1.10 Prevalence of smoking in other high-risk sub-groups of the population

Last updated: March 2022

Suggested citation: Greenhalgh, EM, Bayly, M, Puljevic, C, & Scollo, MS. 1.10 Prevalence of smoking in other high-risk sub-groups of the population. In Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors].  Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2022. Available from  Available from  http://www.tobaccoinaustralia.org.au/chapter-1-prevalence/1-10-prevalence-of-smoking-in-other-high-risk-sub-

 

Discussion of general trends in smoking prevalence in Australia overlooks population sub-groups that have much higher smoking rates, or for whom smoking causes unique or disproportionate problems. Individuals with lower socio-economic status or lower educational attainment are more likely to smoke, as discussed in Sections 9.1 and 9.2 Aboriginal and Torres Strait Islander peoples, discussed in the preceding section and in detail in Chapter 8, also show substantially higher smoking rates than the rest of the population, as do members of some other culturally and linguistically diverse communities (see Section 1.8). The following is a brief discussion about other population groups among whom smoking prevalence is either higher than overall Australian prevalence, or for whom smoking poses greater than usual health risks:

 

1.10.1 Smoking in pregnancy

Addressing smoking during pregnancy is of particular importance since tobacco use harms both the mother and the foetus. 1

The Australian Institute of Health and Welfare reports data on births in Australia through the National Perinatal Data Collection. Since 1991, it has collected information concerning both the mother (including demographic profile and matters relating to the pregnancy and birth) and the baby (such as sex, birth-weight and other health indicators). 2

The NPDC reported that in 2019, 9.3% of women who gave birth smoked at some time during pregnancy, down from 9.6% in 2018, 12.5% in 2012 and 17.4% in 2005. 2-5 In 2019, about one-fifth of women who reported smoking during the first 20 weeks of pregnancy did not continue to smoke after 20 weeks. 2 The Australian National Perinatal Data Collection also reported that women who smoked during pregnancy tended to have a later first antenatal visit, and one fewer antenatal care visit during their pregnancy, on average. 2

There are significant variations in the prevalence of smoking during pregnancy in certain sub-populations, reflecting smoking behaviour in these groups within the wider population. In 2019, notable differences in the proportions of women smoking during the first 20 weeks of pregnancy were observed for the following groups:

  • Women who lived in the most disadvantaged areas were about six times more likely to smoke during pregnancy than women living in least disadvantaged areas (17.0% compared to 2.7%)
  • Those living in very remote areas were about five times more likely to smoke in pregnancy than women in major cities (34.7% compared to 6.7%), and almost twice as likely as those in remote areas (19.6%)
  • Women who have had multiple previous pregnancies are more likely to smoke during pregnancy. Almost one-third (29.3%) of women who had four or more previous pregnancies smoked during pregnancy.
  • The likelihood of smoking during pregnancy decreased with maternal age. Almost one-third (31.6%) of pregnant women and girls under the age of 20 smoked during the pregnancy, compared to about 6% of those aged 35 years and older. 6
  • Rates of smoking also substantially differ for teenage pregnancies compared to young women aged 20­–24 years. About one-fifth (20.6%) of women aged 20–24 years smoked during pregnancy, compared to 31.6% of women and girls under the age of 20. 2

The prevalence of smoking during pregnancy among women with Aboriginal or Torres Strait Islander backgrounds is reported in Section 8.3.5. Other research has shown that women without a partner, the less educated, 7 those with lower socio-economic status 7, 8 and women with a psychiatric disorder 9 are more likely to smoke during pregnancy. Data from the US shows similar patterns. In 2016, 7.2% of women smoked during pregnancy, with prevalence highest among those aged 20–24 years and declining with maternal aged. Large differences in smoking during pregnancy were observed by ethnicity, highest level of educational attainment, and by state. 10

Mirroring smoking prevalence across the general population, rates of smoking during pregnancy also vary by state and territory. Figure 1.10.1 shows rates of smoking during pregnancy by state and territory for 2010 to 2019. It can be seen that in all years, smoking during pregnancy was highest in the Northern Territory and lowest in the Australian Capital Territory. Rates of smoking were also high in Tasmania and Queensland relative to the national average over this ten-year period, the decline in smoking during pregnancy was greatest for Tasmania (6.5 percentage points), most of which occurred between 2010 and 2011. Large declines were also observed in South Australia (8.7 percentage points) and the Australian Capital Territory (5.7 percentage points). For most jurisdictions, the majority of the decline in smoking prevalence during pregnancy occurred between 2010 and 2013. An overall decline continued for most states and territories during 2019, with the exception of New South Wales. 2   

