Scottish Health Survey 2013 - volume 1: main report

4 Smoking

Linsay Gray and Alastair H Leyland

SUMMARY

Smoking prevalence

• In 2013 one in five (21%) of adults reported that they smoked cigarettes. Men remain significantly more likely than women to smoke (23%, compared with 20%). Prevalence was highest among those aged 25 to 54 (24-25%).
• The decline in cigarette smoking continued in 2013, with a significant drop in the percentage of adults aged 16 and over reporting that they smoked cigarettes since 2012 (from 25% to 21%). The decline between 2012 and 2013 is not matched by a decline in the figures reported by the Scottish Household Survey (SHS). Future years of data from both surveys will be required to determine whether this reduction is due to sampling variation or represents a true decrease in the last year.
• Smokers, on average, smoked 13.0 cigarettes per day (13.5 for men and 12.4 for women), with those aged 65 to 74 smoking the most per day (average 17.0 cigarettes). The average number of cigarettes smoked per day by smokers aged 16-64 declined from 16.7 cigarettes per day in 1995 to 12.7 in 2013.
• Once an objective measure of smoking (salivary cotinine) was adjusted for, current cigarette smoking prevalence in 2012/2013 was 27%, four percentage points higher than the estimate based on self-report data only (23% in 2012/2013). The adjusted estimate was the same as in 2008-2011.

Children's exposure to tobacco smoke in the home

• A new target has been set to reduce children's reported exposure to second-hand tobacco smoke in the home from 12% (the figure in 2012) to 6% by 2020. The figure for 2013, 11%, was not significantly different to the percentage exposed in 2012 (12%). Exposure levels varied significantly by age in 2013, with lower reported exposure among younger children.

Non-smokers exposure to tobacco smoke

• One in seven (14%) non-smoking adults reported being exposed to second-hand smoke in their own or in someone else's home in 2013, while 17% reported being exposed to smoke in any public place.
• Non-smokers' (aged 16-74) exposure to tobacco smoke in their own or others' homes has declined over the years (from 33% in 1998 to 15% in 2013) but did not change significantly between 2012 and 2013.
• Exposure levels were similar for men and women. Younger non-smokers remain most likely to be exposed to second-hand smoke in their own or someone else's home (31% of non-smokers aged 16-24), and in any public place (35% of non-smokers aged 16-24).
• An objective measure of tobacco exposure is also collected on the survey. The cotinine levels in the saliva samples collected from participants confirmed that there has been a decline in male and female non-smokers exposure to tobacco over the last decade (geometric mean cotinine levels of 0.40ng/ml in 2003 and 0.08ng/ml in 2012/2013). The decline between 2010/2011 and 2012/2013 was also statistically significant.

4.1 INTRODUCTION

4.1.1 Policy background

Reducing smoking is a major priority for improving health in Scotland. Cigarette smoking is the world's leading cause of preventable poor health and premature death.^[1] In Scotland, tobacco use is associated with over 13,000 deaths (around a quarter of all deaths) and around 56,000 hospital admissions every year.^[2]

Two of the Scottish Government's National Performance Framework (NPF) National Indicators are relevant to smoking.^[3] There is a specific indicator on reducing the proportion of adults who are current smokers, as well as a more general indicator on reducing premature mortality (deaths from all causes in those aged under 75)^[4] for which smoking is a significant contributory factor.

The Scottish Government launched its Tobacco Control Strategy in March 2013,^[5] outlining the intention to create a 'tobacco-free generation' (defined as 'a smoking prevalence among the adult population of 5% or lower') by 2034. Themes covered in the strategy include health inequalities, prevention, protection and cessation, and a range of actions up until 2018 are set out.

One of the 46 actions in the Strategy was to establish a target to reduce the proportion of children exposed to second-hand smoke in the home. The target, announced in March 2014, is to reduce children's exposure from 12% to 6% by 2020; progress towards it will be monitored using data from the Scottish Health Survey (SHeS). A further action was to develop a new NHS Scotland HEAT target^[6] to succeed the target on the provision of smoking cessation services, which ended in March 2014 and saw approximately 125,000 successful 'quits' at one month post quit since April 2011^[7], including more than 70,000 in the 40% most deprived areas. The new target is to achieve at least 12,000 successful quits at twelve weeks post quit, in the 40% most deprived areas within each NHS Health Board (60% for island boards) over the one year ending March 2015.

4.1.2 Reporting on smoking in the Scottish Health Survey (SHeS)

Good quality data on smoking behaviour and exposure to second-hand smoke are important for monitoring trends relevant to the Strategy. The SHeS data presented in this chapter complement the data provided by the Scottish Household Survey^[8] which is used to measure the current NPF indicator on reducing smoking amongst adults. The chapter presents figures for prevalence of smoking among adults aged 16 and over, and for non-smokers' and children's exposure to second-hand smoke. Two sources of data are used: self-reported information and direct objective assessment of smoking status and second-hand smoke exposure via cotinine in saliva samples.

