Tobacco use among adolescents in Scotland: profile and trends

2. SMOKING OVER TIME

SMOKING PREVALENCE

Adult smoking prevalence in Scotland has fallen from 31% in 1999 to 20% in 2014.^[9] The main source of data on adult smoking is the Scottish Household Survey. Since 1982, SALSUS and its predecessors have provided comparable data on smoking by S2 and S4 (roughly 13 and 15 year olds) in mainstream schools in Scotland. Smoking among adolescents is currently at its lowest level since surveys began and a detailed report on the tobacco data gathered in the 2013 wave of SALSUS is available on the ISD website.^[10]

On the basis of question options about whether they have ever smoked and how often they smoke, pupils can be categorised as 'non-smokers', 'occasional smokers' (less than 1 cigarette a week) or 'regular smokers' (smokes at least 1 cigarette a week). The proportion of 13 and 15 year olds who smoke regularly has decreased over time and is now at its lowest level since the survey began. It is now 2% of 13 year olds, down from a peak of 8% in 1998 (Figure 2.1), and 9% of 15 year olds, from a peak of 29% in 1996 (Figure 2.2).

Figure 2.1 - Smoking status in 13 year olds

Base: all 13 year olds (full bases in Appendix A, Table A.1)

Figure 2.2 - Smoking status in 15 year olds

Base: all 15 year olds (full bases in Appendix A, Table A.1)

Girls had consistently been more likely to smoke regularly than boys of the same age but the difference between the genders has narrowed over time, with little difference by 2013 (Figure 2.3).

Figure 2.3 - Pupils who regularly smoke: both age groups and genders

Base: all 13 and 15 year olds (full bases in Appendix A, Table A.2)

The proportion of pupils who have never smoked has also increased to a peak in 2013 (Figure 2.4).

Figure 2.4 - Pupils who have never smoked: both age groups and genders

Base: all 13 and 15 year olds (full bases in Appendix A, Table A.2)

SMOKING CONSUMPTION LEVELS

While there is no safe level of tobacco smoking, smoking more cigarettes proportionally increases the risk of health serious conditions such as lung cancer, heart disease and chronic obstructive pulmonary disease (COPD).^[11] It is therefore important to have good data on how many cigarettes individuals smoke.

Of all 15 year olds who smoke, there has been a slight shift towards occasional smoking away from regular smoking.^[12] This shift has been more substantial for girls than boys, which may partly explain the recent decline in female regular smoking numbers despite girls still being more likely to have ever tried a cigarette than boys (Figure 2.5).

Figure 2.5 - Smoking consumption: proportion who smoke occasionally

Base: 15 year old boys and girls who smoke (occasional and regular) - 1990 (199); 1992 (200); 1994 (182); 1996 (225); 1998 (363); 2000 (331); 2002 (2798); 2004 (850); 2006 (2486); 2008 (1090); 2010
(3558); 2013 (2230).

SALSUS asks regular smokers how many cigarettes they smoke per week.^[13] The median number of cigarettes smoked by regular smokers has decreased slightly over time, mirroring a decline since 1999 in the average number of cigarettes smoked by adults.^[14] Girls have consistently smoked fewer cigarettes than boys, though the difference is small (Figure 2.6).

Figure 2.6 - Median number of cigarettes smoked per week^[15]

Base: 15 year old regular smokers (boys, girls) - 1990 (99, 100); 1992 (66,133); 1994 (71, 111); 1998 (156, 207); 2000 (123, 204); 2004 (265, 471); 2006 (1319, 525); 2008 (433, 525); 2010 (1433, 1768); 2013 (799, 976)

WHERE PUPILS OBTAIN CIGARETTES

Preventing young people from accessing cigarettes has been a key target of legislation, including the increase in age for sales from 16 to 18, creating a register of tobacco retailers, and the tobacco display ban. These measures directly target primary market sources - buying tobacco directly from a retailer. In comparison, secondary markets are when tobacco is bought or obtained from someone else as a middleman rather than from a shop. The creation of an offence of proxy purchase aimed to tackle one secondary source. SALSUS asks where and how smokers obtain their cigarettes by presenting respondents with a range of primary and secondary sources.

The most common primary market for regular smokers in both age groups has consistently been the category 'newsagents, tobacconists and sweetshops' but the percentage of pupils accessing cigarettes in this way has declined markedly over time. Secondary markets - such as buying cigarettes from other people or being given cigarettes by friends - have remained generally constant through this time period (Table 2.1).

When grouped together, the percentage of 13 year old regular smokers purchasing from any primary market has fallen from 80% in 1990 to 16% in 2013^[16]. Similarly, the percentage of 15 year olds doing so has fallen from 94% to 33% over the same time period. Secondary sources, on the other hand, have remained relatively constant, decreasing from 64% to 56% and from 58% to 48% for 13 and 15 year olds respectively (Figures 2.7 and 2.8). In 1990, 87% of 15 year old regular smokers obtained cigarettes from newsagents, tobacconists and sweetshops; by 2013, this figure had decreased to 22%. Other primary sources (supermarkets, garages, markets and other shops) were not such significant sources when the question was first asked but have also declined.

The likely explanation for the marked decline in primary market sources is the introduction of legislation to raise the age for sales from 16 to 18, as the largest single decrease for purchasing cigarettes from primary sources was between 2006 and 2008, which coincides with the age increase in 2007. Similarly, a second decline occurs between 2010 and 2013, coinciding with the Tobacco and Primary Medical Services (Scotland) Act 2010 which required businesses to be on the national Tobacco Retailers Register to legitimately sell tobacco.

