Abstract
BackgroundToday’s primary school children have grown up in a climate of strong smoking restrictions, decreasing tobacco use, and the emergence of e-cigarettes. Children’s exposure to tobacco declined substantially in years following the introduction of smoke-free legislation, with smoking uptake and perceived smoking norms declining. There is debate regarding whether emergence of e-cigarettes may interrupt trends in children’s smoking perceptions, or offer a means for adults to limit children’s exposure to tobacco. This study examines change in children’s tobacco and e-cigarettes experimentation (ever use), exposure to secondhand smoking and vaping, and perceived smoking norms.MethodsData from four, repeat cross-sectional surveys of Year 6 primary school pupils (age 10–11 years) in Wales in 2007, 2008, 2014 and 2019 (n = 6741) were combined. E-cigarette use and perceptions were included in 2014 and 2019 surveys. Analyses used binary logistic regression analyses, adjusted for school-level clustering.ResultsChild tobacco experimentation and most indicators of exposure to tobacco smoke indicated a graded decreasing trend over time from 2007 to 2019. Exposure to e-cigarettes increased from 2014 to 2019, as did pupil awareness of e-cigarettes (OR = 2.56, 95%CI = 2.12–3.10), and parental use (OR = 1.26, 95%CI = 1.00–1.57). A decrease in child e-cigarette experimentation was not significant (OR = 0.80, 95%CI = 0.57–1.13). Children’s normative perceptions for smoking by adults and children indicated a graded decrease over time (OR = 0.66, 95%CI = 0.54–0.80; OR = 0.69, 95%CI = 0.55–0.86; respectively from 2014 to 2019). However, fewer reported disapproval of people smoking around them in 2019 relative to 2014 (OR = 0.68, 95%CI = 0.53–0.88). Higher exposure to tobacco cigarettes and e-cigarettes in public places, cars and households were associated with favourable normative perceptions for tobacco smoking; however in models adjusted for exposure to both associations of e-cigarette exposure were attenuated.ConclusionChildren’s experimentation with and exposure to tobacco, and their perceptions of smoking as a normative behaviour, have continued to decline alongside growth in exposure to e-cigarettes. Although a large majority of pupils reported they minded people smoking around them, there was some evidence of diminishing disapproval of secondhand smoke since 2007. Further research is needed to understand whether use of e-cigarettes in cars and homes is displacing prior smoking or being introduced into environments where smoking had been eliminated.
Highlights
Today’s primary school children have grown up in a climate of strong smoking restrictions, decreasing tobacco use, and the emergence of e-cigarettes
Youth smoking rates and attitudes in favour of smoking continued to decline during the emergence of e-cigarettes [11], while our analyses of survey data and qualitative data on primary school pupils in Wales from the present study indicate that parental vaping is associated with perceived smoking norms only where it occurs alongside smoking [33, 34]
To assess whether the apparent inconsistency of the item on smoking rules in the home with other measures of exposure may be due to the changing relevance of the question over time, as a post-hoc analysis, we examined changes in the percentage of pupils who reported that smoking was not prohibited in the home, but identified no-one who did smoke in the home (Fig. 4)
Summary
Today’s primary school children have grown up in a climate of strong smoking restrictions, decreasing tobacco use, and the emergence of e-cigarettes. In the United Kingdom, legislation which prohibited tobacco (cigarette) smoking in enclosed public places and workplaces was recently voted by the Royal Society for Public Health as the biggest public health achievement of the twenty-first century [2] This was implemented with the primary aim of reducing exposure to smoke among groups including those working in the hospitality industry [3], and evidence indicated that it was successful in achieving these aims. In the years following legislation on smoking public places, surveys in the UK and beyond showed strong public support for further action to limit children’s exposure to tobacco [12,13,14], with smoking in cars carrying children banned across the UK from 2015 [15], and restrictions of smoking in school grounds and playground from 2021 [16, 17]
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