4.1.3 Comparability with other UK statistics

The Health Survey for England, Health Survey for Northern Ireland and Welsh Health Survey provide estimates of smoking prevalence in the other countries within the UK. A Government Statistical Service publication on the comparability of official statistics across the UK advises that the smoking prevalence estimates across these surveys are only partially comparable as they are conducted separately and have different sampling methodologies.^[9] Smoking prevalence estimates from UK-wide Integrated Household Survey for Scotland, Wales, England and Northern Ireland have been deemed as fully comparable.

4.2 METHODS AND DEFINITIONS

4.2.1 Questions on smoking

Questions on smoking have been included on SHeS since 1995.^[10] Some small changes made to the questions in 2008 and 2012 are outlined in the relevant annual reports.^[11],[12]

The questions included in the survey focus on:

• current smoking status,
• frequency and pattern of current smoking,
• the number of cigarettes smoked by current smokers,
• ex-smokers' previous smoking history,
• exposure to second-hand smoke,
• desire to give up smoking, and
• medical advice on giving up smoking.

4.2.2 Methods of data collection

For adults aged 16 and 17 information on cigarette smoking is collected via a paper self-completion questionnaire, offering them privacy to answer without disclosing their smoking behaviour in front of other household members. At the interviewer's discretion, those aged 18 and 19 can either answer the questions in the self-completion booklet or as part of the main interview. For adults aged 20 and over information is collected as part of the main face to face CAPI interview. The questions included in the self-completion questionnaire and the main interview are mostly similar. However, the self-completion questionnaire excludes questions on: past smoking behaviour, desire to give up smoking and medical advice to stop smoking.

4.2.3 Cotinine

Since its inception in 1995, SHeS has been collecting saliva samples to assess people's cotinine levels. Cotinine, a derivative of nicotine, is an objective measure of smoking and exposure to second-hand smoke. Levels above a certain threshold (12ng/ml) indicate that someone has smoked recently, while levels below the threshold are a measure of exposure to second-hand smoke.

Inclusion of cotinine assessment in the survey allows for an objective cross-check on self-reported smoking behaviour which is known to under-estimate prevalence. Inaccuracies in reporting arise in part from difficulties participants may experience in providing quantitative summaries of variable behaviour patterns, but in some cases arise from a desire to conceal the truth from others, including other household members who may be present during the interview. SHeS is the only data source in Scotland to provide a validated measure of self-reported smoking for the adult population.

All adults aged 16 years and over who took part in the biological module were asked to provide a saliva sample in order to measure cotinine levels. Between 1995 and 2011, saliva samples were collected by a nurse. The change, in 2012, from nurse to interviewer administered sample collection should not affect comparability over time, as the collection and analysis procedures did not change. The protocol for collecting saliva samples is included in Annex B, Volume 2 of this report.

To increase the sample size available for analysis, the figures presented in this chapter are based on data from the 2012 and 2013 surveys combined.

4.2.4 Definitions

The following classifications are used in this chapter:

• Current smoking status based on self-report: current smoker, ex-regular smoker, never regular smoker/never smoked at all.
• Mean number of cigarettes smoked by current smokers: this is measured as number per smoker per day, based on self-report.
• Current smoking status with cotinine adjustment: current smokers, based on self-report, and anyone else with a saliva cotinine level in excess of 12ng/ml are classed as current smokers; non-smokers are those who do not currently smoke, based on self-report, and have a saliva cotinine level below 12ng/ml.

The question on non-smokers' exposure to second-hand smoke was updated in 2012 to include exposure outside buildings (e.g. shops, pubs and hospitals), and in cars. In addition, questions on exposure on public transport and in pubs were dropped in light of the very low level of exposure reported in these places (following the ban on smoking in these locations).

Children's exposure to second-hand smoke is measured in two ways on the survey:

• Whether there is someone who regularly smokes inside the accommodation where the child lives, as reported in the household questionnaire; and
• Parents' and older children's (aged 13-15) reports of whether the child is exposed to smoke at home.

The second of these measures is being used to monitor progress towards the target to reduce children's exposure to smoke at home to 6% by 2020.

4.3 TRENDS IN SMOKING PREVALENCE SINCE 1995

Data on the self-reported cigarette smoking status of adults aged 16-64, between 1995 and 2013, are presented in Table 4.1, alongside data on the smoking status of all adults aged 16 and over since 2003.

Since 1995, cigarette smoking among adults aged 16-64 has declined significantly (from 35% to 24% in 2013), mainly due to a significant drop in prevalence between 1995 and 2008 (from 35% to 29%) and, then again, between 2012 and 2013 (from 27% to 24%). The decline in cigarette smoking has been apparent for both men and women. For men, prevalence declined by 9 percentage points (from 34% to 25%) between 1995 and 2013. There has been an even more pronounced drop of 14 percentage points for women aged 16-64 over this same period (from 36% to 22%). The drop in prevalence between 2012 and 2013 was statistically significant for women aged 16-64 (26% to 22%) but not for men

The decline, since 1995, in cigarette smoking levels corresponded with an overall increase in the proportion of 16-64 year olds reporting that they had never smoked or had never smoked regularly (49% in 1995 and 56% in 2013). The percentage of adults aged 16-64 describing themselves as ex-regular smokers also significantly increased between 1995 and 2013 (from 17% to 20%), with some minor fluctuation in intervening years. The trends for never smoked, never regularly smoked and ex-regular smoking were similar for men and women over this period. Figure 4A, Table 4.1

Smoking trends for men and women aged 16 and over since 2003 were similar to those discussed above for 16-64 year olds (Table 4.1). The percentage of all adults reporting that they were current cigarette smokers declined significantly between 2012 and 2013 (from 25% to 21%). Levels also dropped significantly for women over this period (from 24% to 20%) but not for men (from 25% to 23%).

