Long-term evaluation of the rise in legal age-of-sale of cigarettes from 16 to 18 in England: a trend analysis

OBJECTIVE: To assess the long-term impact of the increase in age-of-sale of cigarettes from 16 to 18 in England in October 2007. METHODS: Data were collected between November 2006 and September 2018 on 252,601 participants taking part in a nationally representative survey of adults aged 16+ in England, the Smoking Toolkit Study (STS). We assessed the impact of the introduction of the increase in age-of-sale on prevalence of ever smoking, current smoking, and quit attempts, among 16–17 year olds compared with 18–24 year olds. RESULTS: Following the increase in age-of-sale, there was a declining trend in ever smoking that was greater among 16–17 year olds than 18–24 year olds (OR 0.990 versus OR 0.993; p = 0.019). Data on current smoking were insensitive to detect a difference between the age groups in a step-level change or change in trend following the increase in age-of-sale (Bayes factors (BFs) 0.75 and 2.10). Data on quit attempts were also insensitive to detect a change in trend (BF 0.71), and despite a greater step-level decline among those aged 16–17 (OR 0.311 versus OR 0.547, p = 0.025), quit attempts remained higher among those aged 16–17. Secondary analysis indicated that post-policy change, trends in current and ever smoking were linear for 16–17 year olds but quadratic for 18–24 year olds (slowing decline). CONCLUSION: There is some evidence from an assessment of long-term trends in the Smoking Toolkit Study that the increase in legal age-of-sale of cigarettes in England was associated with a greater long-term decline in ever smoking among those aged 16–17 compared with those aged 18–24.