1. WHY ADOLESCENT HEALTH IS IMPORTANT Programme Manager – Youth Health
Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS)
WHY ADOLESCENT HEALTH IS IMPORTANT
Emma Hogg
NHS Health Scotland
Programme Manager – Youth Health

2. Adolescent health is important because:
It has a wide ranging influence
It can be influenced by experiences during adolescence
For some, it is compromised
There is significant room for improvement

3. 1. Because it has a wide ranging influence:
Educational achievement, employability, relationships and contribution to society
Success as a future adult, parent, employer/employee, leader and individual
Health outcomes in adulthood and later life
The health of the next generation
Being healthy during the adolescent years is important in itself but also has an impact on other aspects of life. It can:
•impact on a young person’s educational achievement, employability, relationships and contribution to society
•influence how successful a young person will be as a future adult, parent, employer/employee, leader and individual
•affect health outcomes in adulthood and later life
•shape the health of the next generation .

4. 2. Because it can be influenced by experiences during adolescence:
Biological and physical changes
Cognitive developments - advanced reasoning skills, abstract thinking skills, meta cognition
Developments in the ability to perceive, assess and manage emotions
Social skills development
Adolescent health is imp because it can be influenced by experiences during adolescence, not just in the early years.
Now well known (EY collab, Harry Burns, etc.) that experiences in the early years can influence health in later life.
However, experiences during adolescence also play a significant role.
Adolescence is a time of further sig development – this development happens on a number of fronts:
•Biological and physical changes (including brain development) occur during puberty, which result in the capacity to reproduce and influence risk-taking behaviour.
•Cognitive developments (i.e. developments in thinking) occur in
-advanced reasoning skills (such as the ability to think about multiple options, to think hypothetically and to follow a logical thought process);
-abstract thinking skills (which helps young people consider the future, judge options, solve problems and set goals) and
-meta cognition (the ability to think about thinking, which helps young people consider what they are thinking as well as being able to think about how they are viewed by others);
•Developments occur in young people’s ability to perceive, assess and manage their emotions and their capacity to sensitively and effectively relate to others.
•Social skills development occurs and may be influenced by the values, attitudes and behaviours of peers.
These changes bring new challenges and opportunities that can positively or negatively influence health outcomes, both during and after adolescence, over and above the influence of the early years.

5. 2. Because it can be influenced by experiences during adolescence:
It provides second chances:
Consolidate healthy development
Compensate for unhealthy development
Adolescence is therefore a time when:
• Healthy development during the early years can be built on - consolidated rather than compromised
• Unhealthy development during the early years can be compensated for

6. 3. Because, for some, it is compromised:
Wellbeing, obesity, sexual health, physical activity, mental health problems and violence
Clear evidence of inequalities in health
The health of some of our young people is compromised
Scottish data shows us that young people in Scotland are not doing well in a number of areas: wellbeing, obesity, sexual health, physical activity, mental health problems and violence.
There is also clear evidence of inequalities in health among young people. Inequalities in health are unfair differences in the health of the population that occur across social classes or population groups. They are a result of social factors and are not inevitable. Young people at particular risk of health inequalities include (but are not limited to) those who: have experienced domestic abuse, are looked after, are unemployed or experience extreme poverty.