The decline in smoking prevalence between 2012 and 2013 is not matched by a decline in the figures reported by the Scottish Household Survey (SHS), which (as outlined in Section 4.1) is used to monitor the National Performance Framework National indicator "to reduce the percentage of adults who smoke." Future years of data from both surveys will be required to determine whether this reduction is due to sampling variation or represents a true decrease in the last year.

The proportion of adults aged 16 and over who had never smoked or had never smoked regularly increased from 50% in 2003 to 54% in 2013, while the proportion describing themselves as ex-regular smokers changed little between 2003 and 2013 (22-24%). Patterns in cigarette smoking were largely similar for men and women aged 16 and over between 2003 and 2013.

In addition to the decline in smoking prevalence over time, there has also been a steady and significant drop in the mean number of cigarettes smoked by self-reported smokers aged 16-64 (from 16.7 cigarettes per day in 1995 to 12.7 cigarettes per day in 2013). The reduction in mean cigarettes smoked has been more pronounced for men aged 16-64 (from 18.1 cigarettes per day in 1995 to 13.1 cigarettes in 2013) than for women (15.4 and 12.2 cigarettes per day, respectively). The decline observed between 2012 and 2013 was only statistically significant for male smokers aged 16-64 (from 14.7 cigarettes per day to 13.1).

Since 2003, there has also been a significant decline in the mean number of cigarettes smoked per day by all smokers aged 16 and over (from 15.3 cigarettes to 13.0 cigarettes in 2013). Table 4.1

4.4 SMOKING PREVALENCE IN 2013

4.4.1 Smoking prevalence in 2013, by age and sex

Data on the self-reported cigarette smoking status of adults aged 16 and over in 2013 are shown, by age and sex, in Table 4.2. In 2013, men were significantly more likely than women to be current cigarette smokers (23% compared with 20%). Around one in four (24% of all adults, 25% of men and 23% of women) reported that they used to smoke cigarettes regularly, while over half (54%) had either never smoked cigarettes at all or used to smoke them, but not regularly. Women were more likely than men to report having never smoked or having never smoked regularly (57%, compared with 51%).

Table 4.2, Figure 4B and Figure 4C highlight the marked variations in cigarette smoking status by age, noted in previous SHeS reports.^[11],[12] In 2013, cigarette smoking prevalence was highest among those aged 25-54 (24-25%) and lowest among those aged 75 and over (11%). Prevalence estimates for the remaining age groups ranged between 16% and 23%. The overall tendency for lower smoking prevalence among the oldest age group (75 and over) was true for both men (9%) and women (11%).

Naturally, the proportion describing themselves as ex-regular smokers was lowest among younger people (6% for 16-24 year olds) and highest for older age groups (40% for those aged 65-74 and 37% for those aged 75 and over) (Table 4.2). This concurred with an age-related pattern to the percentage reporting that they had never smoked or had never smoked regularly (74% for those aged 16-24; 43% for those aged 65-74; 52% for those aged 75 and over). Both these age-related patterns were more pronounced for men than for women (Figures 4B and 4C).

As also shown in Table 4.2, the mean number of cigarettes smoked per day per adult smoker aged 16 and over in 2013 was 13.0. The mean number smoked by male and female smokers were not significantly different (13.5 cigarettes per day, compared with 12.4 cigarettes). Smokers aged 16-24 smoked the fewest cigarettes per day (9.2 cigarettes), while those aged 65-74 smoked the most on average (17.0 cigarettes). The age-related pattern to cigarette consumption was very similar for male and female smokers. Figure 4B, Figure 4C, Table 4.2

4.4.2 Cotinine-adjusted cigarette smoking status in 2012/2013 combined, by age and sex

Elevated cotinine levels present in some self-reported non-smokers indicate exposure beyond the second-hand degree and suggest misreporting, for whatever reason, of smoking behaviour in the main interview. As discussed in Section 4.2.3, self-reported non-smokers with a cotinine level of 12ng/ml or above are very likely to be recent and/or regular smokers. Adjusted smoking prevalence was calculated by classifying participants as smokers if their cotinine level was 12ng/ml or above, even if they reported being a non-smoker during the interview.

Current smoking prevalence for adults, both before and after adjustment for saliva cotinine level, is presented in Table 4.3. Note that the figures presented in Table 4.3 are based on the sub-sample of participants who participated in the biological module and provided a valid saliva sample.^[13] As the sample size is reduced relative to the entire survey sample, the figures presented here are based on data from both the 2012 and 2013 surveys combined, hence why the self-reported estimates differ to those presented in Table 4.2.

