|Last updated: August 2016
Suggested citation: van der Sterren, A, Greenhalgh, EM, Knoche, D, & Winstanley, MH 8.5 Types of tobacco used by and levels of consumption among Aboriginal peoples and Torres Strait Islanders. In Scollo, MM and Winstanley, MH [editors].Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2016. Available from http://www.tobaccoinaustralia.org.au/8-5-types-of-tobacco-used-by-and-levels-of-consump
Most tobacco used by Aboriginal peoples and Torres Strait Islanders is in the form of manufactured cigarettes. The National Drug Strategy Household Surveys (NDSHS) of 2001,3 2004,4 2007,5 2010,6 and 20137 found that average consumption levels among Indigenous smokers were higher than among other Australian smokers. In 2013, Indigenous smokers aged 14 and over reported consuming, on average, 115 cigarettes each week (16 cigarettes daily) compared with 95 cigarettes per week (14 per day) for non-Indigenous smokers. Indigenous men reported smoking 122 cigarettes per week, or 17 per day, compared to 96 cigarettes per week, or 14 cigarettes daily for non-Indigenous men; Indigenous women reported smoking 108 cigarettes weekly, or 15 cigarettes daily, compared with 94 cigarettes per week, or 13 cigarettes daily, for non-Indigenous women.7 The NDSHS data should be interpreted with some caution as sample sizes of Indigenous people are low, and survey methods may not capture a representative sample (see note i in Section 8.3). Data from the 2008 National Aboriginal and Torres Strait Islander Social Survey (which has a larger sample size) provides an estimate of the level of cigarette consumption for Indigenous smokers aged 15 and over of 15 cigarettes per day.8 However, this figure is based on national data, and just as smoking rates vary between locations (see Section 8.3.1), consumption rates are also likely to vary (see below).
The national data sets indicate that most Indigenous smokers smoke fewer than 20 cigarettes per day,3–7,9–11 and this is supported by local level studies.9,12–17 Several studies conducted in communities across the Northern Territory have estimated rates of tobacco consumption using data on the sale of tobacco from local community stores and/or wholesalers,9,17 with three also collecting self-reported rates.14–16 Using sales data to estimate consumption is a practical and non-invasive method of estimating tobacco consumption in small remote communities with mostly Aboriginal populations, but sales data for lower aggregate levels is not routinely collected across Australia states and territories. Such studies have found that Aboriginal people in remote Northern Territory communities smoke between 614 and 1616 cigarettes per day. One study in three communities in Arnhem Land (in the Northern Territory’s ‘Top End’)15 found self-reported consumption rates of 10–11 cigarettes/smoker/day and store sales based rates of 9–13 cigarettes/smoker/day. When comparing ‘lighter smokers’ (<10 cigarettes/day) to ‘heavier smokers’ (≥10 cigarettes/day), ‘heavier smokers’ tended to be older, were more likely to be daily smokers, and were almost three times more likely to be men than women.15 A survey using wholesale tobacco data from Northern Territory remote communities calculated tobacco consumption to be 7 cigarettes/day/person aged 15 and over (note that this measure is ‘per person’, not ‘per smoker’), and found that tobacco consumption in 14 Aboriginal communities in the ‘Top End’ was more than double that in eight Central Australian communities (9 versus 4 cigarettes/day/person aged 15 and over).9 In another study using sales data in five Central Australian communities, daily smoking consumption was estimated to be between 6 and 8 cigarettes per day (based on assumptions of 70% and 50% smoking prevalence respectively).17 Although smoking prevalence rates may be high in these communities, consumption is low, and in many cases is lower than the consumption rate for non-Indigenous smokers of 14 per day.17 However, it should be noted that these findings might not be generalisable to the broader Indigenous population, as consumption levels tend to vary geographically.
