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Smoking: a childhood addiction

21 May, 2009

Smoking: a childhood addiction

The Health Bill 2009 contains tough new measures to help stop children and young people from taking up smoking. Hazel Cheeseman from ASH outlines the latest evidence and explains how midwives can help put tobacco out of sight. The Health Bill 2009 contains tough new measures to help stop children and young people from taking up smoking. Hazel Cheeseman from ASH outlines the latest evidence and explains how midwives can help put tobacco out of sight.

Midwives magazine: June/July 2009

Almost half of all pregnant women under the age of 20 smoke – double the national average (Infant Feeding Survey, 2005). Tobacco is unique – the only legally available consumer product that kills half of its users when used as intended. As well as being a major cause of cancer, heart and respiratory disease, smoking also causes conditions such as infertility and diabetes and exacerbates many others like multiple sclerosis and Crohn’s disease (ASH, 2008a).
Over 100,000 smokers die in the UK each year from their habit, but many more suffer years of ill health, harming not just themselves but those around them. Maternal smoking is a significant cause of miscarriage, low birthweight babies, sudden infant death syndrome, glue ear and acute respiratory disease in infancy and childhood (ASH, 2008b).

Children with parents who smoke are much more likely to take up smoking themselves (Royal College of Physicians, 1992). The younger people start to smoke, the more likely they are to become heavily addicted and never manage to quit. 

The measures in the Health Bill 2009 are designed to help prevent young people from taking up smoking and support smokers who have made the choice to quit by prohibiting the display of tobacco in shops and restricting its availability through vending machines. The legislation covers both Wales and Northern Ireland and the measures are under consideration by the Scottish Parliament.

Why we need new measures

In 2003, almost all advertising, promotion and sponsorship of tobacco was banned (Tobacco Advertising and Promotion Act, 2002). However, this did not remove the most pervasive form of tobacco promotion: the subtle branding messages on cigarette packs.

Since the ban on advertising, point-of-sale displays of tobacco have become even more prominent. They are larger with a more sophisticated use of lighting and colour and the number of different brand variants they display has also increased significantly. The number of variants within a single brand family have increased by a third since 2003, giving a single logo or brand name much more shelf space to advertise their product (ASH, 2008c).

A recent UK study demonstrated the impact of the industry’s advertising activity (Centre for Tobacco Control Research, 2008). Since the ban on tobacco advertising, the number of young people who are aware of new brands has increased significantly (Centre for Tobacco Control Research, 2008). This is despite a ban on tobacco advertising on billboards, in TV commercials and in newspapers, and the elimination of promotion and sponsorship of sporting events like snooker and motor racing. Point-of-sale displays have a significant impact on young people, with 46% of teenagers aware of tobacco marketing at the point of sale (Centre for Tobacco Control Research, 2008).

Brand awareness is also closely linked to smoking initiation. The Centre for Tobacco Control Research found that for every additional brand that a 15-year-old could recall, their interest in trying smoking increased significantly. Point-of-sale displays are effective in recruiting young people to smoking. For this reason, the World Health Organization (WHO) has defined such displays as a type of advertising and recommends that they are banned completely (WHO, 2008).

Industry misinformation

The tobacco industry has argued that such marketing has no impact on children and that its sole purpose is to allow adult smokers to choose between brands (Tobacco Manufacturers Association, 2008). However, the evidence shows that only 6% of adult smokers use displays to make a choice about what they will purchase, while 94% know what brand they will buy before they walk in the shop (Centre for Tobacco Control Research, 2008). 

The tobacco industry and its front organisations have also suggested that these measures will financially cripple small shops, claiming they will cost thousands of pounds to implement. In reality low-cost solutions exist, are in widespread use in Canada and are entirely feasible in the UK as well. The Department of Health has given small retailers until 2013 to comply with the measure to allow ample time to explore a range of possible solutions (Department of Health, 2009).

Iceland was the first country to ban retail display of tobacco products in 2001. The tobacco industry has persistently used data from a small sample of young people in Iceland to claim the ban has had no effect on youth smoking despite being reprimanded by the Icelandic Public Health Institute who generated the data. The Institute recommends using a much larger survey of all 16 year olds, which shows that smoking prevalence fell from 18.6% two years before the ban to 13.6% two years after, which is double the previous rate of decline (ESPAD, 2004, 2008).

Vending machines

Restricting the sale of tobacco to children from vending machines is also a necessary measure to protect children from starting smoking. Currently, 17% of 11 to 15 year olds regularly buy tobacco from vending machines and test purchasing shows that children are often not challenged when buying tobacco from a vending machine (The National Centre for Social Research and the National Foundation for Educational Research, 2007). ASH believes that the government should follow the lead of the 22 other European countries who have already banned the sale of tobacco from vending machines.

Write to your MP

Midwives can help make a real difference on this issue by putting forward the public health case to MPs explaining why it  is so important that young people do not start smoking and the adverse effects of smoking on the mother, her unborn child and her family.


ASH. (2008a) Essential information. Smoking statistics: illness and death. See: http://tinyurl.com/qj9foj (accessed 7 May).

ASH. (2008b) Essential information. Young people and smoking. See: http://tinyurl.com/pl7jjl (accessed 7 May).

ASH. (2008c) Beyond smoking kills. See: www.ash.org.uk (accessed 7 May).

BMRB Social Research. (2005) Infant feeding survey. See: http://tinyurl.com/oo7bsz (accessed 7 May).

Centre for Tobacco Control Research. (2008) Point of sale display of tobacco products. See: http://tinyurl.com/ph6ff2 (accessed 13 May).

Department of Health. (2009). Impact assessment for the Health Bill 2009. See: http://tinyurl.com/qu2pdg (accessed 13 May).

Royal College of Physicians. (1992) Smoking and the young. Royal College of Physicians: London.

Tobacco Advertising and Promotion Act. (2002) See: http://tinyurl.com/rbkcoz (accessed 7 May).

Tobacco Manufacturers Association. (2008) Response of the tobacco manufacturers
association to the consultation on the future of tobacco control. See: http://tinyurl.com/oxmnn (accessed 7 May).

The National Centre for Social Research and the National Foundation for Educational Research. (2007) Smoking, drinking and drug use among young people in England in 2006: headline figures. See: http://tinyurl.com/qh6de4 (accessed 13 May).

The European School Survey Project on Alcohol and Other Drugs (ESPAD). (2004) The ESPAD report 2003: alcohol and other drug use among students in 35 European countries. See: http://tinyurl.com/p634qg (accessed 13 May).

The European School Survey Project on Alcohol and Other Drugs (ESPAD). (2008) The 2007 ESPAD report: substance use among students in 35 European countries. See: http://tinyurl.com/pvg3gl (accessed 13 May).

WHO. (2008) Framework convention on tobacco control. Guidance for the Implementation of Article 13. See: www.http://tinyurl.com/pg2a9z (accessed 7 May).

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