Smoke-free Generation Research Articles

Estimating Young Adult Uptake of Smoking by Area Across the United Kingdom.

There is majority support in parliament and across the United Kingdom to implement a "smoke-free generation" policy which would mean people born on or after January 1, 2009, could never legally be sold tobacco. To explore the potential impact this policy could have, we estimated the number of young adults (18-25 years) currently taking up smoking each year by area across the United Kingdom. Using data from the Office for National Statistics (ONS), Annual Population Survey (APS), and Smoking Toolkit Study (STS), we estimated the total number of 18- to 25-year-olds taking up smoking each year, based on national estimates of population size (ONS) and the proportion who reported ever having regularly smoked (STS). We used local data on adult smoking rates (APS) to apportion the national estimated number of young adults taking up smoking to specific areas. Around 127500 18- to 25-year-olds in the United Kingdom start smoking regularly each year (~350 each day); 105700 each year in England, 11500 in Scotland, 6500 in Wales, and 3800 in Northern Ireland. Uptake estimates varied across localities: for example, North East Lincolnshire had the highest proportion of young adults taking up smoking each year (3.9%) and Wokingham had the lowest (0.9%). Despite reductions in smoking prevalence over recent decades, hundreds of young adults in the United Kingdom start smoking every day. Data on rates of uptake among individual local authorities can be used to focus attention locally prior to the introduction of new age of sale laws.

Age control – the fundament for introducing a smoke-free generation

Age control – the fundament for introducing a smoke-free generation

Smoke-free generation legislation in the United Kingdom

Smoke-free generation legislation in the United Kingdom

Pursuing a smoke-free generation.

The United Kingdom may soon become a world leader in forging a smoke-free generation. Last month, the country passed a bill that bans the sale of cigarettes to anyone born in 2009 or later. The prime minister claims the policy will "phase out smoking in young people almost completely as early as 2040." A final vote by Parliament is expected next month. Tobacco claims 8 million lives every year, and could claim a billion lives over this century-mostly in low- and middle-income countries. For every person that dies, at least 30 more suffer from smokingrelated chronic disease. The benefits of a tobacco-free society would be transformational.

‘Stopping the start’: support for proposed tobacco control policies – a population-based survey in Great Britain 2021–2023

ObjectivesThis study assessed public support for four proposed tobacco control policies in Great Britain: (1) Raising the sales age of tobacco by 1 year every year (Smokefree Generation); (2) Raising...

Trends in Exclusive Non-Cigarette Tobacco Smoking in England: A Population Survey 2013-2023.

The UK Government intends to implement a "smokefree generation" policy prohibiting the sale of all tobacco products to people born after 2008. National surveys provide comprehensive data on cigarette smoking, but little is known about patterns of non-cigarette tobacco smoking across key population groups. Using data from a nationally representative cross-sectional survey of adults in England, collected monthly between September 2013 and September 2023 (n = 196721), we estimated time trends in exclusive non-cigarette tobacco (eg, cigar/pipe/shisha) smoking prevalence, overall and by age, gender, occupational social grade, region, ethnicity, and vaping status. Interviews were conducted face-to-face until March 2020 and via telephone thereafter. From September 2013 to September 2023, there was a non-linear increase in exclusive non-cigarette tobacco smoking prevalence (from 0.36% to 1.68%; prevalence ratio = 4.72 [95% CI = 3.43-6.48]). Prevalence was relatively stable up to February 2020 (at an average of 0.46%), then increased sharply at the start of the COVID-19 pandemic (at the same time as survey methods changed), to 0.90% (0.82%-0.99%) in March 2020. This was followed by a steadier rise, peaking at 1.97% in May 2022, before falling slightly to 1.68% by September 2023. In 2022/2023, 1 in 10 smokers (10.8% [9.64%-12.0%]) exclusively used non-cigarette tobacco. The rise in prevalence was observed across all subgroups but was most pronounced among younger adults (eg, reaching 3.21% of 18-year-olds vs. 1.09% of 65-year-olds). Prevalence was consistently higher among men and current vapers. Although exclusive use of non-cigarette combustible tobacco remains rare among adults in England, it has increased in recent years, particularly among younger ages. As of September 2023, there were approximately 772800 adult exclusive non-cigarette tobacco smokers in England; around five times more than a decade earlier. The proportion of adults in England who do not use cigarettes at all but smoke other combustible tobacco products has increased substantially in recent years, with a particularly pronounced rise among young people. The inclusion of non-cigarette combustible tobacco products under the proposed "smokefree generation" policy is therefore likely to be important for achieving the greatest reduction in youth uptake of tobacco smoking, as it would ensure young people who are unable to legally buy cigarettes do not buy other combustible tobacco products that are similarly harmful to health.

