Over two thirds of those trying one cigarette go on to become daily smokers, and on average it takes someone 30 attempts to quit successfully, often taking many years. Preventing smoking initiation is therefore vital. However, we can only reduce deaths from smoking now by helping current smokers quit. It takes decades before reductions in youth smoking rates translate into reductions in smoking-related mortality.
Furthermore, reducing adult smoking, particularly in the most disadvantaged communities, reduces youth exposure to smoking role models and access to tobacco, and is key to reductions in youth initiation. Young people growing up in households where people smoke are 4 times as likely to become smokers themselves. Smoking among young people is twice as common among those from disadvantaged backgrounds, transferring inequalities in smoking rates from generation to generation.
The policies likely to have the greatest impact on smoking rates among people are raising the age of sale for tobacco to 21 and reducing smoking imagery in the entertainment media.
Rates and trends
Smoking among children under 16 in England has been monitored since 1982 when current smoking was 19%. In 2000 it was still 19%, but by 2018 it had declined by nearly three quarters to 5%. Read more in Fact Sheet: Young People and Smoking.
This has been accompanied by declines in smoking among 16 and 17 year olds, which fell by two thirds from 23.3% to 7.8% between 2007 and 2019. Read more in Report: Profile of 16/17-year-old smokers.
Despite these declines, every day in England 280 children under 16 start smoking.
Smoking rates among 16-24 year olds have only fallen by a half since 2000, from 32.9% in 2000 to 15.7% in 2020.
Raising the age of sale
Raising the age of sale for tobacco in England from 16 to 18 in 2007 immediately reduced smoking prevalence in 16 and 17 year olds by 30%, as did raising the age to 21 in the US for 18-20 year olds, with smoking initiation declining in future years. Both in the UK and US raising the age of sale is associated with narrowing inequalities in youth smoking initiation.
Read more: Briefing paper on the evidence supporting increasing the age for sale for tobacco from 18 to 21 in England (T21)
Smoking on screen
Since all advertising, promotion and sponsorship is banned in the UK, exposure to smoking in the entertainment media has become an increasingly important factor in youth smoking initiation.
A causal relationship exists between exposure to smoking on screen and smoking initiation. The quantity of tobacco imagery is the determining factor, not the context (it is irrelevant whether smoking is condoned, encouraged or glamourised). This is most likely due to social learning, as most tobacco imagery onscreen is unbranded.
Currently Ofcom regulates TV, video-on-demand, and video-sharing platforms. The BBFC provides age classifications for film and videos/DVDs and the Video Standards Council classifies video games. See ASH law guide for more detail on regulation.
The RCP and ASH have made recommendations for how smoking on screen should be regulated to reduce youth exposure to smoking imagery.
Young people are most likely to start smoking by trying an individual cigarette, rather than buying a packet. Putting warnings on each cigarette stick, such as ‘Smoking kills’ has been found to reduce appeal, increase perceptions of harm, and is likely to help deter smoking. Dissuasive cigarettes would also make the image of single cigarettes in the media less attractive. This is a policy which would be cheap to implement and has population-level impact.
Read more: APPG on Smoking and Health. Delivering a smokefree 2030: The All Party Parliamentary Group on Smoking and Health recommendations for the Tobacco Control Plan 2021. June 2021
Youth smoking prevention campaigns
Youth smoking prevention campaigns have limited evidence of effectiveness.
The tobacco industry ran youth smoking prevention campaigns, claiming that they were good corporate citizens while diverting attention from more effective tobacco control measures such as ad bans. Their campaigns did not reduce youth smoking, proving that such campaigns are not necessarily effective.
Even evidence-based youth smoking campaigns are limited in impact, particularly now smoking rates in young people have declined so significantly. All young people should be educated about the harms of smoking as a core part of health education, but targeted smoking prevention campaigns are expensive compared to other interventions such as raising the age of sale. Investment in such campaigns should be limited to disadvantaged communities with the highest rates of smoking, where need is greatest.