In 2012/2013 combined, 23% of adults aged 16 and over included in this analysis - 23% of the men and 23% of the women - self-reported as current cigarette smokers. When adjusted for participant cotinine levels, prevalence was higher, at 27%, for all adults (28% for men and 26% for women). The adjusted estimates in 2012/2013 (for men, women and all adults) were identical to those in the 2008-2011 period. The 4 percentage point gap (5 points for men and 4 for women) between self-reported smoking status and the cotinine-adjusted smoking prevalence is consistent with findings from the 2003,^[14] 2009,^[15] and 2011^[16] reports. In absolute terms, the discrepancy between the self-reported and adjusted smoking estimates was greatest for men aged 16-24 (6 percentage point difference); 55-64 (8 percentage points) and 65-74 (7 percentage points) and among women aged 55-64 (6 percentage point difference). Table 4.3

4.5 EXPOSURE TO SECOND-HAND SMOKE

4.5.1 Children's exposure to second-hand smoke since 2012, by age and sex

The proportion of children aged 0-15 living in accommodation where someone smoked is presented in Table 4.6. A second measure, reported exposure to smoke in the home, is also presented. The latter of these is the being used to monitor progress towards the target to reduce children's exposure to smoke in the home to 6% by 2020.

In 2013, one in six (16%) children lived in accommodation in which someone smoked (18% of boys and 15% of girls). The three percentage point drop from 2012 (19%) was not statistically significant.

The percentage of children exposed to second-hand smoke in the home was lower than the percentage living in accommodation in which someone smoked (11%, compared with 16%). Children's exposure to second-hand smoke in the home has not changed significantly since 2012 (12%). Levels of second-hand smoke exposure in the home did not vary significantly between boys and girls (11% and 10%, respectively).

The youngest age groups were least likely to live in accommodation where someone smokes (10% of those aged 0-1), and to be exposed to second-hand smoke in the home (5% of those aged 0-1). Whereas older children (aged 10 and above) were most likely both to live in accommodation in which someone smoked (19-20%) and to be exposed to second-hand smoke in the home (14-15%). Table 4.4

4.5.2 Trends in adult non-smokers' self-reported exposure to second-hand smoke since 1998

Since 2008, self-report non-smoking adult participants have been asked if they are regularly exposed to second-hand smoke in a variety of public and private settings. Previous SHeS reports^{[11],[12],[15]} noted that second-hand smoke exposure had fallen markedly since the introduction of the ban on smoking in public places in 2006. As noted in Section 4.2.4, questionnaire changes introduced in 2012 mean that some trends can no longer be reported across the series (trend figures for the period up to 2011 can be found in Table 4.6 of the 2011^[16] report).

Non-smokers' self-reported exposure to smoke in a variety of contexts, since 1998, is presented in Table 4.4. Since the 1998 survey did not include adults aged 75 and over, the following discussion of trends is based on adults aged 16-74 only; figures for all adults aged 16 and over since 2003 are also presented in Table 4.4.

There has been an overall decline in the proportion of non-smokers aged 16-74 reporting being exposed to second-hand smoke in their own or other people's homes (from 33% in 1998 to 15% in 2013). Much of the decline occurred between 1998 and 2010, with little change thereafter (Table 4.4). The three percentage point drop between 2012 and 2013 (from 18% to 15%) was not a statistically significant change.

Due to changes in definitions (see footnotes to Table 4.5), data on second-hand smoke exposure in any public place in 2013 is only comparable with 2012. Under the new definition, the percentage of both male and female non-smokers aged 16 and over exposed in any public place was 17% in 2013, with little change from 2012 (16% for both sexes).

Non-smokers' exposure to second-hand smoke in other public places; at work; and in cars/vans did not change significantly between 2012 and 2013. Similarly, the proportion of male and female non-smokers reporting that they were exposed to second-hand smoke outside buildings (e.g. pubs, shops, hospitals) did not change significantly over this period. Table 4.5

4.5.3 Adult non-smokers' exposure to second-hand smoke in 2013, by age and sex

Data on the percentage of non-smokers aged 16 and over exposed to second-hand smoke in their own or other's home; at work; outside buildings; in cars/vans; and in other public places, in 2013, are presented in Table 4.6. One in seven (14%) non-smokers reported being exposed to second-hand smoke in their own or someone else's home in 2013. Similar proportions reported being exposed to smoke outside public buildings (14%) and in any public place (17%). Seven in 10 non-smokers reported that they were not exposed to second-hand smoke in any of the places asked about.

Rates for male and female non-smokers' exposure to second-hand smoke were very similar in 2013, with the exception that male non-smokers were significantly more likely than females to report second-hand exposure to smoke at work (6% compared with 3%).

The oldest non-smokers (aged 75 and over) were more than twice as likely as the youngest (aged 16-24) to report that they were not exposed to smoke in the places asked about (88% and 42%, respectively) (Figure 4D). Correspondingly, the youngest non-smokers were twice as likely as those aged 25-54 and around three to five times as likely as those aged 55 and over to report that they were exposed to smoke in their own or someone else's home (31%, 13-15% and 6-9%, respectively). Exposure in any public place was also much more common among non-smokers aged 16-24 (35%) and 25-34 (24%) compared with 6-14% for other age groups. Figure 4D, Table 4.6

4.5.4 Trends in adult non-smokers' exposure to second-hand smoke since 2003: cotinine levels

The distribution of cotinine level data for non-smokers is typically very skewed and for this reason geometric means^[17] (rather than arithmetic means) have been calculated as these take extreme values into account (the Glossary at the end of this volume contains more details on these terms). To be included in the following analysis, self-reported non-smokers had to have cotinine levels below 12ng/ml (as already mentioned, levels of cotinine which exceed this amount are indicative of exposure beyond the second-hand degree and suggest misreporting of smoking behaviour in the main interview). The geometric mean cotinine levels for validated non-smokers are presented for 2003, 2008/2009, 2010/2011 and 2012/2013 in Table 4.7.