From policy to practice: creating a smokefree generation.

From policy to practice: creating a smokefree generation.

Public support for smoke-free private indoor and public outdoor areas in the Netherlands: A trend analysis from 2018-2022.

In addition to smoke-free policies in indoor public and workplaces, governments increasingly implement smoke-free policies at beaches, in parks, playgrounds and private cars ('novel smoke-free policies'). An important element in the implementation of such policies is public support. In the context of the ambition of the Netherlands to reach a smoke-free generation by 2040, we investigated temporal changes in public support for novel smoke-free policies. We analyzed annual cross-sectional questionnaires in a representative sample of the Dutch population from 2018 to 2022. Multivariable logistic regression was applied to model public support for each smoke-free policy area as a function of time (calendar year), smoking status, gender, and socioeconomic status. Interaction terms were added for time with smoking status and with socioeconomic status. A total of 5582 participant responses were included. Between 2018 and 2022, support increased most for smoke-free policies regarding train platforms (+16%), theme parks (+12%), beaches (+10%), and terraces (+10%). In 2022, average support was higher than 65% for all categories of smoke-free places and highest for private cars with children (91%). Regression analyses indicated significant increases in support over time within each category of smoke-free places (adjusted odds ratio, AOR between 1.09 and 1.17 per year), except smoke-free private cars with children (AOR=0.97; 95% CI: 0.89-1.05). Regardless of smoking status, support was high for places where children often go. Support for novel smoke-free places in the Netherlands is high and increasing, in particular for places frequented by children. This indicates the potential to implement such measures in the Netherlands.

Understanding adolescent consumption patterns and attitudes towards the "puff" on the path to a smoke-free generation: a 2022 French perspective.

Tobacco use remains the leading preventable cause of death in France, with 75,000 deaths each year. France aims to reduce smoking and achieve a smoke-free generation by 2032. However, recent tobacco industry innovations which mainly target young people, could undermine this goal. The main objective of this study is to assess the knowledge and consumption patterns of the "puff" among French adolescents in 2022. A cross-sectional study using a structured online survey on a representative sample of 400 adolescents aged 13 to 16 years was conducted from July 4th to 20th, 2022. Around 66% of adolescents reported having heard of the puff", and one in ten having tried it. Slightly fewer of them have tried cigarettes; 89.6% of experimenters reported that it allowed them to explore unique flavors, 81.9% found it fun to play with the puff-cloud, and 94.5% of regular consumers considered it a stylish or cool product. 76% of adolescents believe that the puff is dangerous to their health, 71.6% describe it as a polluting device, and 62.8% think it's a gadget. The "puff" is widely known by French adolescents and more commonly used than cigarettes, due, in part, to marketing specifically designed to target youth. That is why it could represent a threat to the smoke-free generation objectives. Public health policy could be informed by the ecological awareness of adolescents as a new lever of counter-influence to prevent this kind of consumption, as did ACT with the #stopcigarettespollution prevention campaign.

