8.3 Prevalence of tobacco use among Aboriginal peoples and Torres Strait Islanders

Last updated: August 2016 
Suggested citation: van der Sterren, A, Greenhalgh, EM, Knoche, D, & Winstanley, MH 8.3 Prevalence of tobacco use among Aboriginal and Torres Strait Islander people. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2016. Available from http://www.tobaccoinaustralia.org.au/chapter-8-aptsi/8-3-prevalence-of-tobacco-use-among-aboriginal-peo

Tobacco use is widespread among Aboriginal and Torres Strait Islander populations,1 although prevalence varies between regions and communities across Australia. The first major national study measuring smoking prevalence in the Indigenous population was the National Aboriginal and Torres Strait Islander Survey of 1994,2 subsequently updated with the National Aboriginal and Torres Strait Islander Social Surveys of 2002, 2008, and 2014–15.3–5 National baseline data on drug use among urban Aboriginal peoples and Torres Strait Islanders were also collected in 1994 as a supplement to the National Drug Strategy Household Survey.6 Successive National Drug Strategy Household Survey reports in 1998,7 2001,8 2004,9 2007,10 2010,11 and 201312 have included data on tobacco use among these populations. The National Health Surveys of 199513 and 200114 also provide data sets, and the National Aboriginal and Torres Strait Islander Health Surveys for 2004‒0515 and 2012–131 have been added to this series, expanding on the Indigenous component of the earlier National Health Survey reports. As the most recent report in these series, most of the data presented in this section come from the National Aboriginal and Torres Strait Islander Social Survey, 2014–155 and the National Aboriginal and Torres Strait Islander Health Survey for 2012–13.1

Table 8.3.1 shows the prevalence of daily smoking in 2014–15 by sex, Indigenous status, and age group. When compared to the overall Australian population, Aboriginal peoples and Torres Strait Islanders have a substantially higher prevalence of smoking for all age groups among both men and women. Thirty-nine per cent of the combined Aboriginal and Torres Strait Islander population aged 15 and over were daily smokersi,5 compared with 14% in the general population.16 After adjusting for differences in age structure, Aboriginal and Torres Strait Islander people aged 15 years and over were almost three times as likely as non-Indigenous people to be daily smokers.15 Prevalence appeared to be slightly higher among Aboriginal people (39%) than Torres Strait Islander people (35%). There were no significant differences between Indigenous men and women in daily smoking except for 15–24 year olds and 45–54 year olds, where the proportion of men was higher.5

Table 8.3.1
Percentage (rounded) of current daily smoking* among Aboriginal peoples and Torres Strait Islanders by sex, Indigenous status and age group, 2014–15

 

Indigenous status

Age group

15–27

18–24

25–34

35–44

45–54

55–64

65–74

75+

Males

Indigenous

34.4

46.6

47.0

50.7

34.9

34.4^

Non-Indigenous

3.9

12.8

22.5

20.1

19.3

17.1

10.5

3.6

Females

Indigenous

26.5

44.4

46.4

41.4

28.2

26.5^

Non-Indigenous

2.3

15.1

12.1

13.4

15.5

12.4

7.0

4.5

* Current daily smokers are those who smoke one or more cigarettes (either manufactured or roll-your-own), cigars or pipes per day, on average. Chewing tobacco and smoking of substances other than tobacco are excluded.

^ The oldest age group reported in the National Aboriginal and Torres Strait Islander Social Survey was 55+ 

Sources: National Aboriginal and Torres Strait Islander Social Survey, Australia, 2014–15;5 National Health Survey: First Results, Australia, 2014–1516

There have been progressive decreases in daily smoking prevalence among Indigenous Australians over time. In 2002, almost half (49%) of Aboriginal and Torres Strait Islander people aged 15 years and over were daily smokers, with rates declining to 45% in 2008, and to 39% in 2014–15. Prevalence declined across this period for both Indigenous men (51% to 46% to 41%) and women (47% to 43% to 36%).5 The prevalence of smoking in the non-Indigenous population has also declined since the early 2000s, resulting in the gap between the daily smoking rate in the Indigenous population and non-Indigenous population remaining steady at about 26%.1  

