In general, the results on cigarette smoking among European students can be interpreted as showing positive developments. Today, the majority of adolescents have never smoked (54 %) and less than one quarter (21 %) of the sample can be considered current smokers. With regard to national patterns, Italy stands out with the highest prevalence of current smoking (37 %), followed by Bulgaria and Croatia (both 33 %), whereas Iceland has by far the lowest rate (6 %), with Moldova (9 %) and Norway (10 %) ranking next lowest. Due to the relatively high addictive potential of nicotine, a particularly problematic pattern of use is early onset of smoking (Nutt et al., 2010). International studies suggest that the risk for dependence is higher when adolescents start smoking at an earlier age (Breslau and Peterson, 1996; Everett et al., 1999). Therefore, it is important to note that the proportion of adolescents who have started daily smoking at a very early age (before age 13) has largely decreased over the last 20 years. Most ESPAD countries follow this general pattern, with only a few exceptions showing stable rates of early onset of daily smoking over time (Cyprus, France, Italy and Romania).
Looking at the overall ESPAD trends for cigarette smoking, gender differences seem to narrow over time. In 1995, boys showed higher rates than girls with regard to all indicators. In 2015, these differences no longer existed or had become smaller. However, gender convergence is more marked in terms of prevalence of use, whereas problematic patterns of use (daily smoking, early onset) are still more prevalent among boys.
The trend data indicate an overall decrease in lifetime, last-30-day and daily cigarette use. Although the ‘Health behaviour in school-aged children’ (HBSC) study has a shorter observation time (2002-2010), trends on weekly tobacco use support the ESPAD results (Hublet et al., 2015). Tobacco use decreased in all observed European countries between 2002 and 2010, and this trend may be considered to be at least partially driven by policy measures that have been implemented in the majority of European countries in the context of the Framework Convention of Tobacco Control (FCTC) over the past two decades (Shibuya et al., 2003). The most important preventive guiding principles are information on the health hazards of tobacco and comprehensive multisectoral measures including price and tax measures, protection from exposure to environmental tobacco smoke, packaging and labelling, restriction of tobacco advertising, promotion and sponsorship, the implementation of cessation measures and limiting the access of underage persons to tobacco products. Increases in tobacco prices, which have made tobacco products less accessible to adolescents, are very likely to have played an important role (Agrawal et al., 2012). Although smoke-free legislation, as a measure to protect the population from exposure to second-hand smoke, does not target smoking behaviour per se, there is evidence that smoke-free legislation reduces tobacco use (Müller et al., 2010). In the global context, the total tax burden on cigarettes is highest in the European region, nevertheless, in most European countries other important measures, such as plain packaging and full restrictions on tobacco advertising, are still pending (World Health Organisation, 2012).