Sunak’s smoke-free generation: spare a thought for the tobacco industry

Sunak’s smoke-free generation: spare a thought for the tobacco industry

Evaluating achieving tobacco control targets in Belgium using modelled projections

Abstract Background Tobacco use in Belgium remains a key public health concern with an estimated 15% of adults reporting daily tobacco use in 2018. In 2022, the Belgian government launched the “Interfederal Strategy 2022-2028 for a Smoke-free Generation.” The strategy outlines a number of targets for reducing daily tobacco use among adults 15+ years and young adults 15-24 years. We evaluate the feasibility of achieving these targets given current daily smoking trajectories at a national and regional level. Methods We modelled time trends of smoking in Belgium based on repeated cross-sectional data taken from the nationally representative Belgian Health Interview Survey. We applied a Bayesian inference model, the integrated nested Laplace approximation, to obtain a time series of daily tobacco use for adults by age, sex, and region of Belgium from 1997 to 2018. We then projected this model to 2070 using population projections from the Belgian Federal Planning bureau for population distributions. We compared trajectories with targets from the Interfederal Strategy to assess whether they are likely to be achieved. Results The national target of reducing daily smoking among adults 15+ years to 10% by 2028 and 5% by 2040 will not be achieved on current trajectories. Wallonia has the highest level of people smoking daily and is projected to miss the targets by the largest margin. Flanders is expected to reach the 10% threshold by 2032. The target for reduction of prevalence of daily smoking among youth 15-24 years to 6% by 2028 will not be achieved before 2040. Smoking among the youngest age group (15-24 years) is decreasing rapidly with prevalence of daily smoking in that age group projected to be < 2% in Flanders by 2059. Conclusions No region of Belgium is expected to achieve targets for reduction in daily smoking given current trajectories. Tobacco control policies in the country should be re-assessed, targeted and intensified. Key messages • The Belgian national target of 5% daily smoking prevalence in adults by 2040 will not be achieved. • Differences in smoking trajectories in Belgium exist by age and region; tobacco control policies should be targeted.

Understanding Second-hand Smoke (SHS) Exposure among University Students in Selangor and Perak, Malaysia: Role of Parents and Peers

Second-hand smoke (SHS) exposure remains a significant public health concern worldwide, posing various adverse effects on individual health during both short- and long-term exposures. University students in Malaysia are particularly at risk due to the potential influence of parents and peers on their SHS exposure. However, there is a lack of comprehensive research exploring the extent of this influence and its implications for effective intervention strategies. This cross-sectional study administered an online questionnaire to 387 students from two universities in Selangor and Perak. Prevalence rates of SHS exposure were determined, and factors associated with exposure were identified through descriptive and multivariable logistic regression analysis. Almost half (49.9%) of the participants had been exposed to SHS. Female students had a reduced risk of exposure by more than half compared to male students (p = 0.050). Meanwhile, those who had a smoking parent and smoking friends had approximately four times (p = 0.000) and two times (p = 0.002) the increased likelihood of being exposed to SHS, respectively, then those who did not. Participants with higher household income (p = 0.000) and higher mothers’ educational attainment (p = 0.028) had a significantly lower risk of SHS exposure. In conclusion, gender, parental smoking, peer smoking, and socioeconomic status were identified as factors associated with SHS exposure. Parental and peer awareness and understanding of SHS risk must be enhanced to minimise its exposure among their children and friends. Hence, health policymakers should address strategies such as ongoing public awareness campaigns, the extension of a smoking ban on advertising, promotion, and marketing of tobacco products, and rules for smoking prohibition at home to drive Malaysia’s effort towards a smoke-free generation.

Risk factors for adolescent smoking uptake: an analysis of prospective data from the Millennium Cohort Study

