Health Survey for England, 2022 Part 1

This report presents key statistics about children’s health and health-related behaviours in 2022. It describes children’s cigarette smoking, e-cigarette use, experience of drinking alcohol, fruit and vegetable consumption and general health.

Detailed tables accompanying this report can be accessed here.

• The proportion of children aged 8 to 15 who have ever tried a cigarette decreased from 19% in 1997 to 3% in 2022.
• In 2022, 12% of children aged 8 to 15 had ever used an e-cigarette or vaping device.
• The proportion of children aged 8 to 15 who had ever drunk alcohol fell from 45% in 2003 to 14% in 2022.
• In 2022, 34% of 13 to 15 year olds reported ever having drunk alcohol, compared with 2% of 8 to 12 year olds.
• 19% of children aged 5 to 15 ate the recommended five or more portions of fruit and vegetables a day.  

Children and young smokers experience more risks to their respiratory health than their non-smoking peers (Source: Action on Smoking and Health (ASH)). Those who begin smoking during childhood are more likely to continue smoking into adulthood (Source: Chen and Millar, 1998).

Children aged 8 to 15 were asked about their experiences of cigarette smoking within a self-completion questionnaire, ensuring confidentiality from other household members, in particular parents and caregivers.

Children’s experiences of cigarette smoking were captured using two questions. Children were asked: ‘Have you ever tried smoking a cigarette, even if it was only a puff or two?’ followed by a choice of six statements which measure frequency of cigarette smoking:

• I have never smoked a cigarette
• I have only smoked a cigarette once or twice
• I used to smoke sometimes, but I never smoke a cigarette now
• I sometimes smoke cigarettes, but I don’t smoke every week
• I smoke between one and six cigarettes a week
• I smoke more than six cigarettes a week

Children were counted as having smoked a cigarette if they had selected any option other than ‘I have never smoked a cigarette’.

Within this topic report year on year trends have been discussed where data is comparable.

Parents were defined as current smokers if they answered ‘yes’ to the question ‘Do you smoke cigarettes at all nowadays?’. They were defined as former regular smokers if they answered ‘yes’ to the question ‘Have you ever smoked cigarettes?’ and also confirmed that they had smoked cigarettes regularly, at least once a day. Parents were classified as having never regularly smoked if they had either never smoked or had not smoked at least one cigarette a day. For 2022, parental smoking status combined data on smoking status of any participating parents. In previous years parental smoking status had been separated out for mothers and fathers.

In 2022, 3% of children aged 8 to 15 reported that they had ever smoked a cigarette. The proportion of children aged 8 to 15 who had ever smoked a cigarette decreased from 19% in 1997 to 3% in 2022. The proportions were similar for boys and girls.

For more information: Table 1

The English Index of Multiple Deprivation (IMD) is a measure of area deprivation, based on 37 indicators, across seven domains of deprivation. IMD is a measure of the overall deprivation experienced by people living in a neighbourhood, although not everyone who lives in a deprived neighbourhood will be deprived themselves. To enable comparisons, areas are classified into quintiles (fifths). For further information about the IMD, see the HSE 2022 Methods documentation, available on the first page.

The proportions of children reporting they had ever smoked varied by area deprivation with no clear pattern.

For more information: Table 2

Evidence suggests that parental smoking status is one of the main risk factors linked with smoking initiation among children. Children who live in a household where one or both parents currently smoke are more likely to try smoking or become smokers themselves, compared with children living in non-smoking households (Source: ASH: Young people and smoking).

To establish the current smoking status of children’s parents or guardians, data for adults who took part in the HSE interview was linked to their children’s records if they were the legal parent or guardian of the child and lived in the same household. 

Self-reported cigarette smoking was more common among children who had a parent who currently smoked (8%) than children who had a parent who was a former smoker (1%) and children whose parents never smoked (2%).

For more information: Table 3

Electronic cigarettes (e-cigarettes) and other vaping devices use a range of methods that allow their users to inhale nicotine as a vapour rather than via tobacco smoke. Their use among children and young people in Britain has increased in recent years (Source: ASH: Use of e-cigarettes among young people in Great Britain).

