Last updated: March 2021
Suggested citation: Greenhalgh, EM, Bayly, M, Hanley-Jones, S. & 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; 2021. 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).2-6
The NPDC reported that in 2017, 9.9% of women who gave birth smoked during pregnancy, unchanged from 2016, but down from 13% in 2012 and 17.4% in 2005.5,6 Smoking during pregnancy has declined by 34.8% since 2007. In 2017, 22% of women who reported smoking during the first 20 weeks of pregnancy did not continue to smoke after 20 weeks. Further data from the 2016 National Drug Strategy Household survey showed that while 16% of women reported that they smoked before they knew they were pregnant, while 11% reported smoking after they were aware of their pregnancy.6 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.
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 2017, 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 (17.8% compared to 2.9%)
- Those living in very remote areas were almost five times more likely to smoke in pregnancy than women in major cities (33.7% compared to 7.2%), and twice as likely as those in remote areas (17.6%)
- Women with Aboriginal or Torres Strait Islander backgrounds were almost four times more likely to smoke during pregnancy than non-Indigenous women (44.3% compared with 11.8%)
- The likelihood of smoking during pregnancy decreased with maternal age. One-third (33.7%) of women and girls who became pregnant before the age of 20 smoked during the first half of 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. In 2015 one-third (32%) of teenage mothers smoked during the first 20 weeks and 25% smoked after 20 weeks of pregnancy, while 21% of mothers aged 20–24 years smoked during the first 20 weeks and 16% smoked after 20 weeks of pregnancy.7
Other research has shown that women without a partner, the less educated,8 those with lower socio-economic status8,9 and women with a psychiatric disorder10 are more likely to smoke during pregnancy. Data from the US shows similar patterns. In 2016, 7.2% of mothers 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. 11
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 2018. 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 nine-year period, the decline in smoking during pregnancy was greatest for Tasmania (6 percentage points), most of which occurred between 2010 and 2011. Large declines were also observed in South Australia (6.8 percentage points) and the Australian Capital Territory (5.6 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 2018, with the exception of Tasmania, the Northern Territory and to a lesser extent New South Wales12
Prevalence of smoking during any stage of pregnancy 2010 to 2018, by state and territory and Australia %
The health consequences of smoking and exposure to secondhand smoke during pregnancy are discussed in Chapters 3 and 4 respectively. 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, with 17.5% of Australians reporting having a mental or behavioural condition in 2014–15.13 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.14,15 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 more than 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%). 16 These excessive smoking rates contribute to higher levels of tobacco-caused morbidity and mortality among people with mental illness.17 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.18
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 children19 —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 2011 Australian National Census showed that there were about 105,000 homeless people in Australia at that time. 21
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.22 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%.22 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.23,24 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.25 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.25 Only 13% of prison entrants reported never having smoked, while 10% were ex-smokers.25 Within prison, tobacco use is commonly accepted as part of prison life and can often be used as currency in gambling or other trade.26
In 2018, 75% of all 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.25 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%.25
In 2011, the National Preventative Health Strategy27 identified the prison population as a priority area for future interventions (see Chapter 7 and Chapter 9). As of 2019, 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 banned smoking said they were current smokers, compared with more than half (56%) of dischargees from prisons which allowed smoking.25 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).25
The elevated smoking rates in the prison population reflects the overwhelmingly disadvantaged backgrounds of inmates. Indigenous people, those from low socioeconomic backgrounds, drug users, and the less educated are substantially over-represented in the prison system, as are those suffering mental illness.24-26 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 184.108.40.206.1, 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. 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.28 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).29
Most individuals with substance use disorders smoke tobacco as well.26 International14 and Australian14, 30, 31 research shows that in this population, smoking rates range from 68%14 to 90%30 (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.32 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.33, 34 Cessation interventions tailored to the needs of people with substance use disorders are discussed in Section 220.127.116.11.
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.16
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.19
For a discussion of cessation interventions tailored to LGBTQI people, see Section 7.19.9.
Relevant news and research
For recent news items and research on this topic, click here .(Last updated January 2021)
1. US Department of Health and Human Services. The health consequences of smoking. A report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Public Health Service, Office of the Surgeon General, 2004. Available from: http://www.surgeongeneral.gov/library/smokingconsequences/.
