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Teenage Smoking in United Kingdom

Background:
Young peoples tobacco use continues to be a widely recognised public health challenge in UK. In November 2010, the government introduced the White Paper Healthy lives, Healthy People: Our Strategy for Public Health in England which set the governments long-term ambitions for improving public health in England. The White Paper recognised the harmful effects smoking has on public health and made a commitment to publish a tobacco control strategy with the aim to minimise tobacco use. It is estimated that each year in England around 340,000 children under the age of 16 who have never smoked before try smoking cigarettes (Department of Health, 209). Every year, around 200,000 children and young people start smoking regularly (HM Government, 2010).Of these 67% start before the age of 18 and 84% by age 19 (Robinson & Bugler, 2008). The annual Government survey of smoking among secondary school pupils defines regular smoking as smoking at least one cigarette a week. However, in 2011 pupils classified as regular smokers smoked a mean (average) of 35.6 cigarettes a week, approximately five a day. Occasional smokers consumed on average 3.5 cigarettes a week (ICHS, 2012).The number of cigarettes smoked by both regular and occasional smokers have fallen significantly since 2007. The proportion of children who have ever smoked continues to decline. In 2011, 25% of 11-15 year olds had smoked at least once, the lowest proportion since the survey began in 1982 when 53% had tried smoking (ICHS, 2012). Previously, girls had been more likely than boys to have ever smoked and to be regular smokers. However, in 2011, a similar proportion of boys and girls said they had tried smoking (25% and 26% respectively.) The prevalence of regular smoking increases with age, from less than 0.5% of 11 year olds to 11% of 15 years old. Smoking initiation is associated with a wide range of risk factors including: parental and sibling smoking, the ease of obtaining cigarettes, smoking by friends and peer group members, socio-economic status, exposure to tobacco marketing, and depictions of smoking in films, television and other media (Royal College of Physician, 2010).

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Smoking and health:


Evidence shows that smoking has negative effects on young peoples health, including respiratory illnesses, poorer lung function, and asthma related illnesses. It can also impair lung growth (Muller, 2007). Young smokers are two to six times more susceptible to coughs, increased phlegm and wheezing than their non-smoking peers (Royal College of Physicians, 1992).There is evidence that young people who smoke experience high rates of nicotine dependence and tend to continue the habit into adulthood (Gervais et al, 2006). Around twothirds of people who smoked started the habit before the age of 18 (HSCIC, 2010).The risks to young smokers continue into later life. Individuals who start smoking before the age of 18 face a greater risk of all types of tobacco related cancers, linked primarily to their earlier exposure to the harmful toxins from cigarettes. Furthermore, girls who start smoking at a young age are much more likely to develop bronchitis or emphysema in adulthood than those who began smoking as adults (Gervais et al, 2006). .

Teenage smokers and cessation service:


Cigarette smoking among children aged 1115 years constitutes a persistent and substantial health issue in Britain. Based on figures for England in 2004 (Department of health, 2005). Responding to this situation, there has been some official recognition of the need for cessation services to target young people. In September 1999 the Health Education Authority (later to become the Health Development Agency) sponsored a conference titled Smoking Cessation in Young People: Should we do more to help young smokers to quit? On the basis of the findings from the conference, Foulds (1999) concluded that: There is ample evidence from both surveys and telephone help lines which demonstrate that a significant proportion of young smokers want to stop smoking, and are willing to seek help to do so. There is need for current smoking cessation services to consider the needs of young smokers. The message, however, does not appear to have been translated into concerted action. Although children were identified in the Smoking Kills White Paper as a target group for reduced smoking, they have received a surprising lack of attention in terms of the service provision linked to smoking cessation. This point is illustrated by the Health Development Agency's recommendations to primary care trusts and service providers West et al (2003) and West et al (2003a). While these recommendations do not completely overlook the matter of service provision for young people the fact that young smokers are identified in the Government's targets serves to ensure that they receive some mention on various occasions it is difficult to escape the impression that young people are of marginal concern compared with the general adult population of smokers and the specific target groups of pregnant women and mothers with young children. In the recommendations for service providers one short paragraph is dedicated to the question What services should be provided for teenagers?(West et al, 2003a). This reads:

There have been some studies looking at the needs of this group, but there is no hard evidence on which to recommend a particular approach and a stages-of-change derived intervention has not shown any benefits.

