Cigarette smoking more prevalent, harder to quit among rural vs. urban Americans

Peer-Reviewed Publication

INDIANA UNIVERSITY

 

IMAGE: MARIA PARKER. view more 

CREDIT: INDIANA UNIVERSITY

BLOOMINGTON, Ind. -- A new study by Indiana University researchers found that from 2010 to 2020, a larger proportion of rural Americans smoked cigarettes -- and their odds of quitting smoking were lower -- compared to those living in urban areas.

"Cigarette smoking prevalence is higher in rural than urban U.S. communities, and that disparity has only increased over time," said Maria Parker, an assistant professor of epidemiology and biostatistics in the IU School of Public Health-Bloomington. "We wanted to see if quit ratios might account for some of rural vs. urban area smoking disparity, beyond a higher smoking prevalence."

The study team was led by Parker and included colleagues at IU, Rutgers University and Yeshiva University. Their findings were recently published in JAMA Network Open.

Using deidentified data from the U.S. Department of Health and Human Services' 2010-20 National Survey on Drug Use, the researchers analyzed adults who had smoked at least 100 cigarettes in a lifetime, which they defined as lifetime cigarette smoking. Current smoking was defined as smoking one or more cigarettes in the past month, and former smoking as no cigarettes in the past year. Overall and annual quit ratios were estimated as proportions of former smokers among lifetime smokers.

The researchers found that of the 161,348 lifetime cigarette smokers analyzed, 33.5% were former smokers.

In 2020, current smoking prevalence was higher in rural than urban areas -- 19.2% vs 14.4% -- whereas quit ratios were similar in rural and urban areas, at 52.9% and 53.9%, respectively.

However, from 2010 to 2020, the odds of quitting smoking were 75% lower in rural areas compared to urban ones.

Over time, smoking quit ratios among both rural and urban populations increased.

"Our findings support that a persistent rural/urban disparity exists," Parker said. "Not only were smoking prevalence estimates higher in rural areas, but quit ratios were lower in rural areas than urban areas. Rural residents may face more barriers to using smoking cessation services than urban residents, or they may be in an earlier stage of motivation to quit."

Parker said that smoking intervention at the clinical setting, health system or population level might improve reach and sustainability of cessation services for rural residents. She said that leveraging existing smoking quit lines and telehealth solutions may also help rural residents by minimizing barriers to access.

Additional IU authors on the paper include researcher and biostatistician Erik S. Parker and student Emma Eggers, both of the School of Public Health-Bloomington.

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JOURNAL

JAMA Network Open

DOI

10.1001/jamanetworkopen.2022.25326 

ARTICLE TITLE

Trends in Rural and Urban Cigarette Smoking Quit Ratios in the US From 2010 to 2020

Cigarette smoking more prevalent – and harder to quit – among rural vs. urban Americans

Peer-Reviewed Publication

RUTGERS UNIVERSITY

Cigarette smoking is more prevalent among Americans residing in rural areas and they also have a more difficult time quitting smoking than urban residents, according to a study involving Rutgers researchers.

 

The study, published in JAMA Network Open, found smoking prevalence was higher in rural than urban areas – 19.2 percent versus 14.4 percent. While the number of smokers quitting in 2020 was similar in both rural and urban areas – 52.9 percent compared with 53.9 percent – the odds of quitting between 2010 and 2020 were 75 percent lower in rural areas compared with urban areas.

 

“Higher cigarette smoking prevalence and lower cessation in rural populations have led to higher rates of smoking-attributable cancer incidence and death in rural, compared with urban residents,” said Andrea Villanti, coauthor of the study, associate professor in the Department of Health Behavior, Society and Policy at the Rutgers School of Public Health and deputy director of the Rutgers Center for Tobacco Studies. “Tobacco cessation, therefore, is a high-impact target for cancer prevention efforts in rural populations.”

 

The study used data from the U.S. Department of Health and Human Services’ 2010–2020 National Survey on Drug Use to analyze adults who had smoked at least 100 cigarettes in a lifetime, which they defined as lifetime cigarette smoking. Current smoking was defined as smoking one or more cigarettes in the past month and former smoking as no cigarettes in the past year. Overall and annual quit ratios were estimated as proportions of former smokers among lifetime smokers.

