'20 classrooms of kids' a day take up smoking

"The equivalent of 20 classrooms-full of children take up smoking every day in the UK," reports The Independent. This disturbing headline comes from estimates of the number of children between the ages of 11 and 15 who start smoking each day. The estimates are based on a major survey of secondary schoolchildren in England.

Approximately 567 out of 6,519 children in this age group were estimated to start smoking each day, which equates to more than 200,000 a year. While this figure is high, the true figures may be higher as children may be reluctant to report their smoking, particularly when at school.

Smoking is one of the leading causes of preventable deaths, and the researchers, the media, the British Lung Foundation and Cancer Research UK have all voiced appropriate concerns about the implications of these findings.

Based on this data it would appear that current anti-smoking messages are either not reaching some children, they do not understand them, or they choose to ignore them.

Additional methods recommended by the researchers include banning the sale of flavoured cigarettes (such as menthol), encouraging TV and film-makers not to portray smoking on screen, and the controversial proposal of introducing plain packaging for cigarettes.

Where did the story come from?

The study was carried out by researchers from the NIHR Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London. These organisations also funded the research.

It was published in the peer-reviewed medical journal Thorax. This is an open access journal, so the study is free to read online or download.

The study was well reported across the media. All outlets highlighted the need for smoking in childhood to be addressed. The Independent and the Mail Online both quoted Dr Penny Woods, chief executive of the British Lung Foundation, who said that, "At current rates, half of these children are likely to eventually die as a result of their habit if they continue smoking".

What kind of research was this?

This research was an analysis of data collected in annual cross-sectional surveys assessing smoking levels in secondary school pupils.

National figures are available on levels of smoking, but the researchers wanted to calculate local rates of smoking uptake among children. This information could help local authorities understand the extent of the problem in their area to help them plan resources to tackle the problem.

What did the research involve?

The researchers looked at data from the "Smoking, drinking and drug use among young people in England" report from 2011 produced by the Health and Social Care Information Centre. This is an annual survey of secondary school pupils in England aged 11 to 15. The survey covered 219 schools and 6,519 children completed the questionnaires.

The researchers compared the rates of smoking in 2011 with the previous year to estimate how many children had taken up smoking over the course of the year.

They then used the proportion of adult smokers in each area of the UK to calculate how the estimated number of new child smokers divided up geographically. They took this approach because the biggest predictor of childhood smoking is reported to be parental smoking. The researchers therefore judged that this approach would be more accurate than just basing calculations on local population size.

Adult rates were taken from the Office for National Statistics Integrated Household Survey (2011/12) and from the Statistics for Wales Welsh Health Survey: smoking (2011).

The results were presented in a "heat map" available online of new child smokers in the UK.

What were the basic results?

Of 3.7 million children aged 11 to 15 across the UK, about 207,000 take up smoking each year. The estimated numbers who start to smoke each day was calculated as:

• 463 in England – around 170,000 per year
• 55 in Scotland – around 20,000 per year
• 30 in Wales – around 11,000 per year
• 19 in Northern Ireland – around 7,000 per year

Figures were also calculated at a more local level, and some examples of the number of children starting to smoke each day were:

• 10 in each Welsh region (average population 8,200 children)
• 9 in Birmingham (child population 74,000)
• 67 in London (child population 458,000) – the equivalent of about two classrooms' worth of children

How did the researchers interpret the results?

Although smoking is known to have become less common in both adults and children over the years, the number of children taking up smoking is still high. As smoking is a major cause of preventable death, it is important that this issue is targeted for reduction.

Conclusion

This important study highlights the need for increased efforts to get the message about the dangers of cigarette smoking across to young people.

The number of pupils surveyed was relatively high, which increases confidence that the estimates are representative of this age group in the UK. However, they may still be underestimates of actual smoking rates, as they relied on children reporting their own smoking in a questionnaire at school.

Given that it is against the law to buy cigarettes until the age of 18, some children may prefer not to report their smoking, even if they were told that the survey is anonymous and confidential.

The estimates according to geographical region were also based on regional patterns of adult smoking, and this may not reflect child smoking patterns. The smoking survey only covered England and therefore may not be representative of the other parts of the UK.

Despite these limitations, the main point is that there are children who will take up smoking despite all the publicity and campaigns to discourage them.

The results of this study should focus attention on renewing efforts to prevent children starting to smoke, and help children and adults who do smoke to quit.