Smoking, drinking and drug use among young people in England in 2012

Transcription

1 Smoking, drinking and drug use among young people in England in 01 Edited by Elizabeth Fuller A survey carried out for the Health and Social Care Information Centre by NatCen Social Research and the National Foundation for Educational Research

2 Smoking, drinking and drug use among young people in England in 01

3 Smoking, drinking and drug use among young people in England in 01 Edited by Elizabeth Fuller Principal authors Helen Henderson, Laura Nass, Colin Payne, Andrew Phelps and Alice Ryley

4 Published by the Health and Social Care Information Centre Health and Social Care Information Centre responsible statistician: Paul Eastwood, Lifestyles Statistics Section Head Contact via tel: For queries about printed copies of this report, contact: Publications Officer NatCen Social Research 35, Northampton Square London EC1V 0AX Contact via tel: The full text of this publication has been made available to you on the internet. You can find this at Copyright 013, Health and Social Care Information Centre, Lifestyles Statistics. All rights reserved. This work remains the sole and exclusive property of the Health and Social Care Information Centre and may only be reproduced where there is explicit reference to the ownership of the Health and Social Care Information Centre. This work may be re-used by NHS and government organisations without permission. Commercial reuse of this work must be granted by the Health and Social Care Information Centre. This work is subject to the Re-use of Public sector Information Regulations and permission for commercial use must be obtained from the copyright holder. First published 013 ISBN Designed by Davenport Associates

5 Contents Acknowledgements 7 Summary 9 1 Introduction Background The 01 survey How reliable are young people s answers? Precision of estimates About the tables 15 Smoking Laura Nass and Alice Ryley 17.1 Introduction 19. Smoking prevalence and consumption 0.3 Influences on pupils smoking.4 Where pupils get cigarettes 6.5 Dependence on smoking 30.6 Attitudes and beliefs 31.7 Sources of information about smoking 34.8 Factors associated with regular smoking 34 Tables 39 3 Drinking alcohol Colin Payne and Andrew Phelps Introduction Prevalence of drinking alcohol Patterns of drinking alcohol in the last week Obtaining alcohol Where pupils drink Who pupils drink with Consequences of drinking Family influences Attitudes and beliefs Sources of information about alcohol Factors associated with having drunk alcohol in the last week 94 Tables 99

6 4 Drug use Helen Henderson Introduction Prevalence and frequency of drug use Vulnerable pupils and drug use Availability and awareness of drugs Sources of information about drugs Factors associated with drug use in the last year 15 Tables Smoking, drinking and drug use Helen Henderson Introduction How many young people smoke, drink or take drugs? The prevalence of smoking, drinking and drug use Attitudes School teaching about smoking, drinking and drug use 186 Tables Smoking, drinking alcohol and drug use by region Background Smoking Drinking alcohol Drug use 198 Tables 00 Appendices A Survey design, fieldwork and response 05 B Data analysis and reporting 13 C Questionnaire 19 D School questionnaire 47

7 Acknowledgements Social surveys are the work of a team. The editor takes full responsibility for the content of this report, but gratefully acknowledges the contribution of many colleagues. In particular, thanks are due at NatCen to the interviewers who administered the survey in schools; researchers Victoria Hawkins and Helen Henderson; Sarah Allcock, Kay Renwick, Wendy Watson, Christopher Whiffin and their colleagues in the Operations department, for organising the fieldwork and data processing; Joanna D'Ardenne, who led the cognitive testing of new questionnaire elements; Mel Taylor for design input; programmers John Hurn and Sue Corbett; and statisticians Julia Hall and Vicky Marsh. At NFER, we would like to thank Jennie Jupp, Joanne Haswell and their team, who managed the initial contact with schools. We are also grateful to Sharon Thandi, Victoria Cooper, Victoria Jones, Jesmond Smith, Bethan Thomas and Steve Webster at the Health and Social Care Information Centre; Lee McGill at the Department of Health; Rajikiran Egan at the Department for Education; and everyone else in the project team. Above all, the authors would like to thank all the schools that took part for their cooperation, and, most importantly, the pupils who took part in the study. Smoking, drinking and drug use among young people in England in 01 7

