Smoking and mental health - NCSCT

Smoking and mental disorders: special circumstances 7
7.6.4 Looked-after children and smoking
The prevalence of mental disorders among children who are taken into
the care of their local authority is four to seven times higher than that of
children living in private households. 175 The 2002 survey of the mental health
of looked-after children indicated that these children have a high prevalence
of risk-taking behaviours in general as well as increased rates of smoking, 176
finding that three times as many 11–15 year olds in care smoked as those
living in private households. 177 Smoking rates in care are also high in
Scotland, where 75% of young people in residential units reported
smoking. 178
As with the wider population of children, those in care who also have a mental
health diagnosis are more likely to smoke. The 2002 survey data from England
suggested that the prevalence among those with any mental disorder was around
50%, and among those with an emotional disorder 65%, compared with 19% of
those without. 176 Emotional disorders and conduct disorders respectively almost
quadrupled and trebled the chances of currently smoking in looked-after
children (Table 7.1). 176
Looked-after children living in residential care were also four times more likely
to smoke than those in foster care, and those who had been in their current
placement for less than a year were more than twice as likely to smoke as children
and young people who had been in placements for longer. 176 However, according
to one survey, over half would like help to stop smoking. 179
There appear to be many factors influencing the high proportion of smokers
among looked-after children. Interestingly, a survey of young people in
residential units in Scotland found that only 27% had started to smoke while in
care, indicating that many were already smoking when they left their birth
families. 178 This is likely to be a reflection of the stressful or chaotic
circumstances that may have led to being taken into care in the first place. The
factors that affect smoking initiation in other young people, such as peers or
carers smoking, may also have an even greater importance in looked-after
children due to their vulnerability and need to build relationships. This is of
significance, as one 2007 Scottish study 180 reported that a higher than average
proportion of residential unit staff (two of five) smoked, and that almost a third
were smoking in front of children and young people in contravention of
Table 7.1 Smoking status of looked-after young people aged 11–17 by
mental health diagnosis (2002) 176
Emotional Conduct Any mental No mental
disorder (%) disorder (%) disorder (%) disorder (%)
Current smoker 65 51 51 19
Never smoker 20 21 23 45
© Royal College of Physicians 2013 151