BackgroundPreventing smoking uptake among adolescents is essential to achieve a smoke-free generation. The aim of this study was to assess risk factors for smoking in late adolescence and smoking uptake between early and late adolescence, using data from the Millennium Cohort Study. We also present estimates of numbers of smokers and smoking uptake. MethodsAdolescents aged 14–17 years were included in the analysis. In separate logistic regression models, we assessed associations between age, sex, ethnicity, household income, country of residence, current smoking of a caregiver, current smoking of peers and use of social media, and regular smoking (defined as smoking at least one cigarette per week) at the age of 17 years and smoking uptake between the ages of 14 and 17 years (defined as being a never-smoker at the age of 14 years and a regular smoker at the age of 17 years). We also estimated numbers of regular smoking and smoking uptake using the Office for National Statistics 2018–19 population estimates. FindingsData from 8944 adolescents aged 14–17 years with smoking data available were included, 948 (10·6%) of which were regular tobacco smokers at the age of 17 years. 488 (51·5%) of these 948 started smoking between the ages of 14 years and 17 years. Smoking uptake was more common among adolescents reporting caregiver smoking (162 [13·6%] of 1188 vs 324 [5·0%] of 6538 with non-smoking caregivers; p<0·0001); peers smoking (223 [12·6%] of 1764 vs 229 [4·3%] of 5350 without smoking peers; p<0·0001), and those reporting higher (at least 5 h/weekday) social media use (115 [9·8%] of 1176 vs 120 [4·1%] of 2947 with lower [less than 1 h/weekday] social media use; p=0·0059), among 7786 adolescents who did not smoke at age 14. We estimated that 164 313 (95% CI 146 815–181 811) adolescents were regular smokers by the age of 17 years, of whom 101 715 (85 994–117 435) took up the habit between the age of 14 years and 17 years. InterpretationOur findings are a reminder of the transmissibility of the smoking epidemic. Although we only assessed social media use, not actual exposure to online tobacco advertising, our findings strengthen calls for awareness of the changing landscape of tobacco advertising. FundingCancer Research UK (grant reference PPRCTAGPJT\\100005) and the UK National Institute for Health and Care Research School for Public Health Research. The funders had no role in the writing of the manuscript or the decision to submit for publication.

How do New Zealand youth perceive the smoke-free generation policy? A qualitative analysis

IntroductionAotearoa New Zealand (NZ) plans to introduce a smoke-free generation (SFG) policy, alongside denicotinisation and reducing the availability of tobacco products. The SFG has a clear rationale, yet we know...

Creating smoke free environments by local policy

Abstract In The Netherlands, around 20.000 people die each year from the effects of smoking and passive smoking. Every week, hundreds of children become addicted to smoking. To improve the overall public health in the Netherlands, it is important to substantially reduce the prevalence of smokers. Until recent years, municipalities played next to no role in helping to reduce smoking in the Netherlands. The start of a large campaign that aims a smokefree generation by 2040 has changed that. Part of that campaign is to create smoke-free environments. In a two-year program, 90% of the Dutch municipalities started policy and actions to ban smoking from public places, as part of the National Prevention Agreement. The participating municipalities were supported by all 25 Regional Health Services (GGDs) by providing knowledge and manpower on a regional level, together with national, regional and local organisations. The project has a number of successful elements: the GGD received a (very small) budget to actively participate in the region; knowledge was shared between the regions and from national to local level and legal issues were dealt with by the Nat Assoc of Municipalities (VNG). In 2021, 317 out of 352 Dutch municipalities were active in this project. There is a significant increase of smoke-free environments, mostly schoolyards, playgrounds, sports facilities, smoke-free bus stops and municipal institutions. Other results are integrated plans for smoking cessation care and accessible stop smoking service, e.g. in GGD Fryslan the number of registrations for smoking cessation care increased dramatically and 80% actually quit smoking. All parties involved agree that the strength of this project is its positive approach and the broad social support it generates for the Smokefree Generation. It is about persuasion, not compulsion. Working from a national focus towards a smoke-free environment, while taking into account local differences and needs, makes this project a success. Key messages • This project resulted in more local and regional partnerships and an increase of smoke-free environments, bringing the ultimate goal of a Smokefree Generation closer. • 90% of Dutch municipalities have created smoke-free environments with the guidance of the regional GGD, financed by Ministry of Health: multilevel governance works.