7. 4. Because there is significant room for improvement:
The profile of youth health
The availability of national and local data
Understanding and reducing health inequalities
Paying attention to mental well-being
Putting young people at the centre
Ensuring relevant engagement
Raise profile of youth health and its place in healthy development across the life course - Extend the commitment from EYs, taking a life course approach
Data is limited – focus on h behaviours etc. also too many overlapping national surveys putting a burden on YP and others, and big gap in local data.
Limited understanding of Hienq at this stage – lots of work on Hineq is on adults causal evidence and intervention evidence – need to improve understanding
Young people often identify mental wellbeing as being especially important to them. Mental wellbeing is more than the absence of mental health problems and encompasses: good mood, feeling positive, a sense of purpose; a feeling of autonomy and control over one’s life, problem-solving skills; resilience, attentiveness and a sense of involvement with others; the ability to have good relationships with others. New MH policy limited focus on wellbeing
Many health risk behaviours are established during adolescence, and often maintained into adulthood. Consequently, both policy and practice in YHI traditionally focused on health behaviours, especially health risk behaviours (e.g. substance misuse and risky sexual health behaviours). Approach raises a number of concerns. In particular, it is at odds with a person-centred approach and the reality of young people’s lives – young people themselves do not consider their lives in terms of discrete health behaviours. An approach focused on health risk behaviours can also contribute to:
insufficient attention being paid to behaviours that are protective to health e.g. a good diet
problematising young people  
competing agendas between individual health topics, a silo approach in terms of policy and practice and duplication
uncoordinated approaches cascaded from policy makers and practitioners to youth work, community work and school settings 
a focus on behaviours and behaviour change at the expense of looking at wider environmental and fundamental causes of health and health inequalities (such as poverty, unemployment and neighbourhood conditions).
growing evidence different health-promoting and health-risk behaviours have shared influences. For example, risky sexual behaviour and smoking, alcohol misuse and cannabis use have low income and poor housing as a shared risk factor and school connectedness as a shared protective factor.
Acting on these shared influences rather than on individual behaviour may therefore have an impact on several behaviours at once and be a more efficient and effective approach. Also better reflects Hineq agenda
Some good efforts to better engage youth at all levels but need do more

8. Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) 2013
Alcohol
Good afternoon, I’m Iain MacAllister, principal researcher in the Public Health Team, Scottish Government. I am going to quickly run you through some of the main findings on alcohol; my colleague Alison Ferguson will then outline the policy measures we’re currently taking forward to reduce alcohol consumption and harm.
Iain MacAllister and Alison Ferguson

9. Ever drunk alcohol, 2013
For alcohol we have two main prevalence measures we track over time: whether young people have ever drunk alcohol and drinking in the last week.
In terms of ever having drunk alcohol, a third of 13 years olds and 7 in year olds report having drunk alcohol. Encouragingly, the proportion of young people who have never tried alcohol is now at its highest level since 1996.
The proportion of 13 and 15 year olds reporting never having had an alcoholic drink was the highest since 1996

10. Drinking in the past week, 2013
15 year olds
13 year olds
In 2013 around a fifth of 15 year olds and 4% of 13 year olds reported having drunk in the last 7 days. These represent very large falls since 2010 – where over a third of 15 years olds and 14% of 13 year olds drank in the past week. I appreciate the bottom row of this slide is self evident but, given regular media coverage of teenage drinking, it is important to reflect on the fact that the vast, vast majority of this age group are not frequent drinkers. It’s important to challenge the perceived social norm that all young people drink.

11. Trends in weekly drinking, 1990-2013
As the Minister has already noted, weekly drinking is now at the lowest level since the survey series began in Weekly drinking rose in the early part of the 1990s but has generally been falling over the last decade or so. Trends for 13 and 15 year olds follow very similar trajectories as do those for boys and girls. The fall in consumption in 2013 however is the largest on record.
In 2013, drinking in the last week was the lowest recorded since the time series began in 1990

12. Drinking by young people (11-15 years) in England, 1988-2012
I thought it was worth showing you the trend in drinking among young people in England given the similarities. The measure is slightly different and the English survey includes a wider age group so direct comparisons of absolute levels are not valid. But it is interesting that the patterns is very similar – peaking at the start of the last decade and declining since.

13. Average weekly consumption, 2013
One issue I was particularly interested in looking at was whether – with weekly drinking having fallen so significantly – the cohort of remaining drinkers were ‘hard core’ drinkers in the sense that they consumed a lot per week. This doesn’t appear to be the case. Median weekly consumption among 15 year olds fell from 11 units per week in 2010 to 9 units in Median consumption for 13 year olds also fell. So not only is prevalence falling but consumption among those who continue to drink is lower.

14. Attitudes: OK to try drinking?
15 year olds
13 year olds
And what about attitudes to alcohol? SALSUS doesn’t actually ask many attitudinal questions on alcohol (2015 will ask more) but there has been a fall in the percentage of 13 and 15 year olds who think it’s ok to try drinking – down 5 percentage points for 15 years olds and 10 percentage points for 13 year olds. Perhaps more crucially, the numbers who think it’s OK to get drunk are also falling.
Also fall in % that thinks it’s ago to get drunk: 46% % for 15 year olds; 13% % 13 year olds

15. Sources of alcohol (top 3)
In terms of sources of alcohol, for both 13 and 15 year olds most alcohol is obtained from friends and/or relatives.
The vast majority of alcohol is obtained not directly purchased

