Jump to chapter... Home Foreword Acknowledgments IntroductionChapter 1 Trends in the prevalence of smokingChapter 2 Trends in tobacco consumptionChapter 3 The health effects of active smokingChapter 4 The health effects of secondhand smokeChapter 5 Influences on the uptake and prevention of smokingChapter 6 AddictionChapter 7 Smoking cessationChapter 8 Tobacco use among Aboriginal peoples and Torres Strait IslandersChapter 9 Smoking and social disadvantageChapter 10 The tobacco industry in Australian societyChapter 11 Tobacco advertising and promotionChapter 12 The construction and labelling of Australian cigarettesChapter 13 The pricing and taxation of tobacco products in AustraliaChapter 14 Social marketing and public education campaignsChapter 15 Smokefree environmentsChapter 16 Tobacco litigation in AustraliaChapter 17 The economics of tobacco controlChapter 18 The WHO Framework Convention on Tobacco ControlAppendix 1 Useful weblinks to tobacco resources

As well as regional variations noted in the table above, there are also variations in the prevalence of smoking during pregnancy in certain sub-populations, presumably reflecting smoking behaviour in these groups within the wider population. For example, women who were most disadvantaged were four times more likely to smoke than women who were least disadvantaged (28% compared to 6%). Women with Aboriginal or Torres Strait Islander backgrounds were more than three times more likely to smoke during pregnancy than non-Indigenous women (53% compared with 16%). The likelihood of smoking during pregnancy decreased with maternal age. Forty-one per cent of girls who became pregnant while still teenagers smoked during pregnancy.⁴

In 2009, a program for national data development was completed to add nationally agreed data items on smoking during pregnancy to the Perinatal National Minimum Data Set from 2010. Work is also underway to develop data elements for the collection of antenatal care information, risk factors during pregnancy including alcohol and drug use, and Indigenous status of the baby.⁴

Other research has shown that women without a partner, the less educated,⁵ those with lower socio-economic status^5,6 and women with a psychiatric disorder⁷ are more likely to smoke during pregnancy.

The health consequences of smoking and exposure to secondhand smoke during pregnancy are discussed in Chapter 3 and Chapter 4 respectively. For information on issues related to quitting smoking during pregnancy, refer to Chapter 7.

1.10.2 Smoking and mental illness

Mental health problems are common within the Australian population, with 1 in 10 Australians (children and adults) reporting a long-term mental or behavioural problem.^8,9 Mental health problems include both mild and occasional problems as well as more debilitating conditions, such as major depression and very serious psychotic illnesses such as bipolar disorder and schizophrenia, characterised by fundamental distortions of thinking, perception and emotional response.¹⁰ Individuals with mental health conditions have a higher prevalence of smoking and those who smoke tend to smoke more heavily than the general population.^11,12 Higher rates are observed in those with severe mental illness than in those with mental health problems and the highest rates are observed among those with a diagnosis of psychosis.¹² It has been argued that citation bias exists in the reporting of smoking among people with schizophrenia, with studies that report high prevalence cited more often than studies reporting low prevalence.¹³ Australian research has reported smoking rates of up to 35% among patients suffering from common mental disorders^14,15 (defined as affective, anxiety or substance use disorders). An international meta-analysis of studies on smoking among people with schizophrenia reported pooled prevalence of 60%. An Australian study found rates of 73% in men and 56% in women with psychotic illnesses such as schizophrenia.¹⁶ Among mentally ill in-patients with co-existing alcohol and other drug problems, smoking rates as high as 90% have been observed.¹⁵ People with mental health illnesses who live in institutions have higher rates of smoking than those living in the community.

These excessive smoking rates contribute to higher levels of tobacco-caused morbidity and mortality among people with mental illness.¹⁷

Smokers living with mental illness are severely disadvantaged both by their illness and by expenditure of limited resources on tobacco products—see Chapter 9 for further discussion. Smokers who suffer from severe mental health illnesses, and those living in institutions, were identified in the National Preventative Health Strategy¹⁸ as requiring specialised strategies to assist in cessation. For further discussion on cessation in this target group, see Chapter 7.

1.10.3 Lone parents

In Australia between 2004 and 2006, 22% of all family groups were led by a lone parent, and on average, one in five children younger than 15 were cared for in a family with one parent.¹⁹ Eighty-seven per cent of lone parents bringing up children aged under 15 are women.¹⁹

Australian research has found that the overall prevalence of smoking among lone mothers is about 46%, with those younger in age (18–29 years) reporting the highest prevalence (59%).²⁰

Lone parenthood is associated with social and economic disadvantage,²¹ and is discussed further in Chapter 9.

1.10.4 The homeless

Homelessness is defined as lacking adequate access to safe and secure housing. The 2001 Australian National Census showed that there were about 100,000 homeless people in Australia at that time.²²

Individuals experiencing homelessness have a poorer health status than the general population, with those who are 'street homeless' (those usually dwelling on streets or in parks, in derelict buildings or other temporary shelters) being the worst affected.²³ Melbourne-based research has shown a greatly elevated prevalence of smoking among homeless people (77%), with those who are street homeless reporting higher rates of 93%.²³ For further discussion refer to Chapter 9.

1.10.5 The prison population

The prevalence of smoking in the prison population is far higher than among the general population,^{24, 25} and tobacco use is commonly accepted as part of prison life.²⁶ It is not unusual for tobacco to be used as currency in gambling or other trade.²⁶

Research undertaken in 2001 examining smoking in New South Wales prisons found that 78% of male and 83% of female inmates were smokers.²⁶ Most (95%) inmates smoked roll-your-own cigarettes, a far higher proportion than that seen in the rest of the population; this is most likely due to the lower cost than factory-made cigarettes, but may also be an indicator of a greater degree of addiction.²⁶ Forty-one per cent of prisoners who smoked reported that they smoked more heavily in prison than when in the community. Illicit drug use was closely connected to tobacco use, with about 90% of individuals who had ever injected drugs, or used cannabis, being smokers as well.²⁵ Eighty-six per cent of inmates aged under 25 years were smokers, compared to 64% of prisoners aged over 40 years. Prisoners who smoked were less likely to have completed their schooling. A small number of smokers had started smoking in prison (7%).²⁶

The elevated smoking rates in the prison population reflect, to a large extent, the increased likelihood of disadvantaged socio-economic backgrounds in inmates. Indigenous people, drug users and the less educated are over-represented in the prison system, as are those suffering mental illness.^25,26 As noted elsewhere in this chapter, each of these factors predicts higher smoking rates.

The National Preventative Health Strategy¹⁸ identified the prison population as a priority area for future interventions. For further information, see Chapter 7 and Chapter 9.

1.10.6 Other drug use

Tobacco use commonly co-exists with other drug use. The National Drug Strategy Household Survey of 2010 examined tobacco use and use of other substances (Table 1.10.2). Controlling for age and sex, smokers were over five times as likely to have used marijuana (29%) than non-smokers (7%), and were almost four times as likely to have used any illicit drugs (34% compared with 11%, respectively). In 2005, 4–5 out of 10 secondary school students who reported having used marijuana, amphetamines, hallucinogens or ecstasy, said that they had used tobacco concurrently.²⁷

Most individuals with substance use disorders smoke tobacco as well.²⁶

International¹¹ and Australian^11,15,28 research shows that in this population, smoking rates range from 68%¹¹ to 90%.¹⁵ The relationship between tobacco and other drug use is complex, and may be subject to genetic and neurobiological determinants, as well as psychological and social influences.^29,30 Cessation interventions tailored to the needs of poly-drug users are discussed in Chapter 7, Section 7.19.7.

References

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