|Last updated: December 2017
Suggested citation: Greenhalgh, EM, Bayly, M, & Winstanley, MH. 1.6 Prevalence of smoking—teenagers. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2017. Available from http://www.tobaccoinaustralia.org.au/chapter-1-prevalence/1-6-prevalence-of-smoking-teenagers
Most adults who smoke started smoking when they were teenagers,1,2 therefore preventing tobacco use among young people is an integral part of ending the tobacco epidemic.3 Encouraging Australian data show that in 2014, the prevalence of smoking among teenagers was at its lowest since surveys began more than three decades earlier.4 Also encouraging is that those who are taking up smoking are doing so later in their teen years.5 In 2013, the average age of initiation of tobacco use was 16.2 years, which was a statistically significant increase from 16.0 years in 2010 and 15.6 years in 1995.5,6 An estimated 16,586 Australian school children progressed from experimental to established smoking behaviour in 2014,i down from 17,900 in 20117 and 22,077 in 2005.8
National surveys of smoking behaviours among Australian secondary students have been undertaken at three-yearly intervals since 1984 — refer detailed reports for surveys in 1984,9 1987,10 1990,11 1993,12 1996,13 1999,14 2002,15 2005,16 2008,17 2011,7 and 2014.4 These surveys have been conducted as a collaborative effort of different organisations in each Australian state and territory and have been led by the Cancer Council Victoria (formally the Anti-Cancer Council of Victoria). These data provide the most comprehensive, consistently collected statistics available on smoking among adolescents in Australia.ii
The prevalence of smoking among adolescents increases with age. Table 1.6.1 shows that in 2014,4 smoking was extremely rare among 12-year-olds, but that by the age of 17, 13% of males and 11% of females were current smokers (i.e., reported having smoked in the past week). Since 1984, the difference in smoking prevalence between male and female students has reduced considerably. In 2014, there were similar proportions of 12– to 17-year-old male (5.4%) and female (4.9%) current smokers.
Reflecting patterns among adults (see Section 1.3), smoking among secondary students has fluctuated over time. Prevalence declined during the 1980s but increased during the first half of the 1990s, before declining again after 1996. Between 2008 and 2011, while the decreases continued among younger students, prevalence plateaued for the 16 to 17-year-olds. The most recent period of 2011 to 2014 has seen a return to the downward trend among all age groups, with a significant decrease in the proportions of current smokers.4 The prevalence figures recorded for 2014 are the lowest since the survey series began in 1984—see Figure 1.6.1.
Prevalence of Australian secondary school students who report smoking in the last week, Australia 1984 to 2014: 12–15 year olds and 16–17 year olds
Source: White and Williams 2015 4
The first return to a downward trend in the mid– to late–1990s in smoking among teenagers coincided with the launch in 1997 of the high-profile, media-led and nationally coordinated National Tobacco Campaign.18 Although not specifically targeted at children, teenagers reported being aware of the campaign,19 and the campaign’s success in reducing adult smoking rates appears to have had the unintended but positive consequence of reducing smoking among young people.14 Other tobacco control activities over the same period—for example, increased tobacco taxes, publicity surrounding the introduction of smokefree environments, and stricter enforcement of regulations relating to sales to minors and smokefree areas—are also likely to have contributed to the decline in smoking prevalence among secondary school students.20,7 Similarly, the renewed decline in smoking among older teenagers in 2014 has come in the wake of the launch of the updated National Tobacco Strategy in 201221 and the implementation of a number of important tobacco-control strategies, such as plain packaging,22 large tobacco excise increases (see Chapter 13 Section 2), expanding smokefree environments (see Chapter 15), and new mass media campaigns.
Percentage of Australian secondary students who smoked in the last week, 1984–2014
A limitation of secondary school data is that young people are required to remain in formal schooling only up until they have completed year ten, after which time they must remain in education, training, or employment up until the age of 17 (with requirements varying slightly by state). Therefore, measuring smoking prevalence among 16 and 17 year olds attending school is not fully representative of all teenagers in these age groups, particularly in the earlier survey years when there were fewer such requirements and leaving school early was more common. However, school retention rates have increased over time,23,24 and teenagers are now strongly encouraged to remain in school until the completion of Year 12 or its vocational equivalent.25 Therefore, the most recent figures likely reflect smoking prevalence rates among older teenagers more accurately than in the earlier years. Even so, these figures probably underestimate prevalence among 16– and 17–year olds to some extent. Teenagers who are committed to school, and have high academic aspirations, are less likely to smoke.26 Conversely, the transition to the workplace may expose some school-leavers to higher levels of peer smoking behaviour if they pursue a semi-skilled or unskilled vocation. Workers in blue collar occupations are more likely to be smokers (see Section 1.7.2).
The Global Youth Tobacco Survey (GYTS) is a joint project of WHO, the US Centers for Disease Control and Prevention, the Canadian Public Health Association and most WHO member states. The GYTS is a schools-based survey of teenagers aged 13‒15, which has enabled consistent data collection from 395 sites encompassing 131 countries, plus the Gaza Strip and the West Bank.27 Table 1.6.2 summarises some of the available data by WHO region, for the years 2007–14.