Data from the National Aboriginal and Torres Strait Islander Health Survey show that between 2002 and 2012–13, the proportion of Indigenous ex-smokers increased from 15% to 20%, and the proportion of Indigenous never smokers increased from 33% to 36%. Among young people aged 15–17 years, the proportion who had never smoked increased from 61% in 2002 to 77% in 2012–13, and for those aged 18–24 years, increased from 34% to 42%, suggesting that there has been a progressive decrease in uptake by young Aboriginal and Torres Strait Islander people.1  

The considerable impact of smoking on the health of Aboriginal peoples and Torres Strait Islanders is detailed in Section 8.7. For discussion about recommended tobacco-control interventions designed to meet the needs of these population groups, refer to sections 8.10 and 8.13.

8.3.1 Geographical variations in smoking rates

While the figures in the above tables provide a broad overview of smoking prevalence among Aboriginal peoples and Torres Strait Islanders, it is important to note that patterns of smoking are not uniform throughout Aboriginal and Torres Strait Islander communities. Although smoking prevalence among Indigenous Australians has been declining in both non-remote and remote areas, most of the change has occurred in non-remote areas. The proportion of daily smokers in non-remote areas decreased from 48% in 2002 to 37% in 2014–15, while in remote areas, there was a decrease of only three percentage points over the same period, from 50% to 47%.5 Figure 8.3.1 shows the proportion of current daily smokers by remoteness area and Indigenous status. 

Figure 8.3.1. Age-standardised percentage of current daily smokers aged 18+ by remoteness area and Indigenous status, 2014–15.

Source: National Aboriginal and Torres Strait Islander Social Survey, Australia, 2014–15, Table 235

There are also differences in prevalence rates among the states and territories (Figure 8.3.2). 

Figure 8.3.2 Percentage of current daily smokers, Aboriginal and Torres Strait Islander people aged 18+, by state or territory, 2014–15

Source: National Aboriginal and Torres Strait Islander Social Survey, Australia, 2014–15, Table 235

There are also variations in prevalence by gender within these jurisdictions. For example, in 2012–13 (National Aboriginal and Torres Strait Islander Health Survey data), daily smoking was more common among Indigenous men living in the Northern Territory (58%) and South Australia (46%) than Indigenous women in these states (44% and 35%, respectively; see ABS Table 24).1

More striking, however, are the variations in smoking behaviour between smaller regions and individual communities. The 2012–13 National Aboriginal and Torres Strait Islander Health Survey examined prevalence of smoking as defined by Aboriginal and Torres Strait Islander Commission region,ii and found a large variation between regions.1 For example, daily smoking prevalence ranged from 28% in the Australian Capital Territory, to 68% in Katherine. There were also marked gender differences within some regions; prevalence among Indigenous men in West Kimberley was 89%, compared with 48% among Indigenous women in the same region (see ABS Table 23).1 Other regional and community-specific surveys have also demonstrated marked differences. For example, a survey of Aboriginal and Torres Strait Islander women aged 15–34 years in 23 communities in far north Queensland found a smoking prevalence of 62%,17 and studies have confirmed higher levels of smoking in the Top End of the Northern Territory than for the Indigenous population as a whole.18–21 The most recent of these studies found smoking prevalence of 76%20 and 70%21 in Top End communities. 

Readers interested in examining earlier regional prevalence surveys are referred in the first instance to the comprehensive literature review by Ivers,22 which provides a summary of research up until 1999.

8.3.2 Socio-economic factors

Socio-economic factors are strongly related to smoking behaviour throughout the general Australian population (see Chapter 1, Section 1.5 for further discussion).

