Discussion

Although the historical trend for smoking in both adults and children is downwards,6 the figure is still high and pressure needs to be maintained to ensure that the necessary public health measures are sustained and new initiatives are introduced to reduce it further. Measures that are recognised to be effective and need to be sustained include making tobacco less affordable by increasing taxation and reducing the illicit trade as well as continuing to run sustained, well-funded anti-smoking media campaigns. New measures include putting all cigarettes out of sight in all shops (due to be implemented in England in Spring 2015), the introduction of legislation for standardised packaging to reduce children's exposure to branding and the extension of smoke-free legislation to private vehicles. The banning of additives such as menthol which make cigarettes more palatable for children is also an important objective.

The data presented here are based on extrapolation from survey data and thus necessarily approximate. However, the availability of local estimates will enable pressure to be brought directly to bear on those with responsibility for developing and enforcing regulations in particular locations which may be more salient than a national figure.

Local authorities, which following the Health And Social Care Act (2012) now have responsibility for public health, should be encouraged to develop tobacco control policies and programmes designed to reduce local smoking prevalence and live up to their obligations under both the WHO Framework Convention on Tobacco Control Article 5.3 to protect their public health policies from the commercial and vested interests of the tobacco industry (http://www.who.int/fctc/guidelines/adopted/article_5_3/en/) and also the Tobacco Control Plan for England (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213757/dh_124960.pdf). Action on Smoking and Health (ASH) has developed the Challenge, Leadership and Results (CLeaR) standard for tobacco control, which was launched in July 2012 and as of August 2013, 89 out of around 150 upper tier authorities have signed up to it. The CLeaR standard is effectively a score card which local authorities can use to check whether their tobacco control policies live up to best practice (http://www.ash.org.uk/information/clear-excellence-in-local-tobacco-control).

Figures for child smoking uptake in specific areas may be useful when challenging members of parliament who have accepted hospitality, such as trips to Glyndebourne or The Chelsea Flower Show, from the tobacco industry.9

There are some limitations of the data presented. Although the Smoking Drinking and Drug Use Survey is relatively large with over 6000 respondents, the analysis is dependent on comparisons by age and sex and the sample sizes within these categories are clearly smaller. The analysis is also dependent on the publicly available data which have been rounded. Although rounding errors will, to some extent, cancel each other out this does add some uncertainty to the national-level estimate. A further limitation, specifically related to the local-level data, is that it is based on the assumption that smoking uptake by children is proportionate to adult smoking rates, since accurate local childhood smoking rates are not available. In addition, the estimates assume a constant ratio between adult and child population across the UK. However, the mean proportion of 11–15-year-olds to over 18s in England is 7.5% with a SD of 0.8%, so the spread is low and this is therefore unlikely to introduce significant bias (see online for data sources). Finally, although the data are presented at a UK level, this is based on an extrapolation of survey data from English children to the UK population.

In addition to this, while our figures are for under-16s, the age limit on buying tobacco products is 18. It is interesting to note that, although the Smoking Drinking and Drug Use in Young People Survey is collecting data for the 11–15 years age group, the national ambition for reduction in smoking prevalence in young people is for 15-year-olds and is to reduce smoking prevalence from 15% in 2009 to 12% or less by the end of 2015. This is problematic, as the data for 15-year-olds are based on small sample sizes and the CIs wide. Furthermore, there are also no robust data on smoking in 16-year-olds and 17-year-olds. This is a critical transitional period for smoking behaviour and falls below the legal age limit for buying tobacco products, so and it would be useful to have robust annual data on how many contemporary 16–17-year-olds are smoking, and how much.

Smoking is among the largest causes of preventable deaths worldwide. The present data should help to raise awareness of childhood smoking and to focus attention on the need to address this important child protection issue.