9.1 Socio-economic position and disparities in tobacco exposure and use

Socio-economic disparities are evident in exposure to tobacco and in tobacco use, from before birth, during childhood, during adolescence and early adulthood and right through adult life.

9.1.1 Disparities in smoking during pregnancy

Data from the 2010 National Drug Strategy Household Survey indicate that female smokers in the most disadvantaged socio-economic group consumed almost twice the number of cigarettes per week as women who were least disadvantaged (an average 113.5 compared with 66.1 cigarettes per week).1

Data from state perinatal statistics units indicated that women from Aboriginal or Torres Strait Islander backgrounds were more than three times more likely to smoke during pregnancy than non-Indigenous women (49.6% compared with 13.1%).i Likelihood of smoking during pregnancy decreased with maternal age. Thirty-seven per cent of teenagers who become pregnant report that they continued to smoke.2

Other research has shown that disadvantage across a woman's life course increases the risk of being a smoker at pregnancy.3 Women without a partner, the less educated,4,5 those of lower socio-economic status,4,6 those living in a deprived neighbourhood7 and women with a psychiatric disorder8 are more likely to smoke during pregnancy.

9.1.2 Disparities in exposure of children to secondhand smoke

Children from disadvantaged families are far more likely to be exposed to secondhand smoke at home. Lower household income, lower parental (or head of house) education level and living with multiple adult smokers are predictive of children's exposure to smoking in the home.9,10

Data analysed from the 2010 National Drug Strategy Household Survey indicate that while the majority of households with dependent children where at least one person smokes only allow smoking outdoors, this is significantly less likely to be the case for children in the most disadvantaged areas (77% of smoking households with bans on smoking indoors in the most disadvantaged compared with 90% in the least disadvantaged areas). Given the higher rates of smoking among those in the disadvantaged groups, this means that children from the most disadvantaged areas of Australia are more than six times more likely to be exposed to smoking in their own homes as children from the most advantaged areas. More than 1 in every 10 of these highly disadvantaged children live in a household where at least one adult at least occasionally smokes indoors.

Table 9.1.1
Percentage of children exposed to smoking in the home, by quintile of disadvantage, Australia, 2010

Quintile of disadvantage*

% households with at least one smoker

% of these who only smoke outdoors

% of these who smoke indoors

% of children exposed to some indoor smoking


























Likelihood of lowest compared with highest





Source: Gartner and Hall 201211

* Based on socio-economic indexes for areas, Australian Bureau of Statistics

Although children of many low socio-economic status (SES) smokers are exposed daily to tobacco smoke in the home, legislative developments, such as bans in Australian states and territories on smoking in cars carrying children (see Chapter 15, Section, help reduce the number of areas where children may be exposed to secondhand smoke. Widespread smokefree legislation means that children of non-smoking parents might not be exposed to environmental tobacco smoke at all, for months at a time.

Research from overseas reports the same associations between deprivation and the likelihood of secondhand smoke exposure in children, with maternal and paternal smoking habits, household poverty and lower parental educational levels being common predictors of exposure.9, 10, 12, 13

9.1.3 Disparities in smoking behaviours among young people

In 2008 in Australia, younger students living in disadvantaged areas were more likely to experiment with smoking than students living in more advantaged areas.

Figure 9.1.1 shows that in 2008, younger students living in the most advantaged areas of Australia were about 15% less likely to report having smoked at some time in the last month than students residing in the least advantaged areas.14


Figure 9.1.1

Figure 9.1.1
Proportion of monthly smokers among secondary-school students aged 12–15 years by relative socio-economic disadvantage, Australia, 2008

Source: Data file provided to Merryn Pearce of the Tobacco Control Unit, Cancer Council, April 2012, by V White, Centre for Behavioural Research in Cancer, Cancer Council Victoria

Among older students in 2008, smoking was more common among students from more advantaged areas, with students from most advantaged SES areas about 25% more likely to smoke than those from the most disadvantaged areas. Among younger students (aged 12–15 years) in 2008, while there was little difference in the prevalence of current smoking across the different SES groups, smoking was slightly more common among the least advantaged groups (Figure 9.1.2).


Figure 9.1.2

Figure 9.1.2
Proportion of weekly smokers among secondary school students aged 12–15 and 16–17 years by relative socio-economic disadvantage, Australia, 2008

Source: Data file provided to Merryn Pearce of the Tobacco Control Unit, Cancer Council, April 2012, by V White, Centre for Behavioural Research in Cancer, Cancer Council Victoria

9.1.4 Disparities in smoking prevalence among adults

Consistent with findings from the US,15–17 UK,18,19 Canada,20,21 New Zealand22,23 and other developed countries,24–31 data on current smoking from recent Australian Bureau of Statistics National Health Surveys,32-35 recent National Drug Strategy Household Surveys,1,36,37 and surveys assessing the impact of the National Tobacco Campaign38 and state Quit campaigns,39 all show a clear social gradient in smoking behaviour among adults, with rates of current smoking significantly higher and the proportion of people who have never smoked significantly lower in lower socio-economic groups.

