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 shows that in 2022/2023, the prevalence of smoking among teenagers was at its lowest since surveys began almost four decades earlier, and those who are taking up smoking are doing so later in their teen years.4,5 In 2022/2023, the average age of initiation of tobacco use was 16.6 years, and while the average age of initiation has remained stable since 2019, it has substantially increased from 15.7 years in 2001.5 Moreover, an estimated 5,271 Australian school children progressed from experimental to established smoking behaviouri in 2022/2023,4 down from 14,488 in 2017,6,7 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, except for 2020 when the survey was postponed to 2022/2023 due to the COVID-19 pandemic. Detailed reports can be found for the surveys conducted in 1984,11 1987,12 1990,131993,14 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.ii
1.6.1 Latest estimates of prevalence of smoking among teenagers
The prevalence of smoking among adolescents increases with age. As seen in Figures 1.6.1 and 1.6.2, in 2022/2023, older students (aged 16–17 years) were more likely than younger students (aged 12–15 years) to currently smoke (i.e. reported having smoked in the past week) (3% vs 2%, respectively).4 Figure 1.6.2 shows that since 1996, 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 (12–15 years) and older students (16–17 years); 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 Figures 1.6.1 and 1.6.2.
The 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.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 (see InDepth 11A), large tobacco excise increases (see Section 13.6), expanding smokefree environments (see Chapter 15), and new mass media campaigns (see Chapter 14).
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).iii 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,25 and teenagers are now strongly encouraged to remain in school until the completion of Year 12 or its vocational equivalent.26 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.27 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, 19 million children aged 13–15 years smoked cigarettes in 2012–2022 (see Table 1.6.1). The global smoking prevalence among boys was 6.5%, with the prevalence being highest in the European region and lowest in the African region. For girls, the global smoking prevalence rate was 3.0%, with the prevalence being substantially higher in the Americas and European regions than in the other regions. Boys in lower middle-income countries had the highest prevalence in the world, while girls in this income group had the lowest.28
National data have also been reported for New Zealand, Canada, England, Ireland, and the USA. 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 1.6.3–1.6.5 show the prevalence of smoking (past month, past week, and daily) for students aged around 14–15 years* from national surveys in Australia, the USA, 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).
- Australia: The Australian Secondary Students’ Alcohol and Drug (ASSAD) survey is a triennial survey of 12-17 year old students and measures teenage substance use in Australia, with approximately 20,000 students per wave in 2017 and 10,000 in 2022/23. Past month smoking is measured by asking “Have you smoked cigarettes in the last four weeks?” For past week and daily smoking, students were asked to write the number of cigarettes smoked each day over the past week, and the prevalence rates were derived from this. Year 9 students (generally aged 14-15 years) were selected29.
- USA: The High School Youth Risk Behaviour Survey30 is a biennial survey of students in grades 9-12 (with a sample size of approximately 20,000 in 2023) and monitors priority health behaviours and experiences among students in the USA. Past month smoking was calculated by students who had reported smoking on at least one day during the past 30 days before the survey, and daily smoking was calculated from students who had smoked on all 30 days before the survey. Students in 9 th grade (aged 14-15 years) were selected.
- Canada: The Canadian Student Tobacco, Alcohol and Drugs Survey31 is a biennial survey administrated to students in grades 7-12 across Canada (approximately 60,000 students per wave). Students in Grade 9 were selected. Current daily smokers were defined as those who currently smoke and have smoked at least one cigarette per day for each of the 30 days preceding the survey. For 2014-2015, Canada had high sampling variability so suppressed the estimate for Grade 9. The survey was carried out in 2021-22 instead of 2020-21 due to Covid-19.
- New Zealand: The ASH Year 10 Snapshot Survey32 surveys 20,000-30,000 students each year on their smoking and vaping behaviour and attitudes. The survey was not carried out in 2020 due to Covid-19. Smoking rates were measured using the question “How often do you smoke now?” We calculated past month smoking by combining the responses for “at least once a day”; “at least once a week”, and “at least once a month”. Past week was calculated by combining responses of “at least once a week” and “at least once a day”.
- Ireland: Data came from the Irish results from the European Schools Project on Alcohol and Other Drugs,33,34 a European school survey that collects data on substance use among 15-16 year old students (slightly older than the other comparator countries) in as many European countries as possible. The Irish sample comprised approximately 2,000 students per wave. Past month and daily smoking were calculated from the question “How often have you smoked cigarettes during the last 30 days?” Note that confidence intervals were not published for the Irish prevalence rates.
- England: The Smoking, Drinking and Drug Use Among Young People Survey35 is a biennial survey of secondary school students in years 7 to 11 (aged 11 to 15), with approximately 12,000-14,000 students per wave. Past week smokers (regular smokers) were defined as those usually smoking at least one cigarette per week. Results for 15-year-olds are shown.