 

The researchers found that of the 161,348 lifetime cigarette smokers analyzed, 33.5 percent were former smokers.

 

According to the researchers, the findings support the existence of a persistent rural/urban disparity, possibly attributed to the fact that rural residents may face more barriers to using smoking cessation services than urban residents or may be in an earlier stage of motivation to quit.

 

They suggest smoking intervention at the clinical setting, health system or population level might improve reach and sustainability of cessation services for rural residents. Tobacco cessation resources, including telephone quit lines and telehealth counseling could also reduce barriers to accessing tobacco treatment in rural residents.

 

The study team was led by Indiana University and included researchers at Yeshiva University.

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JOURNAL

JAMA Network Open

DOI

10.1001/jamanetworkopen.2022.25326 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Trends in Rural and Urban Cigarette Smoking Quit Ratios in the US From 2010 to 2020

DUH OH

Shop displays of e-cigarettes and smoking paraphernalia could undermine effectiveness of banning tobacco display

Highly visible displays of e-cigarettes and smoking related products found in almost all shops and supermarkets that sell tobacco

Peer-Reviewed Publication

BMJ

Efforts to discourage people from smoking by banning tobacco retail displays in shops and supermarkets could be weakened by prominent displays of electronic (e) cigarettes and smoking paraphernalia, suggests new research published in the journal Tobacco Control.

Researchers found that the vast majority of retailers that sell tobacco, albeit out of view, had prominent displays of e-cigarettes (used as a smoking cessation aid) and smoking paraphernalia, such as cigarette lighters.

Displays of tobacco products at the point of sale in retail stores are banned in many countries because of their potential link to increased smoking and higher susceptibility to smoking in children.

Twenty countries, including England, implemented tobacco point of sale display bans between 2001 and 2016 and increasingly they have been replaced with covered tobacco storage units often placed alongside tobacco signage and displays of e-cigarettes and smoking paraphernalia.

However, the extent of this potential problem is unknown because the visibility and placement of e-cigarette and smoking paraphernalia point of sale displays has not been described in detail.

A team of researchers from the universities of Bristol and Cambridge aimed to address this gap to inform future research by examining the impact of e-cigarette and smoking paraphernalia point of sale displays on tobacco smoking, particularly in children, as well as differences in visibility according to area of deprivation.

Researchers visited 166 stores in Bristol and Cambridge, of which 133 sold the relevant products and agreed to take part. These included small and large format stores of four supermarket chains and a randomly selected sample of convenience stores.

A standardised checklist was used to create a total visibility score for point of sale displays of e-cigarettes and smoking paraphernalia that were encountered, while other measures of visibility and placement were also captured.

Results showed that both e-cigarette and smoking paraphernalia point of sale displays were present in 96% of stores. These point of sale displays were highly visible across all stores with an average visibility score of 14.7 out of 17 for e-cigarettes and 12.7 out of 17 for smoking paraphernalia on the checklist.

Analysis of the results also revealed that the use of multiple display units was more common for e-cigarettes (53%) than for smoking paraphernalia (12%). Signage was present in most stores (62%) for e-cigarettes, but not for smoking paraphernalia (5%).

Visible pricing was present in most stores (70%) for e-cigarettes, but less so (45%) for smoking paraphernalia.

Most stores had smaller e-cigarette (74%) and smoking paraphernalia (93%) displays than their tobacco storage unit, and these were positioned next to it (49% and 50%, respectively).

Just over half (53%) of stores had some form of promotional material for e-cigarettes, with the most common types involving price (23%), ease of use (15%), and flavours (14%).

The researchers did not find any clear evidence of a relationship between visibility and deprivation status of the store’s location.

The authors acknowledged that having data from stores in only two cities could limit how generalisable its findings were. However, this is the first study (to their knowledge) to describe the visibility and placement of e-cigarettes and smoking paraphernalia in large tobacco retailers and a standardised measure of visibility was used.

They conclude: “E-cigarette and smoking paraphernalia point of sale displays are near ubiquitous and highly visible in supermarkets and convenience stores in two cities in England.

“The high frequency and visibility of these displays could be undermining the effectiveness of the tobacco point of sale display ban. Their impact on smoking in children merits urgent attention.”

