Last updated: October 2020
Suggested citation: Wood, L., Hanley-Jones, S., Greenhalgh, EM., & Maddox, R 5.10 Cultural background. In Greenhalgh EM, Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2020. Available from: https://www.tobaccoinaustralia.org.au/chapter-5-uptake/5-10-cultural-background
5.10.1 Uptake of smoking among children from culturally and linguistically diverse environments
Australian research from the 1990s indicated that young people living in households where English is spoken were more likely to smoke than those living in households where a language other than English is the first language, however, little recent data is available.1, 2 Research published in 2000 found 3 that in a group of year 10 and 11 students in Sydney, those from an English-speaking background were much more likely to be smokers (27%) than teenagers from Arabic (16%), Vietnamese or Southeast Asian backgrounds (8%). Teenagers from Vietnamese, Southeast Asian and Chinese backgrounds were also more likely to report that their families had rules at home about smoking, that they were usually supervised, and that they had lesser amounts of pocket money than other ethnic groups. Each of these factors independently correlates with a lower uptake of smoking (see Sections 5.12 and 5.14).
An earlier Sydney-based study also showed that young adolescents (aged 12–13) who spoke a language other than English (LOTE) at home were much less likely to smoke than children from an English-speaking background.1 The authors speculate that these lower rates may be due to stricter cultural attitudes opposing smoking among adolescents; students may be more likely to socialise with other children speaking the same LOTE at home and sharing the same cultural attitude, hence reducing the likelihood of peer smoking pressures; and/or that tobacco advertising had failed to reach these groups.
Prevention programs targeted for culturally and linguistically diverse populations in Australia are discussed in Chapter 7, Section 7.19.7.
There is some evidence that acculturation (a process in which migrants adopt mainstream values and behaviours of their new culture) is associated with increased smoking rates among young people from Asian backgrounds living in Western countries.4 However, familial factors such as spending time with parents, having parents who do not smoke, and having parents who disapprove of smoking can protect against smoking among Asian youth in Western countries.5 Influence on smoking behaviour through remote acculturation was observed for Mexican adolescents exposed to American smoking culture via globalised mass media and the internet. A stronger orientation towards US culture was found to be a risk factor for smoking among Mexican adolescents, while a greater orientation towards Mexican culture was considered a potential preventative factor.6
5.10.2 Uptake of smoking among Aboriginal and Torres Strait Islander peoples
Smoking prevalence among Aboriginal and Torres Strait Islander young people has declined significantly.7, 8 Between 1994 and 2018/19, there was a significant decline in current smoking prevalence for young adults aged 18–24 years from 55.4% in 1994 to 39.5% in 2018/19. This represents a 15.8 (8.6,23.1) percentage point decrease in smoking prevalence among Aboriginal and Torres Strait Islander young people and was consistent with declines in current daily smoking prevalence among the total Aboriginal and Torres Strait Islander population (50.0% to 40.2% between 2004–05 to 2018–19).9 In addition, the proportion of young people who had never smoked increased between 2012–13 to 2018–19 from 43% to 50% for Aboriginal and Torres Strait Islander people aged 18–24 years.8, 10
Data from the Australian Secondary Students’ Alcohol and Drug Survey (ASSAD) showed most (70%) Aboriginal and Torres Strait Islander students in 2017 were never smokers, up from 49% in 2005.11 The ASSAD data showed that 7% of participants aged 12–15 years and 18% of people aged 16–17 years were currently smoking.11
Aboriginal and Torres Strait Islander children who do smoke, generally begin smoking at an earlier age than non-Indigenous children.12 However, Aboriginal and Torres Strait Islander children report similar influences on uptake of smoking to children everywhere. Being part of a peer group that smokes, smoking among family members and parents, and having a positive attitude towards smoking are strong predictors of smoking among both Aboriginal and Torres Strait Islander and non-Indigenous children.13, 14 Offsetting boredom, stress relief and social pressures within the community15-17 are the most commonly cited reasons for taking up smoking among young Aboriginal Australians, as well as an expression of rebellion and a means of risk taking.16, 18 Research from Western Australia shows that young Indigenous people are more likely to describe overt peer pressure in relation to taking up smoking, and to report smoking as a more normal occurrence among their non-Indigenous peers.18, 19 Non-participation in the giving and sharing of tobacco within some communities can result in a sense of isolation.17 Australian research also suggests experimentation with other substances such as alcohol and cannabis also correlates with the adoption of smoking among Aboriginal and Torres Strait Islander and non-Indigenous primary school children.14 Other substance use, including cannabis and alcohol, has been shown to be an important risk factor for smoking for Indigenous and non-Indigenous Australian students alike. Tobacco and alcohol use association was weaker for Indigenous students. However, the prevalence of tobacco, alcohol and cannabis use in the past month was significantly higher among Indigenous than non-Indigenous students.20
