Smoking Among Young People

This topic area covers statistics and information relating to young people smoking tobacco and using e-cigarettes in Hull including local strategic need and service provision. Further information relating to Smoking in Pregnancy is given under Maternal Health and Infants within Children and Young People, and Smoking Among Adults is given under Lifestyle Factors within Adults. Smoking information has been collected within Hull’s Health and Wellbeing Surveys (both young people and adults) and full reports are available under Surveys within Tools and Resources.

Headlines

• Tobacco is a unique product. It is the only consumable that, when used in the intended way, kills half of its users.
• As smoking and deprivation is associated this acerbates the inequalities associated with poverty and deprivation. Smoking is the main contributor to health inequalities. It is estimated that 1.5 million children in the UK are living in circumstances of severe financial deprivation whose plight is exacerbated by parental smoking. It also accounts for approximately half of the difference in life expectancy between the lowest and highest deprivation groups.
• Just under a half of young people in Hull live with a smoker (57% of young people who live in the most deprived fifth of areas of Hull compared to 29% of children living in least deprived fifth of areas of Hull). Most smokers start young (two-thirds before the age of 18). Children growing up among smokers are three times more likely to become smokers themselves.
• Among secondary school pupils in Hull in 2016, 5.9% of males and 9.1% of females smoked (overall 7.9%). Prevalence increased with age so the highest percentage who smoked was among those aged 15-16 years in school year 11 (11.7% of males and 21.1% of females).
• In 2016, it was estimated that there were 15,830 young people aged 11-16 years living in Hull, and that around 1,135 of them smoked.
• The smoking prevalence among young people in Hull has decreased dramatically between 2002 and 2016 particularly among females. In 2002, almost half of year 10 girls smoked compared to 14.6% in 2016 (falling from 12.7% to 9.2% among year 10 boys). Despite these falls the smoking prevalence is slightly higher in Hull than England, and smoking prevalence is strongly associated with deprivation being around twice as high among young people living in the most deprived fifth of areas of Hull compared to those living in the least deprived fifth of areas of Hull.
• Action on Smoking and Health (ASH) estimate that smoking costs Hull’s society a total of £120 million each and every year. This does not include the cost of Hull smokers purchasing tobacco products which is an estimated £88 million per year.
• Overall, 7.9% of boys and 5.9% of girls currently use e-cigarettes, and prevalence increased with age, and was very strongly associated with tobacco smoking. Among those who had never smoked tobacco, 1.8% currently use e-cigarettes, 9.1% had previously tried e-cigarettes and 89.1% had never used e-cigarettes. However, among regular tobacco smokers, 49.1% currently use e-cigarettes, 42.9% had previously tried e-cigarettes and only 8.0% had never used e-cigarettes. The percentage using e-cigarettes was slightly higher than the percentage who smoked tobacco among boys.

The Population Affected – Why Is It Important?

Tobacco is a unique product. It is the only consumable that, when used in the intended way, kills half of its users. This makes it one of the biggest causes of death and illness in the UK. Smoking causes around 80% of lung cancers, but can also cause cancer in many other parts of the body. Smoking also increases the risk of developing heart and circulation problems such as coronary heart disease, stroke, peripheral vascular disease and cerebrovascular disease. It also damages the lungs increasing the risk of bronchitis, emphysema and pneumonia, and other chronic obstructive pulmonary disease. Smoking can also cause or exacerbate numerous other health problems, and there are further risks caused by smoking in pregnancy and breathing in second hand smoke. Every year, there are around 64,000 deaths attributable to smoking in England. Smokers who die prematurely lose on average about 10 years of life.

There are also specific serious risks to the baby if their mother smokers during pregnancy (further specific details are given within Smoking in Pregnancy under Pregnancy and Maternal Health under Children and Young People). Second-hand smoke is very dangerous for anyone exposed to it, but it is particularly dangerous for children. Children exposed to second-hand smoke are at risk of ear infections, chest infections, bronchitis, pneumonia, breathing problems, allergies, asthma attacks and meningitis. Furthermore, nearly three quarters of children worry that their mum or dad will die because they smoke. Not only that, but if someone smokes in the household, children are three times more likely to smoke when they grow up. Most smokers start young (two-thirds before the age of 18 years).

The estimated to cost of smoking in England is in excess of £17 billion per year which is made up of £13.2 billion in lost productivity, £2.4 billion in healthcare, £1.2 billion in additional or earlier adult social care, and £283 million for costs associated with fires. In addition, it is estimated that people in England spend around £12 billion every year on legal and illegal tobacco products (just under £2,000 per smoker).

