8.4 Smoking among Aboriginal and Torres Strait Islander children and teenagers

Last updated: August 2016 
Suggested citation: van der Sterren, A, Greenhalgh, EM, Knoche, D, & Winstanley, MH 8.4 Smoking among Aboriginal and Torres Strait Islander children and teenagers. 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/8-4-smoking-among-aboriginal-and-torres-strait-isl

8.4.1 Prevalence

8.4.1.1 National surveys

The National Health Surveys, the 2004–05 and 2012–13 National Aboriginal and Torres Strait Islander Health Surveys, and the National Drug Strategy Household Surveys (NDSHS) of 1998, 2001, 2004, 2007, 2010, and 2013 have collected data among Aboriginal peoples and Torres Strait Islanders aged 14 or 15 and older, or 18 and older; however, individual year-of-age breakdowns are not published in any of these surveys and numbers of Indigenous participants in the younger age ranges would be extremely small in the NDSH surveys. The most recent National Aboriginal and Torres Strait Islander Health Survey for 2012–13 reported that 21.3% of Indigenous young people aged 15–17, and 43.8% of those aged 18–24  were current daily smokers, compared to 4.1% and 17.3%  of non-Indigenous young people in the same age groups, respectively (from the Australian Health Survey 2011–13).1 

From 1996 onwards, the Australian Secondary Students’ Alcohol and Drug (ASSAD)   survey included the option to report being of Aboriginal and/or Torres Strait Islander descent.2 Between 1996 and 2005, Indigenous students consistently reported higher levels of smoking than non-Indigenous students (see Table 8.4.1). After adjusting for state, education sector, sex, age, academic ability and amount of pocket money available, these differences were significant for most years and smoking behaviours (only three were not significant—see Table 8.4.1). A decline in smoking prevalence among Indigenous students was noted, with most of that change occurring between 1999 and 2002, and little change between 2002 and 2005. Smoking prevalence among non-Indigenous students also declined, but more evenly across the years.2 

Table 8.4.1
Percentage of students self-identifying as Indigenous and non-Indigenous who have ever smoked, who are monthly smokers, current smokers, and committed smokers in each survey year between 1996–2005* (data not weighted)

Smoking behaviour

12–15 year olds

16–17 year olds

1996

1999

2002

2005

1996

1999

2002

2005

Ever smoked

       

*

*

   

Non-Indigenous

54%

47%

40%

29%

73%

69%

63%

51%

Indigenous

61%

61%

50%

47%

78%

76%

75%

66%

Monthly smokers†

               

Non-Indigenous

22%

20%

14%

9%

34%

33%

26%

21%

Indigenous

30%

32%

22%

20%

48%

49%

39%

36%

Current smokers‡

               

Non-Indigenous

18%

16%

11%

7%

29%

28%

21%

15%

Indigenous

27%

28%

19%

17%

44%

43%

29%

33%

Committed smokers§

           

*

 

Non-Indigenous

11%

10%

7%

4%

21%

19%

15%

9%

Indigenous

19%

22%

14%

14%

37%

36%

22%

24%

* Differences between Indigenous and non-Indigenous students are significant except for the cells indicated

† Monthly smoking—smoked in the past four weeks

‡ Current smoking—smoked in previous seven days

§ Committed smoking—smoked on three of previous seven days

Source: White V, Mason T and Briggs V 2009 6

In 2008, the ASSAD survey included an ‘extension’ whereby an additional 19 schools from rural areas of Western Australia, Queensland, Victoria, South Australia and the Northern Territory were surveyed. The increase in the rural sample also increased the Indigenous sample. From the 400 schools surveyed as part of the 2008 ASSAD and the ASSAD Extension, 1317 students identified as Indigenous. About 35% of 12–15 year old Indigenous students had ever smoked, with 15% smoking in the month before the survey and 12% smoking in the past week. Indigenous students also had higher mean scores than non-Indigenous students on ‘intention to smoke in the next 12 months’, which is considered indicative of students’ receptivity to taking up smoking and is predictive of future smoking among adolescents and adults.3 This finding is consistent with those of the earlier ASSAD surveys.2