The geometric mean cotinine level for non-smokers reduced significantly between 2003 and 2012/2013 (from 0.40ng/ml to 0.08ng/ml in 2012/2013). The biggest reduction occurred between 2003 and 2008/2009 (from 0.40 to 0.11ng/ml), with a further significant drop between 2010/2011 and 2012/2013 (from 0.11ng/ml to 0.08ng/ml). Mean cotinine levels have declined significantly since 2003 for both male and female non-smokers and levels have been very similar to for both sexes since 2008/2009 (0.09ng/ml for men and 0.08ng/ml for women in 2012/2013). Table 4.7

Table list

Table 4.1 Cigarette smoking status, 1995 to 2013
Table 4.2 Cigarette smoking status, 2013, by age and sex
Table 4.3 Smoking prevalence estimates without and with saliva cotinine adjustment, 2012/2013 combined, by age and sex
Table 4.4 Children's exposure to second-hand smoke, 2012, 2013, by age and sex
Table 4.5 Non-smokers' exposure to second-hand smoke, 1998 to 2013
Table 4.6 Non-smokers' exposure to second-hand smoke, 2013, by age and sex
Table 4.7 Saliva cotinine levels among self-reported cotinine validated non-smokers, 2003 to 2012/2013 combined

Additional tables available on the survey website include:

• Cigarette smoking status, by age & key demographics
• Smokers: Mean number of cigarettes smoke a day, by age & key demographics
• Smokers: Number of times tried to stop smoking, by age & key demographics
• Smokers: Whether want to give up smoking, by age & key demographics
• Smokers: Longest period ever managed to stop smoking, by age & key demographics
• Past/present smokers: Medical practitioner advised to stop smoking, by age & key demographics
• Past/present smokers: Nicotine replacement used, by age & key demographics
• Persons smoking in accommodation (adults & children), by age & demographics
• Non-smokers (adults & children): Where exposed to smoke, by age & demographics
• Non-smokers (adults): Does passive smoke bother informant by age & demographics
• Smoking rules in households (adults & children), by age & demographics

Table 4.1 Cigarette smoking status, 1995 to 2013

Aged 16 and over									1995 to 2013
Cigarette smoking status	1995	1998	2003	2008	2009	2010	2011	2012	2013
	%	%	%	%	%	%	%	%	%
Men
Current cigarette smokera
16-64	34	36	32	29	28	29	27	28	25
16+	n/a	n/a	29	27	25	26	24	25	23
Ex-regular cigarette smoker
16-64	18	18	19	19	19	18	18	17	20
16+	n/a	n/a	24	24	24	24	23	23	25
Never regular cigarette smoker / never smoked at all
16-64	49	46	49	51	53	53	55	55	55
16+	n/a	n/a	47	49	51	50	52	52	51
Mean per current smoker per day
16-64	18.1	17.6	15.9	15.6	15.2	14.6	14.2	14.7	13.1
16+	n/a	n/a	15.9	15.7	15.4	14.8	14.3	14.7	13.5
Standard error of the mean
16-64	0.31	0.29	0.35	0.49	0.44	0.46	0.38	0.52	0.51
16+	n/a	n/a	0.33	0.46	0.41	0.43	0.35	0.48	0.49
Women
Current cigarette smokera
16-64	36	33	31	28	27	28	26	26	22
16+	n/a	n/a	28	25	25	25	22	24	20
Ex-regular cigarette smoker
16-64	16	16	17	19	17	19	17	18	21
16+	n/a	n/a	20	22	20	21	20	21	23
Never regular cigarette smoker / never smoked at all
16-64	49	51	52	53	56	54	58	56	57
16+	n/a	n/a	53	53	55	54	57	55	57
Mean per current smoker per day
16-64	15.4	15.2	14.8	13.6	13.5	13.3	13.2	12.3	12.2
16+	n/a	n/a	14.7	13.7	13.4	13.1	13.3	12.4	12.4
Standard error of the mean
16-64	0.21	0.24	0.29	0.33	0.30	0.29	0.33	0.43	0.43
16+	n/a	n/a	0.27	0.31	0.27	0.27	0.30	0.40	0.40
All adults
Current cigarette smokera
16-64	35	35	31	29	28	28	26	27	24
16+	n/a	n/a	28	26	25	25	23	25	21
Ex-regular cigarette smoker
16-64	17	17	18	19	18	18	17	17	20
16+	n/a	n/a	22	23	22	23	22	22	24
Never regular cigarette smoker / never smoked at all
16-64	49	48	51	52	54	54	57	55	56
16+	n/a	n/a	50	51	53	52	55	54	54
Mean per current smoker per day
16-64	16.7	16.4	15.3	14.6	14.3	13.9	13.7	13.5	12.7
16+	n/a	n/a	15.3	14.7	14.4	13.9	13.8	13.5	13.0
Standard error of the mean
16-64	0.19	0.19	0.26	0.31	0.29	0.28	0.28	0.36	0.35
16+	n/a	n/a	0.24	0.28	0.26	0.26	0.26	0.34	0.34
Bases (weighted):
Men 16-64	3901	3937	3156	2520	2916	2795	2926	1868	1882
Men 16+	n/a	n/a	3819	3066	3560	3422	3581	2292	2330
Women 16-64	3994	3966	3307	2618	3047	2925	3045	1939	1968
Women 16+	n/a	n/a	4267	3348	3905	3750	3906	2489	2534
All adults 16-64	7895	7903	6463	5138	5962	5720	5971	3807	3850
All adults 16+	n/a	n/a	8086	6413	7465	7173	7487	4780	4864
Bases (unweighted):
Men 16-64	3523	3356	2749	2072	2387	2273	2409	1510	1596
Men 16+	n/a	n/a	3582	2829	3265	3092	3263	2119	2131
Women 16-64	4406	4194	3442	2679	3198	3067	3162	1963	2068
Women 16+	n/a	n/a	4514	3600	4227	4109	4243	2677	2746
All adults 16-64	7929	7550	6191	4751	5585	5340	5571	3473	3664
All adults 16+	n/a	n/a	8096	6429	7492	7201	7506	4796	4877

