Last updated: September 2021
Suggested citation: Greenhalgh, EM, Maddox, R, van der Sterren, A, Knoche, D, & Winstanley, MH. 8.4 Smoking among Aboriginal and Torres Strait Islander children and teenagers. In Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2021. Available from: http://www.tobaccoinaustralia.org.au/8-4-smoking-among-aboriginal-and-torres-strait-isl
188.8.131.52 National surveys
The National Health Surveys, the National Aboriginal and Torres Strait Islander Health Surveys, and the National Drug Strategy Household Surveys (NDSHS) have collected data among Aboriginal and Torres Strait Islander peoples aged 14 or 15 years and older. However, individual year-of-age breakdowns are not published in any of these surveys and the numbers of Aboriginal and Torres Strait Islander participants in the younger age groups of the NDSH surveys are small. The most recent National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) for 2018–19 reported that 16.4% of Aboriginal and Torres Strait Islander young people aged 15-17 years had ever smoked.1 This estimate is substantially lower than the other national estimates such as the Australian Secondary Students’ Alcohol and Drug (ASSAD) survey, which reported 24% of Aboriginal and Torres Strait Islander students aged 12–15 years and 45% aged 16–17 years had ever smoked in 2017. The discrepancy is likely due to reporting bias in NATSIHS survey as majority of youth smoking data was collected while an adult was present.2,3
From 1996 onwards, the ASSAD survey included the option for participants to indicate being of Aboriginal and/or Torres Strait Islander descent—see Figures 8.4.1 and 184.108.40.206 The prevalence of smoking among Aboriginal and Torres Strait Islander students has declined over time, with current smokers declining from 27% to 10% among 12-15 year olds, and from 44% to 18% among 16-17 year olds between 1996 to 2017.4
Figure 8.4. 1 Percentage of Aboriginal and Torres Strait Islander students aged 12–15 years who have ever smoked, who are monthly smokers, current smokers, and committed smokers in each survey year between 1996–2017* (data not weighted)
Figure 8.4.2 Percentage of Aboriginal and Torres Strait Islander students aged 16–17 years who have ever smoked, who are monthly smokers, current smokers, and committed smokers in each survey year between 1996–2017* (data not weighted)
† Monthly smoking—smoked in the past four weeks
‡ Current smoking—smoked in previous seven days
§ Committed smoking—smoked on three of previous seven days
* The 2008 ASSAD survey included an additional 19 schools from rural areas of Western Australia, Queensland, Victoria, South Australia and the Northern Territory.
Survey years may not be directly comparable.
Source: 1996-2005 data drawn from White V, Mason T and Briggs V 2009;4 2008 to 2017 drawn from Heris C, Guerin N, Thomas DP, Eades SJ, Chamberlain C, and White VM.5
In 2008, the ASSAD survey included an ‘extension’ whereby an additional 19 schools from rural areas of Western Australia, Queensland, Victoria, South Australia and the Northern Territory were surveyed. The increase in the rural sample also increased the Aboriginal and Torres Strait Islander sample. From the 400 schools surveyed as part of the 2008 ASSAD and the ASSAD Extension, 1317 students identified as Aboriginal and Torres Strait Islander. About 35% of 12–15 year old Aboriginal and Torres Strait Islander students had ever smoked, with 15% smoking in the month before the survey and 12% smoking in the past week.6
220.127.116.11 State and regional surveys
A number of regional surveys of Aboriginal and Torres Strait Islander adolescents who smoke have been undertaken, varying in size, scope, methodology and methods. This may reflect the diversity of Aboriginal and Torres Strait Islander peoples across Australia, including the diversity of nations, cultures, languages and experiences that Aboriginal and Torres Strait Islander peoples represent, including experiences with tobacco use.7
These state and regional surveys generally show that the prevalence of smoking increases with age. Findings from the 2009 Victorian Adolescent Health and Wellbeing Survey, which surveyed young people in schools in years 7, 9 and 11, showed that 36.1% of Aboriginal young people aged 12–17 years had ever smoked, and 21.2% had smoked in the past month. Among Aboriginal and Torres Strait Islander students who reported smoking cigarettes in the last 30 days, approximately half reported smoking less than one cigarette per day, and about 20% smoked six or more cigarettes per day. Almost two-thirds (63.7%) of Aboriginal youth reported having ‘very’ or ‘sort of’ easy access to cigarettes.8 A small study undertaken in the Northern Territory in 2011 found that 46% of Aboriginal and Torres Strait Islander participants aged 13–20 years were smokers.9 The Western Australian Aboriginal Child Health Survey 2000–02 found that smoking increased with age, from 16% of 12–13 year old males and 19% of 12–13 year old females, up to 56% of 17 year old males and 60% of 17 year old females.10
A 2004 study in rural North Queensland showed that 24% of Aboriginal and Torres Strait Islander students in years 8‒12 smoked. In the younger grades (years 8‒10), 18% of Aboriginal and Torres Strait Islander males and 26% of females were smokers. Prevalence increased with age for males and females, with the highest incidence of smoking occurring in years 11 and 12 among Aboriginal and Torres Strait Islander males (46%). Given the lower rate of high school retention11-13 and higher levels of school absenteeism among Aboriginal and Torres Strait Islander teenagers,13,14 which predominantly results from barriers to access (physical, cultural, economic, and informational barriers), attendance and achievement;15 school-based surveys may result in an underestimation of smoking prevalence, particularly among students in Year 10 and beyond. The 2001–02 Western Australian Aboriginal Child Health Survey showed that Aboriginal and Torres Strait Islander children aged 12‒17 years who did not attend school had substantially higher smoking rates (48% of boys and 64% of girls) than those who did attend school (25% of boys and 31%).10 Nonetheless, authors of a North Queensland study commented that their results ‘challenge the belief that Aboriginal and Torres Strait Islander youth are significantly different in their smoking patterns and behaviours compared to non-Indigenous secondary school students in rural regions’ (p101). They concluded that geographical location may be a more important determinant of smoking in regional areas, with students sharing similar attitudes, beliefs and behaviours regarding cigarette use.12
