8.5 Types of tobacco used by and levels of consumption among Aboriginal peoples and Torres Strait Islanders

The national data sets indicate that most Indigenous smokers smoke fewer than 20 cigarettes per day,^3–,8 and this is supported by local level studies.^6,9–14 Several studies conducted in communities across the Northern Territory have estimated rates of tobacco consumption using data on the sale of tobacco from stores and/or wholesalers^6,14, with three also collecting self-reported rates^11,12,13. Using sales data to estimate consumption has been found to be a practical and non-invasive method of estimating tobacco consumption in small remote communities with mostly Aboriginal populations. These studies have found that Aboriginal people in these remote Northern Territory communities smoke between 6¹¹ and 15.8¹³ cigarettes per day. One study in three communities in Arnhem Land (in the Northern Territory's 'Top End')¹² found self-reported consumption rates of 10–11 cigarettes/smoker/day and store sales based rates of 8.6–12.9 cigarettes/smoker/day. When comparing 'lighter smokers' (<10 cigarettes/day) to 'heavier smokers' (≥10 cigarettes/day), 'heavier smokers' tended to be older, were more likely to be daily smokers, and were almost three times more likely to be men than women.¹² A survey using wholesale tobacco data from Northern Territory remote communities calculated tobacco consumption to be 6.8 cigarettes/day/person aged 15 and over (note that this measure is 'per person', not 'per smoker'), and found that tobacco consumption in 14 Aboriginal communities in the 'Top End' was more than double that in eight Central Australian communities (8.6 versus 3.5 cigarettes/day/person aged 15 and over).⁶ In another study using data of sales from community stores in five Central Australian communities, daily smoking consumption was estimated to be between 5.9 cigarettes/day to 8.3 cigarettes per day (based on assumptions of 70% and 50% smoking prevalence respectively).¹⁴ Although smoking prevalence rates may be high in these communities, smoking frequency is low, and in many cases is lower than the daily cigarette consumption rate for non-Indigenous smokers of 14 per day.¹⁴ However, it should be noted that most of these studies have been undertaken in the Northern Territory, and just as prevalence varies from community to community, it is likely that consumption levels vary too.

Studies have also reported low levels of nicotine dependence among pregnant Indigenous women. A study of pregnant Indigenous women in a community in north Queensland found that over 60% of current tobacco users smoked 10 or fewer cigarettes per day; furthermore, 40% of these women scored 3 or lower on the Fagerström Test for Nicotine Dependence indicating low physical nicotine dependence.⁹ Similarly, a Northern Territory study of maternal smoking found that 71% reported smoking 10 or fewer cigarettes per day.¹⁰

It is also important to realise that the above figures represent average consumption levels. A number of reports observe that since tobacco is often shared, and its purchase is dependent upon availability of funds, consumption may be sporadic and concentrated around pay days. ^2,14,15,16 Research involving urban Indigenous female smokers in Perth showed that about half of those respondents who smoked less often than daily, only smoked in conjunction with drinking alcohol. About the same proportion did not purchase cigarettes themselves since the cultural expectation of sharing cigarettes catered for their needs.¹⁷

There are no national data on use of roll-your-own tobacco ('rollies') in the Aboriginal and Torres Strait Islander population, but it is likely that use among these groups would be at least similar to or possibly higher than levels among the total Australian population, in part due to its price advantage² and possibly also because of its facility as a product for chewing, or for blending with cannabis (see Section 8.11.2). Watson et al found that more than a third of Indigenous smokers in surveyed Northern Territory communities smoked hand-rolled cigarettes in 1986–87.¹⁸ A 2008 cross-sectional survey in three Northern Territory communities reported that of 305 smokers aged 16 years and over, 57% smoked both factory-made cigarettes and loose 'roll-your-own' tobacco, 34% smoked factory-made cigarettes only, 2% smoked only loose tobacco, and 1% only chewed tobacco.¹² In comparison, the National Drug Strategy Household Survey of 2007 found that about 17% of Australian smokers used both roll-your-own tobacco and factory-made cigarettes, and only 5% of all smokers used loose tobacco exclusively.⁵

8.5.2 'Chop-chop'

Chop-chop is unbranded loose tobacco leaf, sold on the black market at about half the price of properly taxed tobacco on a weight for weight basis.¹⁹ Most of its popularity results from its price, but it is also favoured by some due to the common misconception that because it is has not undergone the usual manufacturing into cigarettes, it is has no additives and is less harmful to health.^20,21

The National Aboriginal and Torres Strait Islander Tobacco Control Project report found that Aboriginal and Torres Strait Islander communities in Queensland, New South Wales, the Australian Capital Territory, Victoria and Tasmania use chop-chop.² Chop-chop is popular among these communities for the same reasons that it is popular with non-Indigenous Australians, but there are no data on the extent of its usage. As with other tobacco products, its use tends to be cyclical, peaking around pay days. Because chop-chop is generally sold in bulk quantities, it is often purchased communally. The belief in these communities that chop-chop serves as a safer alternative to cigarette smoking is cause for concern and needs to be appropriately addressed.²

For further information on chop-chop, refer to Chapter 1, Section 1.11.2, Chapter 3, Section 3.27.2, Chapter 13, Section 13.7.9.

