Long-term evaluation of the rise in legal age-of-sale of cigarettes from 16 to 18 in England: a trend analysis

Beard, Emma; Brown, Jamie; Jackson, Sarah E; West, Robert A.; Anderson, Will; Arnott, Deborah; Shahab, Lion

doi:10.1186/s12916-020-01541-w

Cited by 10 publications

(7 citation statements)

References 47 publications

(63 reference statements)

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“…Increasing the age of sale of cigarettes is one strategy that may be effective both in reducing uptake and in narrowing inequalities in smoking. 18,19 Second, the pandemic appears to have had equity-positive impacts on smoking. Progress in reducing smoking prevalence has historically been slower for disadvantaged groups.…”

Section: Discussionmentioning

confidence: 99%

Have there been sustained impacts of the Covid-19 pandemic on trends in smoking prevalence, uptake, quitting, use of treatment, and relapse? A monthly population study in England, 2017-2022

Jackson

Tattan‐Birch

Shahab

et al. 2022

Preprint

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Background: This study aimed to examine whether there have been sustained impacts of the Covid-19 pandemic on smoking patterns in England. Methods: Data were from 101,960 adults (≥18y) participating in a monthly representative household survey between June-2017 and August-2022. Interview were conducted face-to-face until March 2020 and via telephone thereafter. Generalised additive models estimated associations of the pandemic onset (March-2020) with current smoking, uptake, cessation, quit attempts, medium-term abstinence, and use of support. Models adjusted for seasonality, sociodemographic characteristics, and (where relevant) dependence and tobacco control mass-media expenditure. Findings: Before the Covid-19 pandemic, smoking prevalence fell by 5.2% per year; this rate of decline slowed to 0.3% per year during the pandemic (RRΔtrend=1.06, 95%CI=1.02-1.09). This slowing was evident in more but not less advantaged social grades (RRΔtrend=1.15, 1.08-1.21; RRΔtrend=1.00, 0.96-1.05). There were sustained step-level changes in different age groups: a 34.9% (95%CI=17.7-54.7%) increase in smoking prevalence among 18-24-year-olds, indicating a potential rise in uptake, in contrast to a 13.6% (95%CI=4.4-21.9%) decrease among 45-65-year-olds. There were sustained increases in quitting among past-year smokers, with a 120.4% (95%CI=79.4-170.9%) step-level increase in cessation and a 41.7% (95%CI=29.7-54.7%) increase in quit attempts. Interpretation: In England, the rate of decline in adult smoking prevalence stagnated during the Covid-19 pandemic. Potential reductions in smoking prevalence among middle-aged adults and sustained increases in quitting among smokers may have been offset by a sustained rise in uptake among young adults. The slowing in the rate of decline was pronounced in more advantaged social grades.

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Section: Discussionmentioning

confidence: 99%

Have there been sustained impacts of the Covid-19 pandemic on trends in smoking prevalence, uptake, quitting, use of treatment, and relapse? A monthly population study in England, 2017-2022

Jackson

Tattan‐Birch

Shahab

et al. 2022

Preprint

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“…This should be considered when taking into account the cost‐effectiveness of any increase in the age of sale, as it may reflect a group which is already highly responsive. Some of this decline may be a consequence of a longer‐term reduction in uptake of smoking following the increase in legal age of sale to 18 in 2007 [15].…”

Section: Discussionmentioning

confidence: 99%

“…In relation to the last of these, studies have demonstrated the long‐ and short‐term efficacy of the increase in the legal age of sale of cigarettes in England from 16 to 18 years on 1 October 2007. There was a greater immediate fall in smoking prevalence in 16–17‐year‐olds following the increase in age of sale than in older age groups and a greater long‐term decline in ever smoking among those aged 16–17 compared with those aged 18–24 [12–15].…”