8.4.2 Age at uptake
Aboriginal and Torres Strait Islander peoples who smoke have generally begun smoking at an early age. The National Aboriginal and Torres Strait Islander Health Survey in 2004–05 showed that about 10% of Aboriginal and Torres Strait Islander adults who were current and former smokers had commenced regular smoking prior to the age of 13 years. By the age of 18 years, 68% of current and former Aboriginal and Torres Strait Islander smokers were smoking regularly. Aboriginal and Torres Strait Islander peoples living in non-remote areas were more likely to be smoking before the age of 13 years than those living in remote areas (11% compared with 5%).16
Other research has also pointed to an early age of uptake of tobacco use among Aboriginal and Torres Strait Islander children.14,17,18 However, as the various prevalence surveys described above, regional variation is evident and is likely to reflect a range of factors and socio-demographic characteristics that impact tobacco use. Within Aboriginal and Torres Strait Islander communities, one report found a general perception among adults that children were taking up smoking at about the age of 10 years.19 Aboriginal and Torres Strait Islander young people in the Top End of Australia reported that experimenting with smoking usually started between 10 to 13 years of age in 2011, but frequently took the first puff earlier and as early as seven or eight years of age.9 Another study in North Queensland found that by age 12 years, 26% of Aboriginal and Torres Strait Islander smokers had begun smoking.12
Early uptake increases duration of exposure, and hence the risk of tobacco-related death20 and diseases.21 Furthermore, research shows that the earlier a young person starts smoking, the more likely they are to become addicted, to continue smoking as adults, and to smoke heavily.22 Encouragingly, research published in 2020 found that although most Aboriginal and Torres Strait Islander adolescents and young adults who had smoked daily started smoking before age 18 years, but initiation may be delayed until early adulthood for an increasing number of Aboriginal and Torres Strait Islander peoples who smoked daily. Results showed that three quarters of daily smoking was established before age 18 years (one-quarter of smokers started before 15 years of age and about 50% started between 15 and 17 years). The remaining quarter started smoking as adults (aged 18+)—and this proportion appeared to be increasing over time.23 Encouragingly, there has also been significant declines in smoking prevalence among young Aboriginal and Torres Strait Islander peoples between 2002 and 2014-15, as fewer Aboriginal and Torres Strait Islander peoples take up smoking.23
8.4.3 Influences on smoking behaviour
As outlined in 8.1 Aboriginal and Torres Strait Islander peoples: social disadvantage, health and smoking—an overview, and 8.2 History of tobacco use among Aboriginal and Torres Strait Islander peoples, and above, Aboriginal and Torres Strait Islander peoples are diverse. However, Aboriginal and Torres Strait Islander peoples have common experiences of colonisation. Colonisation has actively eroded power, community resources, social structures and intergenerational connectedness, including removal and relocation of Aboriginal and Torres Strait Islander peoples from their land, removal of children, as well as payment and rations of tobacco prior to engagement with the cash economy.7 As a result, the associated impacts and added stressors resulting from colonisation directly and indirectly impact tobacco use. Evidence indicates that the drivers associated with tobacco use are generally similar for Aboriginal and Torres Strait Islander peoples and non-indigenous peoples (see Chapter 5). However, Aboriginal and Torres Strait Islander peoples are disproportionality exposed to such drivers through the machinery of colonisation, and may experience additional risk factors that increase their likelihood of smoking.7, 24-26
A 2019 review of factors influencing smoking among Indigenous adolescents aged 10–24 years living in Australia, New Zealand, Canada and the US found that age, mental health, physical activity, attitudes to smoking and knowledge of risks, and other substance use were related to smoking, as well as smoking behaviours and attitudes of family, quality of relationships and socio-economic status. Secondhand smoke exposure, smokefree spaces, high visibility of smoking, campaigns and health warnings were also commonly reported influences.24 Previous studies in Australia have reported similar influences,9,10,12,14,19,27-29 while one study found that Aboriginal and Torres Strait Islander peoples who had been removed from their natural family were far more likely to be a smoker,29 and another study finding that smoking was twice as common among Aboriginal and Torres Strait Islander peoples experiencing moderate-high levels of discrimination, compared to those not reporting experiences of discrimination.30 Further, stressful life events, financial insecurity and household structure (e.g. single parent households) increased the likelihood of smoking uptake.31 Smoking can also be an expression of rebellion, a way of risk-taking, a means of offsetting boredom or alleviating stress, or a way to cope with depression.19,32-34 Colonisation, experiences of intergenerational trauma and discrimination, and cultural connection may also be important factors in the uptake of smoking among Aboriginal and Torres Strait Islander young people, however, these are often overlooked.24
