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

Last updated: December 2017 
Suggested citation: Greenhalgh, EM, Bayly, M, & Winstanley, MH. 1.7 Trends in the prevalence of smoking by socio-economic status. In Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors].  Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2020. Available from http://www.tobaccoinaustralia.org.au/chapter-1-prevalence/1-7-trends-in-the-prevalence-of-smoking-by-socioec

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 2016.

Table 1.7.1
Tobacco smoking status, people aged 14 years and older, by SES characteristics, 2016 (per cent)

* Never smoked 100 cigarettes (manufactured and/or roll-your-own) or the equivalent amount of tobacco

† Smoked 100 cigarettes (manufactured and/or roll-your-own) or the equivalent amount of tobacco and reports no longer smoking
‡ Smoked daily, weekly or less than weekly
# From Index of social disadvantage of place of residence
Source: National Drug Strategy Household Survey 2016, Specific population groups Chapter 8, Supplementary data tables 6

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

Figure 1.7.1
Prevalence of current smoking*, people aged 14+ years, by SES characteristics, 2016 (per cent)

* Smoked daily, weekly or less than weekly
† Among households with dependent children.
Source: National Drug Strategy Household Survey 2016, Specific population groups Chapter 8, Supplementary data tables 6

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 Chapter 3, Section 3.31 .

1.7.2 Trends over time in smoking and socioeconomic status

Figure 1.7.2 shows the prevalence of regular smoking by SEIFA quintiles from 2001 to 2016. Over this period, regular smoking declined linearly among all quintiles (controlling for age and sex), and encouragingly for the most recent period of 2013–16, the greatest (and only significant) reduction in prevalence occurred among the most disadvantaged smokers. Overall, the absolute gap in smoking prevalence between the most and least disadvantaged stayed fairly constant for the decade 2004–2013 at about 14%, before narrowing to about 12% in 2016. 

Figure 1.7.2
Prevalence of regular* smokers† in Australia, persons 18 years and over, 2001 to 2016‡, by socio-economic index for area

* Includes those reporting that they smoke ‘daily’ or ‘at least weekly’.
† Includes persons smoking any combination of cigarettes, pipes or cigars.
‡ All data weighted to the Australian population appropriate for each survey year and may vary slightly from data presented in previous edition.
Source: Centre for Behavioural Research in Cancer analysis of National Drug Strategy Household Survey data from 2001 to 2016.
The data are grouped in quintiles calculated using one of the socio-economic indexes for areas (SEIFA) developed by the Australian Bureau of Statistics.  The ABS’s Index of Advantage/Disadvantage is based on a continuum of advantage to disadvantage. 

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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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