Table 9.1.2 sets out Australian data from the 2007–08 National Health Survey published by the Australian Bureau of Statistics.

Table 9.1.2
Prevalence of daily smoking, Australians 15 years and over by socio-economic and labour force status, 2007–08


Persons (%)

Total population, 15 years+


Labour force status





Index of disadvantage

5th quintile (most advantaged)


1st quintile (most disadvantaged)


Source: Australian Bureau of Statistics 200935 (p32)

Table 9.1.3
Socio-economic characteristics by smoking status, persons 14 years and older, Australia, 2010


Never smoked* (%)

Ex-smokers† (%)


All persons (aged 14+)




Labour force status

Currently employed












Engaged in home duties




Retired or on a pension




Volunteer/charity work




Unable to work









Without post-school qualifications




With post-school qualifications




Main language spoken at home









Source: Australian Institute of Health and Welfare 20111 Table 3.4 (p27)

* Never smoked more than 100 cigarettes or the equivalent tobacco in their life

† Smoked at least 100 cigarettes or the equivalent tobacco in their life, and no longer smoke

‡ Smoked daily, weekly or less than weekly

The 2010 National Drug Strategy Household Survey tells a similar story. Table 9.1.3 sets out data on smoking status among those of varying employment status, those with and without post-school qualifications, and those living in areas marked by varying levels of income, educational attainment and unemployment. (Note that the figures in Table 9.1.3 cover the population from 14 years of age and so they vary somewhat from those in Chapter One, Section 1.7, which computed adult smoking prevalence just for those respondents aged 18 years and over.)

Figure 9.1.3 plots data on smoking status by the level of social disadvantage of the area that people live in.

The proportion of people who classify themselves as ex-smokers is almost identical among people living in areas of varying degrees of social disadvantage.


Figure 9.1.3

Figure 9.1.3
Smoking status by relative social disadvantage, persons 14 years and older, Australia, 2010: never smokers, ex-smokers and current smokers

Source: Australian Institute of Health and Welfare 20111 Table 3.4 (p28)

9.1.5 Disparities in reported cigarette consumption

In addition to being more likely to have ever smoked and to be current smokers, those in disadvantaged groups also generally report smoking a greater number of cigarettes each day.32,40

Table 9.1.4
Mean number of cigarettes smoked per day, (self-reported) current smokers aged 14 years and older, by social characteristics, by sex, Australia, 2010






Mean number of cigarettes smoked/day

All persons (aged 14+)





Without post-school qualifications




With post-school qualifications





Currently employed












Engaged in home duties




Retired or on a pension




Volunteer/charity work




Unable to work








Socio-economic status

1st quintile (most disadvantaged)




2nd quintile




3rd quintile




4th quintile




5th quintile (most advantaged)




Main language spoken at home









Indigenous status

Aboriginal and/or Torres Strait Islander




Other Australian




Source: Adapted from Australian Institute of Health and Welfare 20111 Table 3.9. (p36)

9.1.6 Disparities in duration of smoking

Among people who have quit smoking, those with lower levels of occupation, income and education are likely to have smoked for longer periods of time prior to quitting. Table 9.1.5 sets out the mean number of years prior to quitting for people who reported being ex-smokers in the 2001 National Drug Strategy Household Survey.41,42

Table 9.1.5
Mean duration of smoking prior to quitting, Australia, 2001


Median duration of smoking (years)


Blue collar


White collar




Family income ($ pw)

Less than 300




800 and more


Education (years)

9 or less




12 or more


Source: Siahpush et al 200542

Results of multivariate analysis showed that smoking duration from onset to cessation was 14% longer for persons with blue collar rather than professional occupations. Respondents who earned $299 or less per week smoked 38% longer than did those earning $800 or more. Individuals with nine or fewer years of education smoked 13% longer than those with 12 or more.

Note, however that trends in smoking cessation are not uniformly more favourable in higher SES groups for all age and gender groups. A cross-sectional study of young, middle-aged and older women in Australia for instance found that for women aged 70–75 years, those with the highest educational attainment were more likely to have ever smoked than those with the lowest level of attainment. This was in contrast to findings for the other two cohorts, where this association was reversed, with a stronger association between low levels of education and ever smoking among those aged 18–23 years (younger) than those aged 45–50 years (mid-age). Similarly, for older women, those in the most skilled occupational classes were most likely to have ever smoked, with opposite findings for mid-age women.43 The differences in patterns of uptake between cohorts may be explained by trends towards greater social freedom for women since the late 1960s.