Current use of any tobacco product* among school students aged 13‒15 by sex and World Health Organization region, 2007–14^
* ‘Current use’ is defined as any use during the past 30 days. Any tobacco product includes cigarettes, chewing tobacco, snuff, dipping tobacco, cigars, cigarillos, little cigars, pipes, bidis, waterpipes or betel nut combined with tobacco.
† Percentages are rounded
^Updated data for Africa and Europe not available as at October 2015; figures represent 2000-07
National data have also been reported for New Zealand, Canada, Ireland, England and the US. These data are of interest since these countries have adopted, to a greater or lesser extent, tobacco control measures which are similar to those operating in Australia. Key findings from some international surveys are reported briefly here and interested readers should refer to the primary sources for further information. Due to methodological differences, it should be noted that these data are not directly comparable with Australian data or with each other.
Results from the most recent New Zealand showed that the current smoking rate in youth (those aged 15–17 years) dramatically declined between 2006–07 and 2016–17, falling from 16% to 4%.29 The latest Canadian Student Tobacco, Alcohol and Drugs Survey found that in 2014–15, less than 2% of students in grades 6–9 and about 10% of students in aged 15–19 were current smokers.30 Ireland’s Health Behaviour in School-aged Children Survey 2014 reported that 8% of 10‒17 year olds were current smokers.31 A 2016 survey of 11–15 year-olds across England found that 6 per cent were current smokers.32 In 2016 in the US, 8% of high school students and 2% of middle school students reported current use of cigarettes.33
ii A second national series reporting smoking patterns among teenagers commenced with the National Campaign Against Drug Abuse Household Survey in 1985.15 Now known as the National Drug Strategy Household Survey, these reports provide information on the population aged 14 and over, but most do not present information for individual year of age. Sample sizes are smaller than for the Australian Smoking, Alcohol and Drug Use surveys. Collection of data through confidential questionnaires administered at school (as occurs with ASSAD) is superior for this age group compared to the NDSHS's phone-based or household drop and collect surveys where teenagers' responses can be overhear/read by parents.
1. US Department of Health and Human Services. Preventing tobacco use among young people. A report of the Surgeon General, 1994. Atlanta, Georgia: Public Health Service, Centers for Disease Control and Prevention, Office on Smoking and Health, 1994. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_1994/index.htm
2. Hill D and Borland R. Adults' accounts of onset of regular smoking: influences of school, work and other settings. Public Health Reports, 1991; 106(2):181–5. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1580225&blobtype=pdf
3. US Department of Health and Human Services. Preventing tobacco use among young people: A report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2012. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/2012/ .
4. White V and Williams T, Australian secondary school students’ use of tobacco in 2014. Centre for Behavioural Research in Cancer, Cancer Council Victoria; 2015. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/school11 .
5. Australian Institute of Health and Welfare. National Drug Strategy Household Survey detailed report: 2013. Cat. no. PHE 183 Canberra: AIHW, 2014. Available from: http://www.aihw.gov.au/publication-detail/?id=60129549469&tab=3 .
6. Australian Institute of Health and Welfare. 2010 National Drug Strategy Household Survey: survey report. Drug statistics series no. 25, AIHW cat. no. PHE 145.Canberra: AIHW, 2011. Available from: http://www.aihw.gov.au/publication-detail/?id=32212254712&libID=32212254712&tab=2 .
7. White V and Bariola E. 3. Tobacco use among Australian secondary students in 2011, in Australian secondary school students’ use of tobacco, alcohol, and over-the-counter and illicit substances in 2011. Canberra: Drug Strategy Branch Australian Government Department of Health and Ageing; 2012. Available from: http://www.nationaldrugstrategy.gov.au.
8. White V and Scollo M. How many children take up smoking each year in Australia? [Letter]. Australian and New Zealand Journal of Public Health, 2003; 27:359−60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14705294
9. Hill D, Willcox S, Gardner G, and Houston J. Tobacco and alcohol use among Australian secondary schoolchildren. Medical Journal of Australia, 1987; 146(3):125–30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3494905
10. Hill D, White V, Pain M, and Gardner G. Tobacco and alcohol use among Australian secondary school students in 1987. Medical Journal of Australia, 1990; 152(3):124–30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2300011
11. Hill D, White V, Williams R, and Gardner G. Tobacco and alcohol use among Australian secondary school students in 1990. Medical Journal of Australia, 1993; 158(4):228–34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8426543
12. Hill D, White V, and Segan C. Prevalence of cigarette smoking among Australian secondary school students in 1993. Australian Journal of Public Health, 1995; 19(5):445–9. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1753-6405.1995.tb00408.x/full
13. Hill D, White V, and Letcher T. Tobacco use among Australian secondary students in 1996. Australian and New Zealand Journal of Public Health, 1999; 23(3):252–9. Available from: http://www3.interscience.wiley.com/journal/120141556/abstract
14. Hill D, White V, and Effendi Y. Changes in the use of tobacco among Australian secondary students: results of the 1999 prevalence study and comparisons with earlier years. Australian and New Zealand Journal of Public Health, 2002; 26(2):156–63. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1467-842X.2002.tb00910.x/abstract
15. White V and Hayman J. Smoking behaviours of Australian secondary school students in 2002. National Drug Strategy monograph series no. 54, Canberra: Australian Government Department of Health and Ageing, 2004. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/content/mono54 .