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9 Summary This survey is the latest in a series designed to monitor smoking, drinking and drug use among secondary school pupils aged 11 to 15. Information was obtained from 7,589 pupils in 54 schools throughout England in the autumn term of 01. Smoking (Part ) There has been a long-term decline in the prevalence of smoking since the mid-1990s. In 01, less than a quarter (3%) of pupils had tried smoking at least once. In 1996, nearly half (49%) of 11 to 15 year olds had done so. 4% of pupils said that they smoke at least one cigarette a week, the survey definition of regular smoking. In 01, boys and girls were equally likely to smoke. The prevalence of regular smoking increased with age, from less than 0.5% of 11 year olds to 10% of 15 year olds. Being a regular smoker was associated with other risky behaviours, such as drinking alcohol, taking drugs and truancy. Two thirds (67%) of pupils reported that they had been exposed to second-hand smoke in the past year. 55% of pupils said that this had happened in someone else s home, 43% in their own home, 30% in someone else s car and 6% in their family s car. Smokers tended to know other people who smoke: almost all the pupils who said that they smoked had friends who did so, compared with about half of non-smokers. Regular smokers were also more likely than occasional smokers or non-smokers to have family members who smoked (8% of regular smokers, compared with 71% of occasional smokers and 68% of non-smokers). The number of smokers a pupil lives with is related to whether or not he or she smokes. % of pupils who didn t live with any smokers were regular smokers, compared with 5% who lived with one person who smoked and 16% of those who lived with three or more smokers. Copyright 013, Health and Social Care Information Centre. All rights reserved. Since 007, when the minimum age at which pupils can be sold cigarettes was increased from 16 to 18, the proportion of pupils who have tried to buy cigarettes in a shop has fallen: from 17% in 006 to 5% in 01. However, half of pupils who have tried to buy cigarettes reported that they were never refused. Rather than trying to buy cigarettes in shops, pupils were more likely to have asked someone else to buy cigarettes for them (proxy purchasing), and were more likely to get cigarettes as a result. In 01, 8% of pupils had asked somebody to buy cigarettes on their behalf, and nine out of ten (88%) were successful at least once. Most pupils thought that people of their age smoked to look cool in front of their friends (84%), because they were addicted to cigarettes (70%) or because their friends pressure them into it (70%). The report also includes findings on the patterns of cigarette consumption, dependence on smoking, beliefs and attitudes about smoking, sources of information that pupils found helpful, and personal and school characteristics associated with regular smoking. Smoking, drinking and drug use among young people in England in 01 9

10 Drinking alcohol (Part 3) Less than half of pupils (43%) had ever drunk alcohol. Boys and girls were equally likely to have done so. The proportion of pupil who have had an alcoholic drink increased from 1% of 11 year olds to 74% of 15 year olds. One in ten pupils (10%) had drunk alcohol in the last week. This continues the downward trend in since 003, when a quarter (5%) of pupils had drunk alcohol in the last week. Older pupils were more likely to have drunk alcohol in the last week: the proportion who had increased from 1% of 11 year olds to 5% of 15 year olds. Pupils who had drunk in the last week had drunk an average (mean) of 1.5 units. Median consumption, a more reliable measure, was lower (8.0 units). Most pupils who had drunk alcohol in the last week had consumed more than one type of drink. Boys were more likely than girls to have drunk beer, lager or cider, whereas girls were more likely than boys to have drunk spirits, alcopops or wine. Younger pupils were most likely to drink with family members, older pupils were most likely to drink with friends. Since 006, there has been an increase in the proportions of pupils who usually drink at home or in other people s homes or at parties with friends, and a reduction in the proportion drinking outside. Half (50%) of pupils who had drunk alcohol in the last four weeks said that they had been drunk at least once during that time. Although 61% of them said that they had deliberately tried to get drunk, 39% said they had not. Whether pupils drink or not was strongly influenced by the behaviour and attitudes of their families. Pupils were more likely to drink alcohol if someone they live with does: 83% of pupils whose households did not include anyone who drank had never themselves drunk alcohol, compared with 30% of pupils who lived with three or more drinkers. Similarly, pupils who thought their families didn t like them drinking were less likely to have drunk alcohol than those who thought their families didn t mind if they drank. 87% of pupils who felt that their parents would disapprove had never drunk alcohol had never drunk alcohol, compared with 8% of those who thought that their parents wouldn t mind as long as they didn t drink too much. The proportion of pupils who think it is OK for someone of their age to drink alcohol has fallen in recent years. In 01, 8% of pupils thought that it was OK for someone of their age to drink once a week compared with 46% in 003. Pupils beliefs about why people of their age drink alcohol varied according to whether or not they have drunk alcohol themselves. Pupils who have never drunk alcohol were more likely than those who have to think that people of their age drink because of social pressures: to look cool in front of their friends or because their friends pressure them into it. Pupils who have drunk alcohol were more likely than non-drinkers to believe that people of their age drink to be sociable with friends or because it gives them a rush or buzz. The report also includes findings on patterns of drinking, where pupils get alcohol, beliefs and attitudes about drinking alcohol, sources of information that pupils found helpful, and personal and school characteristics associated with having drunk alcohol in the last week. Drug Use (Part 4) In 01, the prevalence of illegal drug use was at its lowest since 001, when the current method of measurement was first used. 17% of pupils had ever taken drugs, 1% had taken them in the last year and 6% in the last month. Boys and girls were equally likely to have taken drugs, and older pupils were more likely than younger ones to have done so. The prevalence of ever having taken drugs increased with age from 7% of 11 year olds to 31% of 15 year olds. There were similar patterns for drug use in the last year (from 4% to 4%) and in the last month (from % to 13%). 10 Smoking, drinking and drug use among young people in England in 01 Copyright 013, Health and Social Care Information Centre. All rights reserved.