Stake Holders Involved in Teenage smoking cessation service:

Health Planners

Health employers

Clinicians
Teenage Smoking cessation service Stake Holders

The Government

Teenage smoker

A multi integrated effort need to put in action to be successful in teenage smoking cessation programme. It is not only the duty of government to make sure to keep the teenager away from smoking. Everyone in the society that includes school teachers, parents, health planner, clinicians, and the teenage smoker them self need to be involved in the whole process to make the smoking cessation programs successful. Ethical Principles in Teenage smoking cessation Service: Ethical principles related to smoking cessation service include: Collect information Act on information Advocacy and empowerment Provide information Achieve community health with respect for individual rights Feedback from the community (Public health leadership society, 2002)

All the stakeholders that include public and private sectors involve in teenage smoking cessation service need to collect effective information about teenage smoking that could be from research or local and national survey. A set of good and effective policies need to be initiated by the government based on the information collected. Public support need to be

gain on those policies to make teenage smoking cessation service successful and ensure advocacy. Governance: http://www.smokefreeaction.org.uk/files/images/VM_graph.jpg In March 2011, the government published Healthy Lives, Healthy People: A Tobacco Control Plan for England (Department of Health, 2011). This stated that tobacco use amongst adults must be tackled in order to reduce the number of young people who take up smoking. National ambitions to cut smoking rates in England by the end of 2015 were introduced: To reduce smoking prevalence among adults to 18.5% or less; To reduce rates of regular smoking (defined as smoking at least one cigarette a week) among 15 year olds to 12% or less; and To reduce smoking during pregnancy to 11% or less (measured at the time of birth). Six priority areas for action were defined to achieve these ambitions: Stopping the promotion of tobacco; Making tobacco less affordable; Effective regulation of tobacco products; Helping tobacco users quit; Reducing exposure to second-hand smoke; and Effective communications for tobacco control. In October 2007, it became illegal to sell tobacco products to anyone under the age of 18(rather than 16, as previously). The Tobacco Control Plan acknowledges this but states that young people continue to find new ways to evade the law, either by directly purchasing or getting tobacco through other means. The strategy sets out the aim to continue efforts to reduce the availability of tobacco to young people. There is evidence to suggest that the display of tobacco products in shops can affect young peoples future intentions to smoke.

The Health Act 2009 was introduced to prohibit the display of tobacco products at the point of sale by the end of 2013. It also banned sales from vending machines from October 2011. Both measures were introduced explicitly to protect young people from the harms of smoking. New legislation came into effect in April 2012, ending tobacco displays in all large shops and supermarkets; this will be extended to smaller shops in 2015. Below there are some initiatives taken by the Government to reduce teenage smoking in UK? Reducing affordability:

There is considerable evidence to show that making tobacco less affordable is an effective way of reducing the prevalence of smoking (and young people are particularly sensitive to price).34Reductions in affordability can be driven by taxation on tobacco products or prior on tobacco products. The availability of cheaper illicit tobacco products undermines the effectiveness of high prices and increases affordability, especially for more disadvantaged groups who are more likely to buy illicit tobacco.17 Action on illicit tobacco:

Joint action by the UK Border Agency overseas and HM Revenue & Customs (HMRC) at home continues to maintain downward pressure on the market for illicit tobacco, and HMRC has employed an additional 200 staff devoted to tackling hand-rolled tobacco (Department of health, 2010). Government has developed a cross-departmental illicit tobacco marketing strategy to encourage reductions in demand for illicit tobacco. Vending machines:

Since vending machines are self-service, they offer easy (and often unsupervised) access to tobacco, including for young people under the legal age at which they may be sold tobacco (18 years). Government will prohibit the sale of tobacco from vending machines, subject to Parliamentary consideration of regulations. Reducing the attractiveness of tobacco products. Removal of the display of tobacco products by retailers. Limiting exposure to tobacco use in the media. Reducing the promotion of tobacco through tobacco accessories.

Increasing awareness of the harms of tobacco.

Legal Aspects of teenage smoking cessation:


Health policy is largely formulated and implemented by the devolved administrations of each of the member countries of the United Kingdom. However, as tobacco falls within the remit of a number of different government departments: e.g. Treasury, Business, HMRC as well as Health, tobacco control policy is partly determined at UK-wide level and partly by the devolved administrations. The four nations of England, Scotland, Wales and Northern

