Coverage of the Survey of smoking, drinking and drug use among young people in England has focused – not surprisingly – on the news that fewer children are tolerant of their peers drinking. Given the number of headlines reporting on ‘Binge Britain’, this is great to see. Since 11 to 15 year olds, like the rest of us, are more likely to drink than smoke or take illicit drugs, Chris Sorek from Drinkaware might be right when he suggests that the fact that more children don’t approve of their peers drinking is an early sign of a change in the nation's drinking culture.
By contrast, the long-term decline in young people’s smoking has passed without comment. The 2010 survey measured the lowest ever levels of regular smoking – just one in twenty 11 to 15 year olds smoke at least once a week. Yet thirty years ago smoking in this age group was as common as drinking alcohol is now. In 1982, the year the survey started, the majority (53%) of 11 to 15 year olds had tried smoking. By the age of 15, a quarter of boys and girls considered themselves regular smokers.
In the same year, 1982, 35% of adults smoked. Even then, the health impacts of smoking were known. In the intervening years, a combination of persuasion, taxation and increasing restrictions on where people can smoke have made smoking less attractive and less tolerated. Now just one in five adults smoke.
So smoking is no longer the common experience it once was. In one sense this is a public health triumph. But it’s not all good news.
Smoking is a major cause of health inequalities. In England, smoking still causes more premature death than the next six causes put together. Men and women in the lowest income quintile are three times as likely to smoke as those in the highest income quintile. The better-off are less likely to start smoking and find it easier to stop. This translates directly into mortality. The 2010 Marmot review of health inequalities reported that “Smoking accounts for approximately half of the difference in life expectancy between the highest and the lowest income groups.”
What has this to do with schoolchildren’s smoking habits? Well, the survey of smoking, drinking and drug use among young people in England highlights the extent to which parents who smoke influence their children. This manifests itself in several ways. Boys and girls are increasingly likely to smoke as the number of smokers they live with increases; 22% of 11 to 15 year olds who live with three or more smokers smoke regularly, compared with 2% who live in non-smoking households. Young people who live with smokers are more likely to report that their families are more tolerant of their own smoking. Parents are also sources of cigarettes; one in ten regular smokers in this age group is given cigarettes by their parents and a similar proportion say that their parents buy cigarettes for them from shops.
This is all the more concerning because there is evidence that those who take up smoking in their teens find it hardest to give up as adults. Already two-thirds of 11 to 15 year old regular smokers say that they would find it hard not to smoke for a week, and three-fifths had tried (and failed) to give up.
Of course, there are other reasons why children start to smoke. But our research makes a powerful case that public health policy must address the inter-generational effects of smoking. Otherwise, it has the potential to be a deadly inheritance that will affect the poorest the most.