a Current cigarette smoker excludes those who reported only smoking cigars or pipes

Table 4.2 Cigarette smoking status, 2013, by age and sex

Aged 16 and over								2013
Cigarette smoking status	Age							Total
	16-24	25-34	35-44	45-54	55-64	65-74	75+
	%	%	%	%	%	%	%	%
Men
Current cigarette smokera	22	28	28	24	22	20	9	23
Ex-regular cigarette smoker	5	18	23	21	33	47	49	25
Never regular cigarette smoker / never smoked at all	73	54	49	55	45	33	41	51
Mean per current smoker per day	9.4	10.7	12.2	16.8	16.5	17.7	*	13.5
Standard error of the mean	1.03	0.96	0.80	1.17	1.14	1.65	*	0.49
Women
Current cigarette smokera	18	22	20	25	24	13	11	20
Ex-regular cigarette smoker	7	20	24	21	27	35	29	23
Never regular cigarette smoker / never smoked at all	74	58	55	54	48	53	60	57
Mean per current smoker per day	[8.9]	9.8	12.3	14.6	13.7	[16.0]	[10.6]	12.4
Standard error of the mean	[0.99]	0.75	0.91	0.84	0.91	[1.34]	[1.08]	0.40
All adults
Current cigarette smokera	20	25	24	24	23	16	11	21
Ex-regular cigarette smoker	6	19	24	21	30	40	37	24
Never regular cigarette smoker / never smoked at all	74	56	52	55	47	43	52	54
Mean per current smoker per day	9.2	10.3	12.2	15.6	14.9	17.0	11.1	13.0
Standard error of the mean	0.72	0.63	0.65	0.73	0.76	1.22	1.01	0.34
Bases (weighted):
Men	325	367	387	436	366	269	178	2330
Male smokers	73	104	106	97	76	46	14	516
Women	322	389	412	462	383	303	264	2534
Female smokers	57	84	83	114	90	37	30	495
All adults	647	756	799	898	749	572	442	4864
All smokers	130	188	189	211	166	83	44	1011
Bases (unweighted):
Men	200	310	339	394	353	318	217	2131
Male smokers	50	91	97	92	82	52	20	484
Women	235	419	432	540	442	373	305	2746
Female smokers	48	99	90	128	104	44	33	546
All adults	435	729	771	934	795	691	522	4877
All smokers	98	190	187	220	186	96	53	1030

a Current cigarette smoker excludes those who reported only smoking cigars or pipes

Table 4.3 Smoking prevalence estimates without and with saliva cotinine adjustment, 2012/2013 combined, by age and sex

Aged 16 and over with valid saliva cotinine measurement								2012/2013 combined
Smoking prevalence	Age							Total
	16-24	25-34	35-44	45-54	55-64	65-74	75+
	%	%	%	%	%	%	%	%
Men
Unadjusted self -report: smoke cigarettes	25	33	23	26	23	19	2	23
Adjusted estimate, adding self-reported non-smokers with saliva cotinine of 12ng/ml or over	31	36	27	29	31	26	6	28
Differencea	6	3	4	3	8	7	3	5
Women
Unadjusted self-report: smoke cigarettes	29	27	21	26	26	13	11	23
Adjusted estimate, adding self-reported non-smokers with saliva cotinine of 12ng/ml or over	31	32	26	29	30	17	13	26
Differencea	2	4	6	3	4	4	2	4
All adults
Unadjusted self-report: smoke cigarettes	27	30	22	26	24	16	7	23
Adjusted estimate, adding self-reported non-smokers with saliva cotinine of 12ng/ml or over	31	34	26	29	30	22	10	27
Differencea	4	4	5	3	6	5	3	4
Bases (weighted):
Men	143	152	154	184	152	119	77	981
Women	128	139	169	191	161	128	106	1020
All adults	271	291	323	375	313	247	183	2002
Bases (unweighted):
Men	103	120	137	157	145	160	91	913
Women	89	144	190	206	208	147	126	1110
All adults	192	264	327	363	353	307	217	2023

a Because of rounding, the actual differences shown may be different from the apparent difference between the two percentages

