8.4 Smoking among Aboriginal and Torres Strait Islander children and teenagers
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8.4.1 Prevalence
8.4.1.1 National surveys
The only national data collection of smoking prevalence in Aboriginal and Torres Strait Islander children is from the National Aboriginal and Torres Strait Islander Survey 1994 (NATSIS),37 as reported by the Australian Bureau of Statistics in its Occasional Paper on Smoking among Indigenous Australians published in 1997.45 National Health Surveys, the most recent National Aboriginal and Torres Strait Islander Health Survey and National Household Drug Strategy Household Surveys have variously collected data among Aboriginal and Torres Strait Islanders aged 14 or 15 and older or 18 and older, and the most recent NATSISS data collection commences with the population aged 15-plus. Individual year-of-age breakdowns are not published in any of these surveys, meaning it is not possible to provide national smoking rates by individual teenage year other than for 1994.
The NATSIS of 1994, as reported by the ABS45 found that smoking rapidly increased with age for both males and females aged between 13 and 17. At age 13, between 5% and 8% of Indigenous children were smokers, and by the age of 17, smoking prevalence was about 45% for Indigenous males and 35% for females. Overall prevalence for Indigenous children aged between 13 and 17 was about 22% for both males and females, but prevalence soared for both sexes in the next age bracket (18–24) with 61% of males and 53% of females reporting current smoking.37 A broad comparison may be drawn between these figures and those published from the Australian Secondary Schools Alcohol and Drug (ASSAD) survey from the previous year (1993),64 although it should be noted that the data sets are not methodologically the same. Compared to Indigenous teenagers in 1994, in 1993 Australian schoolchildren overall had a higher prevalence of smoking in the age groups 13–15, after which prevalence levelled out at about 28% for boys and 31% for girls aged 16 and 17,64 lower prevalences than for their Indigenous counterparts. Indigenous males were more likely to smoke than Indigenous females, but in the national data set for Australian school pupils, 17-year-old girls had a higher prevalence of smoking than 17-year-old males. It may be that higher rates of Indigenous smoking in the older age groups in part reflects the fact that the NATSIS 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.65
8.4.1.2 State and regional surveys
A range of region-specific surveys have been undertaken, varying in size, scope and methodology,66-70 resulting in a spectrum of findings, some of which are summarised below. Some broad similarities may be observed. As would be expected, all surveys confirm that prevalence of smoking increases with age. Studies from Western Australia,66, 70 the Northern Territory67 and New South Wales68 have found that by the end of secondary school, Indigenous teenagers are smoking at a higher rate than their non-Indigenous counterparts or than the overall national prevalence figure for school students of their age, while research from rural North Queensland is equivocal. 69 Given the lower rate of high school retention5, 68, 69 and higher levels of school absenteeism among Indigenous teenagers,67 schools-based surveys as a measure of smoking prevalence may not be fully representative of this age group. This point becomes clear with the Western Australian Aboriginal Child Health Survey (WAACHS).70
The WAACHS was conducted between 2000–02 and gathered data on a broad range of indicators from a population-based sample.70[9] Table 8.5 presents data on smoking.
Table 8.5
Aboriginal people and Torres Strait Islanders living in Western Australia aged 12–17 who have smoked cigarettes regularly* by age and sex, 2000–02
|
Age |
12 |
13 |
14 |
15 |
16 |
17 |
Total |
|
(% rounded) |
|||||||
|
Males |
12 |
20 |
26 |
41 |
43 |
56 |
31 |
|
Females |
12 |
26 |
39 |
50 |
55 |
60 |
40 |
|
Total |
12 |
23 |
33 |
45 |
49 |
58 |
35 |
Source:WAACHS70
While the two data sets cannot be directly compared due to different methodologies, a broad comparison may be drawn with data from the National Australian Secondary School Student Surveys reported in Chapter 1, Table 1.5 . A comparison of these data shows that in about 2002, Western Australian Indigenous teenagers had a substantially higher prevalence of smoking in all age groups compared with a national sample of Australian secondary-school children taken at about the same time. Indigenous girls were also more likely to smoke than Indigenous boys, whereas the gender gap previously noted in the national secondary school surveys has become less apparent. However it is important to note that the Western Australian data includes children who are no longer attending school, whereas the national data is restricted to pupils. Because leaving school at an earlier age is associated with increased smoking behaviour, the national data for older school pupils may under-represent true smoking prevalence among older teenagers since it does not survey those no longer within the school system. The WAACHS showed that Indigenous children aged 12–17 who did not attend school had substantially higher smoking rates than those who did attend school. Overall, 25% of boys who attended school had smoked, compared to 49% who were not still in school. Among girls, 31% of school attendees were smokers, compared to 64% who were not still in school.70
Other Western Australian-based research into smoking behaviour among young Indigenous people aged 8–17 in Albany found that tobacco was most commonly the drug used first among this population group.66 Frequent smokers (defined as those who had smoked on the day before the interview; in the preceding week and the previous four weeks) increased with age, from 4% of the 8–12 age group to 44% of the 15–17 year-old age group. Compared with overall Western Australian prevalence figures for secondary-school children aged 12–17, Indigenous children in Albany of secondary-school age or who had left school were more likely to have smoked in the last week (21% compared with 36%).