11 Pupils were more likely to have taken cannabis than any other drug. In 01, 8% of pupils reported that they had ever been offered drugs. The report also includes findings on the use of individual drugs, frequency of taking drugs, drug use by vulnerable pupils, and personal and school characteristics associated with having taken drugs in the last year. Smoking, drinking and drug use (Part 5) The estimates from this survey indicate that in England in 01, around 10,000 pupils aged between 11 and 15 were regular smokers, around 30,000 had drunk alcohol in the past week, 00,000 had taken drugs in the last month, and 370,000 had taken drugs in the last year. Around half (5%) of pupils aged between 11 and 15 said that they had tried smoking, drunk alcohol or taken drugs at least once in their lives. 17% had done one or more of these recently. They were more likely to have drunk alcohol in the last week (10%) than to have smoked in the last week (6%) or to have taken drugs in the last month (also 6%). There was considerable overlap between behaviours. For example, 6% of pupils reported taking drugs in the last month and most of those (4% of all pupils) had smoked or drunk alcohol in the last week, or had done both. Almost all schools said that they provide pupils with lessons about tobacco, alcohol and legal and illegal drugs, and most schools said that they provide pupils with at least one lesson a year about each of these topics. Around three in five pupils said that they recalled having lessons about smoking, drinking alcohol or drug use in the last year. Most pupils think that their school has given them enough information about smoking (74%), drinking (71%) and drug use (68%). The report also includes comparisons of pupils views on the acceptability of smoking, drinking alcohol and taking different types of drugs, and background on the provision of education and advice about smoking, drinking and drug use in schools. Smoking, drinking alcohol and drug use by region (Part 6) Data from 011 and 01 have been combined to enable comparisons of the prevalence of smoking, drinking and drug use between regions. The proportion of pupils who had ever smoked varied across regions from % in London and the East and West Midlands to 30% in the North East. Differences between regions in the prevalence of regular smoking were not significant. Copyright 013, Health and Social Care Information Centre. All rights reserved. The proportion of pupils who drank alcohol was lower in London than anywhere else; 31% of pupils in London had ever drunk alcohol. Outside London, the proportion of pupils who had ever drunk alcohol ranged from 36% in the West Midlands to 51% in the North East. The same pattern was seen for drinking alcohol in the last week. The proportion of pupils who had ever tried drugs was lower in regions in the north and midlands than in the south of England. There was no significant variation by region in the proportions of pupils who had taken drugs in the last year or the last month. Smoking, drinking and drug use among young people in England in 01 11

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13 1 Introduction 1.1 Background This is the latest in the series of surveys of secondary school children in England which provides the national estimates of how many young people aged 11 to 15 smoke, drink alcohol or take illicit drugs. The first survey in the series, carried out in 198, measured the prevalence of smoking among pupils and described their smoking behaviour. Trends in smoking were monitored by similar surveys carried out every two years. Questions on alcohol consumption were added to the survey in 1988; the 1998 survey was the first to include questions on the prevalence of drug use. Since 000, the survey has been carried out annually by the National Centre for Social Research (NatCen Social Research since February 01) and the National Foundation for Educational Research (NFER). Each survey now includes a core section of questions covering the following: pupils experience of smoking, drinking and drug use; consumption of cigarettes and alcoholic drinks in the last week; and awareness and availability of specific named drugs. As well as these core measures, questionnaires since 000 have included more detailed questions, with the focus alternating between smoking and drinking in one year and drug use the next. The focus in 01 was smoking and drinking, and this report reflects that. Copyright 013, Health and Social Care Information Centre. All rights reserved. Smoking cigarettes, drinking alcohol and the use of illicit drugs, particularly by young people, have long been seen as key policy concerns. Since 010 there have been several strategic initiatives in each of these areas. 1 Underage drinking was highlighted in the coalition government s Programme for government. The White Paper Healthy lives, healthy people: our strategy for public health in England, published in November 010, included alcohol and drug misuse and smoking as key public health priorities, and also identified ways in which healthy behaviour could be promoted among children and young people at school. 3 In December 010, the Home Office published a new drug strategy, 4 which also included alcohol dependence within its scope. Actions to reduce smoking were set out in the tobacco control plan, published in March This included the ambition to reduce rates of regular smoking among 15 year olds to 1% or less by An initiative including government, business and the voluntary sector, The public health responsibility deal, was also published in March It includes a number of pledges on alcohol, and new pledges have been added since. 8 The government s alcohol strategy was published in March More detail about these and other government policies on smoking, drinking alcohol and drug use can be found in the relevant sections of this report. 1. The 01 survey 1..1 Survey design Following consultation with survey users, the design of the sample was changed in 010. For surveys between 000 and 009, the sample of schools was stratified by school type and sex Smoking, drinking and drug use among young people in England in 01 13

