2.7 Factors driving changes in tobacco consumption

Changes over time in the proportion of people smoking in the population and the amounts smoked by people who continue to smoke are driven by factors including:

• demographic trends such as the post-war baby boom, increasing life expectancy, and migration patterns
• marketing practices of tobacco companies, including promotion and the nature of the product itself, both of which can increase the uptake of smoking and resumption of smoking among those who have quit
• the relative heaviness of smoking among those who quit versus those who continue to smoke
• the affordability of tobacco products driven by economic trends, industry pricing strategies, government excise and customs duties and other charges and taxes and availability of illicit tobacco
• the effects of other policy measures introduced by government, including those that reduce opportunities to smoke, such as smoking bans in public places and workplaces, and those that encourage cessation and discourage uptake
• changing social factors such as increasing public awareness of the health risks of smoking and levels of public tolerance about exposure to tobacco smoke.

Changes in per capita consumption of tobacco products result from the combined effects of:

1. changes in the proportion of people in the population who regularly smoke and
2. changes in the amounts of tobacco smoked by people who smoke regularly.

Figure 2.7.1 plots changes in smoking prevalence against reported numbers of cigarettes smoked by people who currently smoke in Australia since 1980. Reported numbers of cigarettes smoked per person who continued to smoke increased in the 1980s at the same time as prevalence of smoking declined. Between 1992 and 1998 reported consumption fell while prevalence stayed flat. Prevalence and consumption fell in parallel between 1989 and 1992, between 1998 and 2004, and between 2010 and 2013. Reported consumption flattened between 2004 and 2010 and again from 2012 onwards, while prevalence continued to decline to 2022-23. (These observations are consistent with data available up to 2019, presented in Table 2.2.6 in Section 2.2, which are based on excise receipts rather than reported consumption.)

2.7.1 Stages of tobacco consumption in Australia

Per capita consumption of tobacco appears to have gone through a number of stages in Australia as evident in Figure 2.7.2.

2.7.1.1 Increases in consumption in the inter-war and post-war periods

Figure 2.7.2 shows that overall per capita consumption of tobacco products in Australia dipped in the wake of shortages during Depression years and immediately following World War II, and then rose steadily until the early 1960s. The increase between the late 1940s and early 1960s can be attributed to the combined effect of:

• rising levels of affluence and disposable income during the 1950s combined with little increase in the real price of tobacco products, resulting in cigarettes becoming more affordable—see Chapter 13, Section 13.6.3
• progressive increases in marketing to and subsequent use of tobacco products by women
• progressive increases in marketing and subsequent use of factory-made cigarettes by men as well as by women—much more convenient to smoke than roll-your-own and other tobacco products—leading to higher consumption per person who smokes.

Per capita consumption of tobacco products peaked in Australia in 1960 following the introduction of television and before the restriction of broadcasting of tobacco advertisements—see Chapter 11, Section 11.0.

It is possible that early media coverage about the health risks of smoking in publications such as the Reader’s Digest may have contributed to a number of short-term dips in consumption in the late 1950s.

2.7.1.2 Trends in consumption during the 1960s and 1970s

Figure 2.7.2 shows a marked decline in per capita consumption in the early and mid-1960s, which was the time during which landmark reports about the health effects of smoking were released in Britain in 1962¹ and in the US in 1964² and 1967.³ Per capita consumption rallied again over the 1970s as the baby boomers ‘came of age’, many seeing smoking as a badge of rebellion in the so-called ‘youth revolution’, and a marker of the sexual liberation and economic emancipation of women.⁴ The early 1970s also saw more vigorous marketing of tobacco products on billboards, through sponsorships and in magazines following the phasing out of advertising on TV and radio—see Chapter 11, Section 11.0.