16. Purchasing from licensed premises
The proportion of 15 years olds purchasing alcohol from a shop has fallen from 11% in 2010 to 7% in 2013, and has halved from 6% to 3% for 13 year olds. Purchasing from pubs is relatively rare with 2% of 13 and 15 year olds who have ever drunk reporting successfully purchasing from a bar.
Given policy initiatives aimed at preventing purchasing from licensed premised, the sharp decrease in the percentage purchasing alcohol from a shop since 2010 is encouraging. However, clearly we need to do more here.
Purchasing from pubs less common – 2% of 13 and 15 year olds said they bought alcohol form a pub.

17. ‘Proxy purchasing’ – sources
39% of 13 year olds and 58% of 15 year olds who had ever drunk alcohol said they had got someone else to buy it for them in the last four weeks
There remains a concern over proxy purchasing, however, and Alison will discuss this in a minute. SALSUS finds that 4 in year olds and 6 in year olds who have drunk alcohol report getting someone else to purchase it. The most common sources of purchased alcohol for both 13 and 15 year olds is a mother, father, carer or an older friend. Around 1 in and 15 year olds report getting a stranger to buy them alcohol.

18. Effects of drinking – drunkenness
Of those who have ever drunk alcohol, 44% of 13 year olds and 70% of 15 years report having been drunk
Of those who have ever drunk alcohol, 44% of 13 year olds and 70% of 15 years report having been drunk (a fall since 2010). 30% of 15 year olds who have drunk alcohol report never being drunk while, worryingly, 20% report being drunk more than 10 times.

19. Consequences, 15 year olds (top 3)
As those who have ever drunk, 44% of 13 year olds and 60% of 15 year olds reported at least one negative consequences
Pupils who had ever had an alcoholic drink (32% of 13 year olds pupils and 70% of 15 year olds) were asked whether, in the past year, they had suffered any effects from drinking alcohol. Negative consequences due to drinking were relatively common - 44% of 13 year olds and 60% of 15 year olds reported at least one negative consequences.
Top 3 for 15 year olds were vomited, done something later regretted and had an argument. Also relatively high numbers who report texting, ing or using social media and wishing they hadn’t. More severe consequences – trouble with police, admitted to hospital relatively uncommon.
Girls more likely than boys to report one or more negative effects due to drinking alcohol. Although difficult to know if this is because they actually do suffer more negative effects or if they are more likely to see the consequences as negative!
Girls more likely than boys to report one or more negative effects
due to drinking alcohol

20. Alcohol-related hospital admissions, aged under 15, 1981/2 – 2013/4
We can’t easily track consequences of drinking over time but I thought this graph was quite interesting. This shows alcohol-related hospital admissions among under 15 year olds since Recalling the prevalence of weekly drinking graph, this shows a roughly similar pattern as one would expect. As drinking prevalence rose in the 1990s, so did alcohol-related admissions. As consumption as fallen, so has harm.

21. Why this matters
Reduction in immediate exposure to risky and harmful behaviour – injuries, admissions, unintended behaviour, etc.
International studies have shown that delaying the age of onset of drinking may be important in reducing the risk of alcohol problems and dependence in later life.
Changing (real and perceived) social and cultural norms around alcohol.
BUT difficulty in disentangling cause and effect. However, clear potential to reduce alcohol-related harm over the long term.
I’ll had over to Alison to talk through some of the measures we’re taking to address alcohol-related harm.

22. The Burden of Alcohol Misuse
Total cost of alcohol misuse is £3.6 billion (£900 per adult per year)
Alcohol-related hospital admissions have quadrupled since the 1980s – almost 700 people per week admitted
Alcohol-related deaths have almost doubled since the early 1980s with over 20 deaths per week
Drink almost 20% more alcohol than England

23. Alcohol-related hospital admissions and deaths, 1981-2013

24. Scotland’s Alcohol Strategy – Changing Scotland’s Relationship with Alcohol
Whole population approach, not just targeted interventions
Over 40 actions covering prevention / treatment / education / licensing etc.
Covers reducing consumption; supporting families and communities; positive attitudes, positive choices; and improved support and treatment
Based on WHO’s Global Strategy to reduce harmful use of alcohol
Invested £278 million since 2008 to tackle alcohol misuse