Tables 4.4 Children's exposure to second-hand smoke, 2012, 2013, by age and sex

Aged 0 - 15							2012, 2013
Exposure to second-hand smoke in own home	Age						Total
	0-1	2-3	4-6	7-9	10-12	13-15
	%	%	%	%	%	%	%
Boys
Whether anyone smokes in accommodation
2012	9	23	18	23	21	17	19
2013	8	15	18	22	18	22	18
Reported exposure to second-hand smoke in own home
2012	3	9	8	17	17	13	12
2013	4	9	9	10	15	16	11
Girls
Whether anyone smokes in accommodation
2012	7	16	17	13	26	27	18
2013	12	13	14	11	19	18	15
Reported exposure to second-hand smoke in own home
2012	3	8	11	7	17	20	12
2013	7	6	12	7	14	14	10
All children
Whether anyone smokes in accommodation
2012	8	19	18	18	24	21	19
2013	10	14	16	17	19	20	16
Reported exposure to second-hand smoke in own home
2012	3	8	9	12	17	16	12
2013	5	8	10	9	14	15	11
Bases (weighted):
Boys 2012	111	125	171	164	165	178	914
Boys 2013	110	129	179	169	184	169	941
Girls 2012	113	123	162	148	178	149	873
Girls 2013	110	112	184	154	185	152	898
All children 2012	224	248	333	312	342	327	1787
All children 2013	221	242	363	323	369	321	1839
Bases (unweighted):
Boys 2012	115	119	169	159	151	166	879
Boys 2013	129	139	191	177	155	157	948
Girls 2012	123	132	171	159	169	154	908
Girls 2013	128	135	189	156	151	132	891
All children 2012	238	251	340	318	320	320	1787
All children 2013	257	274	380	333	306	289	1839

Table 4.5 Non-smokers' exposure to second-hand smoke, 1998 to 2013

Non-smokers aged 16 and over								1998 to 2013
Exposure to second-hand smokea	1998	2003	2008	2009	2010	2011	2012	2013
	%	%	%	%	%	%	%	%
Men
In own home
16-74	18	15	10	9	9	8	7	6
16+	n/a	14	10	9	8	8	7	6
In other people's home
16-74	21	16	12	10	11	10	11	10
16+	n/a	15	11	9	10	9	10	9
At work
16-74	23	16	6	6	6	5	6	7
16+	n/a	15	5	5	5	5	6	6
Outside buildings, e.g. pubs, shops, hospitals
16-74	n/a	n/a	n/a	n/a	n/a	n/a	12	15
16+	n/a	n/a	n/a	n/a	n/a	n/a	11	14
In cars / vans
16-74	n/a	n/a	n/a	n/a	n/a	n/a	2	2
16+	n/a	n/a	n/a	n/a	n/a	n/a	2	2
In other public places
16-74	25	26	6	5	7	8	8	8
16+	n/a	25	6	5	6	7	7	7
In own or other's home
16-74	31	24	19	18	17	16	17	15
16+	n/a	24	18	17	16	15	16	14
In any public place (12 onwards)b
16+	n/a	n/a	n/a	n/a	n/a	n/a	16	17
Not exposed to smoke in these places (12 onwards)c
16+	n/a	n/a	n/a	n/a	n/a	n/a	69	70
Women
In own home
16-74	18	13	10	8	8	6	9	6
16+	n/a	13	9	8	8	6	8	6
In other people's home
16-74	25	21	13	13	14	10	13	11
16+	n/a	19	12	12	12	9	11	10
At work
16-74	14	9	2	3	2	3	3	4
16+	n/a	8	2	3	2	2	3	3
Outside buildings, e.g. pubs, shops, hospitals
16-74	n/a	n/a	n/a	n/a	n/a	n/a	13	16
16+	n/a	n/a	n/a	n/a	n/a	n/a	12	14
In cars / vans
16-74	n/a	n/a	n/a	n/a	n/a	n/a	2	2
16+	n/a	n/a	n/a	n/a	n/a	n/a	2	1
In other public places
16-74	28	28	6	6	7	7	8	7
16+	n/a	26	5	5	6	7	8	6
In own or other's home
16-74	35	29	21	19	19	14	19	16
16+	n/a	27	19	18	18	14	17	15
In any public place (12 onwards)b
16+	n/a	n/a	n/a	n/a	n/a	n/a	16	17
Not exposed to smoke in these places (12 onwards)c
16+	n/a	n/a	n/a	n/a	n/a	n/a	70	71
All adults
In own or other's home
16-74	33	27	20	19	18	15	18	15
16+	n/a	25	18	17	17	14	17	14
In any public place (12 onwards)b
16+	n/a	n/a	n/a	n/a	n/a	n/a	16	17
Not exposed to smoke in these places (12 onwards)c
16+	n/a	n/a	n/a	n/a	n/a	n/a	70	70
Bases (weighted):
Men 16-74	2897	2476	1950	2429	2302	2464	1550	1625
Men 16+	n/a	2695	2137	2655	2524	2707	1709	1786
Women 16-74	3077	2677	2197	2574	2474	2648	1662	1799
Women 16+	n/a	3088	2508	2941	2826	3029	1899	2033
All adults 16-74	5973	5153	4147	5003	4776	5111	3211	3424
All adults 16+	n/a	5783	4645	5596	5350	5736	3608	3819
Bases (unweighted):
Men 16-74	2552	2299	1771	2146	1991	2166	1403	1417
Men 16+	n/a	2576	2031	2466	2281	2482	1612	1611
Women 16-74	3321	2850	2353	2764	2667	2844	1784	1921
Women 16+	n/a	3284	2724	3199	3089	3292	2080	2193
All adults 16-74	5872	5149	4130	4910	4658	5010	3187	3338
All adults 16+	n/a	5860	4755	5665	5370	5774	3692	3804

