1.7 Trends in the prevalence of smoking by socio-economic status

Show / hide chapter menu

In Australia^1-3 and many other countries,⁴ smoking behaviour is inversely related to socio-economic status, with disadvantaged groups in the population being more likely to take up and continue smoking. The authors of a seminal British report on poverty and smoking observed that one can 'almost study social disadvantage itself through variations in smoking prevalence' (p78).⁵

Table 1.7.1 sets out data from the National Drug Strategy Household Survey on smoking status by various socio-economic characteristics for Australians 14 years and over in 2010.

Figure 1.7.1 plots the prevalence of current smoking in the same year.

A number of socio-demographic variables are closely connected with the likelihood of smoking. Siahpush and Borland⁷ examined the correlation of smoking behaviour with several factors, including education, family income and Index of Relative Socio-economic Disadvantage (IRSD).ⁱ This research found that all three measures of socio-economic status—education, income and IRSD—were independently and significantly related to the likelihood of smoking for both sexes. Of these three measures, IRSD was most strongly related to smoking status. Individuals falling within the highest IRSD category of disadvantage were about twice as likely to smoke as individuals in the lowest IRSD category, irrespective of individual levels of education and income. This finding suggests that the influence of neighbourhood is an important contributing factor to whether an individual smokes or not. Siahpush and Borland describe this as a 'contextual effect', occurring because smoking is normative behaviour in a particular environment, or because there are other physical, cultural, social or economic factors in those areas that encourage or lead to smoking.⁷

The relationship between smoking and social disadvantage is discussed in greater detail in Chapter 9. Differences in smoking rates among socio-economic groups result in different patterns of tobacco-caused ill health and disease. For discussion, see Chapter 3, Section 3.31.

1.7.1 Trends over time in smoking and educational level

Increasing education levels are associated with decreased likelihood of smoking.

Figure 1.7.2 indicates that between 1980 and 2010, those with a tertiary level education had consistently lower levels of smoking than other members of the community (although levels of smoking were not statistically significant between tertiary education and Year 12/post secondary in 1980) (controlling for sex and age). However, over this period, for each education group, there was a significant linear decline in smoking rates, with the rate of change most substantial among those who had a tertiary level of education as well as those with Year 12/some post-secondary education.

In the more recent period, between 2001 and 2010, smoking rates declined significantly only among those with tertiary education. This trend is shown in Figure 1.7.2. Reflecting long-term trends, Australians who had completed school up to Year 9 (or less), were significantly more likely to be regular smokers across this period, controlling for age and sex, than any other education level except those who had completed up to Year 10 or 11. In 2010, the smoking rate for those with a Year 10/Year 11 education (27%) was significantly higher than that for any other education level (Table 1.7.2). Smoking rates among Australians with a Year 12 education were significantly lower than those with less education or with a trade certificate. As in previous years, in 2010 those with a tertiary education have significantly lower smoking rates than all other education groups.

As the proportion of Australians completing high school to the end of Year 12 and those attaining post-school qualifications have increased over time,^8–14 it is likely that higher educational achievement rates have contributed to the overall decline in smoking among the Australian population.

1.7.2 Trends over time in smoking and occupation

Smoking behaviour is clearly stratified by occupational level, with increasing occupational prestige correlating with a decreased likelihood of smoking. Occupation level is based on the current occupation of survey respondents. In the National Drug Strategy Household Surveys, respondents who were not employed at the time of the survey (such as retirees, or people engaged in domestic duties) were not asked for a previous occupation and are classified as not being in paid work.

In 2010, smoking prevalence among upper white collar workers was significantly lower than for any other occupational group. In 2010, only 13% of individuals in upper white collar employment were smokers, compared with 31% of those working in lower blue collar employment, 26% of upper blue collar workers, 20% of lower white collar workers and 17% of those not in the workforce (Table 1.7.3).

Figure 1.7.3 shows trends in smoking prevalence by occupation level between 1980 and 2010. Due to variability in the way occupation level has been obtained over the survey years, results should be interpreted with some caution.

