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MPs have recently voted to ban anyone in England born after 2009 from buying cigarettes, as part of the government’s plan to achieve a smoke-free generation.
Smoking is the single most important preventable cause of ill health and death globally. In England alone, around 64,000 people in England die each year from a smoking-related disease such as lung cancer, stroke and heart attacks.
There’s also the economic impact of smoking. Every year, around £14 billion is lost due to people being off ill or out of work as a result of smoking-related illnesses. Illnesses linked to smoking also cost the health and social care system around £3 billion per year. And, in 2022-2023, more than 400,000 hospital admissions could be attributed to smoking.
Research shows that most smokers start in their teens and become addicted for life. Many want to quit, but find it exceedingly difficult to do so because of their nicotine addiction. Indeed, one study noted that it may take thirty or more attempts before a smoker is successful in quitting.
Stopping smoking at any age is beneficial. But the effect is greatest if young people are prevented from smoking in the first place.
Public health benefits
Smoking rates in the UK have been falling over the last few decades, in part helped by tobacco control efforts during this time. In 2022, just under 13% of adults (around 6.4 million people) in England smoked cigarettes compared to nearly half the population in 1974.
Young adults are more likely to be smokers than older adults, partly due to tobacco marketing that targets them. However, it takes many years for the harms of smoking to manifest. Effectively banning young people from ever being able to start smoking cigarettes would have many benefits for public health.
Smoking causes countless preventable diseases. These include nine out of ten cases of chronic obstructive lung disease, seven out of ten cases of lung cancer, early heart disease, stroke, dementia, and diabetes, as well as numerous other cancers and medical conditions – such as stomach ulcers and severe asthma.
These diseases are often lethal. Indeed, smoking causes one in four of all UK cancer deaths, one in three deaths due to lung disease and one in nine circulatory disease deaths.
These harms are not limited only to smokers, either. Non-smokers exposed to secondhand smoke also suffer increased risks of these harms. This is particularly a concern for children, babies and pregnant women. Pregnant women exposed to secondhand smoke are also at greater risk of stillbirth and congenital malformations, low birth weights and cot deaths.
The prevalence of smoking is also greater in poorer communities and is a major contributor to the difference in life expectancy between richer and poorer areas. Smoking-related diseases are more common in areas of deprivation, and lead to more hospital admissions and greater NHS pressures in those areas.
Notably, ill health and deaths due to smoking are avoidable. By reducing the number of people who can smoke cigarettes, this will have considerable public health benefits – both in the short-term and long-term, and for both smokers and non-smokers.
Other considerations
A ban on sales to youths on its own will not be enough to eliminate smoking.
First, if the ban is not enforced or adhered to it won’t be effective. Currently, it’s already illegal to supply cigarettes to young people under the age of eighteen. But one 2019-2020 survey found that a quarter of under-18s who were regular smokers reported getting their cigarettes from shops. Retailers complying with the ban may help reduce underage smoking.
Yet even if most mainstream retailers comply with the ban, there’s also the problem of illegal cigarette sales to young people. In 2021-2022, the illicit market was estimated to make up nearly 18% of all tobacco trade in the UK.
Public support is also needed for the legislation to be effective. While many people may support the government’s ambition to be smokefree by 2030, there will also be many who don’t support the ban. Numerous MPs have even been outspoken in their opposition to the ban – citing concerns that it may encourage an illicit tobacco trade, be difficult to enforce and that other measures could be more effective in preventing young people from smoking.
What’s needed to drive down smoking rates in young people is a comprehensive package of measures. Measures such as teaching young people on the harms of tobacco in schools, mass media campaigns and smoke-free policies in public spaces can all help to prevent the uptake of smoking and change society’s attitudes to its use.
Help for those who want to quit is also needed. Plain packaging of cigarettes, as well as tax increases on tobacco products to raise their prices, are also effective.
Vaping is safer than smoking and is another tool that may help people addicted to nicotine to stop smoking. However, it isn’t a solution to youth smoking rates as vapes are still highly addictive and can cause lung injury. Worryingly, youth vaping is on the rise – with one study finding that 24% of 16-to-19-year-olds in England having vaped in the past month.
The UK’s previous tobacco control efforts between 1998 and 2010 may have prevented 210,000 deaths. These included interventions such as the NHS’s Stop Smoking Services, which was set up to target disadvantage smokers. But around half a million more people will die from smoking by 2030 if action is not taken now. There are many more lives that can be saved.
Andrew Lee has previously received research funding from the National Institute for Health Research. He is a member of the UK Faculty of Public Health and the Royal Society for Public Health, and has previously worked for Public Health England.
