Tobacco use among adolescents in Scotland: profile and trends

1. BACKGROUND AND METHODOLOGY

This report uses data from the 1990-1998 Smoking Among Secondary Schoolchildren Survey series and the 2000-2013 Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) to investigate the factors associated with tobacco use in 13 and 15 year old school pupils in Scotland and changes in these over time.

POLICY CONTEXT

Tobacco remains the primary preventable cause of ill health and premature death in Scotland. Tobacco control has been a population health priority of the Scottish Government since its establishment and policy milestones since 1999 have been:

• Legislation banning tobacco advertising in 2002^[1]
• A complete ban on smoking in all enclosed public spaces in 2006^[2]
• An increase in the age for tobacco sales from 16 to 18 in 2007
• An overhaul of tobacco sale and display law, including a ban on automatic tobacco vending machines and the display of smoking-related products in shops^[3]
• The establishment of the first Tobacco Retailer Register in the UK
• The creation of an offence of 'proxy purchase'
• Comprehensive awareness-raising campaigns
• Record investment in NHS smoking cessation services.

In March 2013, the Scottish Government published its current tobacco control strategy, Creating a Tobacco-Free Generation: A Tobacco Control Strategy for Scotland,^[4] which set a target for adult smoking prevalence to be reduced to 5% or lower by 2034. Progress towards this target is measured using data on smoking from the Scottish Household Survey. As most smokers start as teenagers and almost none after the age of 25, key to the Strategy's success is reducing smoking in young people by creating an environment where they choose not to smoke and where it is harder for under-18s to access cigarettes through limiting supply.

SURVEY BACKGROUND AND PURPOSE

The Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) is the Scottish Government's main source of data on adolescent substance use. SALSUS is a continuation of a long established series of national surveys on smoking, drinking and drug use (Figure 1.1). These were carried out jointly in Scotland and England between 1982 and 2000 to provide a picture of young people's smoking, drinking, and drug use behaviours.

Since 2002, SALSUS has measured progress towards Scottish Government targets for smoking and drug use, and is used to inform the Scottish Government priority of addressing harmful drinking among young people. The survey series also provides local prevalence rates for smoking, drinking and drug use across Alcohol and Drug Partnerships (ADPs), local authorities and NHS Boards. SALSUS data are used in a number of the ADP national core indicators, which allows them to monitor their progress against a common set of outcomes. ADPs and their community planning partners make extensive use of SALSUS data in local needs assessments and in developing their strategic priorities.

Reports from the 2013 survey, include a detailed smoking topic report, can be found here: http://www.isdscotland.org/Health-Topics/Public-Health/SALSUS/Latest-Report/.

Figure 1.1 - History of SALSUS and its predecessors

METHODOLOGY

SALSUS is a confidential, self-completion questionnaire that is currently completed by S2 and S4 pupils (average age 13 and 15 years) in school (previous waves surveyed S1-S4). The survey covers items on smoking, drinking and drug use, as well as a number of contextual questions about lifestyle, health and wellbeing, and social circumstances.

The sample size has increased over time. Until 1998, the sample size was between 2,000 and 3,000 interviews per wave, increasing to 3,538 in 1998 and to 4,774 in 2000. In 2002, the sample size was increased to 23,090 to allow robust estimates at local authority, NHS Health Board, and ADP levels. After 2002, it was decided that alternate waves would have a sample size large enough to provide robust estimates at sub-Scotland level and this happened until the large 2010 wave. There was no survey undertaken in 2012, and the 2013 wave was designed as a large rather than a small wave, with an achieved sample size of 33,685.

Since 1990, the datasets from SALSUS and its predecessors have been deposited in the UK Data Archive. ^[5] In 2015, the Scottish Government commissioned Ipsos MORI to examine the feasibility of combining these datasets into one to facilitate greater use of this resource, and, if it were deemed feasible, to create a unified dataset together with accompanying documentation. After examining changes in the methodology and questionnaire coverage, the feasibility study concluded that the data were consistent enough that a combined dataset would allow meaningful analysis of trends over time.^[6] This combined dataset has now been constructed and this report is one of the first uses of this.

The analysis in this report is primarily descriptive, apart from the logistic regression reported on in chapter 6. It was undertaken by an Aberdeen University PhD student intern who was based in the Scottish Government's Health Analytical Services Division. Information about how the analysis was undertaken can be found in Appendix A.1. Analysis was undertaken using SPSS for Windows v.16.01.1 and R was also used for the generation of figures. The dataset, and the individual survey data from 1990 to 2013 used to create it, are available from the UK Data Archive and a user guide has been published on the Scottish Government's website.^[7]

Low rates of regular and occasional smoking by 13 year olds place preclude meaningful analysis for that age group in relation to a number of topics, therefore, several chapters only discuss response data collected from 15 year old pupils and also focus on regular smoking. Due to question changes in different waves of the survey series, the analysis often does not include data from the entire time series. Numbers in tables and graphics in the body of the report may vary from numbers in tables in the appendices due to weighting.

The infographics used in this report were taken from the Noun Project.^[8] Credits for individual images are provided in Appendix D.