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JOURNAL

Tobacco Control

DOI

10.1136/tobaccocontrol-2020-056314 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Electronic cigarette and smoking paraphernalia point of sale displays: an observational study in England

ARTICLE PUBLICATION DATE

13-Sep-2021

Vaping is linked to heightened eating disorder risk among U.S. college students

An increase in eating disorders during the COVID-19 pandemic and the prevalence of vape pens and e-cigarettes among young people is cause for concern

Peer-Reviewed Publication

UNIVERSITY OF TORONTO

Toronto, ON – A new study published in the journal Eating Behaviors found that vaping or e-cigarette use is associated with a heighted risk of developing an eating disorder among US college students. This finding is particularly important given the common use of vape pens and e-cigarettes and an increase in the prevalence of eating disorders amidst the COVID-19 pandemic among young people.

The study, which analyzed a sample of over 51,000 U.S. college students who participated in the 2018-2019 Healthy Minds Study, highlights the need for more research and clinical assessment and intervention for those who exhibit both substance use and eating disorders.

“The higher prevalence of vaping among those with eating disorder symptoms is concerning given that the co-occurrence of these behaviors can exacerbate physical health complications such as cardiovascular, pulmonary, and neurological problems,” says lead author Kyle T. Ganson, PhD, MSW, assistant professor at the University of Toronto’s Factor-Inwentash Faculty of Social Work.

The researchers also found that participants who reported receiving an eating disorder diagnosis, such as anorexia nervosa or bulimia nervosa, over the course of their life had a higher prevalence of vaping or e-cigarette use. Additionally, among those who reported vaping or e-cigarette use, nicotine vaping was the most common to have been recently used among participants with and without eating disorder symptoms.

“Nicotine vaping may be used by individuals to support eating disorder behaviors and goals, such as suppressing appetite and catalyzing weight loss,” says Ganson. “Nicotine vaping can lead to dependence and future polysubstance use.”

“The study’s findings are especially relevant as we have seen a surge in referrals for eating disorders and substance use disorders during the pandemic,” said co-author Jason M. Nagata, MD, MSc, assistant professor at the University of California, San Francisco’s Department of Pediatrics. “Young people who are struggling with their eating or substance use should seek help from a health professional. Clinicians should screen young people for disordered eating and substance use, especially during the pandemic.”

The researchers emphasize the need for further clinical assessment of eating disorders among college students who report vaping or e-cigarette use, as well as additional federal and state regulation of vape pens and e-cigarettes to protect the health and well-being of young people.

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JOURNAL

Eating Disorders

DOI

10.1016/j.eatbeh.2021.101566 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Associations between Vaping and Eating Disorder Diagnosis and Risk among College Students

ARTICLE PUBLICATION DATE

11-Sep-2021

 

Smokers who start below age 20 become more addicted and find it difficult to quit

Reports and Proceedings

EUROPEAN SOCIETY OF CARDIOLOGY

Amsterdam, Netherlands – 25 Aug 2023: Researchers urge governments to raise the legal age to purchase cigarettes to 22 years or higher as study finds it becomes less addictive and easier to quit as people get older. The research is presented at ESC Congress 2023.1

In 2020, more than one in five people worldwide used tobacco.2 Tobacco kills up to half of its users.2 Smokers below the age of 50 years have a five-fold higher risk of developing cardiovascular disease compared with their non-smoking peers.3 The legal age to purchase tobacco is 18 years old in many countries but in some nations there are no age restrictions. It is estimated that nearly 9 out of 10 adults who smoke cigarettes daily first try smoking by age 18, and 99% first try smoking by age 26.4

This study examined the relationship between the age of smoking initiation, nicotine dependence and smoking cessation. The study included smokers who had visited a smoking cessation clinic in Japan. Participants completed the Fagerström test for nicotine dependence (FTND) which asks questions such as “How soon after you wake up do you smoke your first cigarette?”, “Do you find it difficult to refrain from smoking in places where it is forbidden” and “How many cigarettes per day do you smoke?”. Scores for each answer were added up for a total score indicating a nicotine dependency of low (score 1-2), low to moderate (3-4), moderate (5-7) or high (8 or higher).