While the factors related to the uptake of smoking are similar for Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians, colonisation and its ongoing impact provides vital context for understanding smoking related behaviours among the Aboriginal and Torres Strait Islander population.21 The introduction and active entrenchment of tobacco through colonisation led to widespread use and the normalisation of tobacco by Aboriginal and Torres Strait Islander peoples.21 As a result, indigeneity is frequently used as a proxy for a constellation of factors that influence tobacco use.22 The ongoing trauma, racism, stress and exclusion from employment and education caused by colonisation and government policies, including but not limited to tobacco being used as a form of payment and issuing of tobacco as rations on missions are implicated with tobacco use.21, 23-25
The higher prevalence of smoking in Aboriginal and Torres Strait Islander adults, to which colonisation contributed, means that many young Indigenous people live in settings in which smoking is the norm. It is also likely that factors such as poorer school connectedness and lower levels of education play a role.21, 24 Smoking among Aboriginal and Torres Strait Islander children and teenagers, including influences on smoking behaviour, is discussed in greater detail in Chapter 8, Section 4.
Relevant news and research
For recent news items and research on this topic, click here. (Last updated October 2020)
1. Tang L, Rissel C, Bauman A, Fay K, Porter S, et al. A longitudinal study of smoking in year 7 and 8 students speaking English or a language other than English at home in Sydney, Australia. Tobacco Control, 1998; 7(1):35–40. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/7/1/35
2. Rissel C, Ward J, and Jorm L. Estimates of smoking and related behaviour in an immigrant Lebanese community: Does survey method matter? Australia and New Zealand Journal of Public Health, 1999; 23:534–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10575779
3. Rissel C, McLellan L, and Bauman A. Factors associated with delayed tobacco uptake among Vietnamese/Asian and Arabic youth in Sydney, NSW. Australian and New Zealand Journal of Public Health, 2000; 24(1):22–8. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-842X.2000.tb00718.x
4. Ma GX, Tan Y, Toubbeh JI, Su X, Shive SE, et al. Acculturation and smoking behavior in Asian-American populations. Health Education Research, 2004; 19(6):615. Available from: http://her.oxfordjournals.org/content/19/6/615.full
5. Wong G, Ameratunga SN, Garrett NK, Robinson E, and Watson PD. Family influences, acculturation, and the prevalence of tobacco smoking among Asian youth in New Zealand: Findings from a national survey. Journal of Adolescent Health, 2008; 43(4):412–6. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1054139X08001535
6. Lorenzo-Blanco EI, Arillo-Santillan E, Unger JB, and Thrasher J. Remote acculturation and cigarette smoking susceptibility among youth in Mexico. J Cross Cult Psychol, 2019; 50(1):63-79. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31223173
7. Heris CL, Eades SJ, Lyons L, Chamberlain C, and Thomas DP. Changes in the age young Aboriginal and Torres Strait Islander people start smoking, 2002–2015. Public Health Res Pract, 2019. Available from: http://www.phrp.com.au/issues/online-early/changes-in-the-age-young-aboriginal-and-torres-strait-islander-people-start-smoking-2002-2015/
8. Thurber K, Walker J, Maddox R, Marmor A, Heris C, et al. A review of evidence on the prevalence of and trends in cigarette and e-cigarette use by Aboriginal and Torres Strait Islander youth and adults. Aboriginal and Torres Strait Islander Health Program, National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 2020. Available from: https://openresearch-repository.anu.edu.au/bitstream/1885/210569/1/Aboriginal%20cigarette%20ecigarette%20prevalence%20trends_2020.pdf
9. Maddox R, Thurber KA, Calma T, Banks E, and Lovett R. Deadly news: The downward trend continues in Aboriginal and Torres Strait Islander smoking 2004-2019. Australian and New Zealand Journal of Public Health, 2020. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33104287
10. Australian Bureau of Statistics. 4715.0 - National Aboriginal and Torres Strait Islander Health Survey, 2018-19: Smoking. ABS, 2019. Available from: https://www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/4715.0Main%20Features152018-19?opendocument&tabname=Summary&prodno=4715.0&issue=2018-19&num=&view=
11. Heris CL, Guerin N, Thomas DP, Eades SJ, Chamberlain C, et al. The decline of smoking initiation among Aboriginal and Torres Strait Islander secondary students: Implications for future policy. Australian and New Zealand Journal of Public Health, 2020. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32776634
12. Australian Bureau of Statistics. Tobacco smoking - Aboriginal and Torres Strait Islander people: A snapshot, 2004-05. Canberra: ABS, 2007. Available from: http://www.abs.gov.au/ausstats/abs@.nsf/mf/4722.0.55.004#.