14 of intake, and selected across regions in proportion to the distribution of the population of 11 to 15 year olds. 10 In 010, the sample was stratified by Strategic Health Authority (SHA); within each SHA an equal number of schools was sampled. 11 This design was also used in 011, although stratified by nine regions rather than by ten Strategic Health Authorities. 1 This change was designed to enable the publication of more up-to-date regional analyses of the data than was possible with the original design (see Chapter 6). Data were collected from pupils using a self-completion paper questionnaire. These were usually completed during a single school period, generally between 30 and 40 minutes in length. The time taken by individual pupils to complete the questionnaire was not recorded and it is not possible to estimate an average. However, the allotted time was sufficient for almost all pupils to answer the questionnaire in full. In 01 data were also collected from a school staff member about their school s approach to teaching and otherwise informing pupils about smoking, drinking and illicit drug use. A similar questionnaire had been used in some surveys before 009. For further details of the 01 survey design, see Appendix A. 1.. Coverage As well as the core questions on smoking, drinking and drug use, the 01 questionnaire collected more extensive information about smoking and drinking. This included: where pupils get cigarettes and alcohol; dependence on smoking; exposure to second-hand smoke; where and with whom pupils drink; experience of drunkenness; the attitudes of pupils and their families to smoking and drinking; and the impact of school lessons and other sources of information about smoking and drinking. The questionnaire also included a set of questions designed to measure well-being. 13 The school-level questionnaire covered the frequency of teaching about smoking, drinking and illicit drug use in each school year from Year 7 to Year 11, how lessons were delivered, and other relevant school activities. This focus on smoking and drinking is reflected in the content of this report, which also presents main findings on drug use. Results are presented at a national level, including breakdowns by key characteristics such as age and sex. In addition, data from 011 and 01 have been combined to present key survey estimates by region Response The 01 survey achieved a sample of 7,589 pupils aged between 11 and 15 in 54 schools. In addition, school-level data were collected from 148 schools. Further details on survey response are given in Appendix A Weighting The 01 data collected from pupils have been weighted; both unweighted and weighted bases are shown in the tables. For further information, see Appendix B. No weights have been applied to the school-level data. 1.3 How reliable are young people s answers? Are pupils honest? This survey relies on several strategies to encourage honest reporting of behaviours which pupils may wish to conceal from adults or to exaggerate to their peers; these include 14 Smoking, drinking and drug use among young people in England in 01 Copyright 013, Health and Social Care Information Centre. All rights reserved.

15 collecting information in school classrooms rather than homes, and repeated assurances of confidentiality, backed up by survey procedures which demonstrate this. 14 But, as with most surveys, there are limited opportunities to provide independent verification of pupils responses. This has been investigated in two main ways. Between 1990 and 1998 the survey obtained saliva samples from pupils in half of the participating schools. The samples were tested for the presence of cotinine, a major metabolite of nicotine that indicates recent exposure to tobacco smoke, in order to validate the estimates of the prevalence of smoking derived from the questionnaire. Results from these surveys consistently indicated that children were largely honest about their smoking; only a few children in each survey had saliva cotinine levels that clearly contradicted their self-reported smoking behaviour, and there were no significant differences in the prevalence of smoking between children who supplied saliva samples for testing and those who did not. 15,16 Since questions about drugs were introduced in 1998, the questionnaire has asked about Semeron, a fictional drug. In 01, only 11 pupils (0.% of the total sample) reported that they had ever taken Semeron; this matches the experience of previous years, and lends support to the view that most pupils do not exaggerate their drug use. However, reported rates of awareness may be exaggerated, given that 1% of pupils claimed to have heard of Semeron (this, too, has remained at a similar level since the question was introduced) Are pupils accurate? Honesty is not the only factor affecting the accuracy of responses. In particular, recall of the number of cigarettes smoked or the amount of alcohol drunk can be problematic, given that pupils patterns of behaviour between the ages of 11 and 15 may be experimental and episodic rather than habitual and regular. In order to minimise the difficulties of reporting usual behaviour, questions are asked about consumption of alcohol and cigarettes in the last week. In each case the series of questions is designed to provide effective prompts to memory while minimising data loss caused by incomplete recording. These are discussed in more detail in the relevant chapters of this report. 1.4 Precision of estimates As the data are based on a sample (rather than a census) of pupils, the estimates are subject to sampling error. Appendix B details how to calculate sampling errors for this survey, and includes true standard errors and design effects calculated for key survey estimates. Differences are generally commented upon in the text only if they are significant at the 95% confidence level, implying no more than a 5% chance that any reported difference is not a real one but a consequence of sampling error. Copyright 013, Health and Social Care Information Centre. All rights reserved. 1.5 About the tables Percentages may not add up to 100% because of rounding. The following conventions have been used: 0 = less than 0.5%, but not zero - = zero (i.e. no responses were recorded in this answer category) Unweighted bases and weighted bases are shown. Weighted bases are rounded to the nearest integer and individual weighted bases may not add up to the total base because of rounding. A few pupils failed to answer each question. These no answers have been excluded from the analysis, and so tables describing the same population may have slightly different bases. Square brackets are used in tables to warn of small sample bases (between 30 and 49). Estimates based on 9 or fewer cases would not normally be shown. Smoking, drinking and drug use among young people in England in 01 15