2. Laws P, Grayson N, and Sullivan E. Smoking and pregnancy. Aihw cat. No. Per 33. Sydney: AIHW National Perinatal Statistics Unit, 2006. Available from: http://www.npsu.unsw.edu.au/NPSUweb.nsf/resources/AMB_2004_2008/$file/Smoking+and+pregnancy+for+web.pdf.
3. Hilder L, Zhichao Z, Parker M, Jahan S, and Chambers GM. Australia’s mothers and babies 2012. Perinatal statistics series no. 30. Cat. no. PER 69, Canberra: AIHW, 2014. Available from: http://www.aihw.gov.au/publication-detail/?id=60129550033.
4. Australian Institute of Health and Welfare, Australia’s mothers and babies 2015—in brief. Perinatal statistics series no. 33. Cat no. Per 91 Canberra: AIHW; 2017. Available from: https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies-2015-in-brief/contents/table-of-contents.
5. Australian Institute of Health and Welfare. Australia’s mothers and babies 2016—in brief. Perinatal statistics series no. 34. Cat. no. PER 97, Canberra: AIHW 2018. Available from: https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies-2016-in-brief/contents/table-of-contents.
6. Australian Institute of Health and Welfare, Australia’s mothers and babies 2017—in brief. Perinatal statistics series no. 35. Cat no. Per 100 Canberra: AIHW; 2019. Available from: https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-and-babies-2017-in-brief/contents/table-of-contents.
7. Australian Institute for Health and Welfare. Teenage mothers in Australia 2015. PER 93.Canberra: Australian Government, Australian Institute of Health and Welfare, 2018. Available from: https://www.aihw.gov.au/reports/mothers-babies/teenage-mothers-in-australia-2015/contents/table-of-contents.
8. Lu Y, Tong S, and Oldenburg B. Determinants of smoking and cessation during and after pregnancy. Health Promot Int, 2001; 16:355-65. Available from: http://heapro.oxfordjournals.org/cgi/content/full/16/4/355
9. Mohsin M and Bauman A. Socio-demographic factors associated with smoking and smoking cessation among 426,344 pregnant women in New South Wales, Australia. BMC Public Health, 2005; 5:138. Available from: http://www.biomedcentral.com/content/pdf/1471-2458-5-138.pdf
10. Flick L, Cook C, Homan S, McSweeney M, Campbell C, et al. Persistent tobacco use during pregnancy and the likelihood of psychiatric disorders.Flick lh, cook ca, homan sm, mcsweeney m, campbell c, parnell l. American Journal of Public Health, 2006; 96:1799-807.
11. Drake P, Driscoll AK, and Mathews TJ. Cigarette smoking during pregnancy: United States, 2016. Centers for Disease Control and Prevention, 2018. Available from: https://www.cdc.gov/nchs/products/databriefs/db305.htm.
12. Australian Institute for Health and Welfare. Data tables for Australia's mothers and babies 2019—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/summary.
13. Australian Bureau of Statistics. 4364.0.55.001 - National Health Survey: First results, 2014-15 2015. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4364.0.55.001Main+Features12014-15?OpenDocument
14. Lasser K, Boyd J, Woolhandler S, Himmelstein D, McCormick D, et al. Smoking and mental illness. A population-based prevalence study. Journal of the American Medical Association, 2000; 284:2606-10. Available from: http://jama.ama-assn.org/cgi/content/full/284/20/2606
15. McNeill A. Smoking and mental health - a review of the literature. London: Smokefree London Programme, 2001. Available from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.622.6748&rep=rep1&type=pdf.
16. Australian Institute of Health and Welfare. Data tables: National Drug Strategy Household Survey 2019 - 8. Priority population groups supplementary tables. Canberra: AIHW, 2020. Available from: https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/data.
