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Last updated: February 2024

1.7 Trends in the prevalence of smoking by socio-economic status

See Section 9.2 for a detailed overview of smoking prevalence by indicators of disadvantage (e.g., education level, socioeconomic status, employment status, and occupation)

In Australia 1-3 and many other countries, 4 smoking behaviour is inversely related to socio-economic status, with disadvantaged groups in the population being more likely to take up and continue smoking. The authors of a seminal British report on poverty and smoking observed that one can ‘almost study social disadvantage itself through variations in smoking prevalence’ (p78). 5

1.7.1 Latest estimates of prevalence of smoking by indicators of disadvantage

Table 1.7.1 sets out data from the National Drug Strategy Household Survey on smoking status by various socio-economic characteristics for Australians 14 years and over in 2022–23. 6

Figure 1.7.1 plots the prevalence of current smoking in the same year.

The relationship between smoking and social disadvantage is discussed in greater detail in Chapter 9. Differences in smoking prevalence among socio-economic groups result in different patterns of tobacco-caused ill health and disease. For discussion, see Section 9.3.

1.7.2 Trends over time in smoking and socioeconomic status

Figure 1.7.2 shows the prevalence of current smoking (smoking daily, weekly, or less than weekly) by SEIFA quintiles from the National Drug Strategy Household Survey from 2001 to 2022–23. Between 2019 and 2022–23, there were significant declines in current smoking among all groups except the highest socioeconomic status. The steepest decrease was seen among those living in the most disadvantaged areas.

1.7.3 International comparisons of smoking prevalence by socioeconomic status

As discussed in Section 1.3.3 , the timing, duration and magnitude of the smoking epidemic has varied significantly from one country to another. 7 While Westernised countries such as the US, Australia, and Canada have been through all four stages of the epidemic and are now experiencing declining prevalence rates and boast sophisticated tobacco control measures, countries in regions such as Southeast Asia and North Africa are currently in the second stage, with high rates of male smoking and lower (but increasing) levels of female smoking. 4

A systematic review and meta-analysis published in 2017 found a consistent inverse ‘dose–response’ relationship between cigarette smoking and income level in WHO regions for the Americas, South East Asia, Europe, and Western Pacific. Findings were consistent over time and for both genders. 8 Another study looking only at low and middle income countries found that while socioeconomic inequalities in tobacco use exist, such disparities varied widely between countries and were much wider in the lowest income countries. In one quarter of the countries examined, the reverse pattern was evident among women (i.e., higher smoking among the more advantaged). 9

People who immigrate from non-western to western countries move from an earlier to a more advanced stage of the smoking epidemic, which can affect smoking behaviours. A study examining the association between SES and smoking among immigrants to the US found that being foreign-born or a second generation immigrant had a protective effect against smoking across all SES groups, but most markedly among those in the lowest SES group. 10 The authors speculated that differences in the smoking epidemic between country of origin and the US might help explain such a pattern among US immigrants, with those countries in stage II of the epidemic (as described above) likely to have similar smoking rates among different socio-economic classes. A systematic review in 2015 explored the role of acculturation in smoking in immigrants from non-western to western countries. Among less acculturated immigrants, prevalence reflected their countries of origin (i.e., was very high in men and very low in women) and thus the early stage of the epidemic. For those who were more acculturated, prevalence indicated an adaption toward the social norm of the western country (i.e., became higher in women and lower in men) and reflected a more advanced phase of the epidemic. 11

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References

1. White V, Hill D, Siahpush M, and Bobevski I. How has the prevalence of cigarette smoking changed among Australian adults? Trends in smoking prevalence between 1980 and 2001. Tobacco Control, 2003; 12(suppl. 2):ii67-ii74. Available from: http://tobaccocontrol.bmj.com/cgi/content/full/12/suppl_2/ii67

2. Siahpush M. Smoking and social inequality. Australian and New Zealand Journal of Public Health, 2004; 28(3):297. Available from: http://www3.interscience.wiley.com/journal/118803503/abstract

3. Siahpush M and Borland R. Trends in socioeconomic variations in smoking prevalence, 1997-2000, in Australia's National Tobacco Campaign. Evaluation Report Volume 3. Every cigarette is doing you damage. Research and Evaluation Committee, Editor Canberra: Commonwealth of Australia; 2002. p 149-59 Available from: http://webarchive.nla.gov.au/gov/20140801053454/http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-publicat-document-tobccamp_3-cnt.

4. Lopez A, Collishaw N, and Piha T. A descriptive model of the cigarette epidemic in developed countries. Tobacco Control, 1994; 3:242-7. Available from: http://tobaccocontrol.bmj.com/cgi/reprint/3/3/242.pdf

5. Marsh A and McKay S, Poor smokers. London: Policy Studies Institute; 1994.

6. Australian Institute of Health and Welfare. National Drug Strategy Household Survey 2022–2023. Canberra: AIHW, 2024. Available from: https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey

7. Lopez AD, Collishaw NE, and Piha T. A descriptive model of the cigarette epidemic in developed countries. Tob Control, 1994; 3:242-7. Available from: http://tobaccocontrol.bmj.com/cgi/reprint/3/3/242.pdf

8. Casetta B, Videla AJ, Bardach A, Morello P, Soto N, et al. Association Between Cigarette Smoking Prevalence and Income Level: A Systematic Review and Meta-Analysis. Nicotine & Tobacco Research, 2017; 19(12):1401-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27679607

9. Sreeramareddy CT, Harper S, and Ernstsen L. Educational and wealth inequalities in tobacco use among men and women in 54 low-income and middle-income countries. Tobacco Control, 2016. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27885168

10. Acevedo-Garcia D, Pan J, Jun H-J, Osypuk TL, and Emmons KM. The effect of immigrant generation on smoking. Social Science and Medicine, 2005; 61:1223-42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15970233

11. Reiss K, Lehnhardt J, and Razum O. Factors associated with smoking in immigrants from non-western to western countries - what role does acculturation play? A systematic review. Tobacco Induced Diseases, 2015; 13(1):11. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25908932

Intro
Chapter 2