16 In tables where age is a variable, those aged 16 have been grouped with 15 year olds. This is because the survey did not include pupils in Year 1, and the small number of pupils aged 16 sampled from Year 11 were not representative of all pupils aged 16. Similarly, pupils aged 10 have been grouped with 11 year olds. The school year classification is based on the standard system of years used in maintained secondary schools. The school years of pupils attending other types of school have been adjusted accordingly. Notes and references 1 For more information about official strategy, guidance and legislation between 1998 and 011, see past reports in this survey series. HM Government (010) The coalition: our programme for government. London. 3 Department of Health (010) Healthy lives, healthy people: our strategy for public health in England. London. 4 Home Office (010) Drug strategy 010 reducing demand, restricting supply, building recovery: supporting people to live a drug-free life Department of Health (011a) Healthy lives, healthy people: a tobacco control plan for England. London. 6 Department of Health (011a), cited above. This aspiration had already been achieved by the time the policy was published, although this was not known by the authors of the tobacco control plan. See Wright V, Gill V (011) Smoking in Fuller E (ed) Smoking, drinking and drug use among young people in England in 010. NHS Information Centre, Leeds. 7 Department of Health (011b) The public health responsibility deal. London, available via the website 8 Up to date information on the Public Health Responsibility Deal can be found on the website. 9 Home Office (01) The government s alcohol strategy For a description of the sample design of these surveys, see Appendix A in Fuller E & Sanchez M (eds) (010) Smoking, drinking and drug use among young people in England in 009. NHS Information Centre, Leeds 11 See Appendices A and B of the 010 report for full details and a discussion of the possible impact on survey estimates. Fuller E (ed) Smoking, drinking and drug use among young people in England in 010. NHS Information Centre, Leeds. 1 This change was made in anticipation of the proposed abolition of Strategic Health Authorities (SHAs) outlined in the Health and Social Care Bill 011, subsequently enacted in the Health and Social Care Act For the purposes of this survey, the boundaries of SHAs and regions are effectively the same, except that the South East region is split into South Central and South East Coast SHAs. 13 These questions, based on Huebner s life satisfaction scale, have been validated and used by the Children s Society in surveys of young people aged between 10 and 15. See Rees G, Bradshaw J, Goswami H, Keung A (010) Understanding children s well-being: a national survey of young people s well-being. Children s Society, London. 7s%0wellbeing.pdf 14 For example the omission of names or other identifiers from the questionnaires pupils complete. 15 See Goddard E & Higgins V (1999) Smoking, drinking and drug use among young teenagers in 1998, TSO, London, for a fuller discussion. 16 The Health Survey for England (HSE) measures smoking among 8 to 15 year olds using confidential selfcompletion questionnaires. The prevalence of self-reported smoking among 11 to 15 year olds is consistently lower than that reported by pupils in this survey; for example in 008, 3% of 11 to 15 year olds reported to the HSE that they smoked at least once a week, compared with 6% reported to this survey. The HSE also collects saliva samples which are tested for cotinine. 15ng/ml of cotinine is used as a threshold, above which the subject can be reliably considered to have smoked in recent days. Once children with cotinine at this level have been taken into account, HSE estimates of the prevalence of smoking are at levels similar to those measured by this survey. See Moody A, Reilly N (009) Children s smoking and exposure to others smoke in Craig R, Mindell J, Hirani V (eds) Health Survey for England 008: Volume 1: Physical activity and fitness. NHS Information Centre, Leeds 16 Smoking, drinking and drug use among young people in England in 01 Copyright 013, Health and Social Care Information Centre. All rights reserved.

17 Smoking Laura Nass and Alice Ryley Key findings for 01 In 01, 3% of pupils had tried smoking at least once. This is lower than in 011 (5%), and continues the decline in the proportion of pupils who have smoked since 1996, when it was 49%. 4% of pupils were categorised as regular smokers; that is, they reported smoking at least once a week. Unlike in previous years, both boys and girls were just as likely to be regular smokers (both 4%). The prevalence of regular smoking has declined from a peak of 13% in As in previous years, in 01, the prevalence of regular smoking increased with age: from less than 0.5% of 11 year olds to 10% of 15 year olds. 6% of pupils reported smoking in the last week. This was higher amongst girls than boys (7% and 6% respectively). Regular smokers smoked on average about 36 cigarettes per week. 67% of pupils reported being exposed to second-hand smoke in the last year. This was most likely to be in someone else s home (55%). 43% said they had been exposed to second-hand smoke in their own homes, 30% in someone else s car and 6% in their family s car. 68% of pupils reported that members of their family smoked. About a third (3%) reported that one or both of their parents smoked. Almost all smokers had at least one friend who smoked (97% of regular smokers and 98% of occasional smokers) compared with about half (51%) of non-smokers. Regular smokers were also more likely than occasional smokers or non-smokers to have family members who smoked (8% of regular smokers, compared with 71% of occasional smokers and 68% of non-smokers). Copyright 013, Health and Social Care Information Centre. All rights reserved. Pupils who lived with someone else who smoked were more likely to smoke themselves. Just % of pupils who did not live with a smoker smoked regularly, compared with 5% of those who lived with one person who smoked and 16% of pupils who lived with three or more smokers. Pupils who smoked were most likely to get cigarettes by being given them by other people (69%), typically by other friends (57%). As well as being given cigarettes by other people (63%), regular smokers were also likely to report buying cigarettes from a shop (60%) or from other people (46%). The proportion of pupils who tried to buy cigarettes in shops in the past year has fallen in recent years, from 17% of pupils in 006 to 5% in % of pupils who tried to buy cigarettes in a shop were refused at least once in other words half (49%) were always successful. In 01, 8% of pupils had asked someone else to buy them cigarettes from a shop in the last year. 88% of these were bought cigarettes by someone else on at least one occasion. Friends were the most likely people to buy cigarettes on a pupil s behalf Smoking, drinking and drug use among young people in England in 01 17