There are strict regulations on the kind of e-cigarettes and vaping devices that can be sold, and how much nicotine they can contain (Source: GOV.uk). It is an offence to sell e-cigarettes to children under 18 in the United Kingdom.

This report uses the term e-cigarette to refer to all vaping devices.

As with cigarettes, children aged 8 to 15 were asked about their experiences of e-cigarettes within a self-completion questionnaire, ensuring confidentiality from other members of the household, in particular parents and caregivers. Children have been asked about their use of electronic cigarettes (e-cigarettes) since 2015.

Children’s experience of e-cigarettes was captured through two questions. Children were initially asked ‘Have you ever heard of e-cigarettes or vaping devices?’. If the child answered yes, they were offered a choice of six statements which measured the child’s personal use of e-cigarettes. Statements included:

• I have never tried e-cigarettes or vaping devices
• I have used vaping devices only once or twice
• I used to use e-cigarettes or vaping devices but I don’t now
• I sometimes use e-cigarettes or vaping devices but don’t use them every week
• I use e-cigarettes or vaping devices regularly, once a week or more

Children who selected any statement other than ‘I have never tried e-cigarettes or vaping devices’ were counted as having used an e-cigarette. 

In 2022, 12% of children aged 8 to 15 had ever used an e-cigarette. Between 2016 and 2022, the proportion of children who had ever used e-cigarettes has varied between 7% and 12%.

E-cigarette use did not differ between boys and girls.

For more information: Table 4

The English Index of Multiple Deprivation (IMD) is a measure of area deprivation, based on 37 indicators, across seven domains of deprivation. IMD is a measure of the overall deprivation experienced by people living in a neighbourhood, although not everyone who lives in a deprived neighbourhood will be deprived themselves. To enable comparisons, areas are classified into quintiles (fifths). For further information about the IMD, see the HSE 2022 Methods documentation, available on the first page.

Children’s e-cigarette use did not differ by area deprivation.

For more information: Table 5

In 2009, the Chief Medical Officer published guidance on the consumption of alcohol by children and young people which outlined recommendations for children to remain alcohol free up to the age of 15, and that consumption in young adults aged 15 to 17 be supervised by an adult (Source: Guidance on the Consumption of Alcohol by Children and Young People). The guidance is based on the understanding that alcohol consumption at any point during childhood is known to have adverse effects on development and a wide range of health and social problems.

Children aged 8 to 15 were asked questions about their experiences of alcohol as part of the self-completion questionnaire. This allowed the child to record their responses confidentially.

Children were asked ‘Have you ever had a proper alcoholic drink – a whole drink, not just a sip?’ This was followed by a further question, added in 1999: ‘Have you ever drunk alcopops (such as Bacardi Breezer, Smirnoff Ice, WKD etc)?’. Children are counted as having drunk alcohol if they answer ‘yes’ to either question.

To establish usual weekly alcohol consumption of children’s parents or guardians, data for adults who took part in the HSE interview was linked to their children’s records if they were the legal parent or guardian of the child and lived in the same household. Parents’ usual weekly alcohol consumption was estimated by recording in detail what they had drunk on an average day when they drank in the past 12 months and multiplying that by how often they reported that they drank alcohol. They were classified into four groups in line with the current guidelines for sensible drinking:

• non-drinkers (who reported that they had not drunk alcohol in the past 12 months)
• ‘lower risk’ (weekly consumption of up to 14 units for men and women)
• ‘increasing risk’ (weekly consumption above 14 and up to 50 units for men, above 14 and up to 35 units for women)
• ‘higher risk’ (weekly consumption above 50 units a week for men, above 35 units for women)

For information about how alcohol units were calculated, see the HSE 2022 report on Adult drinking.

Trends are discussed between 1999 and 2022; data from previous years are not comparable.

In 2022, 14% of children aged 8 to 15 reported ever having had a proper alcoholic drink – a whole drink, not just a sip. The proportions were similar for boys (13%) and girls (15%).  

Since 2003 there has been a decline in the proportion of children aged 8 to 15 who had ever had an alcoholic drink, from a peak of 45% in 2003 to 14% in 2022. Since 2016, the prevalence has remained similar, varying between 15% and 14%.   

In 2022, the proportion of children who had ever had an alcoholic drink varied with age, increasing from 2% of 8 to 12 year olds to 34% of 13 to 15 year olds.