16. White V and Hayman J. Smoking behaviours of Australian secondary students in 2005. National Drug Strategy monograph series no. 59, Canberra: Drug Strategy Branch, Australian Government Department of Health and Ageing, 2006. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/mono59 .
17. White V and Smith G. 3. Tobacco use among Australian secondary students (PDF 87 KB) in Australian secondary school students’ use of tobacco, alcohol, and over-the-counter and illicit substances in 2008. Canberra: Drug Strategy Branch Australian Government Department of Health and Ageing; 2009. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/school08
18. Hill D and Hassard K. Overview, in Australia’s National Tobacco Campaign. Evaluation Report Volume One. Hassard K, Editor Canberra: Commonwealth Department of Health and Aged Care; 1999. Available from: http://webarchive.nla.gov.au/gov/20140801095025/http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-publicat-document-metadata-tobccamp.htm#
19. Tan N, Montague M, and Freeman J. Impact of the National Tobacco Campaign: comparison between teenage and adult surveys, in Australia's National Tobacco Campaign: evaluation report Vol. 2. Hassard K, Editor Canberra: Commonwealth Department of Health and Aged Care; 2000. p 78−103 Available from: http://webarchive.nla.gov.au/gov/20140801053459/http://www.health.gov.au/internet/main/Publishing.nsf/Content/health-pubhlth-publicat-document-tobccamp_2-cnt.htm
20. White V, Warne C, Spittal M, Durkin S, Purcell K, et al. What impact have tobacco control policies, cigarette price and tobacco control program funding had on Australian adolescents' smoking? Findings over a 15-year period. Addiction, 2011; 106(8):1493−502. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03429.x/pdf
21. Intergovernmental Committee on Drugs, National Tobacco Strategy 2012-2018. Commonwealth of Australia; 2012. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/national_ts_2012_2018 .
22. Tobacco Plain Packaging Act. No. 148 2011; Available from: http://www.comlaw.gov.au/Details/C2013C00190 .
24. Australian Bureau of Statistics. 4221.0 Schools, Australia 2005. Canberra: Australian Bureau of Statistics, 2006. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/FFBE2CE6D8296D21CA2576EA0011F617?opendocument .
25. Ministerial Council on Education, Employment, and Training and Youth Affairs. The Adelaide Declaration on National Goals for Schooling in the Twenty-first Century - Preamble and Goals. Tenth Ministerial Council on Education, Employment, Training and Youth Affairs (Adelaide, 22-23 April). Canberra: Department of Education, Science and Training, 1999. Available from: http://www.scseec.edu.au/archive/Publications/Publications-archive/The-Adelaide-Declaration.aspx
26. Tyas S and Pederson L. Psychosocial factors related to adolescent smoking : a critical review of the literature. Tobacco Control, 1999; 7(4):409–20. Available from: http://tobaccocontrol.bmj.com/cgi/content/full/7/4/409
27. Warren C, Jones N, Eriksen M, and Asma S for the Global Tobacco Surveillance System (GTSS) collaborative group. Patterns of global tobacco use in young people and implications for future chronic disease burden in adults. The Lancet, 2006; 367(9512):749–53. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16517275
28. World Health Organization. Current users of any tobacco product (youth rate). 2015. Available from: http://apps.who.int/gho/data/view.main.1805REG?lang=en
29. Ministry of Health, Tier 1 statistics 2016/17: New Zealand health survey. Wellington: Ministry of Health; 2017. Available from: https://minhealthnz.shinyapps.io/nz-health-survey-2016-17-tier-1/.
30. Propel Centre for Population Health Impact, Canadian student tobacco, alcohol and drugs survey. University of Waterloo; 2017. Available from: https://uwaterloo.ca/canadian-student-tobacco-alcohol-drugs-survey/.
31. Keane E, Gavin A, Perry C, Molcho M, Kelly C, et al., Trends in health behaviours, health outcomes and contextual factors between 1998-2014: Findings from the Irish health behaviour in school-aged children study National University of Ireland Galway: Health Promotion Research Centre; 2017. Available from: http://www.nuigalway.ie/media/healthpromotionresearchcentre/hbscdocs/nationalreports/HBSC-Trends-Report-2017-(web).pdf.
32. NHS Digital. Smoking, drinking and drug use among young people in England–2016. 2017. Available from: http://digital.nhs.uk/catalogue/PUB30132
<33. Jamal A, Gentzke A, Hu SS, Cullen KA, Apelberg BJ, et al. Tobacco use among middle and high school students - United States, 2011-2016. MMWR Morb Mortal Wkly Rep, 2017; 66(23):597-603. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28617771