Participants were divided into two groups based on the age they started smoking (less than 20 years old and 20 years or older); 20 years was used as the cut-off as it is the legal smoking age in Japan. Carbon monoxide in the breath was measured to indicate the number of cigarettes smoked in the past 24 hours. Smoking cessation was defined as no tobacco smoking in the past seven days and an exhaled carbon monoxide level less than 7 ppm.

The researchers analysed the associations between nicotine dependency and successful smoking cessation according to the age participants started smoking. The analyses were adjusted for sex and age at the time of attending the smoking cessation clinic.

The study included 1,382 smokers, of whom 30% were women. The average age when attending the smoking cessation clinic for the first time was 58 years. Some 556 smokers started smoking before age 20 (early starters), while 826 smokers were 20 years of age or older when they began smoking (late starters).

Early starters reported a higher number of cigarettes per day (25) compared with late starters, who smoked 22 cigarettes per day. Those who started early had higher respiratory carbon monoxide levels compared with those who started late (19 vs. 16.5 ppm, respectively) and higher FTND scores (7.4 vs. 6.3, respectively). Less than half of early starters (46%) successfully quit smoking compared with 56% of late starters, for an odds ratio of 0.711 after adjusting for sex, age at clinic visit and smoking cessation aids – indicating that early starters were 30% less likely to successfully kick the habit compared with late starters.

Participants were further divided into four groups according to the age they commenced smoking (17 years or less, 18 to 19, 20 to 21, and 22 or older). In the four groups, FTND scores were 7.5, 7.2, 6.7 and 6.0, respectively, showing that those who start smoking aged 22 or older were even less nicotine dependent.

Study author Dr. Koji Hasegawa of the National Hospital Organization Kyoto Medical Center, Kyoto, Japan said: “Our results show that starting smoking early is linked with higher nicotine dependency, even in young adulthood. The study indicates that increasing the legal age to buy tobacco to 22 years or older could lead to a reduction in the number of people addicted to nicotine and at risk of adverse health consequences.”

 

ENDS

Notes to editors

Authors: ESC Press Office
Mobile: +336 61 40 18 84

Email: press@escardio.org

The hashtag for ESC Congress 2023 is #ESCCongress.

Follow us on Twitter @ESCardioNews 

 

Funding: This study was partly supported by Grants-in-Aid for Scientific Research from the Japan Society for the Promotion of Science

Disclosures: None.

 

References and notes

1The abstract “Effect of smoking initiation age on nicotine dependence” will be presented during the session Defining prevention strategies which takes place on Saturday 26 August from 15:15 to 16:00 CEST at Station 10.

2World Health Organization. Tobacco. https://www.who.int/news-room/fact-sheets/detail/tobacco

3Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42:3227–3337.

4Centers for Disease Control and Prevention. Youth and Tobacco Use. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm

 

About ESC Congress 2023

It is the world’s largest gathering of cardiovascular professionals, disseminating ground-breaking science both onsite in Amsterdam and online – from 25 to 28 August. Explore the scientific programme. More information is available from the ESC Press Office at press@escardio.org.

About the European Society of Cardiology

The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

 ALL SMOKING PRODUCES TOXIC PARTICULATES

Smoking exposure during childhood may increase risk of rheumatoid arthritis

Longitudinal study uncovers significant influence of passive exposure to parental smoking on adult-onset incident seropositive rheumatoid arthritis

Peer-Reviewed Publication

BRIGHAM AND WOMEN'S HOSPITAL

A new study by investigators from Brigham and Women’s Hospital found a potential direct link between exposure to parental smoking during childhood and increased risk of seropositive rheumatoid arthritis (RA) later in life. Researchers utilized established longitudinal data from 90,923 women in the Nurses’ Health Study II (NHSII) to elucidate the relationship between passive smoking exposure and incident RA. Passive exposure was broken down into three categories, including maternal smoking during pregnancy, parental smoking during childhood, and years lived with smokers since age 18. Even with personal smoking accounted for, passive exposure to parental smoking during childhood was found to increase risk of incident seropositive RA by 75-percent. Findings are published in Arthritis & Rheumatology.

