5.30 Harnessing predictors of uptake to prevent smoking

Last updated: February 2023

Suggested citation: Hanley-Jones, S, Letcher, T and Wood L. 5.30 Harnessing predictors of uptake to prevent smoking. In Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2023. Available from https://www.tobaccoinaustralia.org.au/chapter-5-uptake/5-30-harnessing-predictors-of-uptake-to-prevent-sm


The National Tobacco Strategy 2004-20091 (NTS) outlined how programs separate from tobacco control programs that address underlying determinants of smoking also help to create environments that support people not to smoke. It talked of the potential benefits that might be gained through investment in programs designed to strengthen community and cultural resources—programs to reduce the chance of educational failure, family conflict, loss of cultural identity and the development of mental health problems. Positive changes from such programs may well reduce uptake among young people of smoking as well as other health-compromising behaviours. Of particular relevance to youth smoking prevention, the NTS endorsed broader government policies and programs that address the underlying causes of disadvantage in our community—for instance, efforts to reduce family conflict and to improve school effectiveness. These measures have strong potential to improve the proportion of students feeling a connectedness with school, and to improve academic achievement, both of which are highly protective against smoking uptake (see Section 5.9).

The 2012-2018 NTS2 addressed the economic determinants of smoking, including the affordability and availability of tobacco products. The strategy included measures to increase the price of tobacco products through taxation and reduce the availability of tobacco products through licensing and zoning, to decrease access among young people. Cultural and environmental determinants of smoking addressed in the strategy include programs aimed at reducing the social acceptability of smoking, such as anti-smoking media campaigns and social marketing programs. The strategy also promoted smoke-free environments particular to young people such as schools, sporting facilities and other public places, to reduce exposure to secondhand smoke and to de-normalise smoking behaviour. In addressing the social determinants of smoking, the strategy recognises that social factors such as peer pressure, family influences, and exposure to tobacco advertising and promotion can influence young people’s smoking behaviour. The National Tobacco Strategy (NTS) 2022-2030 continues these strategies and similarly aims to address further social determinants of smoking by promoting health equity and reducing the impact of social disadvantage on smoking rates. This includes targeting tobacco control interventions to populations that are disproportionately affected by smoking, such as Aboriginal and Torres Strait Islander people, people from low socio-economic backgrounds, and people with mental illness.3

5.30.1 Sport and physical activity as protective factors

Encouraging young people’s involvement in physical activity has been an important strategy in Australia, with funding of junior development in sport a major focus for health promotion foundations aiming to discourage smoking and other unhealthy behaviours.4-6

Physical activity and sport participation are negatively associated with cigarette smoking among young people.7-10 A systematic review examining sports participation and substance use (alcohol, tobacco and illicit drugs) among secondary school and college students aged 13–24 years identified 34 relevant peer-reviewed quantitative studies.11 The studies reviewed suggested that sport participation is related to higher levels of alcohol consumption, but lower levels of both cigarette smoking and illegal drug use. The majority (14) of the 15 studies specifically examining the relationship between participation in sport and cigarette smoking found sports involvement to be negatively related to cigarette use, suggesting that participation in sport may serve as a protective factor against tobacco consumption.11 Research has also found that greater intensity of physical activity is associated with a lower likelihood of smoking; physically active young people smoked fewer cigarettes and were more likely than inactive individuals to be non-smokers or occasional smokers.12 Other research has shown that teens who participate in a wide variety of physical activities, particularly with their parents, are at decreased risk for smoking and other risk factors such as drinking, drugs, violence, smoking, sex and delinquency, compared with teens who watch a lot of television.13

Not all physical activities were equally protective against smoking.  A 2015 study found that certain physical activities were associated with a decreased risk of smoking, while others were associated with an increased risk of smoking.14 The study followed 1356 adolescents aged 14-18 years for four years and measured smoking and physical activity at eight different time points. Physical activities with a decreased risk of smoking included racquet sports, soccer, track and field, running, and aerobic activities (e.g., running, jogging, jumping rope, and swimming laps), which were linked to not smoking. In contrast, physical activities associated with an increased risk of smoking included social and recreational dancing, skating (ice, roller, inline, and skateboarding), walking, using an exercise machine, bicycling, chores, fighting (karate, judo, boxing), and competitive wrestling.14

While smoking prevalence in athletes is generally lower than that observed in young people generally, a 2020 research study found that athletes who played team sports (basketball or football) were three times more likely to smoke than athletes who did individual sports (swimming). The team sport athletes were also more likely to smoke before practice compared to the individual sport athletes.15 Investigators in another study found that adolescents exhibiting decreasing and erratic team sport participation were more likely to be current smokers than adolescents with low or high sport participation concluding that adolescents with decreasing team sport participation are at increased risk of later smoking.16

Research examining adolescents’ perceptions of their physical selves,17 concluded that physical activity plays a part in influencing physical self-perception and is an important factor to consider in smoking interventions aimed at young people. The positive relationship between participation in physical activity such as sport and perception of physical self is supported by other research in this area,18 including a survey among Danish young people aged 16–20 years in which adolescent participation in leisure time physical activity was found to be inversely associated with smoking behaviour.19 This relationship, however, held only among adolescents who perceived physical activity to be an important part of their self-concept, suggesting that participation in leisure time physical activity may have an indirect protective effect on smoking behaviour through its effect on adolescents’ self-concept.19  

Relevant news and research

For recent news items and research on this topic, click  here. (Last updated April 2022)


1. Ministerial Council on Drug Strategy and Department of Health and Ageing. National Tobacco Strategy 2004-2009. Canberra: Commonwealth of Australia, 2005. Available from: http://www.health.gov.au/internet/wcms/publishing.nsf/Content/phd-pub-tobacco-tobccstrat2-cnt.htm.