25. Alcohol Framework - Progress
Challenge 25
Offence for someone to buy alcohol for a young person
Support for diversionary activities through Cashback for Communities
Improved substance use education
Improved support for those children affected by parental substance misuse
Issued guidance for parents and carers about young people and alcohol

26. Alcohol Framework - Progress
Established Alcohol and Drugs Partnerships
470,000 Alcohol Brief Interventions
Multi-buy ban in the off-trade and restricted promotions
Increasing availability of smaller wine measures in the on-trade

27. Alcohol Framework – More to do
Minimum unit pricing
Strengthening legislation relating to giving young people alcohol
Advertising / marketing / social media

28. Drug misuse among 13 and 15 year olds in Scotland 2013
Malcolm Cowie – Drugs Policy Unit
Fran Warren – Justice Analytical Services

29. Policy Background Road to Recovery National Drugs Strategy
Phase 1: Strategy embedded
Phase 2: Focus on the delivery of the strategy – getting the basics put in place
Phase 3: Making sure quality is embedded across all services in Scotland.
Prior to 2008 – no drugs strategy. 2008, SG announced the Road to Recovery National Drugs Strategy.
Phase 1 – R2R was based on consensus on the principle of recovery. Initial activity was undertaken to embed the strategy including securing continued funding for frontline drug treatment, care, and recovery services – to date this stands at over £224 million investment. And mobilising the Public Sector to consider how to respond to the ambitions of the Road to Recovery at a local level.
Phase 2 - Focused on delivery of the Strategy and getting the basics in place for the development and delivery of recovery focused services. Activity included improving access to treatment (with over 20,000 accessing treatment in 2013 alone) and bringing waiting times down to three weeks referral to treatment by establishing a new HEAT target. 30 ADP’s were also formed to develop local strategies and plans in their own areas. A National Naloxone programme was established, Scotland becoming the first country in the world to do so.
Phase 3 – we are now in the third phase of the strategy – focused on quality of service. We have developed Quality Principles that services must aspire to, ensuring that no matter where you are in Scotland, people will have access to the highest quality services to enable and support their recovery. We have a new team working with ADPs delivering coaching and advice on service redesign and workforce development across the country. We have established the world’s first Recovery Consortium – through communications campaigns and the recovery college.

30. Importance of SALSUS
SALSUS provides the most authoritative data on trends in substance use and lifestyle issues among Scotland’s young people.
The survey which began in 1982 was extended in 1998 to include information on drug taking.
The survey series provides invaluable information on drug use by Health Board; ADP; and Local Authority, as well as national data.
The SALSUS 2013 survey continues the national series of biennial surveys of smoking, drinking and drug use among secondary school children, which began in 1982 in order to obtain information on smoking. The survey was subsequently extended in 1990 to include alcohol use and, in 1998, drug taking.
SALSUS alternates between a smaller sample which reports at a national level and (as with the 2013 survey) a larger sample which provide health board, Alcohol and Drug Partnership (ADP) and local authority, as well as national data.
This information is invaluable and has enabled us to compare changing drug trends over a 15 year period.
The SALSUS information shows us that far fewer young people are using drugs than ever before, and that drug use among young people is the lowest in over a decade. It also helps us understand the changes in patterns of drug use, with falling use of traditional drugs, and a change to New Psychoactive Substances /Party drugs.

31. SALSUS 2013 Drugs Findings Prevalence Types of Drugs Used
New Psychoactive Substances (NPS)
Frequency of Drug Use
Being Offered Drugs
Ease of Obtaining Drugs
I’m going to talk about some of the key findings from the SALSUS Drug Misuse report. Specifically…

32. Prevalence
Ever used drugs - 18% of 15 year olds and 4% of 13 year olds.
In the last year - 16% of 15 year olds and 3% of 13 year olds.
In the last month - 9% of 15 year olds and 2% of 13 year olds - the lowest since the survey series began in 1998.
Pupils were provided with a list of drugs alongside some of their street names and asked to indicate if they had taken each of them ‘in the last month’, ‘in the last year’, ‘more than a year ago’ or ‘never’.
18% of 15 year olds and 4% of 13 year olds reported that they had used drugs at some point in their lives - This is down from 21% and 5% in 2010.
16% of 15 year olds and 3% of 13 year olds reported using drugs in the last year – this compares with 19% and 4% in 2010.
9% of 15 year olds and 2% of 13 year olds reported using drugs in the last month – this is down from 11% of 15 year olds and 3% of 13 year olds in 2010.
The proportion of pupils who reported using drugs in the month before the survey was the lowest since the survey series began in 1998.