2.7.1.3 Trends in consumption during the 1980s and 1990s

Per capita consumption of tobacco products reduced steeply over the 1980s and 1990s following the commencement of Quit campaigns (see Chapter 14, Section 14.2) and the imposition of (and subsequent frequent increases in) franchise fees on sales of tobacco products in each Australian state and territory⁵—see Chapter 13, Section 13.6.4.The rapid spread of smokefree policies in workplaces and hospitality venues must have contributed substantially to declines in consumption over this period—see Chapter 15. This period was also associated with significant declines in the prevalence of smoking in Australia.⁶

2.7.1.3.1 Changes in the proportion of people in the population who smoke regularly

There is strong evidence that the introduction of^7-9 and increases in funding for^10,11 social marketing campaigns have contributed to reductions in the proportion of people who smoke in Australia. Analyses of monthly changes in smoking prevalence between 1995 and 2006,¹⁰ 2001 and 2012¹² and 2001 and 2017¹³ suggests that increases in the price of tobacco products have been the most significant policy factor driving reductions in smoking prevalence, with increases in exposure to mass media campaigns also playing a significant role.

2.7.1.3.2 Changes in the amounts smoked by people who smoke regularly

While per capita consumption was flat during the 1970s and declined during the 1980s—and while it is known that the proportion of the population regularly smoking declined between 1976 and 1992 (see Chapter 1, Section 1.3)—there is evidence that consumption by (remaining) people who regularly smoke increased quite markedly over this period. Table 2.3 of the second edition of Facts and Issues: Tobacco in Australia¹⁴ included estimates of the average annual numbers of cigarettes consumed for 1945, 1964 and three-yearly from 1983 to 1992 (years in which survey data provided estimates of the numbers of people smoking regularly in Australia). Using limited data available on average weights of cigarettes in each of the years, it was estimated that the number of cigarettes consumed per adult, per day, increased from about three per day in 1945 to 17 in 1964 to about 27 in 1992.ⁱ

Increased consumption among people who smoked during the 1970s and 1980s was thought to be attributable to:

• earlier average age of uptake than in previous decades, and consequently heavier lifetime use, particularly among women
• lower nicotine levels in cigarettes corresponding with greater market demand for cigarettes labelled ‘low tar’ and thought to be less dangerous, compelling people who smoke to consume more cigarettes to maintain blood nicotine levels similar to those they became used to before switching to lower-tar brands
• the growing trend to smaller, lower-weight cigarettes, which were faster to smoke
• the shift to larger and larger pack sizes, which resulted in cheaper cigarettes and additional increased consumption among people who tend to calibrate the number of cigarettes they smoke to take account of the number they have left in the pack.

Self-report data show a sharp decline in the number of cigarettes smoked per day between 1989 and 1992 and a more gradual decline between 1992 and 1998 (see Section 2.6, Figure 2.6.2). This pattern of change is consistent with the very large increase in the adoption of smokefree workplaces following the release of a judgment in a major legal case about the health effects of secondhand smoke in February 1991—see Chapter 16, Section 16.2.2 and the subsequent increases in adoption of smokefree homes—see Chapter 15, Sections 15.4 and 15.6. Adoption of smokefree policies has been firmly associated with declines in tobacco consumption by individuals who smoked in numerous studies both in Australia¹⁵ and internationally¹⁶ and has been associated with profound declines in most social groups of the acceptability of smoking around others.

2.7.1.4 Trends in consumption during the 2000s

As noted above, substantial increases in the funding for anti-smoking mass media campaigns contributed to reductions in smoking prevalence in the Australian population. The large decline in consumption between 1998 and 2001 resulted from the reduction in both the proportion of people smoking and the amount smoked per person who smoked following the National Tobacco Campaign and reform of taxes on tobacco products resulting in large increase in the price of budget brands^17,18—see Sections 13.3 and 13.6.