2. Intergovernmental Committee on Drugs. National Tobacco Strategy 2012-2018.  2012. Available from: https://www.health.gov.au/sites/default/files/national-tobacco-strategy-2012-2018_1.pdf.

3. Commonwealth of Australia (Department of Health). Consultation draft National Tobacco Strategy 2022–2030.  2022. Available from: https://consultations.health.gov.au/atodb/national-tobacco-strategy-2022-2030/supporting_documents/Draft%20NTS%2020222030%20for%20consultaion%20hub.pdf.

4. Giles-Corti B, Clarkson JP, Donovan RJ, Frizzell SK, Carroll AM, et al. Creating smoke-free environments in recreational settings. Health Education and Behavior, 2001; 28(3):341–51. Available from: http://heb.sagepub.com/cgi/reprint/28/3/341

5. No authors listed. Approved grant funding. Healthway, 2023. Available from: https://www.healthway.wa.gov.au/our-partners/approved-projects-and-partnerships/

6. VicHealth. 30 years of VicHealth: 1987–2017. Carlton South, Victoria: Victorian Health Promotion Foundation 2017. Available from: https://www.vichealth.vic.gov.au/-/media/ResourceCentre/PublicationsandResources/General/VicHealth-30th-anniversary.pdf.

7. Rainey C, McKeown R, Sargent R, and Valois R. Patterns of tobacco and alcohol use among sedentary, exercising, nonathletic, and athletic youth. Journal of School Health, 1996; 66:27-32. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8907735

8. Pate R, Trost S, Levin S, and Dowda M. Sports participation and health related behaviors among US youth. Archives of Pediatric Adolescent Medicine, 2000; 154:904-11. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10980794

9. Villanueva-Blasco VJ, Garcia-Soidan JL, Isorna Folgar M, and Arufe Giraldez V. Association between Tobacco consumption and problematic internet use and the practice of physical activity in Spanish adolescents. International Journal of Environmental Research and Public Health, 2021; 18(10). Available from: https://www.ncbi.nlm.nih.gov/pubmed/34065308

10. Zenic N, Ban D, Jurisic S, Cubela M, Rodek J, et al. Prospective analysis of the influence of sport and educational factors on the prevalence and initiation of smoking in older adolescents from Croatia. International Journal of Environmental Research and Public Health, 2017; 14(4). Available from: http://www.ncbi.nlm.nih.gov/pubmed/28425977

11. Lisha N and Sussman S. Relationship of high school and college sports participation with alcohol, tobacco, and illicit drug use: A review. Addictive behaviors, 2010; 35(5):399-407. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20100638

12. Charilaou M, Karekla M, Constantinou M, and Price S. Relationship between physical activity and type of smoking behavior among adolescents and young adults in Cyprus. Nicotine and Tobacco Research, 2009; 11(8):969–76. Available from: http://ntr.oxfordjournals.org/content/11/8/969.long

13. Nelson M and Gordon-Larsen P. Physical activity and sedentary behavior patterns are associated with selected adolescent health risk behaviors. Pediatrics, 2006; 117:1281-90. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16585325

14. Audrain-McGovern J and Rodriguez D. All physical activity may not be associated with a lower likelihood of adolescent smoking uptake. Addictive Behaviors, 2015; 51:177–83. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26280377

15. De Nitto S, Stefanizzi P, Bianchi FP, Castellana M, Ascatigno L, et al. Prevalence of cigarette smoking: A cross-sectional survey between individual and team sport athletes. Annali di Igiene, 2020; 32(2):132-40. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31944208

16. Rodriguez D and Audrain-McGovern J. Team sport participation and smoking: Analysis with general growth mixture modeling. Journal of Pediatric Psychology, 2004; 29:299-308. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15148352

17. Rodriguez D and Audrain-McGovern J. Physical activity, global physical self-concept, and adolescent smoking. Annals of Behavioral medicine, 2005; 30:251-9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16336076

18. Kirkcaldy B, Shephard R, and Siefen R. The relationship between physical activity and self-image and problem behaviour among adolescents. Social Psychiatry and Psychiatric Epidemiology, 2002; 37:544-50. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12395145

19. Verkooijen K, Nielsen G, and Kremers S. The association between leisure time physical activity and smoking in adolescence: An examination of potential mediating and moderating factors. International Journal of Behavioral Medicine, 2008; 15(2):157–63. Available from: http://www.informaworld.com/smpp/content~content=a793249177~db=all~jumptype=rss