33. Prevalence
Here is a graph from the report on the percentage of pupils using drugs in the month prior to the survey, which shows the decline in last month drug use amongst 13 and 15 year old boys and girls.
For boys and girls together, last month prevalence went from 24% in 1998 to 9% for 15 year olds and from 8% in 1998 to 2% for 13 year olds in 2013.

34. Types of Drugs Used
Cannabis - the most commonly used drug in all three time periods.
15 year olds – other drugs ever used: stimulants (5%), psychedelics (4%).
13 year olds – other drugs ever used: stimulants (1%), psychedelics (1%), opiates (1%) and gas, glue/other solvents (1%).
As in previous years, cannabis was by far the most commonly used drug with much smaller proportions of pupils reporting using other drugs.
17% of 15 year olds and 3% of 13 year olds reported ever using cannabis (down from 19% and 4% in 2010).
9% of 15 year olds and 1% of 13 year olds reported using cannabis in the month before the survey
Both 15 and 13 year olds boys were more likely than 15 and 13 year old girls to report cannabis use in the last month.
Amongst 15 year olds, smaller proportions reported ever using other drugs, e.g. stimulants (5%), psychedelics (4%), gas, glue or other solvents (2%) and opiates (1%).
Amongst 13 year olds, smaller proportions reported ever using other drugs such as stimulants (1%), psychedelics (1%), opiates (1%) and gas, glue or other solvents (1%).

35. New Drugs/NPS
Very small proportions of 15 and 13 year olds reported having used NPS.
4% of 15 year olds and less than 1% of 13 year olds reported ever using one or more NPS.
Most commonly used NPS for 15 year olds - mephedrone, synthetic cannabis and salvia. 13 year olds - synthetic cannabis.
The SALSUS survey asked about a number of NPSs. Those reported in the 2013 survey are GBL or GHB, mephedrone, salvia, synthetic cannabis (spice, black mamba, clockwork orange) and powders or pills that are sold as ‘legal highs’. Some of these drugs were first included in the survey in 2010 (GBL or GHB, mephedrone and spice), but in 2013 further drugs were included (salvia and powders or pills that are sold as legal highs) and ‘spice’ was included in a new synthetic cannabinoid category. As a result of these changes, comparisons cannot be drawn with the 2010 SALSUS data.
The findings showed that very small proportions…
4% of 15 year olds and less than 1% of 13 year olds reported ever using one or more NPS. Of these, 2% reported having taken at least one NPS in the last month.
15 year old boys were more likely than 15 year old girls to report ever having used one or more NPS (5% compared to 3%) and to have taken them in the last month (2% compared to 1%).
Among 15 year olds, the most commonly used NPSs were mephedrone, synthetic cannabis and salvia: 2% of 15 year olds reported ever using these ‘new’ substances, similar to the proportions reporting ever using drugs such as cocaine, ecstasy, poppers and magic mushrooms.

36. Frequency of Drug Use
The vast majority of 15 and 13 year olds reported never using drugs.
There has been an increase in the proportion of pupils who said they have never used drugs since 2010.
The vast majority of 15 and 13 year olds reported never using drugs and, of those who had taken drugs, a high proportion had only taken drugs once. While 18% of 15 year olds reported that they had taken drugs, 7% said that they had only taken drugs once and 2% reported that they used to take drugs sometimes but don't take them anymore.
Compared with 2010, there has been an increase in the proportion of pupils who said they have never used drugs (among 15 year olds, from 80% in 2010 to 82% in 2013 and, among 13 year olds, from 95% in 2010 to 96% in 2013).