13. Tyas S and Pederson L. Psychosocial factors related to adolescent smoking: A critical review of the literature. Tobacco Control, 1999; 7(4):409–20. Available from: http://tobaccocontrol.bmj.com/cgi/content/full/7/4/409
14. Dunne M, Yeo M, Keane J, and Elkins D. Substance use by Indigenous and non-Indigenous primary school students. Australia and New Zealand Journal of Public Health, 2000; 24:546–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11109696
15. Cosh C, Hawkins H, Skaczkowski G, Copley D, and Bowden J. Tobacco use among urban Aboriginal Australian young people: A qualitative study of reasons for smoking, barriers to cessation and motivators for smoking cessation. Australian Journal of Primary Health, 2015; 21:334–41. Available from: http://www.publish.csiro.au/py/PY13157
16. Lindorff K. Tobacco – time for action. National Aboriginal and Torres Strait Islander Tobacco Control Project - final report, Canberra: National Aboriginal Community Controlled Health Organisation, 2002. Available from: https://trove.nla.gov.au/work/26537245?selectedversion=NBD41306181.
17. Johnston V and Thomas DP. Smoking behaviours in a remote Australian Indigenous community: The influence of family and other factors. Social Science and Medicine, 2008; 67(11):1708–16. Available from: http://www.sciencedirect.com/science/article/pii/S0277953608004644
18. Leavy J, Wood L, Rosenberg M, and Phillips F. Try and try again: Qualitative insights into adolescent smoking experimentation and notions of addiction. Health Promotion Journal of Australia, 2010; 21(3):208–14. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21118068
19. Wood L, Lang A, and Coase P. Smarter than smoking qualitative research. A research report. West Perth, Australia: TNS Social Research, 2005.
20. Heris C, Guerin N, Thomas D, Chamberlain C, Eades S, et al. Smoking behaviours and other substance use among Indigenous and non-Indigenous Australian secondary students, 2017. Drug and Alcohol Review, 2020. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32780910
21. Colonna E, Maddox R, Cohen R, Marmor A, Doery K, et al. Review of tobacco use among Aboriginal and Torres Strait Islander peoples. Australian Indigenous Health Bulletin, 2020; 20(2). Available from: https://aodknowledgecentre.ecu.edu.au/learn/specific-drugs/tobacco/
22. Maddox R, Waa A, Lee K, Nez Henderson P, Blais G, et al. Commercial tobacco and Indigenous peoples: A stock take on Framework Convention on Tobacco Control progress. Tobacco Control, 2019; 28(5):574-81. Available from: https://tobaccocontrol.bmj.com/content/tobaccocontrol/28/5/574.full.pdf
23. Brady M. Historical and cultural roots of tobacco use among Aboriginal and Torres Strait Islander people. Australian and New Zealand Journal of Public Health, 2002; 26(2):120-4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/12054329
24. Briggs VL, Lindorff KJ, and Ivers RG. Aboriginal and Torres Strait Islander Australians and tobacco. 2003; 12(suppl 2):ii5–ii8. Available from: https://tobaccocontrol.bmj.com/content/tobaccocontrol/12/suppl_2/ii5.full.pdf
25. Blyton G. Smoking kills: The introduction of tobacco smoking into Aboriginal society with a particular focus on the Hunter region of central Eastern New South Wales from 1800 to 1850. 2010. Available from: http://hdl.handle.net/1959.13/927880