8.4.1.2 State and regional surveys

A number of region-specific surveys of Indigenous adolescent smoking behaviour have been undertaken, varying in size, scope, and methodology. These surveys generally show that the prevalence of smoking increases with age and is higher among Indigenous than non-Indigenous adolescents. Findings from the 2009 Victorian Adolescent Health and Wellbeing Survey, which surveyed young people in schools in years 7, 9 and 11, showed that the proportion of young Aboriginal people who had ever smoked was significantly higher than non-Aboriginal people (36.1% compared to 24.9%). Aboriginal students were also significantly more likely to have smoked in the past year and month, but smoked a similar number of cigarettes per day to non-Aboriginal smokers, with half smoking less than one per day, and about 20% smoking six or more per day. Aboriginal youth were significantly more likely than non-Aboriginal youth to report having ‘very’ or ‘sort of’ easy access to cigarettes (63.7% versus 47.2%).4 

An earlier study of smoking behaviour among Indigenous primary and high school-aged children in three remote Top End (north Northern Territory) communities in 19975 also found that rates of current smokers (those who had smoked in the last week) were higher in most teenage years among the Indigenous population than for the national secondary school population.6 The youngest current smoker was aged six, and 6% of children aged 8 and under were smokers. In the teenage years, experimentation and current smoking increased with age. Among students aged 16 or more, experimentation with smoking was universal, and half were current smokers, equivalent to the adult smoking prevalence for Aboriginal peoples and Torres Strait Islanders from around the same period.5 

A series of surveys undertaken in schools in New South Wales during 1989, 1992 and 19967 also showed that Aboriginal and Torres Strait Islander students aged between 12 and 17 were more likely to smoke than their non-Indigenous counterparts. The most recent of these surveys (1996) found that overall smoking prevalence among children of Aboriginal or Torres Strait Islander descent was 30%, compared to 20% for non-Indigenous children. Smoking prevalence was highest among Indigenous girls (33%), followed by Indigenous boys (27%), non-Indigenous girls (21%) and non-Indigenous boys (19%). Higher patterns of tobacco use were also evident from the earlier years’ survey data.7

Research in the 1990s with community-based samples showed similar trends. A study in Albany, Western Australia found that tobacco was commonly the earliest drug used among Indigenous people aged 8‒17.8 However, most youth (64%) had never smoked tobacco. Frequent smokers increased with age, from 4% of the 8‒12 age group to 44% of the 15‒17 age group. Although not directly comparable because of differences in school retention rates, Indigenous children in Albany (both in and out of school) were more likely to have smoked in the past week than secondary school children aged 12–17 in Western Australia in 1990 (36% compared with 21%).8 Another study of Aboriginal young people in Melbourne found that 29% aged 12–15 years and 63% aged 16–25 years reported being current smokers,9 compared with 18% of 12–15 year olds in the ASSAD survey of 1996.6 Thirty-one per cent of the Melbourne Aboriginal young people aged 12–25 years had never smoked, and 66% of those who were smoking indicated that they wanted to give up.9 More recently, a small study undertaken in the Northern Territory in 2011 found that 46% of Indigenous participants aged 13–20 were smokers, compared with 16% of non-Indigenous participants.10

Not all studies support the finding that Indigenous adolescents have a uniformly higher prevalence of smoking than non-Indigenous adolescents. The Western Australian Aboriginal Child Health Survey 2000–0211 found that the prevalence of smoking was not significantly different between Indigenous and non-Indigenous 12–16 year olds. However, the difference increased with age among girls. Figure 8.4.1 presents data from the 2000–02 survey, as well as the 1993 Western Australian Child Health Survey, which asked the same question of 12–16 year-olds in the general Western Australian population and is the only available comparable data. While the prevalence of smoking tended to be higher among Indigenous females than Indigenous males, by age 17 (not shown in Figure 8.4.2 as data is not available for non-Indigenous 17 year olds), they were smoking at about the same rate (56% for males and 60% for females).11

Figure 8.4.1
Prevalence of Western Australian Indigenous (2000–02) and non-Indigenous (1993) adolescents who have smoked regularly, aged 12–16, by age and sex

Source: Zubrick et al 200411 and Zubrick et al 199512

A 2004 study in rural North Queensland showed that 24% of Indigenous students in years 8‒12 smoked, compared to 30% of non-Indigenous students. In the younger grades (years 8‒10), 18% of Indigenous males and 26% of Indigenous females were smokers, compared to 28% of both sexes among the non-Indigenous students. Prevalence increased with age for both groups, with the highest incidence of smoking occurring in years 11 and 12 among Indigenous males (46%), followed by non-Indigenous females (38%), Indigenous females (32%) and non-Indigenous males (30%). Given the lower rate of high school retention7,13,14 and higher levels of school absenteeism among Indigenous teenagers,5,14 school-based surveys may result in an underestimation of smoking prevalence, particularly among students in Year 10 and beyond. For example, the 2001–02 Western Australian Aboriginal Child Health Survey showed that Indigenous children aged 12‒17 who did not attend school had substantially higher smoking rates (48% of boys and 64% of girls) than those who did attend school (25% of boys and 31%).11 Nonetheless, authors of the North Queensland study comment that their results ‘challenge the belief that Indigenous youth are significantly different in their smoking patterns and behaviours compared to non-Indigenous secondary school students in rural regions’ (p101). They conclude that geographical location may be a more important determinant of smoking than ethnicity in regional areas, with students sharing similar attitudes, beliefs and behaviours regarding cigarette use.13