18 (77%), with strangers being the next most common source (58%). Pupils who were regular smokers were likely to show signs of dependence on the habit. 67% reported that they would find it difficult not to smoke for one week and almost three quarters (7%) would find it difficult to give up altogether. Almost two thirds of regular smokers (63%) had tried to give up smoking. Most pupils (84%) believed that people smoked because they thought it made them look cool in front of their friends. Pupils were also very likely to agree that people of their age smoked because they were addicted to cigarettes (70%), or their friends pressure them into it (70%). Pupils were most likely to say that they got helpful information about smoking from their parents (73%), teachers (71%) and television (69%). Factors strongly associated with smoking include being female, being older, risky behaviours (drinking alcohol, drug use, truancy), and having friends and family who smoke. 18 Smoking, drinking and drug use among young people in England in 01 Copyright 013, Health and Social Care Information Centre. All rights reserved.

19 .1 Introduction.1.1 Background Smoking continues to be a public health concern, with an ongoing focus on the protection of children and young people from its harmful effects. Since 010, the coalition government has continued to develop strategy in this area. A series of White Papers, Healthy lives, healthy people 1 laid out policy for improving public health across England. The aims are to limit the population s exposure to serious health threats, to help people live longer, healthier and more fulfilled lives, and to reduce health inequalities by prioritising the health of the poorest. The White Papers make clear that tobacco consumption will continue to be a key public health priority. Previous government policies had supported several actions aimed at reducing the number of children and young people that smoked. The implementation of an extensive control strategy in 1998 was triggered by White Paper Smoking Kills in which they set a target to reduce the number of children and young people aged 11 to 15 who regularly smoked (defined as usually smoking at least one cigarette a week) from 13% (the proportion in 1996) to 11% by 005 and 9% in The Health Act introduced changes in the law aimed at reducing exposure to second hand smoke and reducing the prevalence of smoking among young people. The Smokefree legislation, implemented in July 007, prohibited smoking in enclosed public spaces, including the workplace. This was unlikely to have a direct effect on the age group covered by this survey, though there may have been indirect effects, for example through the influence of changes in smoking habits by other household members. In October 007, it became illegal to sell tobacco products to anyone under the age of 18 (rather than 16), in England and Wales. The Health Act prohibited the sale of tobacco products from vending machines from 011, and the display of tobacco products at all points of sale by the end of 015. Since 6th April 01 it is illegal for large shops, like supermarkets, to display tobacco products. This extends the overall ban on promoting tobacco products in public in ways that are believed to be particularly attractive to non-smokers and young potential smokers. 5 The White Paper Healthy lives, healthy people: a tobacco control plan for England, published in 011, set out a strategy for reducing tobacco use in the next five years, with the stated aim to reshape social norms to make smoking less desirable, less acceptable, and less accessible. 6 The plan acknowledged that tobacco use amongst adults must be addressed in order to reduce the number of young people who take up smoking. It identified three national ambitions to reach by the end of 015: to reduce smoking prevalence amongst adults in England to 18.5% or less; to reduce the proportion of 15 year olds who are regular smokers to 1% or less; and to reduce rates of smoking throughout pregnancy to 11% or less. Copyright 013, Health and Social Care Information Centre. All rights reserved..1. Smoking and health There is extensive research demonstrating the negative effects of smoking on health. Smoking can contribute to a number of health conditions, including cancers and respiratory, digestive and circulatory diseases. 7 Individuals who start smoking at a young age have higher age-specific rates for all types of tobacco related cancers, linked primarily to their earlier exposure to the harmful toxin from cigarettes. Young smokers are also exposed to more short and long term respiratory symptoms than their non-smoking peers, such as coughing, wheezing and phlegm. Girls who start smoking at a young age are 79% more likely to develop bronchitis or emphysema in adulthood than those who had begun smoking as adults. 8 Further, smoking aggravates asthma symptoms in those already diagnosed, and increases the risk of asthma in young people with no history of the condition. 9 It can also lead to impaired lung growth in children and young adults. 8 There is evidence that 11 to 16 year olds who smoke can also experience high rates of Smoking, drinking and drug use among young people in England in 01 19

