Last updated: December 2023 Suggested citation: Greenhalgh, EM, Jenkins, S, Bain, E, and Winstanley, MH. 1.6 Prevalence of smoking—teenagers. In Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2023. 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 2022/2023, the prevalence of smoking among teenagers was at its lowest since surveys began almost four decades earlier.4 Also encouraging is that those who are taking up smoking are doing so later in their teen years. In 2016, the average age of initiation of tobacco use was 16.4 years, which was a statistically significant increase from 16.2 years in 2013 and 15.6 years in 1995.5 An estimated 14,503 Australian school children progressed from experimental to established smoking behaviour [1] in 2017,6,7 down from 16,586 in 2014,8 17,900 in 2011,9 and 22,077 in 2005.10
National surveys of smoking behaviours among Australian secondary students have been undertaken at three-yearly intervals since 1984, with the exception of 2020 when the survey was postponed to 2022/2023 due to the COVID-19 pandemic. Refer detailed reports for surveys in 1984,11 1987,12 1990,13 1993,14 1996,15 1999,16 2002,17 2005,18 2008,19 2011,9 2014,20 , 20176 and 2022/20234 .These surveys have been conducted as a collaborative effort of different organisations in each Australian state and territory and have been led by Cancer Council Victoria (formerly the Anti-Cancer Council of Victoria). These data provide the most comprehensive, consistently collected statistics available on smoking among adolescents in Australia. [2]
1.6.1 Latest estimates of prevalence of smoking among teenagers
The prevalence of smoking among adolescents increases with age. In 2022/23, older students (aged 16–17 years) were more likely than younger students (aged 12–15 years) to be current smokers (i.e., reported having smoked in the past week) (3% vs 2%, respectively).4 Table 1.6.1 shows that since 1984, the difference in smoking prevalence between male and female students has reduced considerably. In 2022/2023 , there were similar proportions of 12-to-17-year-old male (2%) and female (2%) current smokers.4
1.6.2 Trends over time in smoking prevalence among teenagers
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. In 2022/2023, the prevalence of current smoking was the lowest ever observed. Notably, while smoking prevalence declined between 2017 and 2022/2023 among both younger (aged 12 to 15) and older students (aged 16 and 17); older students exhibited stronger evidence of a recent decline in smoking compared to their younger counterparts, who demonstrated more of a plateau or a slight decrease in smoking between 2017 and 2022/2023—see Figure 1.6.1.
The return to a downward trend in the mid- to late-990s in smoking among teenagers coincided with the launch in 1997 of the high-profile, media-led and nationally coordinated National Tobacco Campaign.21 Although not specifically targeted at children, teenagers reported being aware of the campaign,22 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.16 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.9,23 Similarly, the renewed decline in smoking among older teenagers between 2011 and 2014 came in the wake of the launch of the updated National Tobacco Strategy in 201224 and the implementation of a number of important tobacco-control strategies, such as plain packaging,25 large tobacco excise increases (see Chapter 13 Section 2), expanding smokefree environments (see Chapter 15), and new mass media campaigns. Slower progress in recent years may be at least partly due to an absence of ongoing government investment in mass media campaigns, and the tobacco industry’s proliferation of new products and brand names that circumvent Australian laws and appeal to young people.26
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). [3] Therefore, estimates of smoking prevalence among 16- and 17-year olds attending school may not be 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. School retention rates have increased over time,27 and teenagers are now strongly encouraged to remain in school until the completion of Year 12 or its vocational equivalent.28 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.29 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 9.2).
1.6.3 International comparisons of smoking prevalence among teenagers
Worldwide, 24.1 million children (about 7%) aged 13–15 years smoked cigarettes in 2000–2017 (Table 1.6.2). The rates among boys were consistently about 9–10% for all regions, except in the Eastern Mediterranean Region where it was lower. For girls, prevalence was substantially higher in the Americas and European regions than in the other regions. Girls in high-income countries have the highest prevalence in the world, while the highest rate for boys is in the upper middle-income group of countries.30
National data have also been reported for New Zealand, Canada, Ireland, England and the US. These data are of interest because these countries have adopted, to a greater or lesser extent, tobacco control measures similar to those in Australia. Figures 1.6.2–1.6.4 show the prevalence of smoking (past month, past week, and daily) for students aged around 14-15 years* from national surveys in Australia, the US, New Zealand, England, Ireland and Canada since 1999. As indicated in the notes below the figures, there are methodological differences between surveys in the different countries. However, these surveys do suggest a decline in smoking in all of these English-speaking countries over the past two decades. Readers interested in additional age groups should refer to the primary sources, listed in the notes below.
* Irish students are slightly older on average (15-16 years).
[1] Using the methodology outlined in White V and Scollo M. How many children take up smoking each year in Australia? [letter]. Aust NZ J Public Health, 2003; 27:359-60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14705294
[2] A second national series reporting smoking patterns among teenagers commenced with the National Campaign Against Drug Abuse Household Survey in 1985. 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 (ASSAD). 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 overheard/read by parents.
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References
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