Studies have also reported low levels of consumption among pregnant Indigenous women. A study in north Queensland found that over 60% of pregnant women who were current tobacco users smoked 10 or fewer cigarettes per day; furthermore, 40% of these women were assessed as having low physical nicotine dependence.12 Similarly, a Northern Territory study of maternal smoking found that 71% reported smoking 10 or fewer cigarettes per day.13
It is also important to realise that the above figures represent average consumption levels. A number of reports, specific to Indigenous tobacco use, observe that since tobacco is often shared, and its purchase is dependent upon availability of funds, consumption may be sporadic and concentrated around pay days.2,17–19 Research involving urban Indigenous female smokers in Perth showed that about half of those respondents who smoked less often than daily, only smoked in conjunction with drinking alcohol. About the same proportion did not purchase cigarettes themselves since the cultural expectation of sharing cigarettes catered for their needs.20
There are no national data on use of roll-your-own tobacco (‘rollies’) in the Aboriginal and Torres Strait Islander population, but it is likely that use among these groups would be at least similar to or possibly higher than levels among the total Australian population, in part due to its price advantage2 and possibly also because of its facility as a product for chewing, or for blending with cannabis (see Section 8.11.2). Watson et al found that more than a third of Indigenous smokers surveyed in Northern Territory communities smoked hand-rolled cigarettes in 1986‒87.21 A 2008 cross-sectional survey in three Northern Territory communities reported that of 305 smokers aged 16 years and over, 57% smoked both factory-made cigarettes and loose ‘roll-your-own’ tobacco, 34% smoked factory-made cigarettes only, 2% smoked only loose tobacco, and 1% only chewed tobacco.15 In comparison, the National Drug Strategy Household Survey of 2007 found that about 17% of Australian smokers used both roll-your-own tobacco and factory-made cigarettes, and only 5% of all smokers used loose tobacco exclusively.5
Chop-chop is unbranded loose tobacco leaf, sold on the black market at less than half the price of properly taxed tobacco on a weight for weight basis.22 Most of its popularity results from its price, but it is also favoured by some due to the common misconception that because it is has not undergone the usual manufacturing processes, it is has no additives and is less harmful to health.23,24
The National Aboriginal and Torres Strait Islander Tobacco Control Project report found that people in Aboriginal and Torres Strait Islander communities in Queensland, New South Wales, the Australian Capital Territory, Victoria and Tasmania use chop-chop. Chop-chop is used among people in these communities for the same reasons that it is used among non-Indigenous Australians (i.e., its comparatively low price), but there are no data on the extent of its usage. As with other tobacco products, its use tends to be cyclical, peaking around pay days. Because chop-chop is generally sold in bulk quantities, it is often purchased communally.2
The national surveys of Aboriginal and Torres Strait Islander smoking behaviour have not reported separately on types of tobacco consumed, and all have excluded chewing tobacco. Information on the chewing of pituri and other bush tobaccos and commercially available loose tobacco comes from local studies, many of which are considerably dated. Studies indicate that prevalence of tobacco chewing is low among Aboriginal and Torres Strait Islander people, although it more common in some Central Australian communities (southern NT, northern SA, and eastern WA).