Overall, between 1980 and 2010 (and 2001 and 2010), regular smoking declined linearly among all occupation groups controlling for age and sex. The decline in smoking between 1980 and 2010 has been proportionately greater among upper white collar workers than other workers. Overall, prevalence of smoking among upper white collar workers more than halved over this study period (Error! Reference source not found.), while among lower blue collar workers, prevalence dropped by 42%, suggesting that the differential in prevalence between the highest and the lowest occupational groups is widening over time, a pattern which has been observed in the UK as well.¹⁵ The lower prevalence of smoking among those with higher occupational status may be a result of fewer individuals in these groups having taken up smoking in the first place, rather than being more successful at quitting smoking.¹⁶

References

1. White V, Hill D, Siahpush M and Bobevski I. How has the prevalence of cigarette smoking changed among Australian adults? Trends in smoking prevalence between 1980 and 2001. Tobacco Control 2003;12(suppl. 2):ii67–ii74. Available from: http://tobaccocontrol.bmj.com/cgi/content/full/12/suppl_2/ii67

2. Siahpush M. Smoking and social inequality. Australian and New Zealand Journal of Public Health 2004;28(3):297. Available from: http://www3.interscience.wiley.com/journal/118803503/abstract

3. Siahpush M and Borland R. Trends in sociodemographic variations in smoking prevalence, 1997–2000. Australia's National Tobacco Campaign: evaluation report Vol. 3. Canberra: Commonwealth Department of Health and Aged Care, 2002;Available from: http://www.health.gov.au/internet/wcms/Publishing.nsf/Content/88ED1349FD03EB05CA257331000C3A17/$File/tobccamp3.pdf

4. Lopez A, Collishaw N and Piha T. A descriptive model of the cigarette epidemic in developed countries. Tobacco Control 1994;3:242–7. Available from: http://tobaccocontrol.bmj.com/cgi/reprint/3/3/242.pdf

5. Marsh A and McKay S. Poor smokers. London: Policy Studies Institute, 1994.

6. Australian Institute of Health and Welfare. 2010 National Drug Strategy Household Survey: survey report. Drug statistics series no. 25, AIHW cat. no. PHE 145. Canberra: AIHW, 2011. Available from: http://www.aihw.gov.au/publication-detail/?id=32212254712&libID=32212254712&tab=2

7. Siahpush M and Borland R. Sociodemographic variations in smoking status among Australians aged 18 years and over: multivariate results from the 1995 National Health Survey. Australian and New Zealand Journal of Public Health 2001;25(2):438–42. Available from: http://www3.interscience.wiley.com/journal/118996678/abstract

8. Australian Bureau of Statistics. 4202.0 National Schools Statistics Collection, Australia. Period covered: 1969–1978. Canberra: ABS, 1978. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/37464C7FA3BC2E17CA257441007F7034?opendocument

9. Australian Bureau of Statistics. 4202.0 National Schools Statistics Collection, Australia. Period covered: 1979–1981. Canberra: ABS, 1981. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/76280E68A062FA73CA257441007F9482?opendocument

10. Australian Bureau of Statistics. 4202.0 National Schools Statistics Collection, Australia. Period covered: 1981–1984. Canberra: ABS, 1984. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/37464C7FA3BC2E17CA257441007F7034?opendocument

11. Australian Bureau of Statistics. 4221.0 National Schools Statistics Collection, Australia. Period covered: 1984–1988. Canberra: ABS, 1988. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/55E852F4156D8588CA257441001B384E?opendocument

12. Australian Bureau of Statistics. 4221.0 Schools Australia 1996. Canberra: ABS, 1997. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/second+level+view?ReadForm&prodno=4221.0&viewtitle=Schools,%20Australia~2006~Latest~26/02/2007&&tabname=Past%20Future%20Issues&prodno=4221.0&issue=2006&num=&view=&

13. Australian Bureau of Statistics. 4221.0 Schools, Australia 2005 Canberra: ABS, 2006. Available from: http://abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/E89FF6F9D793BC6DCA25728B000CEF8D?opendocument

14. Australian Bureau of Statistics. 4221.0 Schools, Australia 2010. Canberra: ABS, 2011. Available from: http://abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/87E83B6B2BB80BE6CA257825000E0136?opendocument

15. Jefferis J, Power C, Grahmam H and Manor O. Changing social gradients in cigarette smoking and cessation over two decades of adult follow-up in a British birth cohort. Journal of Public Health 2004;26(1):13–8. Available from: http://jpubhealth.oxfordjournals.org/cgi/reprint/26/1/13

16. Hill DJ, White VM and Scollo MM. Smoking behaviours of Australian adults in 1995: trends and concerns. Medical Journal of Australia 1998;168(5):209–13. Available from: http://www.mja.com.au/public/issues/mar2/hill/hill.html