37. Being Offered Drugs
The proportion of pupils who reported being offered drugs has fallen since 2010.
Proportion of pupils reporting being offered drugs has fallen since 2010.
This chart shows the proportion of pupils that had been offered any drug, by age group and gender from 1998 to 2013
In terms of boys and girls together, in 2010, 42% of 15 year olds and 16% of 13 year olds reported that they had been offered at least one of the drugs on the list provided. This is now down to 37% and 14% in 2013.
Proportion of pupils that had been offered any drug, by age group and gender:

38. Being Offered Drugs
More pupils reported having been offered drugs than reported using them.
15 year olds more likely to have been offered drugs than 13 year olds.
Boys in both age groups more likely to have been offered drugs than girls.
As in previous surveys, a much higher proportion of pupils reported having been offered drugs than reported using them, with 15 year olds more likely to have been offered drugs than 13 year olds.
Boys in both age groups were more likely to have been offered drugs than girls.

39. Types of Drugs Offered
Cannabis - the drug most commonly offered to pupils.
Drugs ever offered to 15 year olds and 13 year olds respectively:
Cannabis (34% and 9%)
Ecstasy (9% and 2%)
Cocaine (8% and 2%)
NPSs (8% and 3%)
Opiates (3.6% and 1.6%)
Cannabis was also the drug most commonly offered to pupils, with boys more likely to be offered cannabis than girls.
34% of 15 year olds and 9% of 13 year olds and reported being offered cannabis.
Other drugs offered:
14% of 15 year olds and 4% of 13 year olds reported being offered stimulants (ecstasy and cocaine the most commonly reported stimulants offered)
9% of 15 year olds and 2% of 13 year olds had ever been offered ecstasy.
8% of 15 year olds and 2% of 13 year olds had ever been offered cocaine.
8% of 15 year olds and 3% of 13 years olds had ever been offered at least one of the five NPSs.
3.6% of 15 year olds and 1.6% of 13 year olds had ever been offered opiates.
4% of 13 year olds said they had been offered gas, glue or other solvents and 4% also reported being offered stimulants.
NPSs offered (GBL/GBH, mephedrone, synthetic cannabis, salvia and powders or pills sold as legal highs)
The NPSs most commonly offered to 15 year olds was synthetic cannabis (5%) followed by mephedrone and salvia (both 3%).

40. Ease of Obtaining Drugs
Older pupils - ‘fairly/very easy’ to get illegal drugs if they wanted to.
Pupils’ reports of ‘easy’ access to drugs rose in line with frequency of drug use.
Pupils who had used drugs were most likely to have got them from a friend.
Older pupils were more likely to report that it would be ‘fairly/very easy’ to get illegal drugs if they wanted to - 40% of 15 year olds compared with 14% of 13 year olds reported that it would be ‘fairly/very easy’ to get illegal drugs if they wanted to.
Pupils’ reports of ‘easy’ access to drugs rose in line with frequency of drug use. Pupils who had used drugs were most likely to have got them from a friend, e.g. a friend their own age or from an older friend, on the last occasion that they used drugs.

41. Summary
Findings from SALSUS have allowed us to map trends in drug use for the 13 and 15 year old age group from 1998 to 2013.
The adaptability of SALSUS helps us keep up with changes to these trends, such as the use of New Psychoactive Substances.
This helps inform our responses to the challenges they pose.
To conclude, SALSUS is an invaluable source of information for Scottish Government drugs officials. The survey series informs us of a decrease in drug use among the younger age group, and that far fewer young people are using drugs than ever before. It also tells us that in Scotland, drug taking among young people is the lowest in a decade.
SALSUS also adapts to changes in drug trends and patterns of drug use. This is especially important as it helps us understand the changes in drug use in Scotland, and captures current information. A good example of this is the information that SALSUS has started to collect on the use of new psychoactive substances. This will enable us in the future to help better understand changing trends in new drug use. Adaptable information such as this helps us shape our policy so that we can respond to these evolving challenges.
Thank you for your time today, and we will now hand you over to Siobhan MacKay who will discuss the latest findings from Smoking.

42. Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS)
Smoking
Good afternoon, I’m Siobhan Mackay, Tobacco Control Team Leader in the Public Health Team, Scottish Government.
I am going to give an overview of tobacco control policy and the main findings on smoking.
Siobhan Mackay

43. Tobacco Control Policy
A lot has happened in the world of tobacco policy over the last decade.
2002: UK Advertising Ban
2004: A Breath of Fresh Air for Scotland paved the way for the introduction of the smoking ban in public places in Scotland in 2006 – the first such legislation in the UK.
2008: Scotland’s Future is Smoke Free: A Smoking Prevention Action Plan. It recognised that if we are ever to see the end of smoking in Scotland, we must reduce the number of young people who take up smoking and committed. The key aim of that Strategy was to reduce the affordability, attractiveness and availability of tobacco products to children and young people.
2010: That strategy led to the Tobacco and Primary Medical (Scotland) Act 2010 which brought in a range of legislative measures to protect young people from tobacco, including a ban on the sale of tobacco from self-service vending machines and our display ban which has been in place in large shops since April 2013 and will come into force for all other shops in April next year.
2013: That takes us to our latest strategy document – Creating a Tobacco Free Generation which for the first time sets a date by which we would like to achieve our vision of a tobacco free Scotland.