“There has been intense interest in mucosal lung inflammation from personal smoking as a site of RA pathogenesis,” said senior author Jeffrey A. Sparks, MD, MMSc, of the Department of Medicine at the Brigham. “But the majority of RA patients aren’t smokers, so we wanted to look at another inhalant that might precede RA.”

RA is an inflammatory disease characterized by arthritis at multiple joints and is associated with morbidity and mortality outcomes. Many people with RA have signs of lung inflammation, and while genetic and environmental factors contribute to risk of developing RA, smoking has long been implicated as a key RA risk factor. Personal (active) smoking is the most well-established environmental risk factor associated with RA, with passive smoking left relatively unexplored.

To link passive smoking and incident RA more conclusively, Sparks and colleagues used data from NHSII questionnaires collected biennially between 1989 and 2017 from 90,923 women aged 35-52 years. Researchers used participant medical records to confirm incident RA and serostatus. Statistical modeling was then used to estimate the direct effect of each passive smoking exposure on RA risk, as well as to control for other factors such as personal smoking.

A 75-percent higher risk of RA was found in individuals who experienced passive childhood exposure to parental smoking. This risk increased in participants who themselves became active smokers. Over the median follow-up of 27.7 years, 532 women in the cohort developed confirmed incident RA cases — the majority (352) of which were seropositive (positive for RA autoantibodies). Maternal smoking during pregnancy and years lived with smokers beyond age 18 showed no significant association with incident RA risk.

Although the all-female nurse participant pool led to high response rates and retention, the study is limited by the absence of men. The team intends to continue with longitudinal studies that encompass both men and women, as to provide critical insight into other rheumatoid conditions and even other autoimmune diseases.

“Our findings give more depth and gravity to the negative health consequences of smoking in relation to RA, one of the most common autoimmune diseases,” said lead and co-corresponding author Kazuki Yoshida, MD, ScD, of the Brigham’s Division of Rheumatology, Inflammation and Immunity. “This relationship between childhood parental smoking and adult-onset RA may go beyond rheumatology — future studies should investigate whether childhood exposure to inhalants may predispose individuals to general autoimmunity later in life.”

Conflict of Interest: None

Funding: This work was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) under award number K23 AR069688 to Dr. Sparks. This work was additionally supported by the Rheumatology Research Foundation R Bridge Award, and by the National Institutes of Health (award numbers L30 AR066953, K24 AR052403, R01 AR049880, R01AR057327, R01 AR119246, R01 HL034594, P30 AR070253, P30 AR072577, P30 AR069625, UM1CA186107, U01 HG008685, 1OT2OD026553, and R03 AR075886). Dr. Yoshida was supported by the Rheumatology Research Foundation K Bridge Award, Brigham and Women's Hospital Department of Medicine Fellowship Award, and K23 AR076453 (NIAMS).

Nurses’ Health Study II was supported by the National Institutes of Health (U01 CA176726, R01CA67262, and U01 HL145386).

Paper cited: Yoshida K et al. “Passive Smoking Throughout the Life Course and the Risk of Incident Rheumatoid Arthritis in Adulthood Among Women” Arthritis Rheumatol. DOI: 10.1002/art.41939

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ARTICLE PUBLICATION DATE

18-Aug-2021

 

U-M study: E-cigarettes could unravel decades of tobacco control

New research finds that UK teens who vape are 33% more likely to smoke cigarettes

University of Michigan

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Teens who regularly use e-cigarettes are equally as likely as their peers from the 1970s to take up cigarette smoking, despite a substantial reduction in the prevalence of teenage cigarette use over the last 50 years, according to a study co-led by the University of Michigan. 

 

U-M researchers, in collaboration with Penn State University and Purdue University, concluded that teenagers who had never used e-cigarettes had an approximately less than 1 in 50 chance of weekly cigarette use, whereas those who had previously used e-cigarettes had more than a 1 in 10 chance. More importantly, teenagers who reported consistent e-cigarette use had nearly a 1 in 3 chance of also reporting current conventional cigarette use.  

 

The study illustrates shifts in the likelihood of youth cigarette use over time and the impacts of e-cigarettes on this trend. The results were derived from three longitudinal studies collected by the Centre for Longitudinal Studies at the University College of London, following teens from three different U.K. birth cohorts. 

