Numbers of Younger Teen Smokers rise while Older Teen Smokers Fall: Smoking Initiation Rates in Europe

An international team of scientists have examined data from six studies to examine when teen smokers take up smoking. The researchers are all involved in the Ageing Lungs in European Cohorts (ALEC) study which is co-ordinated by Deborah Jarvis of Imperial College, London. The study was published in PLOS, which is a peer-reviewed journal. It is available to read online as it is open-access.

Numbers of Younger Teen Smokers rise while Older Teen Smokers Fall: Smoking Initiation Rates in Europe

Smoking is a main cause of avoidable death and increases risk factors in developing respiratory illness, allergies, cancer and cardiovascular disease. It is on the decline in Europe, which is due to the restrictive regulations that countries have introduced. However, more needs to be done to implement effective policies to protect public health. This is reliant on understanding trends of tobacco use over time. The scientists acknowledge that how many people in a population smoke, can depend on how old people are when they start smoking, stop the habit and whether they die from diseases linked to it. 

Not many studies take account of the age that people start using cigarettes, however a 2015 Eurobarometer special report suggested that 19% of European smokers began using cigarettes before they were 15. The use of tobacco at such a young age can have a damaging effect on the organs of the body, and some evidence has suggested that this can affect the future generations who will be born to teen smokers. The World Health Organisation recommends that tobacco use should be monitored in young people aged 13-15, but this age group was not mentioned in the report actioning a 30% reduction in smokers by 2025. 

The scientists looked at trends for smoking initiation in the years 1970-2009, using random samples of European populations. The studies involved almost 120,000 participants from 17 countries. The researchers asked the participants questions about smoking, including a question to design to discover whether they were a regular smoker and how old they were when they began smoking. They grouped the data according to the region of Europe and analysed the results by region and as a whole.

Before 1970, most people began smoking at age 18 if they were male and 19 if they were female. By the 2000s, the age at which people began smoking had reduced to ages 16 and 15. For people aged between 16-20, rates of those beginning to smoke, dropped in the 1970s -2000s. The rate of smoking initiation in Northern Europe were at their lowest in the late 2000s as 20 people per thousand per year began to smoke in their late teens. However other regions had 40-80 smokers per thousand per year, which the scientists considered a high rate of participants taking up the habit.

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Smoking Education Models, Charts & Booklets for Children aged 7-12.

The number of people initiating smoking during early adolescence (11-15 years) increased from 1990 through the 2000s for all regions. Up to forty people per thousand taking up the habit was recorded in West Europe around 2005. The results suggested that while in East, West and South European countries, more needs to be done to discourage early initiation of smoking, Scandinavia and the UK are very proactive at adopting anti-tobacco initiatives. Some of the studies noted that if a person reached the age of 20 without trying smoking, then they were likely to be a non-smoker for the rest of their life.

The increase in tobacco use among young adolescents could be due to strong influence from friends and sibling. Age at puberty has been decreasing, and early puberty onset is linked to early smoking initiation.

Possible strategies to combat adolescents taking up the habit may include increasing tobacco prices, as young people do not usually have access to their own money. The scientists pointed out that hand-rolled products are cheaper and expensive boxed cigarettes may move young people to make their own, increasing access. The scientists recommended equalising the taxation of ready-made and roll-your-own products may help limit this. The law on selling tobacco to minors, should also be enforced through warnings and fines for sellers who flout it, while reducing cigarette advertising and the use of pictorial health warnings can help deter people from trying cigarettes. Finally, maintaining smoke-free places can reduce the places where it is possible to experiment with tobacco.

The studies used finished in 2009, so available data on tobacco control policies was checked by the researchers to bring the study up to date. Between 2007 and 2013, no region of Europe had a clear progress in reducing the smoking initiation rates in adolescents, and the rates are still unacceptably high, therefore there is still a need for further action to discourage rates of smoking from rising again. 

Stoptober is an annual awareness month each October, where people are encouraged to pledge to give up smoking. The NHS offers smoking cessation information and services and online guides including an Under 18s Guide to Quitting Smoking.

Marcon, A., et al., Trends in smoking initiation in Europe over 40 years: A retrospective cohort study. PLOS ONE, 2018; 13 (8): e0201881

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