Tobacco use among adolescents is a critical indicator not only of the initiation of tobacco use but also of the future trends in prevalence of tobacco dependence and tobacco related disease in adults.
Fourteen percent of people aged 13-15 throughout the world smokes cigarettes and 25% of them started this habit before the age of 10. At the moment, longitudinal data on tobacco use among young people are available only in a few economically developed countries. Data from the European School Survey on Alcohol and Other Drugs (ESPAD) shows that the lifetime smoking prevalence (lifetime use 40 or more cigarettes) among young people in many European countries have increased significantly during recent years. On the other hand, Youth Risk Behaviour System (YRBSS) data from the United States shows an encouraging decrease in tobacco consumption among 13-15-year-olds after 1997. This development is especially encouraging since the decrease happened at the same time as the tobacco company’s scale up their marketing efforts of tobacco to young people.
Around 30% of 15-18 year-olds in Europe are smokers. Since the mid- 1990s smoking among young people in the eastern European countries has slightly risen, while rates among young people in western Europe have remained stable over the same period. Smoking among young people in Europe is increasing, even when at the same time tobacco use among adults in fact is decreasing in many European Union countries. Especially alarming is, that the increase is most marked among young girls.
While there is clear evidence of decreasing smoking rates by adults in some European countries, no country has shown a significant decrease in smoking by young people during recent years. Geographical differences in rates of smoking by young people in Europe are significantly smaller than those for adults. Twenty-nine percent of young people (15-16 year-olds) in eastern European countries smoke compared to 26% in western European countries. The difference is only 3% whereas the difference for adults is as big as 10% between smoking prevalence in eastern (34%) and western (24%) European countries. The range between the highest and the lowest prevalence rates in different groups in the eastern and western parts of the WHO EURO Region varies from below 10% to above 50%. Gender differences in smoking rates are also significantly less important among young people compared to those between adults in the region. Twenty-nine percent of 15-16-year-old boys and 25% of girls of the same age smoke. Among adults the corresponding figures are 35% for men and 22% for women.
In the period 1994-1998 the rate of smoking among girls was less than or almost as much as for adult women. Currently, 15-16-year-old girls smoke more (26%) than adult women (22%), according to comparable data from 13 countries in Europe (ESPAD). For 16-17-year-old girls the smoking prevalence rate rises to an even more alarming 28%. For males, the pattern for the same period is more stable, with an average of 30% for boys and 36% for men.
Most of the increase in smoking by young people is due to increased rates in the eastern part of the WHO European Region, especially among girls. In 1995, 18% of girls in eastern Europe were smokers, while the figure in 1999 was 21%. Smoking rates in the western part of the region are today very similar for boys and girls and the gap between boys and girls smoking prevalence is rapidly diminishing also in eastern Europe. In 13 European countries, teenage girls already smoke more or approximately as much as boys.
The highest smoking prevalence rates among 15-year-olds in the EU countries can be found in Austria (32%), Finland (30%) and Germany (33%). The lowest prevalence rates are found in Greece (14%) and Sweden (15%). Among the countries in accession to EU the highest smoking prevalence rate is in Czech Republic (32%) and the lowest in Malta (17%).
In Africa smoking prevalence is increasing dramatically in most countries both among the adult population and among young people. The current youth smoking rate in e.g. Burkina Faso is 37%, in Ghana and Nigeria 17%, in South Africa 24% and in Zimbabwe 58%. The tobacco marketing in Africa is massive and many children start smoking when as young as eight or nine years old. In the Americas smoking prevalence among young people varies very much. The highest prevalence rate can be found in Santiago, Chile, 39%, whereas the lowest current smoking rate is in Antigua and Barbuda, 14%. The exposure to environmental tobacco smoke in the Americas follows the same pattern. In the WHO Eastern Mediterranean region the smoking prevalence among young people is generally quite low, with an exception for Lebanon, were the prevalence for 15-19-year-olds reaches 34%. In the WHO Western Pacific region the Global Youth Tobacco Survey (GYTS) shows alarmingly high smoking rates in e.g. Palau were 59% of 13-15-year-olds are current smokers and in the Northern Marianas were the smoking rate among young people is 62%. Data from Chongqing, China reveals that 39% of the school children that are currently using tobacco smoked their first cigarette before the age of 10.
Table 1
References:
WHO Survey of Health Behaviour in School-aged Children (HBSC)
European School Survey Project on Alcohol and other Drugs (ESPAD)
Control of Adolescents Smoking – study (CAS)
Global Youth Tobacco Survey (GYTS)
Youth Risk Behaviour System (YRBSS), USA
WHO/ACS/UICC Tobacco Control Country Profiles, 2003
WHO European Country Profiles on Tobacco Control 2003