Article Text

Download PDFPDF

Why has adolescent smoking declined dramatically? Trend analysis using repeat cross-sectional data from New Zealand 2002–2015
  1. Jude Ball1,
  2. Dalice Sim2,
  3. Richard Edwards1
  1. 1 Public Health Department, University of Otago, Wellington, Wellington, New Zealand
  2. 2 Dean’s Department, University of Otago, Wellington, Wellington, New Zealand
  1. Correspondence to Jude Ball; jude.ball{at}


Objectives Adolescent smoking has declined in New Zealand and in many other countries since the late 1990s, yet the reasons for the decline are not well understood. We investigated the extent to which established risk factors for adolescent smoking (parental, sibling and peer smoking, and exposure to smoking in the home) explained the downward trend.

Design Trend analysis of repeat cross-sectional data from an annual nationally representative survey.

Setting New Zealand.

Participants Secondary school students aged 14–15 (n=398 221).

Outcome measure Regular (at least monthly) smoking.

Methods For each risk factor (parental smoking, best friend smoking, older sibling smoking and past week exposure to smoking in the home) we plotted prevalence of exposure, 2002–2015. Next, using multivariable logistic regression, we modelled the trend in regular smoking (expressed as an OR for year) adjusting for age, sex, ethnicity and socioeconomic position. The risk factors were added to the model—individually and collectively—to test whether they attenuated the OR for year.

Results Exposure to all risk factors except ‘past week exposure to smoking in the home’ decreased between 2002 and 2015. We observed a strong downward trend in regular smoking among adolescents (OR=0.88 per year, 95% CI 0.88 to 0.88, p<0.001). ‘Best friend smoking’ was the only risk factor that significantly attenuated the trend. However, due to circularity, this factor provides an unsatisfactory explanation for population level smoking decline.

Conclusions The established risk factors that we explored do not appear to have contributed to the remarkable decline in adolescent smoking in New Zealand between 2003 and 2015. Further research is needed to assess the possible contribution of factors outside our model, such as changes in the policy context, the social meaning of smoking and broader social and economic conditions.

  • paediatrics
  • preventive medicine
  • public health
  • epidemiology

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from


  • Contributors All authors contributed to the conception and design of the study. The analysis was executed by DS and JB, with oversight by RE. JB drafted the manuscript with input from all authors.

  • Funding This work was supported by a University of Otago Research Grant 507415.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The survey was approved, as a component of the NZ Youth Tobacco Monitor, by the Ministry of Health Multiregional Health and Disability Ethics Committee in 2007.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data are owned by ASH New Zealand, and cannot be shared by the authors.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.