1.6 Prevalence of smoking—teenagers

Last updated: May 2023
Suggested citation: Greenhalgh, EM, 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 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 behaviour i  in 2017, 6 down from 16,586 in 2014 7 , 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  2014 19 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

 

1.6.1 Latest estimates of prevalence of smoking among teenagers

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  

 

1.6.2 Trends over time smoking among secondary students

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. 

 

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 2020 6

 

The return to a downward trend in the mid–to late–90s 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 2012 23  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

Table 1.6.1
Percentage of Australian secondary students who smoked in the last week by age and sex, 1984–2017

Sources: Hill et al 10-15 ; White and Hayman 16, 17;  White and Smith; 18  White and Bariola; 8  White and Williams; 19  and Guerin and White 2020 4

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 ). 

 

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. 29

Table 1.6.2
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 edition 29

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. 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).

Figure 1.6.2
Prevalence of past month smoking in 14-15 year olds since 1999 in Australia, US, New Zealand and Ireland

 

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Figure 1.6.3
Prevalence of past week smoking in 14-15 year olds since 1999 in Australia, New Zealand, and England

 

Figure 1.6.4
Prevalence of daily smoking in 14-15 year olds since 1999 in Australia, US, New Zealand, Ireland and Canada
Sources and Notes:
  1. 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. 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 (aged 14-15 years) were selected 30 .
  2. US: The High School Youth Risk Behaviour Survey 31 is a biennial survey of students in grades 9-12 (with a sample size of approximately 13,000 per wave) and monitors priority health behaviours and experiences among students in the US. 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.
  3. New Zealand: The ASH Year 10 Snapshot Survey 32 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”.
  4. 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.
  5. England: The Smoking, Drinking and Drug Use Among Young People Survey 35 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.
  6. Canada: The Canadian Student Tobacco, Alcohol and Drugs Survey 36 is a biennial survey administrated to students in grades 7-12 across Canada (approximately 50,000 students per wave). Students in Grade 9 were selected. Daily smoking was calculated from the question “Thinking back over the last 7 days, which days did you smoke at least one whole cigarette?”. For 2014-2015, Canada had high sampling variability so suppressed the estimate for Grade 9.

 

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.

ii  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.

iii See  https://dfat.gov.au/aid/topics/investment-priorities/education-health/education/Documents/australian-education-system-foundation.pdf

 

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References

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