Smoking and the Young

This report concerns smoking and the young, since new smokers are enrolled almost entirely from this group. Tobacco smoking is addictive and does far greater harm than any other addictive drug. Thus, once children and young people start to smoke, stopping or 'quitting' becomes extremely difficult and the likelihood is that they will continue to smoke into and throughout adult life. Although previous reports recommended a ban on tobacco advertising and promotion, tobacco advertising continues, aided and abetted by voluntary agreements between the tobacco companies and the UK government. Tobacco companies claim not to promote cigarettes to children, but in order to maintain the number of customers, they have to replace the 300 smokers who die every day in the UK as a result of smoking. Most new recruits to smoking are under 18 years of age. Much advertising is now subtle and indirect, centering around sporting events such as motor racing with which youngsters identify. Paradoxically, smoking by sportsmen or women would result in a degree of unfitness incompatible with excellence in their chosen sport.More recently, information has become available on the hazards of passive smoking in the broadest sense. Unwittingly, non-smoking children and adults are placed at risk from others' smoke, as is the unborn child during pregnancy. A report summarising the present evidence, Passive smoking: a health hazard, has been recently published (1991) [5].The facts set out above supplied the rationale of the working party who prepared the report to help protect the future health of young people. The report comes at a time of high government awareness of the role of preventive medicine as set out in its consultative document The health of the nation [6]. Many of the responses to this document identified tobacco as the single most important cause of preventable ill-health in the United Kingdom today. The document states the government's intention to reduce the numbers of people starting to smoke and to increase the numbers who stop smoking. It also establishes targets for a national reduction in smoking prevalence by one-third for men and women by the year 2000. Much of this reduction will have to be by prevention of smoking in the young, although this is best achieved in the context of overall reduction in smoking prevalence at all ages. On current trends, it is difficult to see how these targets are going to be met and a new approach is therefore required.The working party who prepared this report includ-Smoking and the Young was published in 1992 and was the fifth report on smoking produced by the College. The previous reports, published in 1962, 1971, 1977 and 1983 [1-4] concentrated on the health effects of active smoking and made specific recommendations to try to reduce levels of tobacco consumption. Over the past 30 years, some progress has been made. For example, individual tobacco consumption has fallen and so have deaths from lung cancer in men. On the other hand, lung cancer has continued to rise in women and the uptake of smoking by teenagers has not changed in the last decade. The figure of 110,000 premature deaths resulting from smoking continues to be cited as the burden which society carries.
This report concerns smoking and the young, since new smokers are enrolled almost entirely from this group. Tobacco smoking is addictive and does far greater harm than any other addictive drug. Thus, once children and young people start to smoke, stopping or 'quitting' becomes extremely difficult and the likelihood is that they will continue to smoke into and throughout adult life. Although previous reports recommended a ban on tobacco advertising and promotion, tobacco advertising continues, aided and abetted by voluntary agreements between the tobacco companies and the UK government. Tobacco companies claim not to promote cigarettes to children, but in order to maintain the number of customers, they have to replace the 300 smokers who die every day in the UK as a result of smoking. Most new recruits to smoking are under 18 years of age. Much advertising is now subtle and indirect, centering around sporting events such as motor racing with which youngsters identify. Paradoxically, smoking by sportsmen or women would result in a degree of unfitness incompatible with excellence in their chosen sport.
More recently, information has become available on the hazards of passive smoking in the broadest sense. Unwittingly, non-smoking children and adults are placed at risk from others' smoke, as is the unborn child during pregnancy. A report summarising the present evidence, Passive smoking: a health hazard, has been recently published .
The facts set out above supplied the rationale of the working party who prepared the report to help protect the future health of young people. The report comes at a time of high government awareness of the role of preventive medicine as set out in its consultative document The health of the nation. Many of the responses to this document identified tobacco as the single most important cause of preventable ill-health in the United Kingdom today. The document states the government's intention to reduce the numbers of people starting to smoke and to increase the numbers who stop smoking. It also establishes targets for a national reduction in smoking prevalence by one-third for men and women by the year 2000. Much of this reduction will have to be by prevention of smoking in the young, although this is best achieved in the context of overall reduction in smoking prevalence at all ages. On current trends, it is difficult to see how these targets are going to be met and a new approach is therefore required.
The working party who prepared this report includ-Smoking and the Young was published in 1992 and was the fifth report on smoking produced by the College. The previous reports, published concentrated on the health effects of active smoking and made specific recommendations to try to reduce levels of tobacco consumption. Over the past 30 years, some progress has been made. For example, individual tobacco consumption has fallen and so have deaths from lung cancer in men. On the other hand, lung cancer has continued to rise in women and the uptake of smoking by teenagers has not changed in the last decade. The figure of 110,000 premature deaths resulting from smoking continues to be cited as the burden which society carries.
ed physicians with an interest in the chest and heart, and experts from child health, public health, epidemiology and health promotion.

## Intervention strategies
The intervention strategies are based on the premise that children and young people have the right not to be exposed to the adverse health effects of tobacco, either through passive or active smoking. The main findings of the report and the recommendations are printed below:

## Major findings
Smoking, the fetus and early life 1. Spontaneous abortions (miscarriages) of viable fetuses are increased in pregnant smokers by more than one-quarter. 2. Premature labour is twice as common in pregnant smokers.
3. Babies born to mothers who smoke are lighter by an average 200 grams (approximately half a pound). Paternal smoking also makes babies significantly lighter.. Stillbirths and early neonatal deaths (perinatal mortality) are increased by approximately onethird in babies of smokers.
5. The effects of smoking in pregnancy extend well beyond infancy with a reduction in growth and educational achievement.
The effects of passive smoking on the health of children 6. Children of smoking parents inhale the same amount of nicotine as if they themselves smoked 60-150 cigarettes per year.
7. Over one-quarter of the risk of death due to the sudden infant death syndrome (cot death) is attributable to maternal smoking (equivalent to one death per day in England and Wales). 8. Infants of parents who smoke are twice as likely to suffer from serious respiratory infection. 9. Symptoms of asthma are twice as common in the children of smokers.
10. One-third of cases of 'glue ear', the commonest cause of deafness in children, is attributable to parental smoking. 11. Children of parents who smoke more than 10 cigarettes per day are shorter than children of per year in the UK advertising and promoting cigarettes. Tobacco advertising perpetuates the myth that tobacco has significant positive qualities of success, glamour, speed and adult behaviour. 43. A tobacco price increase results in a greater reduction in consumption in young people than in adults. In terms of average disposable income, the price of a pack of cigarettes has halved in the last 30 years.
Measures to reduce smoking in the young 44. Children are considerably influenced by tobacco advertising and promotion, particularly girls. They need to be taught the skills to resist the marketing pressures to smoke.
45. There is an urgent need for immediate action to prevent an epidemic of smoking related disease in women occurring as a result of girls starting to smoke during school years. 46. A range of intervention strategies are available which if developed and implemented comprehen-sively would have a major effect in reducing children's smoking to undetectable levels. 47. These strategies should comprise developing personal skills in young people, creating supportive environments, strengthening community action, reorientating health services and building healthy public policy. 48. A ban on tobacco advertising and sponsorship as part of a comprehensive Tobacco Act would have a significant impact on the uptake of tobacco by young people in the UK. 49. There is an urgent need to develop coherent UK government and European Community strategies and policies on tobacco control if the public's health is to be substantially improved.

## Recommendations
The whole of society carries a responsibility for the health of its children. As well as every individual setting an example to children by not smoking, the following groups have particular responsibilities and opportunities in respect of smoking to act in the interest of children's health.