9.1 Socioeconomic position and disparities in tobacco exposure and use

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Socioeconomic 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 2004 National Drug Strategy Household Survey indicate that women in the most disadvantaged socioeconomic group are four times more likely to smoke than women who were
least disadvantaged (28% compared to 6%). Data from state Perinatal
Statistics units indicated that women with Aboriginal or Torres Strait Islander backgrounds are more than three times more likely to smoke during pregnancy than non-Indigenous women (53% compared with 16%).[8] Likelihood of smoking during pregnancy decreased with maternal age. Forty-two percent of teenagers who become pregnant report that they continued to smoke.40

Other research has shown that women without a partner, the less educated,41 those with lower socioeconomic status41, 42 and women with a psychiatric disorder43 are more likely to smoke during pregnancy.43

9.1.2 Disparities in exposure of children to second-hand smoke

Children from disadvantaged families are far more likely to be exposed to second-hand smoke at home.

Data from the ABS National Health Survey indicated that children in the lowest income group were three times more likely to have two parents who were smokers than children in the highest income families (29.7% vs 9.9%). Multiple logistic regression showed that parents who smoked were generally more likely to be young, minimally educated, employed in blue collar occupations, and resident in low-income families.44

Data from the National Drug Strategy Household Survey shows that about one in five children from the most disadvantaged areas in Australia live in household where at least one adult smokes inside at least once each day.45.

Among households in the most advantaged areas, smoking indoors at least once per day was half as likely among those with dependent children as those without. Among households in the most disadvantaged areas, presence of dependent children made no difference to the likelihood of smoking indoors

Whereas children of many low SES smokers are exposed daily to tobacco smoke in homes or cars, in very recent times in an environment of widespread smokefree policies in the education, recreation, hospitality and retail sectors, children of non-smoking parents might not be exposed to environmental tobacco smoke at all, for months at a time.

9.1.3 Disparities in smoking behaviours among young people

In 2005 in Australia, younger students living in disadvantaged areas were more likely to experiment with smoking than students living in more advantaged areas.

Figure 9.2 shows that, in 2005, younger students in the most advantaged areas of Australia were about 35% less likely to report having smoked some time in the last month than students in the least advantaged areas.39

Among older students in 2005 there was no clear socioeconomic difference between rates of current smoking, however among younger students, those in more advantaged areas were about 15% less likely to smoke regularly (at least weekly) than students in less advantaged areas—refer Figure 9.3.

9.1.4 Disparities in smoking prevalence among adults

Consistent with findings from the United States,46, 47 the United Kingdom,48 Canada,49 New Zealand50 and other developed countries,47, 51–54 data on current smoking from recent ABS National Health Surveys,31, 55, 56 recent National Drug Strategy Household Surveys,19 and recent surveys assessing the impact of the National Tobacco Campaign35 and state Quit Campaigns33, 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 socioeconomic groups.

Table 9.1 sets out data from the National Health Survey published by the Australian Bureau of Statistics.

A study analysing data from the 2004–05 National Health Survey in more detail similarly indicated that among Australian workers of both genders, the rate of smoking prevalence by broad occupational category was highest among labourers (39.8%) and intermediate among production and transport workers (36.9%). It was the lowest among professionals (13.3%) and managers and administrators (19.0%).57

After adjusting for age differences, 33% of men and 28% of women in the most disadvantaged areas reported being daily smokers, compared to 16% of men and 11% of women in the most advantaged areas, as measured as being in the first or fifth quintiles of the Index of Relative Socioeconomic Disadvantage respectively.32, 58

Analysis of data from each of the ABS National Health Surveys confirms a highly significant inverse trend with the quintiles representing the most disadvantaged groups showing higher smoking prevalence, both in males and females.55, 56, 59

The 2004 National Drug Strategy Household Survey tells a similar story. Table 9.2 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 9.2 cover the population from 14 years of age and so they vary somewhat from those in Chapter 1, Section 1.7 which computed adult smoking prevalence just for those respondents 18 years and over.)

Figure 9.5 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.

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—see Table 9.3.55, 59

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 9.4 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.18, 60

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, 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 (younger) than those aged 45–50 (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.61 The differences in patterns of uptake between cohorts may be explained by trends towards greater social freedom for women since the late 1960s. Cohort patterns in smoking uptake and quitting are discussed further in Section 9.6 .

9.1.7 Disparities in exposure to second-hand smoke

Because more of them smoke, people in more disadvantaged groups are also more likely to be exposed to second-hand smoke both where they work and where they live.

9.1.7.1
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 15.4.1, 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 9.6, as recently as the late 1990s, blue collar workers were three times more likely to work in environments with no restrictions on smoking.

With legislation mandating adoption of smokefree policies in hospitality venues in all workplaces in most jurisdictions and, disparities in workplace exposure to environmental tobacco smoke are no doubt much less pronounced in more recent times. Data from annual population surveys in Victoria showed for instance that the percentage of people working in factories, warehouses or workshops with no restrictions on smoking was just over 6% in 200562—see Section 9.1.4 for further details.

9.1.7.2 Disparities in domestic exposure

In the 1998 National Drug Strategy Household Survey, almost 50% of respondents with a university degree stated that they do not allow smoking inside their home. For those with no tertiary qualifications the figure was only 34%.63

Among Australian smokers in 2006, those on lower incomes were also significantly more likely than those on higher incomes to allow smoking anywhere in their house, and less likely than those on higher incomes to never allow smoking anywhere in the house—see Figure 9.7.

University-educated smokers are also slightly more likely to report never smoking when non-smokers were present in their cars—see Figure 9.8.

9.1.7.3 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 staff65 and fears about the impact on attendance, treatment and behaviour, 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 significant exposure to second-hand smoke due to large numbers of people smoking in the immediate vicinity of buildings.