In the US, marked differences in the duration of smoking were found between racial groups as well as socio-economic groups. Most minority racial groups were likely to smoke for longer periods and individuals living in poverty smoked on a daily basis for 18 years longer than those with a family income about three times above the poverty line.44

Cohort patterns in smoking uptake and quitting are discussed further in Section 9.7.

9.1.7 Disparities in exposure to secondhand smoke

Because more of them smoke, people in more disadvantaged groups are also more likely to be exposed to secondhand smoke both where they work and where they live. Disparities in workplace exposure

Since the mid-1980s in Australia, when smoking was banned in the federal public service offices and then, increasingly in big and then smaller companies (see Chapter 15, Section 15.4), people in higher status occupations have been more likely to work in places with total bans on smoking. While most workplaces since the late 1980s have restricted smoking to at least some degree, as shown in Figure 9.1.4, as recently as the late 1990s, blue collar workers were three times more likely to work in environments with no restrictions on smoking.


Figure 9.1.4

Figure 9.1.4
Proportion of workers reporting a total ban and proportion reporting no restrictions on smoking in their workplace, Australia 1998: blue collar compared with white collar and professional workers

Source: Adhikari and Summerill 199845

With legislation mandating smokefree policies in hospitality venues and in enclosed workplaces in all Australian jurisdictions (with some exemptions, such as high-roller rooms), disparities in workplace exposure to environmental tobacco smoke are no doubt much less pronounced in more recent times. Data collected from annual population surveys in Victoria showed for instance, that the proportion of indoor workers reporting total smoking restrictions at their usual area of work increased significantly between 1998 and 2007 (from 91% to 95%). The data indicated there was a relatively uniform increase in workplace smoking bans across all socio-economic groups for this period. However some disparity between smokefree workplaces does still exist, with 91% of warehouse, workshop and factory workers reporting a smokefree workplace compared with the average of 95% of all indoor workplaces.46 Disparities in domestic exposure

In the 1998 National Drug Strategy Household Survey, almost 50% of respondents with a university degree stated that they did not allow smoking inside their home. For those with no tertiary qualifications the figure was only 34%.47

Among Australian smokers in 2010–11, those on lower incomes were much more likely to allow smoking anywhere in their house (Figure 9.1.5).

In 2008–09, 82% of university-educated smokers reported never smoking when non-smokers were present in their cars–only slightly more than smokers who had not completed high-school education (Figure 9.1.6).


Figure 9.1.5

Figure 9.1.5
Current smokers' rules about smoking in the home, by annual household income, Australia 2010–11

Source: Data file of responses to eighth wave of the International Tobacco Control Four-country Survey provided to Merryn Pearce of the Tobacco Control Unit, Cancer Council Victoria by T Partos and R Borland, 2012

Note: Figures are percentages


Figure 9.1.6

Figure 9.1.6
Current smokers' smoking behaviour around non-smokers in cars, by educational status, Australia 2008–09

Source: Data file of responses to seventh wave of the International Tobacco Control Four-country Survey provided to Merryn Pearce of the Tobacco Control Unit, Cancer Council Victoria, by T Partos and R Borland , 2012

Note: Figures are percentages Exposure in institutional settings

People spending time in institutions such as correctional facilities, psychiatric hospitals and drug treatment centres are among the most disadvantaged groups in Australia. Given the much-higher-than-average rates of smoking among residents and clients of such facilities and services, high levels of smoking among staff48,49 and fears about the impact on attendance, treatment and behaviour,50 it is only in very recent times that such institutions have begun to introduce smokefree policies. Even after the introduction of such policies, many clients could still be subject to secondhand smoke exposure due to large numbers of people smoking in the immediate vicinity of buildings.

Recent news and research

For recent news items and research on this topic, click here (Last updated October 2016)      


i Different states have used different criteria for assessing smoking status, and routinely collect data at different times in the pregnancy (prior to first antenatal visit, at first antenatal visit, at birth). Provisional data were supplied for Victoria for this report and limited to Perinatal National Minimum Data Set data items. The numbers of mothers and babies in Victoria in Australia may change when the final data are used.


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Recent references

Eiden, R., G. Homish, C. Colder, P. Schuetze, T. Gray, et al., Changes in smoking patterns during pregnancy. Substance Use & Misuse, 2013. [Epub ahead of print]. Available from: http://informahealthcare.com/doi/full/10.3109/10826084.2013.787091

Kabir, Z., S. Keogan, V. Clarke, and L. Clancy, Second-hand smoke exposure levels and tobacco consumption patterns among a lesbian, gay, bisexual and transgender community in Ireland. Public Health, 2013. [Epub ahead of print]. Available from: http://www.publichealthjrnl.com/article/S0033-3506%2813%2900061-9/fulltext


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