SALSUS only started to ask about proxy purchase in 2010 so it is too early to identify any trend. Targeting secondary markets demands more complex responses than for primary sources as it requires behavioural, attitudinal and cultural change so that adults and adolescents do not supply children with cigarettes.

Table 2.1 - Purchasing behaviour: 15 year old regular smokers^[17]

PRIMARY SOURCES	START (1990)	END (2013)	CHANGE
NEWSAGENTS, TOBACCONISTS AND SWEETSHOPS	87%	22%	-65%
SUPERMARKETS	20%	7%	-13%
GARAGES	33%	3%	-30%
VANS	16% (2008)	10%	-6%
OTHER SHOPS	20%	4%	-16%
MARKETS	4% (2006)	2%	-2%
MACHINES	21%	6% (2010)	-15%
INTERNET	1% (2004)	2%	+1%
SECONDARY SOURCES
GET FROM FRIENDS	53%	37%	-16%
GET FROM BROTHER OR SISTER	13%	8%	-5%
GET FROM PARENTS	7%	9%	+2%
TAKE WITHOUT ASKING	4%	9%	+5%
BUY FROM FRIENDS	26% (1998)	18%	-8%
BUY FROM SOMEONE ELSE	13% (1998)	12%	-1%
ASK ADULT I KNOW TO BUY THEM	32% (2010)	32%	±0%
ASK ADULT I DON'T KNOW TO BUY THEM	30% (2010)	27%	-3%
ASK SOMEONE ELSE UNDER 18	16% (2010)	12%	-4%

Base: 15 year old regular smokers - 1990 (154), 1992 (157), 1994 (134), 1996 (172), 1998 (276), 2000 (246), 2002 (2006), 2004 (634), 2006 (1667), 2008 (685), 2010 (2292), 2013 (1362)

Figure 2.7 - Primary and secondary sources: purchases by 13 year olds

Base: 13 year old regular smokers - 1990 (44); 1992 (44); 1994 (45); 1996 (47); 1998 (48); 2000 (63); 2002 (943); 2004 (208); 2006 (421); 2008 (202); 2010 (572); 2013 (288)

Figure 2.8 - Primary and secondary sources: purchases by 15 year olds

Base: 15 year old regular smokers - 1990 (154), 1992 (157), 1994 (134), 1996 (172), 1998 (276), 2000 (245), 2002 (2006), 2004 (634), 2006 (1612), 2008 (679), 2010 (2272), 2013 (1307)

FAMILY AND FRIENDS' SMOKING BEHAVIOUR

Having family members or friends who smoke is associated with adolescent smoking and SALSUS has data on this from 2002. The percentage of 15 year old pupils reporting that their parents, siblings, girl/boyfriend or best friend smokes daily has fallen over time, as smoking prevalence has declined amongst both adult and adolescent populations. Across the entire time series, regular smokers are the group who are most likely to have at least one parent or sibling who smokes and have a best friend or boy/girlfriend who smokes (Figure 2.9 and 2.10).

Figure 2.9 - Parent(s), sibling(s), best friend or boy/girlfriend daily smoking

Base: all 15 year olds that see these people (full bases Appendix A, Table A.3)

Figure 2.10 - Smoking prevalence: Parent(s), sibling(s), best friend or boy/girlfriend daily smoking within prevalence groups

Base: all 15 year old regular smokers (full bases in Appendix A, Table A.3)

Figure 2.11 shows that the majority of those whose best friend or boy/girlfriend smoke are also smokers themselves, 56% of those whose best friend smokes being regular smokers in 2013, compared to the SALSUS average of only 9%. An association with parental or sibling smoking is not as strong, but still contains a much higher percentage of regular smokers than average, though for all groups it is still going down as overall smoking rates fall (Figure 2.11).

Figure 2.11 - Parent(s), sibling(s), best friend or boy/girlfriend daily smoking: smoking prevalence of respondents

Base: all 15 year old regular smokers that have this person who smokes (2002, 2013) - parent(s) (4195, 4709); sibling(s) (1785, 1702); boy/girlfriend (790, 530); best friend (2275, 1483)

The boy/girlfriend and best friend results suggest that smokers are mostly friends with other smokers and non-smokers are mostly friends with non-smokers. This is supported by another question from SALSUS asking how many of the pupil's friends smoke.

Taking all 15 year olds, there has been a general increase in the number of respondents who have no friends that smoke and a decrease in pupils reporting that half or more of their friends smoke (Figure 2.12). This has largely been driven by an increase in non-smokers reporting that none of their friends smoke - regular smokers are still very likely to say that half or more of their friends smoke. Respondents are most likely to have friends with similar smoking behaviours (Figure 2.13).

Figure 2.12 - Pupil's friends who smoke: change over time

Figure 2.13 - Smoking status: proportion of friends who smoke, 2002-2013

Base: all 15 year olds in each smoking group

As would be expected, respondents who reported that all or almost all of their friends smoke are much more likely to be regular smokers. This decreases as the number of friends who smoke does, with 99% of those who have no friends that smoke being non-smokers. There was little large change between 2002 and 2013 in any group (Figure 2.14).

Figure 2.14 - Pupil's friends who smoke: smoking status of respondents

Base: all 15 year old regular smokers in each friend category (2002, 2013) - all or almost all
(1151, 739); more than half/half (2762, 2324); less than half/almost none (4888, 7622); none (1380, 5235)