Figure 1.10.1
Prevalence of smoking during any stage of pregnancy 2010 to 2019, by state and territory and Australia %

Source: Australian Institute for Health and Welfare. Australia's mother and babies data visualisations. Canberra: Australian Government, Australian Institute of Health and Welfare, 2020. Available from: https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies-data-visualisations/contents/antenatal-period/smoking

 

The health consequences of smoking and exposure to secondhand smoke during pregnancy are discussed in Sections 3.7, 3.8, 4.16 and 4.17. For information on issues related to quitting smoking during pregnancy, refer to  Section 7.11.

1.10.2 Smoking and mental illness

Mental health problems are common within the Australian population; in 2019, 16.9% of Australians aged 18+ reported that they had been diagnosed with and or/treated for one or more mental illnesses in the past year. 11 Individuals with mental health conditions have a substantially higher prevalence of smoking and those who smoke tend to smoke more heavily than the general population. 11 Data from the 2019 National Drug Strategy Household Survey showed that Australian adults (18 years and over) who reported having been diagnosed or treated for mental illness in the past year were twice as likely to be a current smoker than those who had not been diagnosed or treated in the past year (24.2.% vs. 12.9%). 12 These excessive smoking rates contribute to higher levels of tobacco-caused morbidity and mortality among people with mental illness. 13 For a detailed overview of smoking and quitting among people with mental illness, see Section 7.12

1.10.3 Single parents

In Australia in 2016, 14% of all families were one-parent families, the vast majority (83%) of which were single female-headed families. 14

In 2019, 29.9% of people aged 14+ years from single-parent households with dependent children were current smokers, compared to 12.2% among households with two parents and dependent children 15 —see Section 1.7 . Single parenthood is associated with social and economic disadvantage, 20  and is discussed further in  Section 7.19.4  and  Chapter 9 .

1.10.4 The homeless

Homelessness is defined as lacking adequate access to safe and secure housing. The 2016 Australian National Census estimates that there were more than 116,000 homeless people in Australia at that time. 17

Individuals experiencing homelessness have a poorer health status than the general population, with those who are ‘street homeless’ (those usually dwelling on streets or in parks, in derelict buildings or other temporary shelters) being the worst affected. 18 Melbourne-based research has shown a greatly elevated prevalence of smoking among homeless people (77%), with those who are street homeless reporting higher rates of 93%. 18 For further discussion refer to  Section 7.19.3 and Chapter 9.

1.10.5 The prison population

Traditionally, the prevalence of smoking in the prison population has been far higher than among the general population. 19, 20 While smoking has decreased substantially over time in the Australian general community, the same is not true for people in custody, whose smoking rates, in facilities which allow smoking, remain high. 21 In 2018, two in three (66%–69%) prison entrants aged 18–44 were daily smokers, compared with just one in seven (14%–16%) people of the same age in the general community. 21 Only 13% of prison entrants reported never having smoked, while 10% were ex-smokers. 21  Similar trends are observed internationally; a systematic review found that rates of smoking among people experiencing incarceration exceed community rates 1.04- to 62.6-fold. 22

In 2018, 75% of all Australian prison entrants reported being current smokers, 67% reported being daily smokers, and 85% reported having smoked at some stage in their life. The average age of taking up smoking was 14, although several prisoners reported that they began smoking as young as three. 21 Upon entry, female prison entrants (86%) were more likely than male prison entrants (74%) to report they were current smokers. Entrants aged 18–24 were most likely to report being current smokers (80%), with those aged 45 and over the least likely at 62%. 21

In 2011, the National Preventative Health Strategy 23 identified the prison population as a priority area for future interventions (see Chapter 7 and Chapter 9).  Similarly, the 2012-2018 National Tobacco Strategy recognised prisons as an important setting for tobacco control efforts and stated that continued leadership is required to reduce the prevalence of smoking among prisoners, and to reduce exposure to second-hand smoke among prisoners and staff working in correctional settings. 24 As of 2021, all Australian states and territories have introduced or announced intentions to introduce complete smoking bans in prisons, except Western Australia. In 2018, only about one-third (30%) of dischargees from prisons that had banne d smoking said they were current smokers, compared with more than half (56%) of dischargees from prisons which allowed smoking. 21 However, there was only a two percentage point difference between prison dischargees’ intentions to smoke upon release from prisons that has banned smoking and prisons which allowed smoking (42% and 44% respectively). 21 High rates of smoking relapse following release from smoke-free prisons is covered in  Section 7.19.10.