44. Creating a Tobacco-Free Generation
A child born last year, will turn 21 in We would like them to become adults in a Scotland where people choose not to smoke - with all the health, social and economic benefits that entails.
That is why we have set a target to reduce Scotland’s adult smoking rates to less than 5% by 2034.
Because our young people are the adults of the future - and because around two-thirds of smokers in the UK started smoking under the age of 18 and over a third started under the age of 16 - we will not achieve our 2034 target unless we sustain reductions in the number of young people taking up smoking.

45. Smoking Rates - 2013 15 year olds 13 year olds 13 year olds
We are delighted that smoking rates amongst 13 and 15 year olds continue to reduce and are now at the lowest levels ever recorded.
Regular smokers
15 year olds: decreased from 13% in 2010 to 9% in 2013.
13 year olds: decreased from 3% in 2010 to 2% in 2013.
Non Smokers - Highest rates for both age groups and genders since 2007 (not recorded before then)
15 year olds: 91%
13 year olds: 98%
Never Smokers (not on slide)
Increased from 45% in 2002 to 76% in 2013.
13 year olds

46. Trends by Age and Gender
Gender and age
15 - girls: peaked at 34% in 1984 and now declined to 9%
15 - boys: peaked at 30% in 1996 and now declined to 8%
13 - girls: pretty much declined from 10% in 1982 to 2% in 2013.
13 - boys: peaked at 11% in 1994 and now decline to 2% in 2013.
Regular smokers
You can see that there are now no differences between boys and girls in either age group.
Occasional smokers
15 – 5% of girls described themselves as an ‘occasional’ smoker compared to 3% of boys.
13 - no differences between boys and girls.
Never smokers
15 - boys were more likely never to have smoked than girls (69% compared to 63% of girls)
13 - girls were more likely to have never smoked than boys (89% compared to 86% of boys).

47. Number of cigarettes smoked
For both age groups, the median number of cigarettes smoked has dropped from between 2010 and 2013.
13 year olds: 25 to 10
15 year olds: 39 to 34
In both age groups there were no significant differences between boys and girls based on the median number of cigarettes smoked.

48. Sources of Tobacco Where are people getting tobacco?
13 year old regular smokers
Most common source was being given cigarettes (50%)
44% said they were given cigarettes by a friend
8% said they were given cigarettes by siblings
6% said they were given cigarettes by a parent/carer
Nearly two fifths (39%) said that they got someone else to buy them for me down from 54% in 2010.
Around one third (32%) said they buy cigarettes from other people.
15 year old regular smokers
Most commonly source was that they get someone else to buy them for me (56%).
Other sources were being given cigarettes (45%), buying from shops (31%) and buying cigarettes from other people (24%).

49. Buying from Shops Access in shops
Between 2010 and 2013 there was a drop in the proportion of regular and occasional smokers in both age groups reporting that they had successfully purchased cigarettes from a shop in the last four weeks.
13 year old regular smokers: 52% - 23%
15 year old regular smokers: 55% - 42%

50. Attitudes: OK to smoke / want to quit
15 year olds
13 year olds
Attitudes
For both 13 year olds and 15 year olds the proportion thinking that it was ‘ok’ to try smoking has decreased compared to 2010.
15 year olds: 63% to 49%
13 year olds: 29% to 18%
Two-fifths (41%) of regular smokers would like to give up smoking.
Of regular smokers who want to give up, 84% have tried to give up smoking in the past.

51. Friends & Family
As research and previous surveys have shown, regular smokers of all ages were more likely to have a large proportion of friends who also smoked.
Regular smokers were more likely than non-smokers to report that at least one of their parents and/or a sibling smoked daily.
60% off regular smokers said that ‘more than half’ or ’all, or almost all’ of their friends smoked, compared to a third of occasional smokers and 4% of non-smokers.
Fifteen year old smokers were more likely than 13 year olds to have a large proportion of friends who smoked.
Where at least one parent smokes daily, smokers were more likely to report that they were allowed to smoke at home.

