By Holly Giles | Deputy Editor
Public attitudes towards smoking have varied over the past hundred years, with the 1930s to 1950s showing a powerful advert of “healthy cigarette” brands prescribed by doctors to now when tobacco use is a known risk factor for lung cancer. Over time more information about the dangers of tobacco have led people away from cigarettes and into the world of e-cigarettes and vaping.
E-cigarettes officially came to market in 2007 but have become more widely known in recent years through the appearance of vaping shops on every town corner. They have been met with mixed reviews including media outcry about a lack of legislation and some people have claimed they are as dangerous as tobacco. Others are worried that e-cigarettes could be a gateway drug introducing people to smoking safely, before they then go on to tobacco.
Cardiff University have analysed smoking behaviour in 11-16 year olds in data collected as part of the School Health Research Network’s Student 2019 Health and Wellbeing survey. This is an annual survey which collects results from over 100,00 secondary school students regarding their physical and mental health.
When looking at the results it showed that 22% of teenagers reported having tried an e-cigarette and current e-cigarette use (defined as weekly or more) was 2.5%, a decline from 3.3% in 2017. Experimentation with e-cigarettes is far more common than tobacco with 22% and 11% having experimented with them respectively.
Whilst e-cigarette use may have gone down in this time, the same cannot be said of tobacco with 4% of teenagers regularly smoking each week, which is the same level as reported in 2013.
Dr Nicholas Page, from the Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, said:
“While our findings show a small decline in youth smoking experimentation form 2017, the percentage of regular smokers has remained unchanged since 2013. As we’ve seen in previous years, the numbers of young people using tobacco increased with age and were higher among young people from less affluent families – showing the substantial inequalities in smoking uptake”.
The numbers of children smoking in this study is particularly concerning as starting at such a young age increases the risk of lifelong addiction. This was explained by the CEO of Ash Wales, Suzanne Cass:
“Sadly, smoking is a lifelong addiction that all too often begins in childhood and we know from our own research that 81% of adult smokers in Wales were 18 or under when they had their first cigarette”.
The report also showed a change in public perception of smoking with a higher percentage of youth now thinking that e-cigarettes and tobacco are equally damaging to health and less now score smoking as worse than vaping. This increase in understanding of the dangers of vaping is a big change since e-cigarettes were first introduced to the market.
Dr Page also suggested this change may be due to the media outbreak caused by vaping-associated lung injury (EVALI) which was dominating headlines during the time the surveys were collected. EVALI was termed by the Centres for Disease Control and Prevention as a newly identified lung disease linked to vaping and e-cigarette use. At its peak in 2019, hospitals across America saw increases in hospital admissions of previously healthy people complaining of shortness of breath, difficulty breathing and fever. It is still not completely known what causes EVALI, but in most cases was due to use of e-cigarettes containing a compound called THC which is a chemical derived from marijuana.
“It is important to place this change in the contact of when our data were collected” explained Page. “While we don’t know whether this had an impact, EVALI has been associated with a similar change in harm perception among adult smokers in England. It remains to be seen whether this continues to be the case in future surveys”.
Despite changes in smoking prevalence across the UK, tobacco use still remains a leading cause of death and disability with smoking being responsible for an estimated 90% of lung cancer cases. This equates to more than 78,000 deaths each year due to smoking, with many more living with a reduced quality of life.
Smoking affects the lungs by directly exposing them to chemicals, including known carcinogens. Affects of smoke of the lungs include a reduced number and activity of cilia in the lungs which work to clean out mucus, destruction of alveoli (the air sacs where gas exchange occurs) and a build up of mucus leading to irritation and coughing. This reduction in air flow can also have impacts elsewhere as oxygen transport to key organs is affected.
Smoking behaviour is controlled so heavily by public attitudes and social norms that it will be interesting to see if these trends continue over time. Whilst vaping and e-cigarette use is on the up, it looks like it will take more than alternatives to reduce tobacco use in young people.
Science and Technology Holly Giles