The comparatively high rates of smoking among the Aboriginal and Torres Strait Islander adults mean that many Aboriginal and Torres Strait Islander children live in households where smoking is generally the norm.35, 36 In 2014–15, although about 58% of Aboriginal and Torres Strait Islander children aged 4–14 years lived with a daily smoker, about 84% lived in a smokefree home.35 However, the rates of household smoking were slightly higher for teenagers aged 15 years and over; 60% lived in a household with a smoker and 81% of lived in a smokefree home.35 Research has shown that the proportion of smokers who reported living in smokefree homes was increasing among Aboriginal and Torres Strait Islander peoples. Smokefree policies reduce secondhand smoke exposure and tobacco use, by reducing the prevalence and reducing initiation of tobacco use (see Section 15.9). Further, decreases in smoking prevalence need to be accelerated, in addition to people who smoke, smoking outside to help minimise secondhand smoke exposure and promote smokefree norms. One study found that the presence of infants, children and adult non-smokers in the household was associated with having a smokefree home. 37
In a Northern Territory study, most participants reported initially stealing cigarettes from family members and experimenting with cousins and peers. Some were also offered tobacco from family members, were asked to roll or purchase cigarettes for others in the family, or had parents buy cigarettes for them.38 In this study, participants also reported that a significant influence on their initiation to smoking was the modelling of adult smoking behaviours, not only their own parents, but also extended family.38 This is supported by Victorian research that found the high prevalence of smoking among adults serves as modelling behaviour for children in Aboriginal and Torres Strait Islander communities.39 Interviews for the National Aboriginal and Torres Strait Islander Tobacco Control Project found that children asked to procure and light up parents’ cigarettes influenced later smoking behaviours.19 Additionally, parents who smoked appeared to have the expectation that their children would smoke as well, and felt that they could not prevent their children from smoking because they would be perceived as hypocritical.39 Families can influence uptake by facilitating access to tobacco;9,36 children commonly report obtaining cigarettes from their parents.39 Similarly, Aboriginal young people in urban settings reported a perception that young people with friends, siblings and teachers who were smokers were more likely to be smokers themselves, and that the culture of sharing and social acceptance of smoking influenced uptake.40 This helps to stress the fundamental importance of smokefree homes and policies in promoting smoke free norms.37
Importantly, there are a number of factors associated with a reduced likelihood of smoking uptake among Aboriginal and Torres Strait Islander youth. The positive role modelling of non-smoking family members is important in helping to prevent smoking initiation.24,38 Home-based factors including: smokefree indoor spaces, parents not smoking around children, strong anti-smoking messages, and clear consequences to smoking, all help to prevent smoking among Aboriginal and Torres Strait Islander young peoples, even when parents smoke.9 A study of Aboriginal young peoples in Melbourne identified appreciation of Koori community values, creative activities, sense of responsibility, sense of belonging and community connection, pride in Koori identity, and sporting activities as protective against smoking. 41 Fitness and the desire to play sport have also been directly reported by young Aboriginal and Torres Islander people as reasons for not taking up smoking.32,33 The significant declines in smoking prevalence among young Aboriginal and Torres Strait Islander peoples between 2004 and 2018-1942 are encouraging, as fewer Aboriginal and Torres Strait Islander peoples take up smoking with more work required to address the influences on smoking behaviours and promote smoke free norms.23
Influences on the uptake of smoking among young people in general are discussed in greater detail in Chapter 5—Factors influencing the uptake and prevention of smoking.
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12. Lowe J, Saeck L, Brough M, Carmont S-A, Clavarino A, et al. Smoking behaviour among Indigenous secondary school students in North Queensland. Drug and Alcohol Review, 2004; 23:101–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14965891
13. Australian Government Productivity Commission. Overcoming Indigenous disadvantage: Key indicators 2009. Canberra: AGPC, 2009. Available from: http://www.pc.gov.au/research/ongoing/overcoming-indigenous-disadvantage/keyindicators2009.
14. Johnston F, Beecham R, Dalgleish P, Malpraburr T, and Gamarania G. The maningrida 'be smokefree' project. Health Promotion Journal of Australia, 1998; 8:12–7. Available from: http://search.informit.com.au/documentSummary;dn=459887031427789;res=IELHEA
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19. Lindorff KJ. Tobacco time for action: National Aboriginal and Torres Strait Islander tobacco control project final report. Canberra, Australia: National Aboriginal Community Controlled Organisations, 2002.
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