Figure 2.10.2 indicates a continuing though somewhat flatter rate of decline in per capita consumption in the mid 2000s corresponding with the continued decline in the prevalence of smoking since 2001 (see Section 1.3); the fall in the early 2000s in reported consumption by those who continued to smoke (see Section 2.3.1) was likely to be in response to extension of smokefree policies throughout the hospitality industry (see Sections 15.4, 15.5 and 15.7).

2.7.1.5 Trends in consumption during the 2010s and 2020s

The 2010s were marked by several large excise increases, first an unscheduled 25% increase in April 2010, then a series of eight annual 12.5% excise increases beginning late 2013. These increases prompted quit attempts and cutting down among people who smoked.^19-21 (See Section 13.6.3 for more information about these tax increases, and Section 13.8 for a description of their impact on tobacco use.)

In 2012, Australia became the first country to implement plain packaging of tobacco products. At the same time, larger graphic health warnings were introduced on tobacco packaging. Plain packaging was not found to have had an impact on the number of cigarettes smoked per day among those that smoked, although reductions were observed in tobacco sales, customs clearances, and population spending, indicating a decline in consumption attributable to reductions in smoking prevalence (see Section 11A.9) also prompted by the refreshed graphic health warnings (see Section 12A.5).

The 2010s and early 2020s have also been characterised by changes in the types of products available and patterns of use. Roll-your-own tobacco has become more popular among people who smoke over this period, especially among young people in Australia^22,23 and in the UK²⁴ and Aotearoa New Zealand.²⁵ The changing patterns of product use will affect estimates of consumption based on manufactured cigarette data. E-cigarettes, untaxed tobacco, and even the COVID-19 pandemic, have likely impacted tobacco use in Australia, and likely have had varying impacts on consumption across population groups. Quantifying, and disentangling, these factors is complex.

2.7.2 Factors affecting trends in tobacco consumption over the last century

As is evident in the discussion above, factors that drive changes over time in the proportion of people smoking regularly and the amount they smoke include:

• demographic trends
• characteristics of people who smoke
• marketing practices of tobacco companies, particularly price promotion strategies
• the affordability of tobacco products
• policies and programs adopted and funded by governments
• social and cultural factors
• the ready availability of tobacco
• changes in availability and use of different products, including roll-your-own tobacco and e-cigarettes.

2.7.2.1 Policy effects on tobacco consumption

Apart from increasing taxes and social marketing campaigns, which have been demonstrated to reduce the prevalence of smoking,^10,26,27 and smokefree policies demonstrated to reduce consumption by remaining people who smoke,^11,12,16 it seems highly likely that many other tobacco-control initiatives have also contributed to declining tobacco consumption, albeit in ways that are difficult to detect^28,29 in standard economic analysis.⁵

Prior to plain packaging, consumer information on tobacco products (health warnings) could readily be undermined by increased attention to colour and branding as part of pack design. Even on branded packs, strengthened warnings are more prominent to teenagers³⁰ and that pictorial warnings have increased knowledge about the health effects of smoking and reduced positive feelings about tobacco products,³¹ and prompted reductions in smoking behaviours.^32,33 Plain packaging, introduced in Australia at the same time as refreshed, larger graphic health warnings on tobacco products, has been shown to reduce the appeal of tobacco products, reduce misperceptions about the harms of smoking, increase the effectiveness of health warnings, prompt quit attempts, and contribute to the decline in smoking prevalence in Australia—see Section 11A.9.

Laws that have substantially reduced sales to minors also appeared to have contributed to declines in teenage smoking both in Australia^11,34 and other countries.^35,36 The effects on per capita consumption of measures that mainly affect young people, such as tightening of access laws and strengthening of health warnings, would not be detectable in total consumption patterns immediately following implementation³⁷ but are likely to exert an effect, the strength of which would increase gradually over time, as people born after these policies were implemented make up an increasingly larger proportion of the Australian population.