As smoking and deprivation are associated this acerbates the inequalities associated with poverty and deprivation. Smoking is the main contributor to health inequalities. Marmot in his original report in 2010 stated that smoking accounts for approximately half of the difference in life expectancy between the lowest and highest groups. Furthermore, as stated in Marmot’s ’10 years on’ report, it is more difficult for individuals to change unhealthy behaviours such as smoking when they are under stress caused by factors such as debt or poor housing.

An analysis commissioned by Action on Smoking and Health published in July 2021 using data for 2016/17 to 2018/19 with prices uprated to January 2020 prices, estimated across the UK that 17.9% of all households (4.98 million households in total) were living in poverty before tobacco expenditure was taken into account, but that this increased to 19.8% of all households (5.50 million households in total) once tobacco expenditure was included. In the subset of households where at least one person smoked, 21.2% of households (995,000 households in total) were living in poverty before tobacco costs were taken into account, but this increased to 32.4% households (1,521,000 households in total) once tobacco expenditure was taken into account. Among households where at least one person smoked, 26.6% of children were living in poverty before tobacco expenditure was taken into account (698,000 children in total), but this increased to 39.2% of children once tobacco expenditure was taken into account (1,029,000 children in total).

The health impacts of quitting smoking can be found in Smoking Among Adults under Lifestyle Factors under Adults.

The Hull Picture

There is limited recent information relating to the prevalence of smoking among young people in Hull. There are no recent estimates of the smoking prevalence in Hull produced nationally with the last estimates produced in 2014. Locally, a Health and Wellbeing Survey was conducted in secondary schools in 2016, and it is recognised that the prevalence of smoking could have changed in the intervening six years. However, the results from the survey are presented below as this is the only estimates available for smoking prevalence among young people living in Hull.

Smoking Cigarettes and Tobacco

In the local Young People Health and Wellbeing Survey 2016, 5.9% of males and 9.1% of females smoked regularly or occasionally, or had smoked cigarettes in the last seven days (overall 7.9%). Prevalence increased with age. Fewer than 3% of children in school years 7 and 8 (aged 11-12 and 12-13 years respectively) smoked compared to 11.7% of males and 21.1% of females among year 11 pupils (aged 15-16 years). For all schools except for year 7, more females smoked compared to males.

Based on the Office for National Statistics mid-year resident population estimates for 2016, there were 15,830 children aged 11-16 years in Hull. Using the smoking prevalence by single year of age from the survey, it is estimated that in 2016 there were around 470 male and 665 female young people in Hull aged 11-16 years who smoked (1,135 in total). Approximately 50 of them were aged 11 or 12 years, 115 aged 13 years, 215 aged 14 years, 300 aged 15 years and 460 aged 16 years.

Whilst the latest prevalence is high among year 11 girls with one in five smoking, the prevalence has fallen dramatically over time in Hull. Over 30% of year 9 girls and almost half of year 10 girls smoked in 2002. In 2002, the survey did not include year 11 pupils who are more difficult to survey due to pressures on their timetable due to examinations, so it is not known what the prevalence might have been in this school year although there is a consistent increase in the prevalence of smoking with age in every survey so it would be anticipated that over half of year 11 girls smoked in 2002.

Between 2002 and 2016, the decrease in prevalence has been around 70% or more for each of the four school years for females with the smallest decrease (of 69%) among year 10 pupils (falling from 47.6% to 14.6%). For males, the decreases have been substantial too, but less than for the females, decreasing by over 70% among males in school years 7 and 8, 51% among those in year 9 and by 28% among those in year 10 (from 12.7% to 9.2%).

It is possible to compare the prevalence in Hull in 2016 with that of England (for 2014). The definitions are slightly different although similar enough that comparisons can be made. The national survey defines a regular smoker as one who smokes at least one cigarette per week. Among male pupils aged 11 and 12 years, none smoked in England compared to 0.7% and 1.4% in Hull respectively. Among male pupils aged 13 and 14 years, 2% smoked in England compared to 1.5% and 6.1% in Hull respectively. Among 15 year olds, 6.8% smoked in Hull compared to 6% in England. Among female pupils, none smoked among those aged 11 and 12 years for both Hull and England. In Hull, 3.8% smoked among those aged 13 years (2% in England), 6.3% smoked among those aged 14 years (6% in England) and 12.9% smoked among those aged 15 years in Hull (9% in England). So the prevalence of smoking was generally slightly higher than England, particularly among the older pupils.

