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Protecting children's health through influencing tobacco policy

Our research championed the opinions and experiences of young people in Wales to inform legislation in the UK, Europe and New Zealand.

Girl smoking cigarette stock image

Tobacco is the largest preventable cause of ill-health in the UK, causing 78,000 deaths each year.

In Wales, legislation has sought to tackle this public health issue with a watershed moment coming in April 2007 when smoking in public places was banned.

Following the ban, Cardiff University researchers carried out a series of research studies to address growing concerns about:

  • the risks of smoking at home and in cars.
  • the relationship between e-cigarettes and smoking among children and young people.

Children’s exposure to smoke in cars and homes

With funding from Welsh Government, the researchers carried out the Children's Exposure to Environmental Tobacco Smoke (CHETS) Wales study.

The team analysed biochemical and survey data from approximately 1,750 10–11-year-old children, drawn from 75 primary schools across Wales and collected in the three months immediately prior to the ban on smoking in enclosed public places, and one year later.

Overall, the team found a reduction in child exposure to second-hand smoke though many children continued to report exposure to second-hand smoke in homes and cars, with children from poorer families reporting the greatest continued exposure.

The study led the researchers to call for further action to regulate smoking in cars carrying children.

In 2014, the survey was repeated with 1,601 Welsh Year Six students.

The Cardiff University team found that in the seven years following the ban on smoking in public places, there had been substantial overall decreases in children’s exposure to smoke in cars and homes, but many children remained exposed.

Key facts

  • The percentage of children reporting that smoking was allowed in their family car halved from 18% in 2008 to 9% in 2014.
  • 20% of children with a parent who smoked continued to report that smoking was allowed in their family car in 2014.
  • Children from poorer families continued to report the greatest exposure to second-hand smoke.

In October 2015, the research informed the Welsh Government decision to ban smoking in cars carrying children.

Beyond the UK, the team’s findings were cited in the Decree on the Air Quality in the Indoor Environment of Vehicles (2018-19), which was adopted by the Flemish Parliament, and ratified in December 2018.

The emergence of new risk via e-cigarettes

Following the ban on smoking in public places, e-cigarettes began to emerge as a potential issue in tobacco control.

E-cigarettes pose challenges in achieving a regulatory balance, specifically between minimising harm in adults via helping them to stop smoking, versus widespread concerns that e-cigarettes might provide a gateway to smoking in young people, or might renormalise smoking by mimicking its action.

In May 2015, the Health Secretary for Wales tabled the Public Health (Wales) Bill, which aimed to bring the use of e-cigarette devices in line with existing restrictions on smoking in enclosed public and workplaces.

Around this time, the Cardiff University team published some of the first estimates of the prevalence of e-cigarette use among young people. These indicated that while the prevalence of experimentation with e-cigarettes was on a par with trying smoking in Wales, regular use was rare, particularly among non-smokers. This challenged assumptions used to justify this legislation that e-cigarettes were renormalising smoking.

Cardiff University research featured extensively in written evidence to the Welsh Government opposing the ban on e-cigarettes during the consultation period for the bill.

Following the consultations, the original Public Health (Wales) Bill was not passed into law.

Instead, the rules relating to banning e-cigarettes in enclosed public spaces were removed and a new draft of the Bill passed into law and became the Public Health (Wales) Act 2017.

Following the removal of e-cigarettes from this legislation, the researchers went on to examine trends in young people’s smoking as e-cigarettes were emerging in the UK, as part of an evaluation of EU Tobacco Products Directive regulations led by the Cardiff University team. This found declines in smoking and increases in anti-smoking attitudes were not reversed by the emergence of e-cigarettes. While one of the first studies of its kind, these findings have been replicated in a number of international contexts since.

The findings were supported by a third all-Wales survey led by the Cardiff team in 2019, which revealed:

  • most children understood adult e-cigarette use a social display of an attempt to stop smoking, rather than as an endorsement of smoking
  • parental use of e-cigarettes to quit smoking was not associated with continued perception of smoking as ‘normal’.

Outside Wales, collaborative research on e-cigarettes including the Cardiff University team was also cited in a 2019 ASH New Zealand and End Smoking New Zealand strategy document.

It included research allaying fears that e-cigarettes were leading to renormalisation of smoking and encouraged smoking uptake amongst young people.

The jointly produced strategy was designed as a lobbying document to increase momentum aligned to the New Zealand Government’s aim to reduce smoking prevalence to <5% by 2025.

In November 2020, the New Zealand Government passed the Smokefree Environments and Regulated Products (Vaping) Amendment Act 2020 with specific references to Cardiff University research in the Cabinet documents discussing the amendments.

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