MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Global Digital Health Unit, School of Public Health, Imperial College London, London, UK.
Nicotine Tob Res. 2020 Oct 29;22(11):1973-1980. doi: 10.1093/ntr/ntaa101.
UK countries implemented smoke-free public places legislation and increased the legal age for tobacco purchase from 16 to 18 years between 2006 and 2008. We evaluated the immediate and long-term impacts of these UK policy changes on youth smoking uptake and inequalities therein.
We studied 74 960 person-years of longitudinal data from 14 992 youths (aged 11-15 years) in annual UK household surveys between 1994 and 2016. Discrete-time event history analyses examined whether changes in rates of youth smoking transitions (initiation, experimentation, and escalation to daily smoking or quitting) or their inequalities (by parental education) were associated with policy implementation. Parallel analyses examined smoke-free legislation and the change in legal age. We interpret the results as a combined effect of the two pieces of legislation as their implementation dates were too close to identify separate effects. Models were adjusted for sex, age, UK country, historical year, tobacco taxation, and e-cigarette prevalence, with multiple imputation for missing data.
For both policies, smoking initiation reduced following implementation (change in legal age odds ratio [OR]: 0.67; 95% confidence interval [CI]: 0.55 to 0.81; smoke-free legislation OR: 0.68; 95% CI: 0.56 to 0.82), while inequalities in initiation narrowed over subsequent years. The legal age change was associated with annual increases in progression from initiation to occasional smoking (OR: 1.26; 95% CI: 1.07 to 1.50) and a reduction in quitting following implementation (OR: 0.57; 95% CI: 0.35 to 0.94). Similar effects were observed for smoke-free legislation but CIs overlapped the null.
Policies such as these may be highly effective in preventing and reducing socioeconomic inequalities in youth smoking initiation.
UK implementation of smoke-free legislation and an increase in the legal age for tobacco purchase from 16 to 18 years were associated with an immediate reduction in smoking initiation and a narrowing of inequalities in initiation over subsequent years. While the policies were associated with reductions in the initiation, progression to occasional smoking increased and quitting decreased following the legislation.
2006 年至 2008 年间，英国各地区实施了无烟公共场所立法，并将购买烟草的法定年龄从 16 岁提高到 18 岁。我们评估了这些英国政策变化对青少年吸烟率及其不平等现象的即时和长期影响。
我们研究了 1994 年至 2016 年间，每年在英国家庭调查中对 14992 名 11-15 岁青少年进行的 74960 人年的纵向数据。离散时间事件历史分析检查了青少年吸烟转变率（开始吸烟、尝试吸烟和升级为每日吸烟或戒烟）的变化或其不平等（按父母教育水平）是否与政策实施有关。平行分析检查了无烟立法和法定年龄的变化。由于两项立法的实施日期太近，无法确定单独的影响，因此我们将结果解释为这两项立法的综合影响。模型调整了性别、年龄、英国地区、历史年份、烟草税和电子烟普及率，并对缺失数据进行了多重插补。
对于这两项政策，实施后吸烟开始减少（法定年龄变化的优势比[OR]：0.67；95%置信区间[CI]：0.55 至 0.81；无烟立法 OR：0.68；95% CI：0.56 至 0.82），而吸烟开始的不平等现象在随后几年缩小。法定年龄的变化与从开始吸烟到偶尔吸烟的进展速度每年增加（OR：1.26；95% CI：1.07 至 1.50）以及实施后戒烟率降低（OR：0.57；95% CI：0.35 至 0.94）有关。无烟立法也观察到类似的效果，但置信区间与零值重叠。
这些政策可能在预防和减少青少年吸烟开始的社会经济不平等方面非常有效。
英国实施无烟立法和将购买烟草的法定年龄从 16 岁提高到 18 岁与随后几年吸烟开始率的立即降低以及开始率不平等现象的缩小有关。虽然这些政策与吸烟开始率的降低有关，但立法后偶尔吸烟的人数增加，戒烟人数减少。
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