Ireland have responsibility for their own smoking cessation and health education campaigns while UK-wide policy and law applies to taxation, smuggling, advertising, and consumer protection issues such as the provision of health warnings on tobacco packaging. Some of these measures are determined by European Union legislation. The law related to inhibit teenage or youth smoking are as follows: The protection from tobacco (Sales from vending machines0 (England) regulations 2012: Sales of tobacco from vending machines is prohibited from 1 October 201. As discussed before most of the teenager got access to the vending machine without proving their age and able to buy cigarettes. The Children and Young Persons (Sale of Tobacco etc.) Order 2007: In force legislation England and Wales. A separate order exists for Scotland. From 1 October 2007 the minimum age for the purchase of tobacco was raised from 16 to 18. The Act updates and amends the Children and Young Persons (Protection from Tobacco) Act 1991. Children and Young Persons (Protection from Tobacco) Act 1991 (External Web Page): In force legislation England, Wales and Scotland only The Act amended and strengthened the existing Children and Young Persons Act 1933 and the Children and Young Persons Act (Scotland) 1937 regarding the sale of tobacco to minors. This Act increased the penalties for the sale of tobacco to persons under the age of 16, prohibited the sale of unpackaged cigarettes and made provision for local authorities to undertake enforcement action relating to offences connected to the sale of tobacco. EU COM(2002) 303 final (Proposal): This council recommendation seeks to tighten tobacco control measures with particular emphasis on youth access to tobacco. Amongst the proposals:

Adult only access to cigarette machines Removal of tobacco products from display Young people to prove their age prior to purchase Banning sales of packets of 10 These recommendations do not call for primary legislation but propose changes to existing legislation such as directives on product regulation and labelling.

Reference List: Department of Health (2011),Healthy lives, healthy people: a tobacco control plan for England. [Online] Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_1 24960.pdf (Accessed 5th December 2012). Department of Health (2009), Impact Assessment for the Health bill [Online] Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsLegislation/DH_ 123583 (Accessed 2nd December, 2012). Gervais A, OLoughlin J et al (2006) Milestones in the natural course of onset of cigarette use among adolescents. Canadian Medical Association Journal, 175(3): 255-261. [Online] Available at: http://www.canadianmedicaljournal.ca/content/175/3/255.short (Accessed 2nd December 2012). Health and Social Care Information Centre. Statistics on smoking: England 2010. Department of Health (2005), Smoking, drinking and drug use among young people in England 2004 [Online] Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_41 18153 (Accessed 3rd December 2012). .

HM Government (2010), A Smoke free Future-A comprehensive tobacco control strategy for England [Online] Available at: http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/MediaCentre/Pressreleasesar chive/DH_111744 (Accessed 2nd December, 2012). J. Foulds (1999), Smoking cessation in young people: should we do more to help young smokers to quit?Health Education Authority, London, p. 17 ICHS (2012),Smoking drinking and drug use among young people in England in 2011. [Online] Available at: http://www.ic.nhs.uk/pubs/sdd11fullreport (Accessed 2nd December 2012). Muller, T (2007), Breaking the cycle of childrens exposure to tobacco smoke. British Medical Association, London. [Online] Available at: http://www.co.marquette.mi.us/departments/health_department/smokefreeup_org/docs/Childr en_Smoking_Report.pdf (Accessed 2nd December 2012). Robinson S & Bugler C (2008) Smoking and drinking among adults, General Lifestyle Survey 2008 [Online] Available at: http://www.ons.gov.uk/ons/search/index.html?pageSize=50&newquery=General+Lifestyle+S urvey+Smoking+and+drinking+among+adults (Accessed 2nd December 2012). R. West, A. McNeill, M. Raw, (2003), Meeting department of health smoking cessation targets: recommendations for primary care trusts Health Development Agency. [Online] Available at: http://www.nice.org.uk/niceMedia/documents/smoking_cessation_targets_part1.pdf (Accessed 3rd December, 2012). R. West, A. McNeill, M. Raw (2003a), Meeting department of health smoking cessation targets: recommendations for service providers Health Development Agency, London. [Online] Available at: http://www.nice.org.uk/niceMedia/documents/smoking_cessation_targets_part2.pdf Royal College of Physicians (20100, Passive smoking and children [Online] Available at: http://bookshop.rcplondon.ac.uk/details.aspx?e=305 (Accessed 2nd December 2012). Royal College of Physicians (1992), Smoking and the young. London: Royal of Physicians.

http://www.apha.org/NR/rdonlyres/1CED3CEA-287E-4185-9CBDBD405FC60856/0/ethicsbrochure.pdf http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/doc uments/digitalasset/dh_111789.pdf

http://www.ic.nhs.uk/webfiles/publications/003_Health_Lifestyles/smoking%20drinkin g%20drug%20use%202011/draft%20folder/Smoking_drinking_and_drug_use_amon g_young_people_in_England_in_2011._Full_report.pdf