Section: Introductionmentioning

confidence: 99%

Who would be targeted by increasing the legal age of sale of cigarettes from 18 to 21? A cross‐sectional study exploring the number and characteristics of smokers in England

et al. 2021

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Aims To establish the number of smokers in England who would be targeted by increasing the age of sale of cigarettes from 18 to 21 years and to assess the smoking and socio‐demographic profile of those smokers. Design and setting Nationally representative cross‐sectional survey of adults in England conducted between January 2009 and July 2019. Participants A total of 219 720 adults. Measurements All participants reported their current smoking status and socio‐demographic characteristics (i.e. age, gender, home ownership, social grade and ethnicity). Smokers reported motivation to quit, urges to smoke and the Heaviness of Smoking Index (HIS). Weighted prevalence statistics were calculated. Multinomial regression and logistic regression were used to assess differences in smoking characteristics among smokers and socio‐demographic characteristics relative to non‐smokers. Findings The prevalence of smoking between January 2009 and July 2019 was highest among those aged 21–30. In 2019, 15.6% [95% confidence interval (CI) = 12.8–18.8%] of 18–20‐year‐olds reported smoking, which is estimated to represent 364 000 individuals in England. Relative to smokers aged 18–20, older smokers (aged 21+) had a higher motivation to quit smoking [odds ratios (ORs) = 1.40–1.45 range] and higher nicotine dependency as measured by urges to smoke (ORs = 1.06–1.24 range) and HSI (ORs = 1.05–2.85 range). Compared with non‐smokers aged 18–20, smokers in this age group had lower odds of being female (OR = 0.89) and higher odds of being of white ethnicity (OR = 2.78) and from social grades C1–E (lower social grades) compared with AB (higher social grades) (OR = 1.19–1.83 range). Conclusion Increasing the age of sale of cigarettes to 21 years in England would currently target approximately 364 000 lower dependent smokers from more disadvantaged backgrounds aged 18–20, who have less motivation to quit.

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“…There is good evidence that raising the MLSA to 18 is associated with reduced smoking rates in the target population in England [3][4][5] and reduced commercial tobacco purchases in Finland, [6] although a study on raised European MLSAs did not find an association with smoking prevalence. [7] Given the evidence base for MLSAs, and the uniquely harmful properties of tobacco, there has been renewed global interest in increasing MLSAs beyond 18.…”

Section: Introductionmentioning

confidence: 99%

What is the relationship between raising the minimum legal sales age of tobacco above 20 and cigarette smoking? A systematic review

Davies,

Bogdanovica,

McGill

et al. 2023

Preprint

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Objectives To determine whether raising the minimum legal sales age of tobacco (MLSA) to 20 or above is associated with reduced prevalence of smoking compared to an MLSA set at 18 or below through systematic review. Design Following a pre-registered protocol on PROSPERO (ref: CRD42022347604), six databases were searched for studies that assessed the association between MLSAs of 20 and above and tobacco smoking or tobacco sales. Assessments on e-cigarettes were excluded. Two reviewers independently extracted study data and used ROBINS-I to assess the risk of bias. Narrative methods were used to synthesise findings. Setting Global, with no language restrictions. Subjects Children and young people aged 11-20. Main outcome measures Current cigarette smoking and cigarette sales. Results 19 studies were reviewed, from which 26 effect estimates were extracted. All studies evaluated Tobacco 21 laws in the United States. Just under half of estimates found a statistically significant association with reduced current cigarette smoking or sales, just over half found no statistically significant association and one estimate found an association with increased cigarette smoking. The positive association appeared to be stronger for older age groups, those from a Hispanic/Latinx background and those with lower education. The degree of study bias was variable. Conclusions There is evidence that raising the MLSA for tobacco to 21 reduces cigarette sales and current cigarette smoking amongst those aged 11-20. It may have the potential to reduce health inequalities. Further research beyond the United States would support generalisability to other settings.

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Long-term evaluation of the rise in legal age-of-sale of cigarettes from 16 to 18 in England: a trend analysis

Cited by 10 publications

References 47 publications

Have there been sustained impacts of the Covid-19 pandemic on trends in smoking prevalence, uptake, quitting, use of treatment, and relapse? A monthly population study in England, 2017-2022

Have there been sustained impacts of the Covid-19 pandemic on trends in smoking prevalence, uptake, quitting, use of treatment, and relapse? A monthly population study in England, 2017-2022

Who would be targeted by increasing the legal age of sale of cigarettes from 18 to 21? A cross‐sectional study exploring the number and characteristics of smokers in England

What is the relationship between raising the minimum legal sales age of tobacco above 20 and cigarette smoking? A systematic review

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