Aboriginal peoples and Torres Strait Islanders are still significantly more likely than non-Indigenous people to be disadvantaged, in measures such as educational attainment, employment, income, and home ownership.4,23 Despite government initiatives to close the employment gap, it widened by 7% between 2008 and 2012–13 (from 22% to 29%). The employment-to-population ratio for Indigenous people aged 15 to 64 increased from 38% in 1994 to 54% in 2008, and then declined to 48% in 2012–13. For non-Indigenous people, it has remained steady at about at about 76%.24 Indigenous Australians have relatively low average weekly incomes compared with non-Indigenous people and are under-represented in the highest income bracket.24 The ratio of Indigenous to non-Indigenous average income is about 0.7.25  

Moreover, individuals from Aboriginal and Torres Strait Islander backgrounds are over-represented among those Australians who experience mental illness (as evidenced by self-reported levels of psychological distress, depression, higher rates of hospitalisation for mental illness, and death and injury through suicide and intentional injury), homelessness, and exposure to the criminal justice system as offenders (with imprisonment at 13 times the rate of non-Indigenous people and juvenile detention at 23 times the rate for non-Indigenous youth).24 Each of these factors is associated with a greater likelihood of smoking (see Chapter 1, Section 1.8). The overall higher degree of disadvantage experienced by Aboriginal peoples and Torres Strait Islanders is likely to be a major contributor to the high prevalence of smoking.

The prevalence of smoking also varies within the Aboriginal and Torres Strait Islander populations according to socio-economic factors, as they do in the general Australian population. Smoking is more prevalent among Aboriginal peoples and Torres Strait Islanders who have less education, are unemployed, are renting rather than owning or buying their own home, and who are in the lower income brackets.26–28 Table 8.3.3 presents findings for the 2012–13 National Aboriginal and Torres Strait Islander Health Survey, with data for the non-Indigenous population from the 2011–12 Australian Health Survey included for comparison. When comparing Indigenous and non-Indigenous people of similar socio-economic status, Indigenous people have a higher smoking prevalence than for non-Indigenous people.

Table 8.3.2
Age-standardised proportion of current daily smoking among Aboriginal peoples and Torres Strait Islanders (2012–13) and the non-Indigenous population (2011–12) aged 18 and over by a range of socio-economic indicators

 

 

Current daily smokers 
(% rounded)

 

Age-standardised rate ratio*

 

Indigenous people

Non-Indigenous people

 

Persons aged 18 years and over

42

16

2.6

Highest year of school completed†

Year 12

28

11

2.6

Year 11

44

21

2.1

Year 10 or below

49

29

1.7

Labour force status

 

Employed

35

16

2.2

Unemployed

56

28

1.7

Not in the workforce

48

19

2.5

* Indigenous to non-Indigenous rate ratios are calculated by dividing the proportion of Indigenous people with a particular characteristic by the proportion of non-Indigenous people with the same characteristic.

† Excludes those still attending school.

Source: National Aboriginal and Torres Strait Islander Health Survey 2012–131 and 2011–12 Australian Health Survey29

Experiencing more than one life stressoriii  and feeling financial stress in the previous year (defined as lacking the ability for themselves or another household member to access $2000 in an emergency) were also indicators for increased risk of smoking in Indigenous adults in the 2002 and the 2004–05 national Aboriginal and Torres Strait Islander surveys.27,28 The 2004–05 survey also reported significant associations between smoking and higher levels of psychological distressiv or having a disability or other long-term health condition.28 Data from the 2002 National Aboriginal and Torres Strait Islander Social Survey show that Aboriginal and Torres Strait Islanders who had been arrested or incarcerated in the last five years were significantly more likely to be smokers; those who reported all four of ‘arrested in last 5 years’, ‘incarcerated in last 5 years’, ‘used legal services in past 12 months’ and ‘victim of violence in past 12 months’ were nearly 10 times more likely to be smokers than those who did not report any of these experiences.27 

Although Aboriginal and Torres Strait Islander communities have had different experiences of colonisation, the colonising process has overall had an important influence on ongoing patterns of tobacco use by Aboriginal peoples and Torres Strait Islanders (see Section 8.2). Detailed analyses of the 1994 National Aboriginal and Torres Strait Islander Survey and the 2002 National Aboriginal and Torres Strait Islander Social Survey identify removal from family as significantly related to being a smoker.26,27 After adjusting for age, gender and socio-economic variables, the 2002 Social Survey data showed that Aboriginal and Torres Strait Islander people were twice as likely to be smokers if they had been removed from their natural family.27  