 

The research was published in the journal Tobacco Control and was supported by the National Cancer Institute, part of the National Institutes of Health, and a seed grant from the Criminal Justice Research Center at Penn State University, while data collection by the Centre for Longitudinal Studies was supported by funding from the Economic and Social Research Council.

 

"The use of e-cigarettes and the proliferation of e-cigarettes have really disrupted those awesome trends and improvements. For kids who have never used e-cigarettes, we do see those historic declines in risk," said Jessica Mongilio, a research fellow at the U-M School of Nursing and one of the lead researchers on the study. "But for kids who do use e-cigarettes, it's almost as if all of those policies and all of those perceptions have done nothing, and they've got a really high risk of smoking cigarettes."

 

Over the past few decades, cigarette smoking has evolved from a once glamorous status symbol to an unhealthy and socially discouraged practice, according to the researchers. This evolution was, in large part, driven by aggressive campaigning that labeled cigarette smoking as a public health risk. 

 

By the late 1990s and into the early 2000s, cigarette smoking was structurally and socially stigmatized, embedded in national federal regulations and health policy. In recent years, cigarette smoking in youths dropped to an all-time low, according to research from the Centers for Disease Control.

 

E-cigarettes, colloquially known as vapes, often sold in bright colorways and in fruity flavors, have quickly emerged as a perceived "safer" alternative to the conventional cigarette. They stand to threaten decades of advocacy, health policy and cultural aversion toward smoking in both the U.K. and United States, the researchers say.

 

The Millennium Cohort Study, or MCS, tracked teens born in England, Scotland, Wales and Northern Ireland in 2000 and 2001 and who were children when e-cigarettes were first commercialized. The British Cohort Study tracked individuals born in 1970, who were teenagers during the 1980s when cigarette use was fairly common and in their 40s when e-cigarettes were commercially available. Finally, the National Child Development Study tracked individuals born in 1958, who were young children when cigarette use was at its cultural peak. 

 

"We took data from different cohorts, essentially different generations of people who live in the U.K., and looked at their probability of smoking cigarettes at least once a week, based on some well-known risk and protective factors," Mongilio said. "For the most recent cohort, we also examined how use of e-cigarettes changed those probabilities.”

 

According to Mongilio and her collaborators, it's not entirely clear whether e-cigarette use directly caused cigarette use, but it’s clear their incidences are strongly related. Still, the MCS cohort will be continuously surveyed over time to further understand how the use of e-cigarettes during the critical developmental teen years will affect their health in the long term. 

 

Ultimately, with the findings of this study, the researchers hope to demonstrate the profound impact of e-cigarettes on today's youth in an attempt to exact meaningful legislative, social and economic change.

 

"The more you can build evidence—the bigger the pile of support—the harder you can make it to ignore. This will lead toward policy changes and toward increased regulations for e-cigarettes and for producers of e-cigarettes," Mongilio said. "I think we're in a place where change is possible and to have increased regulations and enforcement of those regulations for companies that are producing e-cigarettes."

 

Study: Risk of adolescent cigarette use in three UK birth cohorts, before and after e-cigarette (DOI: doi:10.1136/tc-2024-059212)

 

Story written by Sarah Akaaboune, Michigan News

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Journal

Tobacco Control

DOI

10.1136/tc-2024-059212 

UK teens who currently vape as likely to start smoking as their peers in the 1970s

Likelihood of smoking 1.5% among teens who don’t vape, but 33% among those who do

BMJ Group

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UK teens who currently vape are as likely to take up smoking as their peers in the 1970s,  despite a substantial fall in the prevalence of teenage smoking over the past 50 years, suggests a long term intergenerational study published online in the journal Tobacco Control.

The likelihood of starting to smoke among teens who don’t vape was around 1.5%, but 33% among those who do, the findings indicate.

It’s not entirely clear if the rise in popularity of e-cigarettes (vapes) among teens threatens the steady decline in the prevalence of cigarette smoking in this age group, say the researchers, as the published research is somewhat equivocal.

And if historic declines are slowing, it’s not clear how the risk of cigarette smoking among today’s young people—especially those who vape—compares to that of previous generations who came of age before notable tobacco control legislation and the advent of e-cigarettes, they add.