20 dependence on cigarettes, showing signs of addiction within four weeks of starting to smoke. It has even been suggested that smoking a single cigarette is a risk indicator of becoming a regular smoker up to three years later. 8, Measuring smoking All pupils were asked questions about their smoking behaviour, including whether they had ever smoked and for those that had, the number of cigarettes and how often they smoke. Based on their responses, pupils were categorised in three ways: Regular smokers (defined as usually smoking at least one cigarette per week) Occasional smokers (defined as usually smoking less than one cigarette per week) or Non-smokers. The term current smoker used in this chapter refers to those who smoke regularly or occasionally. Pupils who stated that they did not smoke, but who recorded elsewhere that they had smoked at least one cigarette in the past seven days, were re-classified in the analysis as occasional smoker, regardless of the number of cigarettes recorded. 11 Until 00, a detailed smoking diary was used to cover smoking behaviour in the past seven days. This method was replaced in 003 by a question recording the number of cigarettes smoked in each of the previous seven days. This change in method means that estimates of the number of cigarettes smoked in the last seven days since 003 are not comparable with estimates from earlier surveys Outline of content This chapter covers the following topics: Smoking prevalence and consumption Influences on pupils smoking, including family and friends Where pupils get cigarettes Dependence on smoking Attitudes and beliefs Sources of information about smoking Finally this report presents an analysis of factors that are associated with regular smoking among pupils.. Smoking prevalence and consumption..1 Whether pupils have ever smoked In 01, 3% of pupils had tried smoking at least once. There has been a decline in the proportion of pupils who have smoked since 1996, when almost half (49%) of pupils had smoked. (Tables.1a,.1b, Figure.1) Since the mid-1990s, higher proportions of girls than boys had tried smoking. In 01, the proportions were similar; 4% of girls and 3% of boys had ever smoked. The likelihood of having ever smoked increased with age from less than 4% of 11 year olds to 45% of 15 year olds. (Table.).. Regular smoking In this study, pupils are defined as regular smokers if they reported smoking at least one cigarette per week. In 01, 4% of pupils were regular smokers; this is in line with the overall decline in regular smoking since the mid-1990s. (Table., Figure.) Similar proportions of boys and girls smoked regularly; this is a change from the pattern in recent years when girls were more likely than boys to be regular smokers. The proportion of regular smokers increased with age: less than 0.5% of 11 and 1 year olds said that they smoked at least once a week, increasing to 10% amongst 15 year olds for both sexes. (Table.3a,.3b, Figure.3) 0 Smoking, drinking and drug use among young people in England in 01 Copyright 013, Health and Social Care Information Centre. All rights reserved.

21 Figure.1 Ever smoked, by sex: All pupils Boys Girls Percent Year Figure. Prevalence of regular cigarette smoking, by sex: All pupils 5 Boys Girls 0 Percent Year Figure.3 Prevalence of regular cigarette smoking, by sex and age All pupils Boys Girls Copyright 013, Health and Social Care Information Centre. All rights reserved. Percent years 1 years 13 years 14 years 15 years Age Smoking, drinking and drug use among young people in England in 01 1

22 ..3 Cigarettes smoked in the last week In addition to questions about their usual smoking habits, pupils were also asked whether they had smoked any cigarettes in the last week, and if so, how many they had smoked on each day. In 01, 6% of pupils said that they had smoked in the last week. Whether pupils had smoked in the last week differed by sex and age. Girls were more likely than boys to have smoked in the last week (7% of girls, compared with 6% of boys). Older pupils were more likely to have smoked in the last week than younger pupils, with less than 0.5% of 11 year olds reporting that they had smoked in the last week, compared with 15% of 15 year olds. (Table.4) As in previous years, the findings suggest that pupils are likely to underestimate their cigarette consumption when classifying their smoking. For instance, 10% of pupils who reported that they had tried smoking, but never smoked now also said that they had smoked at least one cigarette in the last week. Similarly, 60% of pupils who reported that they usually smoked between one and six cigarettes a week said that they had smoked seven or more cigarettes in the previous week. (Table.5) The majority (94%) of regular smokers said that they had smoked on at least one day in the last week. The mean consumption amongst regular smokers was around 36 cigarettes per week. Boys and girls who smoked regularly consumed similar numbers of cigarettes per week (on average 36. cigarettes and 35.0 cigarettes respectively). 60% of occasional smokers had smoked on at least one day in the last week. The mean consumption amongst occasional smokers was just under four cigarettes per week. (Tables.6-.8)..4 When pupils smoke On each day of the last week, between 3% and 4% of pupils reported smoking at least one cigarette. Pupils who smoked were more likely to smoke on Fridays and Saturdays than on any other day of the week. This was largely accounted for by occasional smokers who were more likely to smoke on Fridays (33%) and Saturdays (36%) than on other days of the week (14% to 19% with no clear pattern across the week). The proportion of regular smokers who smoked on any one day in the last week varied less, between 68% (Sundays) and 79% (Fridays). (Tables.7,.8) On average, the number of cigarettes smoked by regular smokers on any day of the week varied from 5.0 cigarettes on Mondays to 7.3 cigarettes on Saturdays; occasional smokers smoked on average one cigarette a day, except on Fridays and Saturdays when their average consumption was around two cigarettes. (Table.9,.10)..5 Types of cigarettes smoked Current smokers were asked about the type of cigarettes they usually smoked, choosing between packet or hand-rolled cigarettes or either. In 01, 39% of current smokers said that they smoked packet cigarettes, 4% hand rolled cigarettes and 37% smoked both types equally. Girls who smoked were more likely than boys to smoke cigarettes from packets only (45% and 31% respectively) and less likely to smoke roll-ups only (15%, compared with 35%). (Table.11).3 Influences on pupils smoking.3.1 Exposure to second-hand smoke Recent government policy has focused on reducing exposure to second-hand smoke as well as reducing the prevalence of smoking. 13 The 01 survey asked pupils different questions about their exposure to other people s smoke. Pupils were asked how often they were near to other people smoking in four different situations: in their own home, the homes of others, in their family s car or someone Smoking, drinking and drug use among young people in England in 01 Copyright 013, Health and Social Care Information Centre. All rights reserved.