There is a significant association between racism and smoking.30 A study of pregnant Indigenous women in Perth reported that stress related to racial discrimination was a factor contributing to their smoking.31

8.3.3 Prevalence of smoking among pregnant women

Data from the 2012 National Perinatal Data Collection reports that almost half (48%) of Indigenous mothers smoked during pregnancy compared to 13% of non-Indigenous mothers.32 Between 2005 and 2011, there was a statistically significant decline (of 6%) in smoking during pregnancy among Indigenous women, but this drop was much greater among non-Indigenous women (25%).33 Several local or regional studies have confirmed that Indigenous women have a higher prevalence of smoking during pregnancy and after giving birth than non-Indigenous women, with reported smoking prevalence ranging from 41‒67%.34-41 An analysis of the 2007 National Perinatal Data Collection shows that smoking rates for Indigenous mothers was highest for those in outer regional areas (56%) and lowest for those in major cities (49.3%).42 Indigenous mothers aged under 20 years reported smoking rates during pregnancy of 53.6%. Smoking rates declined with age, so that 49.6% of mothers aged 35–39 smoked during pregnancy.42 This trend of higher smoking rates during pregnancy among teenage Indigenous women has also been found in other studies in Queensland, South Australia and Western Australia.36,43,44 The South Australian study also reported that the likelihood of smoking heavily (consuming 20 or more cigarettes daily) increased with age, and at all ages except for during their teens, Indigenous women smoked more heavily during pregnancy than non-Indigenous women.43

See Section 8.7.3.5 for health impact of smoking during pregnancy and Section 8.10.13.3 for tobacco action initiatives that address smoking during pregnancy.

8.3.4 Prevalence of smoking among health workers

A range of small surveys45–51 and anecdotal evidence52 suggest that Aboriginal and Torres Strait Islander health workers have a high prevalence of smoking. Findings have ranged between 38% and 51%,45,47–40,51 and about 60–64%.>46,50 One survey, undertaken as part of the National Aboriginal and Torres Strait Islander Tobacco Control Project, found that 39% of health workers who participated in focus groups for the project were smokers. Lindorff observed that this was likely to be an underestimate of actual smoking rates among health workers, since smokers were noticeably less likely to volunteer to participate.45 Research has found that many Indigenous health workers who smoke, smoke heavily,48 and that tobacco use provides a means of coping with the stressful nature of their workloads.48,50 A 2013 study of Aboriginal health workers in South Australia found that the prevalence of current smokers was 50.6%; non-smokers (49.5%) comprised quitters (22.4%) and never smokers (27.1%).51 Surveys of staff of Aboriginal community-controlled health services in 2012–13 found that smoking prevalence among Aboriginal and Torres Strait Islander staff was lower than their general communities, but only modestly lower than among other employed Aboriginal and Torres Strait Islander people.53 These studies indicate a need for appropriate support and education for health workers as well as the communities in which they work. See Section 8.10.5 for further information on the role of Indigenous health workers in tobacco control, and Section 8.13.5 on policy and funding initiatives to support the health workforce in Aboriginal and Torres Strait Islander health.