To try and find out, they drew on intergenerational data from three nationally representative birth cohorts of UK teens* born in 1958 (National Child Development Study; NCDS), 1970 (The British Cohort Study; BCS), and 2001 (Millennium Cohort Study; MCS). 

As well as baseline surveys at either birth or 9 months, MCS participants provided data at ages 3, 5, 7, 11, 14, 17 and 23; BCS participants at ages 5, 10, 16, 26, 30, 34, 38, 42, 46 and 51; and NCDS participants at ages 7, 11, 16, 23, 33, 42, 46, 50, 55 and 62.

The prevalence of teen smoking was assessed in 1974 among 11,969 NCDS participants, in 1986 among 6222 BCS participants, and in 2018 among 9733 MCS participants. The odds of smoking  among 16 and 17 year olds were estimated, based on a common set of childhood risk and protective factors; teen vaping was included as a predictor in the MCS.

Risk/protective factors included whether they had ever drunk alcohol by age 16 or 17; how engaged they were with education at school; the extent of externalising behaviours reported by the mother or main caregiver at ages 10 or 11; and parental occupation, education, and smoking behaviour— including during pregnancy. 

Analysis of the intergenerational data revealed a steep decline in the prevalence of cigarette smoking among teens, falling from 33% in 1974, to 25% in 1986, and to 12% in 2018. Around half of the MCS participants hadn’t vaped by the time they were 17; 41% said they had previously vaped; and 11% reported current vaping.

The decline in prevalence of teen smoking can be attributed to a mix of tobacco control legislation, better public understanding of the health consequences of smoking, and a shift away from the perception of smoking as socially acceptable, suggest the researchers.

Risk/protective factors also changed over time. For example, the percentage of teens who had started drinking by the age of 16 or 17 fell from 94% in the NCDS to 83% in the MCS. 

The average age at which mothers left education also rose from 15.5 in the NCDS to 17 in the MCS. Similarly, the prevalence of parental smoking fell from over 70% in the NCDS to 27% in the MCS; and fewer mothers continued smoking while pregnant in the MCS than in the NCDS and the BCS.

Many risk factors for teen smoking were similar across the cohorts—drinking before the age of 17 and greater externalising behaviours, for example—as were some child level protective factors—greater engagement with education, for example. 

To illustrate the likelihood of cigarette smoking for an ‘average’ teen (16-17) over time, the researchers worked out predicted probabilities of cigarette smoking with all risk factors included from the intergenerational data. 

This probability was 30% in the NCDS and 22% in the BCS. Among those who had never vaped in the MCS this was around 1.5%, but 33% for the teens who reported current vaping. 

“This probability is especially concerning given the recent increases in e-cigarette use prevalence among UK youth, despite some initial assurances that e-cigarettes would have little appeal to [them],” say the researchers. 

The researchers acknowledge that they were unable to account for some sociodemographic characteristics, including race and ethnicity, due to insufficient sample sizes in the earlier cohorts. And they emphasise that estimates of the associations between vaping and smoking in the MCS aren’t causal and shouldn’t be interpreted as such, especially as the temporal sequencing of smoking and vaping isn’t explicit.

Nevertheless they conclude: “While our research shows that the historic decline in the likelihood of youth cigarette smoking has continued in this recent cohort of UK youth, overall, we find that this is not the case among e-cigarette users. 

“Youth who had never used e-cigarettes had an estimated less than 1 in 50 chance of reporting weekly cigarette use at age 17, while those who had previously used e-cigarettes had over a 1 in 10 chance. Youth who reported current e-cigarette use had an almost 1 in 3 chance of also reporting current cigarette use. 

“As such, the decline in the likelihood of cigarette smoking is waning for youth who have used e-cigarettes—about half of our sample—and has reversed for those currently using e-cigarettes. 

“Among contemporary youth, efforts to reduce cigarette smoking should focus both on those who are currently using e-cigarettes and on the prevention of e-cigarette use among youth, to maintain the promising declines in youth nicotine use in years to come.”

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Journal

Tobacco Control

DOI

10.1136/tc-2024-059212 

Method of Research

Observational study

Subject of Research

People

Article Title

Risk of adolescent cigarette use in three UK birth cohorts before and after e-cigarettes

Article Publication Date

29-Jul-2025