In Hull, the prevalence of smoking increased with increased deprivation. The age-adjusted prevalence of smoking was 6.4% among males who lived in the most deprived fifth of areas of Hull compared to 3.3% among those living in the least deprived fifth of areas, although the trend was not consistent among the five deprivation fifths. Among female pupils, the trend was more consistent with a prevalence of smoking of 13.1% among those who lived in the most deprived fifth of areas of Hull compared to 5.6% among those living in the least deprived fifth of areas of Hull.

The majority of pupils who smoked had smoked 0-5 cigarettes per week. Two year 7 pupils smoked and provided the quantity smoked the previous week, and they had smoked 0-5 and 11-20 cigarettes in the last week. Five of the six year 8 smokers providing quantities had smoked 0-5 cigarettes the previous week and the sixth stated they had smoked 40+ cigarettes. Sixteen of the 32 year 9 smokers had smoked 0-5 cigarettes the previous week (five smoking 6-10, two smoking 11-20, six smoking 21-40 and three smoking 40+ cigarettes the previous week). Of the seventy year 10 smokers, 27 (39%) had smoked 0-5 cigarettes, 10 (14.3%) 6-10 cigarettes, 6 (8.6%) 11-20 cigarettes, 9 (12.9%) smoked 21-40 cigarettes, and 18 (25.7%) smoked 40+ cigarettes the previous week. Among the 46 year 11 pupils, 10 (21.7%) had smoked 0-5, 4 (8.7%) had smoked 5-10, 4 (8.7%) had smoked 11-20, 13 (28.3%) had smoked 21-40 and 15 (32.6%) had smoked 40+ cigarettes the previous week.

Pupils were also asked about their anticipated future smoking behaviour. Among those who currently smoked 56% of males and 60% of females stated they would like to stop smoking, and among those who were non-smokers, 92% of males and 91% of females stated that they intended to never smoke.

Despite being illegal to sell cigarettes to anyone under the age of 18 years, 35% of boys and 24% of girls bought cigarettes from shops. Just over one in five obtained their cigarettes from family members with around one in twelve being given cigarettes by their parents or carers. Three-quarters of girls and over half of boys obtained their cigarettes from friends.

Over half of young people who lived in the most deprived and second most deprived fifth of areas of Hull lived with a smoker, and just under a third of these smokers smoked inside the home (equating to around 17% of these pupils overall exposed to smoke within the home). Among young people living in the least deprived fifth of areas of Hull, 28.5% lived with a smoker and just over one fifth of these smokers smoked inside the home (equating to 6.3% of these young people overall exposed to smoke within the home).

It is known that children growing up among smokers are twice as likely to become addicted to smoking themselves, and there was an association locally between whether the young person smoked and if other people within their household smoked. Among young people who did not live with a smoker, 3.3% smoked themselves. However, among young people who lived with a smoker, 12.3% of the young people smoked. This was increased if the young person lived with a smoker who smoked within the home. Among young people who lived with a smoker who smoked but not inside the home, 10.4% of the young people smoked, but among young people who lived with a smoker and that smoker smoked inside the home, 16.3% of the young people smoked.

Pupils were asked if they thought it was OK for people of their age to smoke cigarettes or tobacco. There was a strong association with age, with around 1% stating it was OK to smoke among year 7 pupils increasing to 22% of male and 37% of female year 11 pupils.

Cost of Smoking in Hull

Action on Smoking and Health (ASH) have produced a Ready Reckoner (2022 edition) to calculate the cost of tobacco at local authority level.

In their 2022 edition of their Ready Reckoner, ASH estimate that there are 44,979 adult smokers aged 18+ years living in Hull (based on prevalence of 22.2% in 2018), and that the total cost of tobacco in Hull is £120.27 million each and every year. This includes the cost to the economy, healthcare, social care and to Fire & Rescue Services.

This does not include the estimated £87.5 million that smokers in Hull spend on tobacco products.

Further more detailed information can be found on the Smoking Among Adults under Lifestyle Factors under Adults, and at https://ash.org.uk/ash-local-toolkit/ash-ready-reckoner-2022/

Use of E-Cigarettes

In the local Young People Health and Wellbeing Survey 2016, fewer than 2% of year 7 pupils used e-cigarettes but this increased with age to around 10% among those in years 10 and 11. The prevalence was generally higher among boys compared to girls, and in fact, the percentage using e-cigarettes was higher than the percentage smoking tobacco among boys.