52. Exposure to second-hand smoke
Nearly a quarter of all pupils reported that someone smoked in their home either every day or most days.
7% of all pupils reported that when they were travelling by car someone smoked inside the vehicle during all or most journeys.
A further 15% reported someone smoking in the car sometimes.

53. E-Cigarettes E-CIGARETTES
This is an emerging area for us. Evidence about rates of use and access by young people is limited but improving. This is the first national data we have on use amongst young people in Scotland.
It shows that 15 year olds were more likely to have tried or used e-cigarettes (17%) compared to 7% of 13 year olds.

54. Who is using E-Cigs Who is using E-Cigs
While only a small percentage of pupils who had never smoked had tried e-cigarettes, it was more common for pupils who are regular smokers, had tried smoking or who used to smoke to have tried e-cigarettes. This is in line with other available data on use amongst young people.
It is reassuring to see very little use amongst those who had never smoked had ever used e-cigarettes, with 4% having tried them (3% trying them once and 1% having tried them a few times).
Again, a small percentage of regular and occasional smokers (6% and 2%) reported using an e-cigarette on a weekly basis.
Thirteen year old boys were more likely to have ever used e-cigarettes than 13 year old girls (8% compared to 6%). There was no difference between 15 year old boys and girls.
This is an area we will continue to monitor as we develop our policy on E-Cigarettes.

55. What are we doing So, what does all this mean in terms of policy.
As mentioned, we have a bold target to reduce smoking rates to less than 5% by One of the most important things we need to do is to limit the wave of new people that take up smoking each year – mainly young people.
These latest SALSUS statistics are very encouraging but we can’t be complacent. At minimum, we need to sustain this position but ideally, we should seek to improve it.
We have a range of action underway to help us along that journey – which we can’t deliver alone.
Young people are at the heart of our ambition and we need them to help deliver it. Last year, we worked with Young Scot to establish a Youth Commission on Smoking Prevention to help co-design future policy. The Commission have recently reported back to Ministers on what young people think should happen to help us achieve our 2034 target. They are now exploring what they can do next to help deliver those recommendations.
We’re also working with colleagues across the UK to bring forward standardised packaging of tobacco. The evidence shows this measure will have a positive effect on reducing the number of young people that take up smoking.
We know families and communities are a factor in a young person’s decision to try smoking. This means we need to work harder, particularly in our most deprived communities, to support smokers to quit. This year, NHS Health Scotland published a review of cessation services in Scotland alongside recommendations to improve efficiency. We are working with NHS Scotland to respond to that.
We are also undertaking a national pilot of the ASSIST peer education programme – this is a peer education programme developed by Universities of Cardiff and Bristol and has proven success in a randomised control trial. It is being run in schools in the Glasgow, Tayside and Lothian over 3 years and will be evaluated to assess its suitability in Scotland.
We are currently consulting on how we should regulate electronic cigarettes. We need to find a balance between the possible benefits these products could offer smokers and concerns about promoting and renormalising smoking behaviours, particularly amongst young people.
And, finally, until we do reach our tobacco-free target, we need to continue to protect those exposed to second-hand-smoke. Particularly, children. This year saw the launch of our ‘take it right outside’ campaign which encouraged adults not to smoke in enclosed spaces with children and we are currently consulting on legislation to ban smoking in cars with children.

56. Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS)
Overview
Emma McCallum

61. Resilience and protective effects
Weekly sports participation, weekly book reading and being involved in a weekly hobby are associated with those least likely to be involved in drugs, smoking or alcohol.
Those with ‘normal’ scores on all of the ‘Strengths and Difficulties’ scales in terms of the emotion, conduct, hyperactivity/inattention and pro-social scales were more likely to refrain from risky behaviours.
Protective effects also shown by having same age friends and a good parental knowledge what the young person is up to.
University aspirations also act as a protective effect (although young people with higher aspirations come from better-off backgrounds, and we suspect that deprivation plays a role in risky behaviour...)

62. Health Analytical Services, Scottish Government
Contact
Emma McCallum
Health Analytical Services, Scottish Government
Website: