|Last updated: February 2019
Suggested citation: Greenhalgh, EM and 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; 2019. 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 2017, 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. 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 behaviouri in 2017,6 down from 16,586 in 20147, 17,900 in 2011,8 and 22,077 in 2005.9
National surveys of smoking behaviours among Australian secondary students have been undertaken at three-yearly intervals since 1984 — refer detailed reports for surveys in 1984,10 1987,11 1990,12 1993,13 1996,14 1999,15 2002,16 2005,17 2008,18 2011,8 201419 and 2017.4 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 2017, smoking was extremely rare among 12-year-olds, but that by the age of 17, 12% of males and 9% 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 2017, there were similar proportions of 12– to 17-year-old male (5%) and female (4%) current smokers.4
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 2017, rates of current smoking were the lowest ever observed. Among older students (aged 16 and 17), smoking rates declined from 1999 to 2017; however, the decline between 2014 and 2017 was not significant—see Figure 1.6.1.
Prevalence of Australian secondary school students who report smoking in the last week, Australia 1984 to 2017: 12–15 year olds and 16–17 year olds
Source: Guerin and White 20184
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.20 Although not specifically targeted at children, teenagers reported being aware of the campaign,21 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.15 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.8, 22 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 201223 and the implementation of a number of important tobacco-control strategies, such as plain packaging,24 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.25
Percentage of Australian secondary students who smoked in the last week by age and sex, 1984–2017
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, 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. School retention rates have increased over time,26 and teenagers are now strongly encouraged to remain in school until the completion of Year 12 or its vocational equivalent.27 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.28 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).
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.29
Prevalence of cigarette smoking and estimated numbers of cigarette smokers among children aged 13–15 years, by WHO region and World Bank country income group
Source: World Health Organization. WHO global report on trends in prevalence of tobacco smoking 2000–2025, second edition29
Note: The average estimates were constructed from surveys conducted in countries in the period 2007–2017 and applied to each country’s United Nations estimated population in 2014. All values are rounded to one decimal place; therefore, the total for both sexes may not equal the sum of values for boys and girls.
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. 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 Health Survey showed that the most substantial reduction in the current smoking rate since 2006–07 was among 15- to 17-year-olds, with 3.6% smoking in 2017–18, compared with 16% in 2006–07.30 The latest Canadian Student Tobacco, Alcohol and Drugs Survey found that in 2016–17, 3% of students in grades 7 to 12 were current smokers, with 1% smoking daily and 2% smoking occasionally. The prevalence of current smoking (3%) was unchanged from 2014–15.31 Ireland’s Health Behaviour in School-aged Children Survey 2014 reported that 8% of 10‒17 year olds were current smokers.32 A 2016 survey of 11–15 year-olds across England found that 6 per cent were current smokers.33 In 2018 in the US, 8% of high school students and 2% of middle school students reported current use of cigarettes.34
i 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
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
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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. Guerin N and White V. ASSAD 2017 statistics & trends: Australian secondary students’ use of tobacco, alcohol, over-the-counter drugs, and illicit substances. Cancer Council Victoria, 2018. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/australian-secondary-students-alcohol-drug-survey
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33. Gentzke AS, Creamer M, Cullen KA, Ambrose BK, Willis G, et al. Vital signs: Tobacco product use among middle and high school students — United States, 2011–2018. Morbidity and Mortality Weekly Report, 2019; 68:157–64. Available from: http://dx.doi.org/10.15585/mmwr.mm6806e1