Studies on the impacts of policies on the prevalence of smoking in Australia have did not detect an effect at the population level of deregulation of nicotine replacement therapies and the subsidy of other treatments for tobacco dependence in Australia.^10,12 Such therapies have all been established to increase success rates of quitters in clinical trials.^38-40 The subsidy of such medicines has contributed to their increased their use in Australia since 2001⁴¹—see Chapter 7, Section 7.16—and could well have increased the frequency with which doctors have advised patients to quit. Controlling for the tendency of those who smoke more heavily to use such medications, there is some evidence that NRT has increased quit rates in real world as well as in clinical settings.^42,43 While the effects of increasing success rates among quitters is quite small and would be difficult to detect in population surveys^12,44 it is plausible that policies that have contributed to greater use of anti-smoking medicines in Australia are also exerting a downward effect on population prevalence and consumption by decreasing the numbers of people who return to smoking following quit attempts.

Researchers have not found a way to quantify precisely the contribution of each of the policy factors described above, and those highlighted in Figure 2.7.3, however it is probable that these would have all contributed in some way—either directly or indirectly, in the longer if not the short term—by having:

• reduced the glamour and appeal of tobacco products
• increased knowledge about health effects
• reduced cues or opportunities to smoke
• reduced the social acceptability of smoking
• reduced withdrawal symptoms during quitting, or
• increased knowledge about how to manage the quitting process.

In combination, all these factors would likely have made some contribution to reducing motivation to smoke and creating an environment that supports non-smoking.

2.7.2.2 Effects of cultural and social forces on tobacco consumption

Government policies are not the only factors that influence smoking attitudes and behaviours.⁴⁵

Seeing other people smoking, whether in real life, on TV, in magazines or in movies, can prompt people who smoke to light up^46,47 and is likely to make smoking seem more normal and acceptable to children. Portrayal of glamorous women and women enjoying new-found independence smoking factory-made cigarettes in Hollywood movies must have been a particularly powerful influence on the uptake of smoking among young women in the inter-war period—see Chapter 5, Section 5.16 for further discussion.

Pierce has demonstrated a measurable effect of print media coverage about the health risks of smoking on cessation rates in the US.⁴⁸ Media coverage about health risks appeared on several occasions during the 1950s and 1960s to exert a detectable effect on per capita consumption in Australia. These effects no doubt continued during the following decades, with continuing high levels of media interest in the smoking issue in this country.^49-54

Humans are highly social, and peer example also exerts powerful effects. Children are much more likely to take up smoking if their parents or peers smoke,^55,56 and adults are much more likely to quit over time if family and friends have quit.⁵⁷ Thus, changes in behaviour by small numbers of individuals can quickly result in changes across much larger groups in the manner of a contagious disease quickly becoming an epidemic.⁵⁷

Apart from social modelling of smoking and awareness of the health effects, decisions about uptake and quitting and about where and when to smoke are also profoundly influenced by the social acceptability of smoking­—see Section 5.24. Alamar and Glantz computed a social unacceptability index based on individuals’ responses to questions regarding locations where smoking should be allowed. A regression analysis showed that the social unacceptability index and price had similar elasticities and that their effects were independent of each other. The researchers estimated that if, through an active tobacco-control campaign, the average individual’s views on the social unacceptability of smoking changed to more closely resemble the views of California residents, there would have been a 15% drop in cigarette consumption, equivalent to a US$1.17 increase in the excise tax on cigarettes.⁵⁸

i The total number of cigarettes consumed in Australia was estimated from the total weight of tobacco excised divided by an estimate of the average weight of cigarettes in that year. (The average weight for some years was based on information from the Australian Customs Service. In later years it was based on data from a study conducted by the Australian Government Analytical Laboratory, which weighed a very large number of cigarettes.) The total number of Australians who smoked was estimated from population statistics and data from surveys conducted by the Anti-Cancer Council of Victoria. Self-report data between 1980 and 1989 also suggested an increase in numbers of cigarettes smoked per (remaining) person who smokes—see Section 2.3.1 and Figure 2.7.1.

Test your knowledge

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