11.P. Workshop: Tobacco control policy strategies to contribute to the EU’s tobacco-free generation goal

Abstract In 2021, the European Union's (EU) ‘Europe's Beating Cancer Plan’ set the goal to achieve a tobacco-free generation in Europe by 2040, which means that less than 5% of people will use tobacco. The EU proposed policies to address internationally relevant issues such as tobacco taxation, cross-border purchases, packaging, flavours, and online advertising. However, many tobacco control policies need to be adopted and implemented at the national or local level. It is therefore important to exchange research findings and insights on national tobacco control policies. In this workshop we present results mainly from the Netherlands. With a 21% smoking prevalence and scores 53 out of 100 points on the Tobacco Control Scale, it may therefore be considered an average European country in terms of its tobacco control. However, the Netherlands has progressed its tobacco control policies in recent years, in part due to the 2018 National Prevention Agreement. This Agreement included the same goal as the European tobacco-free generation goal. Achieving a tobacco-free generation requires the prevention of smoking initiation among young people, but also smoking cessation among those who already smoke. This is especially important among lower socioeconomic groups, as the smoking prevalence in these groups is higher both in adults and adolescents. Therefore, smoking and tobacco products need to be less visible and available in the environment, and easily accessible smoking cessation support needs to be provided. With this workshop, we cluster very recent evidence on the EU's tobacco-free generation goal. We will present evidence on four policy strategies for the smoke-free generation, in which their potential impact and challenges in implementation will be discussed. These presentations will be followed by a plenary discussion on the implications and the relevance of the four strategies taking into account differences between international settings. The presentations will focus on four policy areas: • Policies to reduce smoke-exposure in and around sport clubs • Policies to reduce availability of tobacco products in the retail environment • Policies to reduce smoke-exposure in hospitality venues and homes • Policies to increase access to smoking cessation The objectives of the workshop are: 1. Present evidence of four tobacco control policies strategies 2. Discussion of the international relevance and implications of the results Key messages • We present on multiple settings that can be further capitalised on to achieve a non-smoking norm, including sports clubs, retail outlets, hospitality venues, and the home environment. • The majority of European countries currently does not have strong tobacco control policies in the presented settings, and the potential of such policies throughout Europe will be discussed.

Commentary on Titus et al.: Understanding how smoke-free policies can contribute to smoke-free generations.

Commentary on Titus et al.: Understanding how smoke-free policies can contribute to smoke-free generations.

Children’s rights are part of our DNA: The right to development and Smoke-Free Generation

Children’s rights are part of our DNA: The right to development and Smoke-Free Generation

Evaluating smoking control policies in the e-cigarette era: a modelling study

BackgroundIn jurisdictions in which electronic cigarettes are currently prohibited, policy makers must weigh the potentially lower risk compared with conventional cigarettes against the risk of initiation of e-cigarettes among non-smokers.MethodsWe...

Estimating future smoking in Danish youth - effects of three prevention strategies.

Aims: Preventing smoking and aiding cessation among youth and young adults carries the possibility of reducing future smoking prevalence significantly. This paper estimates the impact on future smoking prevalence of 25 year olds by increasing tobacco prices, securing indoor smoke-free homes and implementing school-based multi-tiered interventions. Methods: Utilizing a multi-state Markov model, a status quo projection of the smoking prevalence from years 2017 to 2030 were compared with projections of the smoking prevalence in 2030 considering the impact of the three prevention strategies. Results: In a status quo projection, 27.0% of Danish 25-year-old females are expected to be smokers in 2030, while 13.2% would be smokers in 2030 were all three prevention strategies in effect from 2019. By itself, increasing tobacco prices by 50% reduced the prevalence of smokers among 25-year-old females to 14.8% in 2030, a relative reduction of 47.5%. For 25-year-old males in 2030 the reductions were similar, with a prevalence of 16.6% when all three prevention strategies were in effect, a relative reduction of 51.5%. Conclusions: Implementing increasing tobacco prices, indoor smoke-free homes and school-based multi-tiered interventions in Denmark is likely to significantly decrease youth smoking prevalence in the future. However, these three strategies will not produce a smoke-free generation without other initiatives.