The elevated smoking rates in the prison population reflects the overwhelmingly disadvantaged backgrounds of inmates. Aboriginal and Torres Strait Islander peoples, those from low socioeconomic backgrounds, people who use illicit drugs, and the less educated are substantially over-represented in the prison system, as are those suffering mental illness. 20, 21, 25 As noted elsewhere in this chapter, each of these factors predicts higher smoking rates. For an overview of smoking bans in Australian prisons, see Section 15.4.4.2.1, and for an overview of interventions tailored to prison populations, see Section 7.19.10.

1.10.6 Other drug use

Tobacco use commonly co-exists with other drug use.

In 2017, of the secondary school students who reported having used marijuana, amphetamines, hallucinogens or ecstasy, more than one-third said that they had used tobacco concurrently (39%, 36%, 38% and 42%, respectively). 26

Analysis of data from the National Drug Strategy Household Survey shows the prevalence of drug use among adult smokers and non-smokers in 2019—see Table 1.10.1. Controlling for age and sex, current smokers were about six times more likely to have used marijuana in the past 12 months than non-smokers, and about four and a half times more likely to have used any illicit drug (including marijuana) in the year prior to the survey. 27  

Table 1.10.1
Past year use of other drugs among current smokers‡ and non-smokers*‡: by sex for Australians aged 18+ years, 2019

 

‡ Smoked daily, weekly or less than weekly
# Includes ex-smokers and never smokers (never smoked 100 cigarettes (manufactured and/or roll-your-own) or the equivalent amount of tobacco)

Source: Centre for Behavioural Research in Cancer analysis of 2019 National Drug Strategy Household Survey data. 30

 

Most individuals with substance use disorders smoke tobacco as well. 29 International 14 and Australian 14, 32, 33 research shows that in this population, smoking rates range from 68% 14 to 90% 32 (see also Section 7.12).  A 2015 international systematic review found that smoking rates among people in addiction treatment are more than double those of people with similar demographic characteristics. 34 The relationship between tobacco and other drug use is complex, and may be subject to genetic and neurobiological determinants, as well as psychological and social influences. 35, 36 Cessation interventions tailored to the needs of people with substance use disorders are discussed in  Section 7.12.5.4.  Similarly, smoking—especially daily smoking—is much more common among adults who meet the criteria for alcohol dependence, or who report drinking in ways that could be harmful or hazardous. In 2019, compared with those at low risk, adults who reported drinking alcohol at harmful or hazardous levels were more than twice as likely to report being a daily smoker (OR=2.21, 95% CI [1.95, 2.50]), while those who met the criteria for alcohol dependence were more than three times as likely to be a daily smoker (OR=3.17, 95% CI [2.67, 3.75]). 34

Figure 1.10.2  Smoking status of Australian adults (18+) at risk of alcohol dependence or harmful/hazardous alcohol use (ASSIST-Lite), 2019 

Source: Greenhalgh E and Scollo M. Alcohol and tobacco use in Victoria and Australia: Results from the 2019 National Drug Strategy Household Survey. Melbourne: Centre for Behavioural Research in Cancer, Cancer Council Victoria, 2021.

 

1.10.7 Lesbian, gay, bisexual, trans, queer and intersex (LGBTQI) people

Smoking rates are significantly higher among lesbian, gay, bisexual, trans, queer and intersex (LGBTQI) people compared with the general population. 35, 36 In the 2019 National Drug Strategy household survey, 22.9% of gay or bisexual people reported being a current smoker, compared with 13.5% of heterosexual people. Daily smoking rates were also much higher: 16.0% compared with 10.7%. While both daily and current smoking prevalence significantly decreased between 2016 and 2019 among heterosexual people, no such change was seen among gay or bisexual people. 15

For a discussion of cessation interventions tailored to LGBTQI people, see Section  7.19.9.

  

Relevant news and research

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