Smoking by primary schoolchildren prevalence and associated respiratory symptoms.

. to conclude. Since it is so hurtful and dangerous to youth I wish that it might have the pernicious nature expressed in the name and that it were as well known by the name of youth's bane as by the name of tobacco' (E. D., 1606). Three and a half centuries were to pass before the use of epidemiological methods confirmed the statements that tobacco 'breedeth many diseases' and 'shorteneth life' (Royal College of Physicians, 1962). A number of studies of adults have shown that respiratory disease is associated with cigarette smoking (Royal College of Physicians, 1971) and there is also increasing evidence that respiratory disease begins in childhood (Douglas and Waller, 1966; Colley and Reid, 1970; Holland, Halil, Bennett, and Elliott, 1969 a and b; Lunn, Knowelden, and Handyside, 1967; Lunn, Knowelden, and Roe, 1970). Holland and his colleagues, in their study of Kent secondary schoolchildren, demonstrated an association between cigarette smoking and respiratory symptoms. There has, however, been no large-scale study of smoking and health among younger children. The study described in this paper attempted to fill this gap. It aimed to investigate the prevalence of smoking by primary schoolchildren and to determine whether a relationship between smoking and respiratory symptoms appears at this early age. STUDY POPULATION AND METHODS The study population consisted of the 8,682 children aged between 10 and 1 j years who were in their final year of primary school in the Administrative County of Derbyshire (excluding the Borough of Chesterfield). In March 1971 these children were asked to complete a self-administered questionnaire on their respiratory symptoms and smoking behaviour. The questionnaire was based on the Medical Research Council (1960, 1967) respiratory questionnaire. It was explained to the children by their teachers and was completed in the classroom. Confidentiality was emphasized and the children were assured that the information would not be revealed to their parents or to the school authorities. Questionnaires were returned directly to the Department of Social Medicine, St. Thomas' Hospital in individual stamped addressed envelopes. There were difficulties in deciding on smoking classifications since it was unlikely that children of this age would be smoking much. Finally, we defined a child who reported smoking at least one cigarette a week as a smoker; a child who had ever puffed or smoked a cigarette, but was not a smoker as defined, as an experimental smoker; and a child who had never smoked as a non-smoker. We grouped the children as 'urban' or 'rural' according to the location of the school they attended (Derbyshire County Report). We were unable to group them according to area of residence since, for reasons of confidentiality, we did not obtain their home addresses.