8.4.2 Age at uptake

According to national data, Aboriginal peoples and Torres Strait Islanders who smoke are more likely to have begun smoking at an earlier age than their non-Indigenous counterparts. A comparison between the National Aboriginal and Torres Strait Islander Health Survey and the National Health Survey, both of 2004–05, shows that about 10% of Indigenous adults who were current and former smokers had commenced regular smoking prior to the age of 13, compared with 5% of non-Indigenous current and former smokers. By the age of 18, 68% of current and former Indigenous smokers were smoking regularly, compared with 54% of non-Indigenous current and former smokers. Indigenous people living in non-remote areas were more likely to be smoking before the age of 13 years than Indigenous people living in remote areas (11% compared with 5%).15

Other research has also pointed to an earlier age of uptake of tobacco use among children of Aboriginal and Torres Strait Islander descent.5,16,17 However as with the various prevalence surveys described above, regional variation is evident, reflecting socio-demographic and cultural factors. Within Aboriginal and Torres Strait Islander communities, there is a general perception among adults that children are taking up smoking at about the age of 10.18 Indigenous young people interviewed in the Top End of Australia in 2011 reported that experimenting with smoking usually started between the ages of 10 and 13, but it was not uncommon to take the first puff earlier and as early as seven or eight years of age.10 Early uptake increases duration of exposure, and hence the risk of development of a range of tobacco-caused diseases.19 Furthermore, research shows that the earlier a young person starts smoking, the more likely they are to become addicted, to continue smoking as adults, and to smoke heavily.20

Research into substance use among Indigenous and non-Indigenous primary school students aged 8–12 in metropolitan and far north Queensland in 1999 found that Indigenous and non-Indigenous children experimented with tobacco at comparable rates, with about one in five students in this age bracket having tried smoking.21 The likelihood of experimentation increased with age; 9% of nine year olds reported having ever smoked, rising to 41% among 12‒13 year old students. Given there were no significant differences between tobacco use by Indigenous and non-Indigenous children, the authors conclude that the excess uptake noted in the Indigenous population occurs in the early years of secondary school. Similarly, research on secondary school students in North Queensland found that only a small proportion of both Indigenous and non-Indigenous current smokers reported that they had started smoking at the age of seven (3% and 2%, respectively). By age 12, 26% of Indigenous and 19% of non-Indigenous smokers had begun smoking.13 Earlier patterns of uptake have also been reported in Albany, Western Australia. Among current Indigenous smokers aged between 15‒17, the mean age of reported first use of tobacco was 9.7 years.8 Twenty-four per cent began smoking before the age of eight, and 71% had commenced by age 13.

8.4.3 Influences on smoking behaviour

Aboriginal and Torres Strait Islander young people are affected by the same determinants of smoking as Indigenous adults (see Section 8.3.2); that is, socio-economic factors such as employment, drinking alcohol, and being taken away from family as a child predict smoking among Indigenous young people.22,23 Similarly, Aboriginal and Torres Strait Islander young people report similar influences on uptake of smoking to non-Indigenous Australians, such as smoking among family members and parents,5,11,13,18,21 having a positive attitude towards smoking, and being part of a peer group that smokes.21,24 These peer influences may work in both directions; some Indigenous young people report seeking out social networks with similar smoking norms and behaviours to their own.10 Families can also influence uptake by facilitating access to tobacco.10 Smoking among Indigenous young people can also be an expression of rebellion, a way of risk-taking, a means of offsetting boredom or alleviating stress, or a way to cope with depression.9,18,25,26 Experimentation with other substances, such as alcohol and marijuana, also correlates with adoption of smoking.21 

