Smoking is among the most insidiously deadly of habits, harming both the one who smokes and those who are exposed to secondhand smoking. Chronic diseases such as obstructive lung disease and some common forms of lung cancer are far more common in smokers and those inhaling second-hand smoke, than in non-smokers.
A new preprint paper on the medRxiv* server exposes the risk factors behind the uptake of smoking in adolescence, which is among the factors that best predict adult smoking.
Earlier research has shown that the majority of adult smokers begin this habit as teenagers. Moreover, the earlier smoking begins, the more likely it is that the individual will continue to smoke as an adult.
However, all adolescents are not equal in their risk status. Prior cross-sectional data has shown that deprivation, for instance, puts children at greater risk of smoking uptake, and thus aggravates the health outcomes.
Yet another established factor is that there are stark differences between groups with high and low socioeconomic status when it comes to the health outcomes of tobacco-related disease.
For these reasons, the UK government has set its aim at achieving a “smoke-free generation”, beginning with an initiative to prevent adolescent uptake of smoking. Its Children’s Charter for Lung Health includes measures to prevent smoking among children.
The data in the current study comes from a follow-up of the UK Millennium Cohort Study (MCS), which had shown a strong predisposition to smoking before the age of 14 years, among those children with parents or caregivers who smoked. As this group of children grows, it has become possible to look at how many young smokers continued to smoke into adolescence, and how many newly took up smoking during this period.
An earlier MCS study, based on a cohort of children born between September 2000 and January 2002, used data on smoking uptake, collected between the ages of 14 and 17 years. The researchers defined new smoking between these ages as smoking uptake, comprising those who had never smoked at age 14 and were smoking regularly at age 17.
Regular smoking at this age was defined as smoking one or more cigarettes a week by that age.
The findings of this study indicate regular smoking was prevalent in over one in ten children in this cohort at the age of 17 years. More than half of these children began smoking between 14 and 17 years. Of the rest, over a tenth were regular smokers at age 14, while 37% had tried smoking or were smoking less than one cigarette a week at this age.
Over one in 20 children who were not smoking at the earlier time point were smoking at least one cigarette a week at age 17. Interestingly, the same factors were found to be linked to those who smoked regularly at age 17 and those who took up smoking between 14 and 17 years.
Ethnic minority status protected against smoking uptake or regular smoking at age 17, but low economic status, as well as being around caregivers or parents who smoked, increased the risk. The lowest household income group had twice the risk of smoking compared to those in the highest income group.
Especially at risk were those teens who, at age 14, had caregivers who smoked. These children were at more than double the risk of smoking uptake between ages 14 and 17, or to smoke regularly at age 17, compared to those with non-smoking caregivers.
Peer group smoking was another risk factor. Such teens were three times more likely to smoke at age 17, and were at double the risk of taking up the habit between ages 14 and 17, vs those with non-smoking peers.
Finally, social media played a large role in promoting smoking uptake in this group. Children who spent 1-5 hours a day on social media had a 40% higher rate of smoking at age 17, while those with more than 5 hours had a doubled risk of either smoking uptake during the years from 14-17 years, or regular smoking at the age of 17.
Overall, there were 160,000 adolescent smokers with a regular habit. Of these, 100,000 started smoking between 14 and 17 years. The highest uptake was in Wales, at ~9%, vs 7% in England.
The data from this cohort indicate that regular smoking by age 17 was associated, in over half the cases, with uptake by age 14. Having caregivers or friends who smoked, and heavy use of social media, were major promoters of the habit, whether new or established, among British teens.
Earlier studies of this cohort showed that two in every 100 children aged 14 were smokers. Moreover, the skewed risk of uptake and regular smoking with lower-income households shows that the harms of smoking are likely to affect poorer individuals disproportionately and that an attempt needs to be made urgently to correct this bias in tobacco use.
Social media is associated with higher smoking rates in other countries as well, notably the USA, which has also reported higher rates of smokeless tobacco use among children who view online advertising for tobacco. The Royal College of Physicians has already urged the government to ban tobacco advertising on social media, a call that gains urgency from this finding.
Moreover, lawmakers should reconsider the fitness of stopping online tobacco advertising once and for all by legislation, keeping in mind the changing profile of these marketing campaigns and their targets.
The ability to identify the variables before the participants took up smoking is a strength of the study. However, smokeless products were not considered, despite the estimates of other researchers that up to 8% of adolescents may use these. The true rate of tobacco use in this group may thus be even higher.
Together, these findings indicate that a large group of UK adolescents still take up smoking despite the government’s pledge to create a “smoke-free generation” and that approaches to address this need to be delivered across childhood.”
In view of the transmissibility of smoking habits and the force of social media to propagate and support it, unified approaches will be needed to ensure that the younger generation is weaned off tobacco.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
Vrinten, C. et al. (2022). Risk Factors for Adolescent Smoking Uptake – Analysis of Prospective Data from the UK Millennium Cohort Study. medRxiv. doi: https://doi.org/10.1101/2022.05.26.22275632. https://www.medrxiv.org/content/10.1101/2022.05.26.22275632v1