Intended for healthcare professionals

CCBYNC Open access

Rapid response to:


Prevalence of vaping and smoking among adolescents in Canada, England, and the United States: repeat national cross sectional surveys

BMJ 2019; 365 doi: (Published 20 June 2019) Cite this as: BMJ 2019;365:l2219

Linked Editorial

Tobacco control: new resources, existing treaties, and emerging challenges

Rapid Response:

Smoking prevalence in young people in England, 2017-2018

Hammond and colleagues report estimates of smoking and vaping prevalence in 2017 and 2018 on the basis of cross-sectional online surveys of 16-19 year olds in the United States, Canada, and England (1). The study provides a useful contribution to an area that is short on data and makes clear the value of monitoring and comparing tobacco control across different countries.

The abstract reports ‘modest increases in England’ in smoking prevalence among 16-19 year olds between 2017 and 2018. The authors accurately noted that there were no nationally representative probability based surveys of 16-19 year olds in England with which to compare their findings. There are, however, two other sources of newly available information which warrant attention: i) the Smoking Toolkit Study (STS) (2), a household survey of people aged 16 and over conducted by Ipsos Mori which employs a hybrid sampling method that includes probability sampling of more than 170,000 output areas in England, and ii) the Annual Population Survey (APS) (3), which is a probability survey of people aged 18 and over. The STS has been shown to produce estimates of smoking prevalence that are similar to other household surveys in England which rely only on probability sampling, and a recent analysis confirmed the survey provides trend data that correspond closely with national sales data (4, 5). The APS is the official source for smoking prevalence in England and included 158,889 adults from England in 2017 and 152,816 in 2018.

In the BMJ paper (1) and technical reports (6, 7), the estimated past 30-day smoking prevalence among English 16-19 year olds is 15.6% (unweighted 6.3%, n=3,970) in 2017 and 16.4% (unweighted unavailable, n=4,423) in 2018. The BMJ paper additionally reports significant increases from 2017 to 2018 in weighted estimates of the related past-week and ≥15 days in past 30 days smoking rates from 9.8% to 11.3% (OR 1.19) and 5.0% to 6.4% (OR 1.31), respectively (unweighted data unavailable). This compares with a current smoking prevalence among 16-19 year olds of 15.6% (unweighted 14.7%, n=1,023) in 2017 and 14.5% (unweighted 14.3%, n=949) in 2018 in the STS (OR 0.92, 95%CI 0.72 to 1.18; Bayes factors based on effect sizes in the Hammond et al paper [half-normal, mean=0, SD=(ln1.19 or 1.31)]=0.41 or 0.28). The APS-reported current smoking prevalence among 18-19 year olds was 12.6% (unweighted 12.6%, n=4,015) in 2017, and 12.5% (unweighted 12.5%, n=3,669) in 2018 (OR 0.99, 95%CI 0.87 to 1.14, with respective Bayes Factors of 0.35 or 0.22 for Hammond et al effect sizes described above).

In summary, whereas Hammond and colleagues reported modest increases in smoking prevalence among 16-19 year olds between 2017 and 2018, both the STS and APS reported numerical declines that did not support modest increases between 2017 and 2018 for 16-19 and 18-19 year olds, respectively. All these sources of information have strengths and limitations. However, given the disparity in Hammond and colleagues’ reported weighted and unweighted data compared with similar weighted and unweighted estimates from two other national surveys consistent with a continuing long-term decline in teenage smoking prevalence, we would argue that the claim that there was a modest increase in smoking among 16-19 year olds in England from 2017 to 2018 be treated with caution.

Cancer Research UK fund the Smoking Toolkit Study data collection and JB’s salary (C1417/A22962). The funders had no final role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. All researchers listed as authors are independent from the funders and all final decisions about the research were taken by the investigators and were unrestricted.

(1) Hammond D, Reid JL, Rynard VL, et al. Prevalence of vaping and smoking among adolescents in Canada, England, and the United States: repeat national cross sectional surveys. BMJ 2019;365:l2219. doi: 10.1136/bmj.l2219.
(2) Brown J, Beard E, West R. Latest trends on smoking in England from the Smoking Toolkit Study. Available at: Accessed 27.06.2019.
(3) Cornish D, Brookman A, Horton M, et al. Adult smoking habits in the UK: 2018. Office for National Statistics 2019. Available at: Accessed 02.07.2019.
(4) Jackson S, Beard E, Kujawski B, et al. Trends in cigarette consumption in England, 2011-2018: A comparison of surveys and recorded sales. Under review.
(5) Fidler JA, Shahab L, West O, et al. 'The smoking toolkit study': a national study of smoking and smoking cessation in England. BMC Public Health 2011;11(1):479. doi: 10.1186/1471-2458-11-479.
(6) Hammond D, Reid JL, White CM, et al. ITC Youth Tobacco and E-cigarette Survey: Technical Report – Wave 1 (2017). University of Waterloo 2018. Available at: Accessed 26.06.2019.
(7) Hammond D, Reid JL, Rynard VL, et al. ITC Youth Tobacco and E-cigarette Survey: Technical Report – Wave 2 (2018). University of Waterloo 2019. Available at: Accessed 27.06.2019.

Competing interests: JB and LS received unrestricted research funding from Pfizer, who manufacture smoking cessation medications. RW and LS undertake research and consultancy for and receives travel funds and hospitality from manufacturers of smoking cessation medications (Pfizer, GlaxoSmithKline and Johnson and Johnson). All authors declare no financial links with tobacco companies or e-cigarette manufacturers or their representatives.

03 July 2019
J Brown
CRUK Principal Research Fellow
Robert J West; Martin J Jarvis; Martin Dockrell (Public Health England); Clare Griffiths (Public Health England); Marie Horton (Public Health England); Lion Shahab
University College London
Dept. of Behavioural Science and Health, 1-19 Torrington Place, WC1E 6BT