8.3.5 Prevalence of smoking among prisoners

Smoking rates among prisoners are generally much higher than in the general community,54 and Aboriginal and Torres Strait Islander people are significantly overrepresented in the prison population. In 2014, 27% of the total adult prisoner population were Indigenous, and between 2000 and 2014 there was an 82% increase in the gap in imprisonment rates between Indigenous and non-Indigenous people.24 The 2012 Australian Institute of Health and Welfare report on the health of Australia’s prisoners found that compared with non-Indigenous people, Indigenous people were more likely to be a current smoker on entry to prison (92% compared with 83%), were more likely to increase cigarette consumption during their incarceration (38% compared with 32%), and were less likely to be an ex- or non-smoker upon discharge (17% compared with 21%).55 However, rates vary between jurisdictions. The 2009 New South Wales Inmate Health Survey found that 83% of Aboriginal male prisoners were current smokers, compared to 71% of non-Aboriginal prisoners; however, Aboriginal prisoners smoked significantly fewer cigarettes per day. Among women, the rates were 88% and 76% for Aboriginal and non-Aboriginal respectively.56 Importantly, the large majority (90% of Aboriginal men and 80% of Aboriginal women) said that they would like to quit smoking.56 Smoking rates while in prison and upon discharge are likely to be lower since all Australian states and territories except Western Australian have introduced or are planning to introduce complete smoking bans. Smoking cessation programs for Indigenous prisoners, and the more recent implementation of total prison smoking bans, are discussed in Section 8.10.13.4.

8.3.6 International comparisons with other Indigenous peoples

International research has shown that Indigenous groups in settler colonial countries use tobacco at significantly higher levels than the dominant population (Table 8.3.4). Notwithstanding the differences between these populations and their specific cultural and historical circumstances, it is likely that these higher prevalence figures also reflect socio-economic disadvantage, and the legacy of colonisation including experiences of marginalisation, family dislocation, racism, disconnection from land, loss of traditional diet and lifestyle, and the subsequent adoption and adaption of Western habits and practices.57

Table 8.3.4
Prevalence rates of current smokers for Indigenous and non-Indigenous people in Canada, New Zealand, the United States and Australia

Country

Indigenous people

Non-Indigenous people

Indigenous group
(year of data)

Prevalence
(%)

Ethnic group
(year of data)

Prevalence
(%)

Canada58*

First Nations on-reserve (2008–10)

43.2

Non-Indigenous (2009–10)

16

Indigenous off-reserve† (2000–01)

34.8

Inuit (2009–10)

44.4

Metis (2009–10)59

34.6

New Zealand60

Māori (2012)

39

European/Other (2012)

15

Pacific Islanders (2012)

25

Asian (2012)

10

United States61*

American Indian/Alaskan Natives (2013)

26.1

Non-Hispanic Blacks (2013)

18.3

Hispanics (2013)

12.1

Asian Americans (2013)

9.6

Non-Hispanic whites (2013)

19.4

Australia5

Aboriginal and Torres Strait Islanders† (2014–15)

39

Non-Indigenous (2014–15)

14

* Aged 18 and over

† Aged 15 and over

i The National Drug Strategy Household Survey for 2013, as in previous years, reports on a small Indigenous sample. The prevalence of smoking reported in the 1994, 1998 and 2001 surveys was similar to that of the other national surveys discussed above. However later surveys returned much lower population prevalence figures of 39% (2004),34% (2007), 38% (2010), and 35% (2013). Given the consistently higher prevalence data published by other, larger national surveys, it is likely that the National Drug Strategy Household Survey figure is an outlier. This is probably due to differences in sampling between the 2001 and subsequent surveys, and to smaller proportionate samples of Indigenous people with each survey. It is known that there is considerable variation in smoking rates between various Indigenous communities, which if not sampled in a comparable manner between surveys, could be expected to skew results.

ii The 36 Aboriginal and Torres Strait Islander Commission regions were legally prescribed areas for the purposes of administration by the now superseded Aboriginal and Torres Strait Islander Commission and the Torres Strait Regional Authority.

iii For the purposes of this survey, the Australian Bureau of Statistics defined stressors as one or more events or circumstances which a person considered to have been a problem for themselves or someone close to them in the last 12 months, including: serious illness, accident or disability, death of a family member or close friend, divorce or separation, inability to obtain work, alcohol or drug-related problems, being the victim of abuse, overcrowding, discrimination or racism. For a full list refer to the Glossary section of the National Aboriginal and Torres Strait Islander Health Survey 2004‒05.14

iv Assessed by a modified version of the Kessler Psychological Distress Scale to measure non-specific psychological distress. See National Aboriginal and Torres Strait Islander Health Survey 2004‒05 for further information.14

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References

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