23 else s car. Pupils were able to report exposure in any of these places from every day or most days down to never in the past year. Two thirds (67%) of pupils had been exposed to second-hand smoke in at least one of these settings. Pupils were most likely to report that in the past year they had been exposed to second-hand smoke in someone else s home (55%). 43% reported exposure to secondhand smoke in their own homes. Pupils were less likely to report being exposed to other people s smoke in their family s car (6%) or someone else s car (30%).Younger pupils were less likely to say they had been exposed to other people s smoke than older ones (61% of 11 year olds, increasing to 76% of 15 year olds), although this pattern varied according to setting and frequency of exposure. (Table.1) In all settings, regular smokers were most likely to say they had been near other people smoking on most days. Half (50%) of regular smokers had been exposed to second-hand smoke on a daily basis in their home, 33% in other people s homes, 3% in their family s car and 17% in someone else s car. In contrast, over the past year, 59% of non-smokers had never been exposed to secondhand smoke at their home, 49% never in someone else s home, 76% never in their family s car and 73% never in anyone else s car. (Table.13, Figure.4) Figure.4 Exposure to second-hand smoke every day or most days, by smoking status All pupils 60 Regular smoker Occasional smoker Non-smoker Percent At home In someone else s home In family s car In someone else s car Where exposed to second hand smoke.3. Whether pupils friends or families smoke Pupils were also asked whether any of their friends or family members smoked cigarettes. Copyright 013, Health and Social Care Information Centre. All rights reserved. Most pupils knew someone who smoked cigarettes, and this was more likely to be a family member (68%) than a friend (55%). Among family members, 3% of pupils reported that a parent smoked, 14% that a brother or sister smoked, and 53% that another relative was a smoker. Pupils were more likely to say that they had friends of their own age or older who smoked (45% and 41% respectively), than younger friends (18%) or a boyfriend or girlfriend (4%) who smoked. (Table.14) The pattern among friends is likely to reflect the pattern of smoking among the different age groups represented by these categories. Similarly, younger pupils were more likely than older ones to say that no one they knew smoked; 8% of 11 year olds, compared with 8% of 15 year olds, and this variation was largely accounted for by the proportions who had friends rather than family who smoked. Whether pupils knew other people who smoked was related to their own smoking behaviour. While only 1% of regular and occasional smokers had no friends or relatives who smoked, 18% of non-smokers said they had no friends or family members who smoked. Smoking, drinking and drug use among young people in England in 01 3

24 Almost all regular smokers (97%) and occasional smokers (98%) had friends who smoked compared with 51% of non-smokers. The pattern was different for family members: regular smokers were most likely to say they had family members who smoked (8% regular smokers, compared with 71% of occasional smokers and 68% of non-smokers reported family members who smoked). (Table.15, Figure.5) Figure.5 Smokers pupils know, by smoking status All pupils Regular smokers Occasional smokers Non-smoker Percent Boyfriend or girlfriend Friends of pupil s own age Older friends Younger friends Smokers pupils know Parents Brothers or sisters Other relatives.3.3 Other smokers at home Pupils were asked how many people they lived with smoked. 63% said they did not live with anyone else who smoked. 3% of pupils lived with one smoker; 11% with two smokers and 3% with three or more people who smoked (data not shown). Pupils who lived in a household where someone else smoked were more likely to smoke than those who did not live with any smokers. The proportion of pupils who smoked increased in line with the number of smokers in their household. For example, % of pupils who did not live with any smokers were regular smokers, 5% of pupils living with one smoker were regular smokers, and this increased to 16% amongst pupils living with three or more smokers. Similarly, the proportion of pupils who were non-smokers decreased with the number of smokers living in the household, from 95% of pupils who lived with no other smokers to 75% of pupils living with three or more smokers. (Table.16).3.4 Perceived family attitudes to smoking Pupils were asked what their families would think about their smoking. Pupils were likely to interpret family as referring primarily to their parents or carers. Questions covered three different situations: Pupils who said that they did not smoke were asked How do you think your family would feel if you started smoking? Pupils who said that they smoked, but their family did not know that they did, were asked How do you think your family would feel if they know you smoked? Pupils who said that they smoked and their families knew they did were asked How does your family feel about you smoking? The answer categories for these three questions were comparable and have been combined for analysis purposes. In 01, the majority of pupils thought that their families would have a negative attitude towards them smoking, with 74% believing that their families would try to stop them smoking and 18% saying that their families would try to persuade them to stop. Only 1% of 4 Smoking, drinking and drug use among young people in England in 01 Copyright 013, Health and Social Care Information Centre. All rights reserved.