8.5.3 Chewing tobacco

The various series of national statistics on Aboriginal and Torres Strait Islander smoking behaviour have not reported separately on types of tobacco consumed, and all have excluded chewing tobacco. Information on the chewing of pituri and other bush tobaccos and commercially available loose tobacco comes from local level studies, many of which are considerably dated. Studies indicate that in most Aboriginal and Torres Strait Islander communities across the country prevalence of tobacco chewing is low, although it has been noted to still be common in communities in Central Australia (southern NT, northern SA, and eastern WA).

Only one large-scale study, undertaken in the Northern Territory between 1986 and 1987,¹⁸ attempted to quantify this form of tobacco use in the Indigenous population, finding that one-quarter of respondents chewed tobacco. Women were more likely to chew tobacco than men (38% compared to 11%), and it was more popular among older age groups of both sexes, with almost half of the population aged over 60 reporting that they chewed tobacco. This study reported that the uptake of chewing occurred at an early age, young girls being taught to chew by their mothers and grandmothers; however, this study is from the mid-1980s, and little is documented about current uptake practices. Three-quarters of chewers used commercial loose flake or plug smoking tobacco, and one-quarter used bush tobacco. All chewers mixed their tobacco with ash, in the traditional manner (see Section 8.2). Only a small proportion of individuals (4%) both smoked and chewed tobacco.¹⁸

However, in this Northern Territory study there was also a strong geographic influence on chewing behaviour. In the Top End region, tobacco was chewed by only 5% of women and 1% of males.¹⁸ More recent studies in Arnhem Land communities of the Top End have also reported low levels of chewing tobacco use in this region. A 2008 study reported that only 1% reported using chewing tobacco exclusively¹², and in a study from 2000, 7% of current smokers (11 of 161) reported that they also chewed tobacco²².

The rates of chewing tobacco are much higher in the central region of Australia. The 1986–87 NT study discussed above found that 61% of women and 20% of men chewed tobacco. Although there have been no recent large-scale studies measuring rates of use of chewing tobacco in Central Australia, one researcher has recently noted that over 30% of Aboriginal women giving birth at the Alice Springs Hospital regularly chew bush tobacco (pituri).²³ Another study in remote South Australia has commented that chewing tobacco 'is mainly practiced by middle aged and older women who are least likely to smoke' (pS71).¹⁴ Clearly, strategies to address tobacco use in the Central Australia region need to include both chewing and smoking, and need to consider that some people (particularly women) are exclusively chewing tobacco.

Studies in other parts of Australia have shown that tobacco chewing occurs at comparatively low levels. A study of smoking behaviour in two Victorian country towns showed that a very small number Indigenous males (0.8%), and no females, chewed tobacco. In these populations, smoking was a majority behaviour (67% of men and 63% of women being current cigarette smokers).²⁴ Another study on tobacco use among urban-dwelling Indigenous women aged 18 and over who attended an Aboriginal medical service in Perth found that 6% of respondents had chewed tobacco at some time, and of these women, just over half continued to chew regularly.¹⁷

The National Aboriginal and Torres Strait Islander Tobacco Control Project provides more recent, anecdotal evidence about continuing use of tobacco in the traditional way, particularly from one of the communities involved in the interviews.² According to the report, native tobaccos are still prepared according to traditional methods and play a valued role in ceremonies. Controls on the use of tobacco are recalled from the old days but no longer practised. Usage is more popular in remote areas, probably reflecting availability as well as historical patterns of use. Native leaf is sometimes mixed with commercially available loose-leaf tobacco, such as Drum or Log Cabin, or the commercial tobaccos are chewed on their own.²

The health consequences of chewing tobacco in these communities have not been evaluated. In traditional use, the native tobaccos were typically only seasonally available, and only in particular locations, and their health effects are not studied. It is not yet clear what impact the chewing of readily available loose smoking tobacco will have on disease prevalence,¹⁸ although several reports and studies identify that the health outcomes from using smokeless tobacco are likely to be similar to using cigarettes.²⁵ Chewing tobacco is associated with cancers of the lip, oral cavity and pharynx, and for Indigenous people in the Northern Territory the incidence of these types of cancers increased by 6.6% annually between 1991 and 2005, while mortality increased by 4.6% annually in the same time period.²⁶ It is not possible, however, on the basis of available data, to calculate the proportions of these deaths attributable to various forms of tobacco use, there being other contributing factors to causation of these cancers, and overall Northern Territory prevalence of chewing being low. A Taiwanese study has found that betel quid chewing during pregnancy is significantly associated with poorer birth outcomes, including low birthweight and reduced birth length;²⁷ it is possible that chewing pituri has similar effects on birth outcomes, although this has not been investigated.ⁱ The historical and cultural elements of native tobacco use are, however, important to the communities in which their use has continued, and any future health campaigns dealing with chewing tobacco would need to be sensitively managed.^2,18

8.5.4 Pipe and cigar use

National surveys of Indigenous smoking behaviour have not collected separate data on pipe or cigar smoking. However it is likely that, as among the general Australian population, use of tobacco in these forms is minimal. The National Drug Strategy Household Survey of 2007 found that 8.3% of smokers aged 14 and over reported some level of pipe or cigar use, and only 1.6% of smokers reported pipe or cigar use exclusively.⁵

The historical associations of pipe use among Indigenous people, particularly strong in parts of Northern Australia, may mean that there are still communities with some levels of pipe smoking (see Section 8.2). Other than anecdotal comments,^15,16 there does not appear to be any published information on this subject.