http://fingertips.erpho.org.uk/search/smoking

ASH  - Second hand Smoke 2007

Rogers. E, Diffusion of innovation Theory, 1995, available at: http://www.stanford.edu/class/symbsys205/Diffusion%20of%20Innovations.htm

Bandura. A, 1977, Social Learning Theory

Healthy Lives, healthy people; a tobacco control plan for England (March 2011)

Public Health Outcomes Framework 2013 to 2016

NICE PH Guidance 23; School-based Interventions to Prevent the Uptake of Smoking Amongst Children and Young People     http://www.nice.org.uk/

NICE PH Guidance 14; Preventing the uptake of smoking by children and young people 2008

NICE PH Guidance 10; Smoking Cessation Services 2008

BMA Board of Science, Breaking the cycle of Children’s exposure to tobacco smoke , 2007.  Available at: http://www.co.marquette.mi.us/departments/health_department/smokefreeup_org/docs/Children_Smoking_Report.pdf (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: https://catalogue.ic.nhs.uk/publications/public-health/surveys/infa-feed-serv-2005/infa-feed-serv-2005-chap10.pdf (last accessed 6 August 2013)

 

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