For more information: Table 6

To establish the alcohol consumption of children’s parents or guardians, data for adults who took part in the HSE interview were combined with their children’s records. For 2022, parental alcohol consumption data was combined for any participating parents. In previous years parental alcohol consumption had been separated out for mothers and fathers.

Children aged 8 to 15 with at least one parent who drank alcohol in the past 12 months were more likely to report drinking alcohol themselves. Children whose parent or parents had consumed alcohol at increased or higher risk levels were more likely to have reported ever having an alcoholic drink compared with children whose parent or parents had not drunk any alcohol in the past 12 months (24% and 5% respectively).

For more information: Table 7

The World Health Organization recommends that children should eat at least 400g, or five portions, of fruit and vegetables a day in order to promote general health and reduce the risk of certain diet related chronic diseases, such as heart disease, stroke and some cancers in adulthood. The NHS interprets this recommendation with advice to eat at least five 80g portions every day (the 5 A Day campaign).

Participants were asked about the amount of fruit and vegetables they had consumed in the last 24 hours, including salads, pulses, dried and fresh fruit, fresh and frozen vegetables, tinned fruit and vegetables, and fruit juices.

These amounts were collated and assessed as a portion size, which is roughly equivalent to 80g of fruit and/or vegetables.

HSE has asked about fruit and vegetable consumption for children every year between 2001 and 2011. These questions were subsequently included for children in 2013, 2014, 2015, 2016, 2017, 2018 and 2022.

In 2022, 19% of children aged between 5 and 15 ate the recommended five or more portions of fruit and vegetables a day. The proportions were similar for boys (18%) and girls (21%).

The proportion of children eating five or more portions of fruit and vegetables a day was 11% in 2003 and then increased to 21% in 2006. Since 2007, the prevalence of eating five or more portions has between 16% and 23% with no clear trend.

Between 2001 and 2004, the average (mean) number of portions consumed among children aged 5 to 15 was stable between 2.5 and 2.7 portions. There was an increase to 3.3 portions in 2006 and 2007, and it has fluctuated between 3.0 and 3.5 since then. In 2022, children consumed an average (mean) of 3.3 portions of fruit and vegetables a day.

For more information: Table 8

The English Index of Multiple Deprivation (IMD) is a measure of area deprivation, based on 37 indicators, across seven domains of deprivation. IMD is a measure of the overall deprivation experienced by people living in a neighbourhood, although not everyone who lives in a deprived neighbourhood will be deprived themselves. To enable comparisons, areas are classified into quintiles (fifths). For further information about the IMD, see the HSE 2022 Methods documentation, available on the first page.

Children’s consumption of five or more portions of fruit and vegetables a day did not vary by area deprivation.

For more information: Table 9

Self-assessed general health and longstanding illness are important indicators of the general health of the population. They are valid measures for predicting future health outcomes and can be used to project the use of health services and provide information and insight for policy development.

Information was collected for children about self-reported general health, longstanding illness, and acute sickness. In 2012, the questions on longstanding illness were changed to be consistent with the harmonised disability questions designed for use in social surveys, as recommended by the Disability, Health and Carers Primary Standards in 2011. These questions explicitly ask about physical and mental health, separate the concept of disability from illnesses or health conditions, and refer to illnesses or conditions ‘lasting or expecting to last longer than 12 months or more’ rather than ‘over a period of time’. A longstanding illness is defined as limiting if the participant reports that it reduces their ability to carry out day-to-day activities.

Acute sickness is defined as any illness or injury (including longstanding conditions) that has caused the participant to cut down in the last two weeks on things they usually did.

Parents or guardians answered on behalf of children aged 0 to 12, and children aged 13 to 15 answered their own questions, with a parent or guardian present.

Between 1995 and 2022, the proportion of children reporting very good or good health varied between 91% and 96% among boys and girls with no clear pattern. In 2022, 93% of both boys and girls reported very good or good health.

For more information: Table 10

The prevalence of acute sickness in children was 9% in 2022. Between 1995 and 2010 prevalence varied between 9% and 14%, and since 2011 between 8% and 10%.  There has been an overall decline in the prevalence since 1995, from 14% to 9%.

For more information: Table 12