A study of smoking behaviour among Indigenous primary and secondary-school aged children in three remote Top End (north Northern Territory) communities in 199767 found that smoking rates were higher in most teenage years among the Indigenous population than for the national secondary-school population, as reported in Australian Secondary Schools Alcohol and Drug (ASSAD) survey of 1996.71 The youngest current smoker was aged six, and 6% of children aged eight and under were smokers. In the teenage years, experimentation and current smoking increased with age. Among pupils 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.39
A series of studies undertaken in schools in New South Wales during 1989, 1992 and 199668 have shown 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.
However not all studies agree with the finding that Indigenous adolescents have a uniformly higher prevalence of smoking than non-Indigenous adolescents. A study into smoking behaviour in Indigenous secondary-school students in rural North Queensland69 showed that among teenagers in Years 8–12, 24% of Indigenous students smoked overall, compared to 30% of non-Indigenous students. In the younger year groups (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, the highest incidence of smoking among students in Years 11 and 12 occurring among Indigenous males (46%), followed by non-Indigenous females (38%), Indigenous females (32%) and non-Indigenous males (30%). Because of lower secondary-school retention rates among Indigenous teenagers, school-based surveys such as this are likely to underestimate smoking prevalence among older age groups; nonetheless the authors 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.' 69 p 101
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 NATSIHS and the NHS, both of 2004-05, has shown that about 10% of Indigenous 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.46
Other research has also pointed to an earlier age of uptake of tobacco use among children of Aboriginal and Torres Strait Islander descent.38, 67, 72 However as with the various prevalence surveys described above, regional variation is evident, reflecting sociodemographic 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 10.6 Age of uptake is an issue of concern, since an early commencement of smoking increases duration of exposure, and hence risk of development of a range of tobacco-caused diseases.73
Research into substance use among Indigenous and non-Indigenous primary school students in metropolitan and Far North Queensland in 1999 found that during primary school years (ages 8–12), Indigenous and non-Indigenous children experimented with tobacco at comparable rates, with about one in five students in this age bracket having tried smoking.74 The likelihood of experimentation increased with age, 9% of nine-year-olds reporting having ever smoked, rising to 41% among 12–13-year-old students. There being no significant difference between tobacco use by Indigenous and non-Indigenous children, the authors of this study conclude that the excess uptake noted in the Indigenous population occurs in the early years of secondary school. Another Queensland-based study seems to bear this out, research on secondary-school students in North Queensland finding that 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), and that 26% of Indigenous and 19% of non-Indigenous smokers had begun smoking by age 12.69
Earlier patterns of uptake have 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.66 Twenty-four percent 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 children report similar influences on uptake of smoking to children everywhere. Being part of a peer group which smokes, smoking among other family members and parents,6, 67, 69, 70, 74 and having a positive attitude towards smoking are strong indicators of smoking behaviour shared by both Indigenous and non-Indigenous children.65, 74 Smoking among Indigenous children can also be an expression of rebellion, a way of risk-taking, or a means of offsetting boredom or alleviating stress.6 Experimentation with other substances, such as alcohol and marijuana, also correlates with adoption of smoking.74
The comparatively high rates of smoking among the adult community mean that many Aboriginal and Torres Strait Islander children live in households where smoking is the norm. A study of smoking behaviour among Indigenous primary and secondary-school aged children in three remote Top End (north Northern Territory) communities 67 found that almost every child (98%) lived with at least one smoker, and 43% lived with five or more smokers. It was common for children to be asked to light cigarettes for adults, about one quarter of the surveyed group having performed this task in the previous week. Focus groups interviewed for the National Aboriginal and Torres Strait Islander Tobacco Control Project found that smokers who, as children, had been asked to procure and light up cigarettes for their parents, were directly influenced into taking up smoking themselves.6
The Top End study also found that 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.67 Children who did not smoke mentioned health effects, being too young, fear of getting into trouble, not liking the taste or smell, and having a non-smoking family as reasons for being non-smokers.67
Victorian research confirms that the high incidence of smoking among adults, including parents, grandparents and community elders, serves as modelling behaviour for children in Indigenous communities.36 Additionally, parents who smoked appeared to have the expectation that their children would smoke as well; and children commonly reported obtaining cigarettes from their parents.36
Other geographic and sociodemographic 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 Wales68 found that children of Aboriginal or Torres Strait Islander descent were twice as likely to dwell 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 to 6%), and about twice as likely to play truant (29% compared to 15%). Indigenous children also reported missing more school for health reasons than non-Indigenous children (28% compared to 18%) although both groups reported much the same incidence of ill health (about 15%).68 Other research has found that smoking is connected with lower levels of school performance, absenteeism and stresses in the home.65 Forero et al make the observation that these factors, combined with the potential for increased incidence of mental health concerns that may result, are cause for concern in this population group, and likely to contribute to their 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.68
Influences on the uptake of smoking are discussed in greater detail in Chapter 5.
[9]Regular smoking is defined as ever having smoked cigarettes daily for at least a month.
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