There was a strong association between smoking cigarettes and tobacco, and the use of e-cigarettes. It is possible to compare smoking prevalence with the use of e-cigarettes among those young people who answered both questions. Among the 2,538 young people who had never smoked tobacco, 0.4% used e-cigarettes daily and 1.4% used e-cigarettes occasionally (and 9.1% had previously tried e-cigarettes but no longer used them). Among the 362 young people who had tried smoking once or twice, 2.5% used e-cigarettes daily and 12.7% used e-cigarettes occasionally (and 46.7% had previously tried e-cigarettes but no longer used them). Among the 72 young people who used to smoke tobacco but no longer do so, 8.3% used e-cigarettes daily and 22.2% used e-cigarettes occasionally (and 45.8% had previously tried e-cigarettes but no longer used them). Among the 65 young people who smoke tobacco occasionally, 6.2% used e-cigarettes daily and 50.8% used e-cigarettes occasionally (and 36.9% had previously tried e-cigarettes but no longer used them). Among the 112 young people who smoke tobacco regularly, 17.0% used e-cigarettes daily and 32.1% used e-cigarettes occasionally (and 42.9% had previously tried e-cigarettes but no longer used them). Among those who had never smoked tobacco, 89.1% had never used e-cigarettes, but among regular tobacco smokers, 8.0% had never used e-cigarettes.

Acceptance of e-cigarettes was higher than that for tobacco. Around 5% of year 7 pupils thought it was OK for young people their age to use e-cigarettes, but this increased to 11%, 21%, 34% and 45% among young people in school years 8, 9, 10 and 11 respectively. The percentages were similar among males and females for each school year except among year 11 pupils where more females thought it was OK to use e-cigarettes (51% versus 41%).

Further information is available under Surveys within Tools and Resources which gives the main report from the Young People Health and Wellbeing Survey 2016, information on smoking prevalence from the Adult Health and Wellbeing Surveys which include young people aged 16-24 years (the latest of which occurred during 2019), and qualitative research undertaken in 2008 and 2012 among secondary school pupils and young people aged 16-24 years which includes attitudes to smoking (Other Local Surveys and Qualitative Research).

Strategic Need and Service Provision

The aims of SmokeFree Hull are to actively promote a smoke-free City, support quit attempts through pharmacotherapies and behavioural support and harness the wider public health workforce to deliver very brief advice to people they have contact with (“make every contact count”). The service works with other health care providers to access existing networks ensuring access to information and support is widely available.  The Service uses a variety of methods to meet the needs of smokers and their families.

Preventing children and young people smoking is an important element of reducing prevalence and improving their health. Children and young people are twice as likely to become smokers if they live with a smoker. Local services work with children and young people to prevent them from starting or help them to quit through a dedicated Children and Young People Service.

The current adult SmokeFree Hull Service has a priority focus on people living in the most deprived wards (where smoking prevalence is the highest), pregnant women, and people with chronic obstructive pulmonary disease, coronary heart disease and mental health illness.

Hull Alliance on Tobacco is a multi-agency Alliance working collaboratively to reduce smoking prevalence. Helping smokers quit is one strand of the Alliance’s Plan which recognises other aspects of tobacco control are needed. This broader approach is supported by the Tobacco Plan for England, World Health Organisation, National Institute of Health and Care Excellence (NICE) and the Regional Tobacco Control Group.

In practice this means that in addition to helping people quit, Hull has effective regulation and enforcement through Trading Standards to reduce the availability of illicit tobacco, underage sales and enforcement of smokefree laws, work in partnership with the NHS as they become smokefree and support all areas through multi-media communication.

The core areas for HALT partners include mental health (parity of esteem), illicit tobacco, e-cigarettes, marketing, and children and young people (denormalising smoking). We want not smoking to be seen as the norm in all local communities. The HALT plan has three key priorities: smoking in pregnancy, supporting a smoke free NHS and health inequalities.

Resources

Hull’s Health and Wellbeing Surveys

NHS Digital. Health Survey for England 2018: https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2018

Action on Smoking and Health: https://ash.org.uk/home/

Estimates of Poverty in the UK Adjusted for Expenditure on Tobacco. Howard Reed, Landman Economics, July 2021. Report commissioned by Action on Smoking and Health. https://ash.org.uk/wp-content/uploads/2021/07/Smoking-and-poverty-July-2021.pdf

SmokeFree Hull: https://www.changegrowlive.org/smoke-free-hull/home

Bump the Habit: www.bumpthehabit.org.uk

Diary of a Chimney Kid. https://chimneykid.co.uk/

National Institute of Health and Care Excellence (NICE) Guidance NG29. https://www.nice.org.uk/guidance/ng209

Health Equity in England: The Marmot Review 10 Years on. https://www.health.org.uk/publications/reports/the-marmot-review-10-years-on

Updates

This page was last updated / checked on 25 August 2022.

This page is due to be updated / checked in April 2023.