Who would be targeted by increasing the legal age of sale of cigarettes from 18 to 21? A cross-sectional study exploring the number and characteristics of smokers in England.

Emma Beard,Deborah Arnott,Robert West,Will Anderson,Lion Shahab,Sarah E Jackson,Jamie Brown

doi:10.1111/add.15421

Abstract

AimsTo establish the number of smokers in England who would be targeted by increasing the age of sale of cigarettes from 18 to 21 years and to assess the smoking and socio‐demographic profile of those smokers.Design and settingNationally representative cross‐sectional survey of adults in England conducted between January 2009 and July 2019.ParticipantsA total of 219 720 adults.MeasurementsAll participants reported their current smoking status and socio‐demographic characteristics (i.e. age, gender, home ownership, social grade and ethnicity). Smokers reported motivation to quit, urges to smoke and the Heaviness of Smoking Index (HIS). Weighted prevalence statistics were calculated. Multinomial regression and logistic regression were used to assess differences in smoking characteristics among smokers and socio‐demographic characteristics relative to non‐smokers.FindingsThe prevalence of smoking between January 2009 and July 2019 was highest among those aged 21–30. In 2019, 15.6% [95% confidence interval (CI) = 12.8–18.8%] of 18–20‐year‐olds reported smoking, which is estimated to represent 364 000 individuals in England. Relative to smokers aged 18–20, older smokers (aged 21+) had a higher motivation to quit smoking [odds ratios (ORs) = 1.40–1.45 range] and higher nicotine dependency as measured by urges to smoke (ORs = 1.06–1.24 range) and HSI (ORs = 1.05–2.85 range). Compared with non‐smokers aged 18–20, smokers in this age group had lower odds of being female (OR = 0.89) and higher odds of being of white ethnicity (OR = 2.78) and from social grades C1–E (lower social grades) compared with AB (higher social grades) (OR = 1.19–1.83 range).ConclusionIncreasing the age of sale of cigarettes to 21 years in England would currently target approximately 364 000 lower dependent smokers from more disadvantaged backgrounds aged 18–20, who have less motivation to quit.

Highlights

Most tobacco use starts during adolescence, and the vast majority of people who are regular smokers during these years become addicted to tobacco [1,2,3]
In 2019, 15.6% of those aged 18–20 were smokers, which accounts for 364 000 individuals in England based on 2019 mid-year census estimates
In England, this study estimates that increasing the age of sale of cigarettes to 21 would currently target approximately 364 000 smokers who are aged 18–20

Summary

Introduction

Most tobacco use starts during adolescence, and the vast majority of people who are regular smokers during these years become addicted to tobacco [1,2,3]. There is a variety of reasons why young people take up smoking. Some think it is fashionable, while others are influenced by social pressure and smoking among friends and family members [4,5]. Impulsivity and related characteristics, low socio-economic status and poor mental health, such as experiencing depression or stress, can increase the risk of starting to smoke [6,7,8,9]. Numerous evidence-based strategies are effective in preventing tobacco use in young people: mass media campaigns, taxation, advertisement restrictions, smoke-free policies and access restrictions [11]. In relation to the last of these, studies have demonstrated the long- and shortterm efficacy of the increase in the legal age of sale of Addiction

Methods

Results

Discussion

Conclusion