The comparatively high rates of smoking among the Indigenous adult community mean that many Aboriginal and Torres Strait Islander children live in households where smoking is the norm. In 2014–15, about 58% of Indigenous children aged 4–14 lived with a daily smoker, and about 16% lived with someone who smoked inside the home.27 A study of Indigenous primary and high school-aged children in three remote ‘top end’ (north Northern Territory) communities5 found that almost every child (98%) lived with at least one smoker. Children who did not smoke cited having a non-smoking family as a reason for abstaining. Although the children surveyed demonstrated a reasonable knowledge about the health effects of smoking, tobacco use appeared to be viewed as a normal and expected part of being an adult.5 It was common for children to be asked to light cigarettes for adults, with about one-quarter having performed this task in the previous week.5 Similarly, interviews for the National Aboriginal and Torres Strait Islander Tobacco Control Project found that children asked to procure and light up parents’ cigarettes influenced later smoking behaviours.18 

Similar influences were noted in a Northern Territory study, where most participants reported initially stealing their cigarettes from family members and experimenting with cousins and peers. Some were also offered tobacco from family members, were asked to roll or purchase cigarettes for others in the family, or had parents buy their cigarettes for them.28 In this Northern Territory study, participants also reported that a significant influence on their initiation to smoking was the modelling of adult smoking behaviours, not only their own parents but also extended family.28 This is supported by Victorian research that has found that the high incidence of smoking among adults serves as modelling behaviour for children in Indigenous communities.29 Additionally, parents who smoked appeared to have the expectation that their children would smoke as well, and felt that they could not prevent their children from smoking because they would be perceived as hypocritical. Children also commonly reported obtaining cigarettes from their parents.5,24 Similarly, urban Aboriginal young people reported a perception that young people with friends, siblings and teachers who were smokers were more likely to be smokers themselves, and that the culture of sharing and social acceptance of smoking influenced uptake.30

Other socio-demographic factors are likely to have a bearing on uptake of smoking among Aboriginal and Torres Strait Islander young people. A series of studies from New South Wales found that children of Aboriginal or Torres Strait Islander descent were twice as likely to live in rural or remote areas. About half of the children reported living with both of their parents, while 48% lived in single parent, step or blended couple families, or with neither parent, compared with 28% of non-Indigenous children. Indigenous children were more than twice as likely as non-Indigenous children to consider their school performance to be below average (15% compared with 6%), and about twice as likely to play truant (29% compared with 15%). Indigenous children also reported missing more school for health reasons than non-Indigenous children (28% compared with 18%) although both groups reported much the same incidence of ill-health (about 15%).7 Each of these factors increase the likelihood of uptake in smoking: lower levels of school performance, absenteeism, and stresses in the home,24 as well as stressful life events, financial insecurity and household structure (e.g. single parent households).31 These factors are likely to contribute to Indigenous Australians’ higher levels of involvement with tobacco and other substances. Programs to assist families, reduce school absenteeism and increase school retention are suggested ways forward, in collaboration with the communities involved.7

Importantly, there are a number of protective factors associated with a reduced likelihood of smoking uptake among Indigenous youth. The positive role modelling of non-smoking family members is important in helping to prevent initiation to smoking.28 Home-based factors including: smokefree indoor spaces, parents not smoking around children, strong anti-smoking messages, and clear consequences to smoking, all help to prevent smoking in Indigenous young people, even when parents are smokers.10 A study of American Indian adolescents identified academic orientation, social support, community mindedness, and strong ethnic identity as being protective against smoking.31 These are similar findings to those of a study of Aboriginal young people in Melbourne that identified appreciation of Koori community values, creative activities, sense of responsibility, sense of belonging and community connection, pride in Koori identity, and sporting activities as protective against smoking.32 Fitness and the desire to play sport have also been directly reported by young Aboriginal and Torres Islander people as reasons for not taking up smoking.9,25

Influences on the uptake of smoking among young people in general are discussed in greater detail in Chapter 5—Factors influencing the uptake and prevention of smoking.  

i It may be that higher rates of Indigenous smoking in the older age groups in part reflects the fact that the National Aboriginal and Torres Strait Islander Survey questioned teenagers irrespective of their attendance at school, while the ASSAD excludes those not in the education system. It is generally reported in the literature that children outside the school system tend to exhibit higher smoking rates than those remaining at school.5

ii Of the young people in the Western Australian Aboriginal Child Health Survey 2000–02 who indicated that they had 'smoked cigarettes more than once or twice', all then went on to indicate that they 'had smoked daily for at least a month at some point in their lives'. These young people were classified as 'regular smokers', but clearly this term cannot be interpreted to necessarily mean 'current smokers'. This makes it difficult to compare to the ASSAD surveys that define smoking characteristics differently. Similarly, the ASSAD surveys define those who have had even 'a puff' as 'ever smokers', while in the 2000–02 Aboriginal child health survey those who have never smoked and those who have smoked 'just once or twice' are classified together.

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References

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