a Percentages add to more than 100% as the categories are not mutually exclusive
b Since 2012 any public place has been defined as: outside buildings, or in any other public places
c These places defined as: in own home, other people's homes, in cars/vans, outside buildings, at work, or in other public places in 2012

Table 4.6 Non-smokers' exposure to second-hand smoke, 2013, by age and sex

Non-smokers aged 16 and over								2013
Exposure to second-hand smokea	Age							Total
	16-24	25-34	35-44	45-54	55-64	65-74	75+
	%	%	%	%	%	%	%	%
Men
In own home	18	6	2	4	4	5	4	6
In other people's home	23	9	10	7	4	7	1	9
At work	7	13	7	7	4	1	-	6
Outside buildings (e.g. pubs, shops, hospitals)	25	19	12	13	11	10	3	14
In cars/vans etc	4	4	1	1	1	2	-	2
In other public places	16	10	5	6	6	4	3	7
In own or other's home	37	13	11	10	8	10	6	14
In any public placeb	32	23	14	16	14	12	6	17
Not exposed to smoke in these placesc	43	61	74	74	76	79	89	70
Women
In own home	11	4	6	5	7	4	5	6
In other people's home	19	15	15	11	5	4	3	10
At work	11	3	4	3	2	-	-	3
Outside buildings (e.g. pubs, shops, hospitals)	31	22	13	11	12	6	4	14
In cars/vans etc	4	2	1	1	2	-	1	1
In other public places	18	9	3	4	4	3	2	6
In own or other's home	26	17	19	15	11	7	6	15
In any public placeb	38	25	15	12	13	8	6	17
Not exposed to smoke in these placesc	41	63	69	75	75	85	88	71
All adults
In own home	15	5	4	5	6	4	5	6
In other people's home	21	12	13	9	5	6	2	10
At work	9	8	5	5	3	1	-	5
Outside buildings (e.g. pubs, shops, hospitals)	28	21	13	12	12	8	4	14
In cars/vans etc	4	3	1	1	2	1	0	2
In other public places	17	9	4	5	5	3	2	7
In own or other's home	31	15	15	13	9	9	6	14
In any public placeb	35	24	14	14	14	10	6	17
Not exposed to smoke in these placesc	42	62	72	75	75	82	88	70
Bases (weighted):
Men	253	263	277	332	286	215	162	1786
Women	263	305	329	348	290	265	234	2033
All adults	515	568	606	680	575	479	395	3819
Bases (unweighted):
Men	150	218	238	292	264	255	194	1611
Women	185	319	342	412	335	328	272	2193
All adults	335	537	580	704	599	583	466	3804

a Percentages add to more than 100% as the categories are not mutually exclusive
b Any public place defined as outside buildings, or other public places
c In own home, other people's homes, in cars/vans, outside buildings, at work, or in other public places

Table 4.7 Saliva cotinine levels among self-reported cotinine validated non-smokers, 2003 to 2012/2013 combined

Self-reported non smokers aged 16 and over with valid saliva cotinine measurementa				2003 to 2012/2013 combined
Saliva cotinine level (ng/ml)	2003	2008/2009 combined	2010/2011 combined	2012/2013 combined
	%	%	%	%
Men
Geometric mean saliva cotinineb	0.44	0.11	0.11	0.09
Confidence interval	(0.40-0.47)	(0.10-0.13)	(0.10-0.13)	(0.08-0.10)
Women
Geometric mean saliva cotinineb	0.37	0.10	0.11	0.08
Confidence interval	(0.34-0.40)	(0.09-0.11)	(0.10-0.12)	(0.07-0.08)
All adults
Geometric mean saliva cotinineb	0.40	0.11	0.11	0.08
Confidence interval	(0.38-0.43)	(0.10-0.12)	(0.10-0.12)	(0.08-0.09)
Bases (weighted):
Men	1513	681	642	708
Women	1583	694	700	755
All adults	3096	1462	1342	1463
Bases (unweighted):
Men	1472	632	598	659
Women	1746	767	781	824
All adults	3218	1493	1379	1483

a To be included within this category, participants had to be both self-reported non-smokers and have a saliva cotinine level lower than 12ng/ml
b Geometric means have been presented for non-smokers as their cotinine data have a very skewed and exponential distribution. A geometric mean is an average calculated by multiplying the values of the cases in the sample and taking the nth root, where n i