17. Lawrence D, Holman C, and Jablensky A, Duty to care. Preventable physical illness in people with mental illness. Perth: The University of Western Australia; 2001
18. Australian Bureau of Statistics. 6224.0.55.001 - labour force, Australia: Labour force status and other characteristics of families, June 2017. 2017. Available from: https://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/ED61C303D1F41AD9CA25848700167308?opendocument
19. Australian Institute of Health and Welfare. Data tables: National Drug Strategy Household Survey 2019 - 2. Tobacco smoking chapter, supplementary data tables. Canberra: AIHW, 2020. Available from: https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/data.
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21. Australian Bureau of Statistics. 2049.0 - census of population and housing: Estimating homelessness, 2011 Available from: https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/2049.0Main+Features12011
22. Kermode M, Crofts N, Miller P, Speed B, and Streeton J. Health indicators and risks among people experiencing homelessness in melbourne, 1995-1996. Aust NZ J Public Health, 1998; 22:464-70.
23. Awofeso N, Testaz R, Wyper S, and Morris S. Smoking prevalence in New South Wales correctional facilities, 2000. Tobacco Control, 2001; 10:84-5. Available from: http://tobaccocontrol.bmj.com/cgi/content/full/10/1/84a
24. Belcher J, Butler T, Richmond R, Wodak A, and Wilhelm K. Smoking and its correlates in an Australian prisoner population Drug Alcohol Rev, 2006; 25 343-8.
25. Australian Institute of Health and Welfare. The health of australia’s prisoners 2018. Cat. no. PHE 246.: AIHW, 2019. Available from: https://www.aihw.gov.au/getmedia/2e92f007-453d-48a1-9c6b-4c9531cf0371/aihw-phe-246.pdf.aspx?inline=true.
26. Baker A, Ivers R, Bowman J, Butler T, Kay-Lambkin F, et al. Where there's smoke, there's fire: High prevalence of smoking among some sub-populations and recommendations for intervention. Drug Alcohol Rev, 2006; 25:85-96.
27. National Preventative Health Taskforce. Australia: The healthiest country by 2020. National Preventative Health Strategy, Canberra: Commonwealth of Australia 2009. Available from: https://www.health.qld.gov.au/__data/assets/pdf_file/0022/424426/nphs-overview.pdf.
28. Australian Institute of Health and Welfare. National Drug Strategy Household Survey, 2019. ADA Dataverse, 2021. Available from: http://dx.doi.org/10.26193/WRHDUL.
29. Guerin N and White V. ASSAD 2017 statistics & trends: Australian secondary students’ use of tobacco, alcohol, over-the-counter drugs, and illicit substances in 2017. Second edition. Cancer Council Victoria, 2020. Available from: https://www.health.gov.au/resources/publications/secondary-school-students-use-of-tobacco-alcohol-and-other-drugs-in-2017.
30. Reichler H, Baker A, Lewin T, and Carr V. Smoking among in-patients with drug-related problems in an Australian psychiatric hospital. Drug Alcohol Rev, 2001; 20:231-7.
31. Degenhardt L and Hall W. The relationship between tobacco use, substance-use disorders and mental health: Results from the national survey of mental health and well-being. Nicotine & Tobacco Research, 2001; 3:225-34
32. Guydish J, Passalacqua E, Pagano A, Martínez C, Le T, et al. An international systematic review of smoking prevalence in addiction treatment. Addiction, 2015. Available from: http://dx.doi.org/10.1111/add.13099
33. Williams J and Ziedonis D. Addressing tobacco among individuals with a mental illness or an addiction. Addictive Behaviours, 2004; 29:1067-83.
34. Kalman D, Morissette S, and George T. Co-morbidity of smoking in patients with psychiatric and substance use disorders. American Journal on Addictions, 2005; 14:106-23. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16019961
35. Li J, Berg CJ, Weber AA, Vu M, Nguyen J, et al. Tobacco use at the intersection of sex and sexual identity in the US, 2007-2020: A meta-analysis. American Journal of Preventive Medicine, 2020. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33218922
36. Praeger R, Roxburgh A, Passey M, and Mooney-Somers J. The prevalence and factors associated with smoking among lesbian and bisexual women: Analysis of the Australian National Drug Strategy Household Survey. International Journal of Drug Policy 2019; 70:54–60. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31082663