Only one large-scale study, undertaken in the Northern Territory between 1986 and 1987,21 attempted to quantify this form of tobacco use in the Indigenous population, finding that one-quarter of respondents chewed tobacco. Women were more likely to chew tobacco than men (38% compared to 11%), and it was more popular among older age groups of both sexes, with almost half of the population aged over 60 reporting that they chewed tobacco. The uptake of chewing occurred at an early age, with young girls being taught to chew by their mothers and grandmothers; however, this study is from the mid-1980s, and little is known about current uptake practices. Three-quarters of chewers used commercial loose flake or plug smoking tobacco, and one-quarter used bush tobacco. All chewers mixed their tobacco with ash, in the traditional manner (see Section 8.2). Only a small proportion of individuals (4%) both smoked and chewed tobacco.21
However, there was also a strong geographic influence on chewing behaviour. In the Top End region, tobacco was chewed by only 5% of women and 1% of males.21 More recent studies in Arnhem Land communities of the Top End have also reported low levels of chewing tobacco use. A 2008 study reported that only 1% reported using chewing tobacco exclusively,15 and in a study from 2000, 7% of current smokers (11 of 161) reported that they also chewed tobacco.25
The rates of chewing tobacco are much higher in the central region of Australia. The 1986–87 NT study found that 61% of women and 20% of men chewed tobacco. Although there have been no recent large-scale studies measuring rates of use of chewing tobacco in Central Australia, one researcher has recently noted that more than 30% of Aboriginal women giving birth at the Alice Springs Hospital regularly chew bush tobacco (pituri).26 Another study in remote South Australia has commented that chewing tobacco ‘is mainly practiced by middle aged and older women who are least likely to smoke’ (pS71).17 Given the potential health effects and addictiveness of chewing tobacco (see section 18.3.3), strategies to address tobacco use in the Central Australia region need to include both chewing and smoking, and need to consider that some people (particularly women) are exclusively chewing tobacco.
Studies in other parts of Australia have shown that tobacco chewing occurs at comparatively low levels. A study of smoking behaviour in two Victorian country towns showed that a very small number of Indigenous men (0.8%), and no women, chewed tobacco. In these populations, smoking was a majority behaviour (67% of men and 63% of women being current cigarette smokers).27 Another study on tobacco use among urban-dwelling Indigenous women aged 18 and over who attended an Aboriginal medical service in Perth found that 6% of respondents had chewed tobacco at some time, and of these women, just over half continued to chew regularly.20
The 2002 National Aboriginal and Torres Strait Islander Tobacco Control Project provided anecdotal evidence that native tobaccos continued to be prepared according to traditional methods and played a valued role in ceremonies. Usage was more popular in remote areas, probably reflecting availability as well as historical patterns. Native leaf is sometimes mixed with commercially available loose-leaf tobacco, such as Drum or Log Cabin, or the commercial tobaccos are chewed on their own.2
The health consequences of chewing tobacco in Indigenous communities have not been evaluated. However, more generally, smokeless tobacco products can cause addiction and a range of cancers, as well as adverse reproductive developmental effects including stillbirth, pre-term birth, and low birth weight. Some smokeless tobacco products are also associated with increased cardiovascular risks and type 2 diabetes.28 Chewing tobacco is associated with cancers of the lip, oral cavity and pharynx, and for Indigenous people in the Northern Territory the incidence of these types of cancers increased by 6.6% annually between 1991 and 2005, while mortality increased by 4.6% annually in the same time period.29 However, it is not possible to separate the causal role of tobacco use in these deaths from other possible contributing factors. An international review of smokeless tobacco use during pregnancy has found indications of an association with poorer birth outcomes, including increased rates of stillbirth and low birth weight;30 it is possible that chewing pituri has similar effects on birth outcomes.i The historical and cultural elements of native tobacco use are, however, important to the communities in which their use has continued, and any future health campaigns dealing with chewing tobacco would need to be sensitively managed.2,21
National surveys of Indigenous smoking behaviour have not collected separate data on pipe or cigar smoking. However it is likely that, as among the general Australian population, use of tobacco in these forms is minimal. The National Drug Strategy Household Survey of 2013 found that only about 1–2% of smokers aged 14 and over reported regular pipe or cigar use.7
The historical associations of pipe use among Indigenous people, with are particularly strong in parts of Northern Australia, may mean that there are still communities with some levels of pipe smoking (see Section 8.2). Other than anecdotal comments,18,19 there does not appear to be any published information on this subject.
i A study is currently underway to investigate the effects of chewing pituri on pregnancy outcomes in Central Australia (see, www.nursing-midwifery.uq.edu.au/the-maternal-and -neonatal-outcomes-of-maternal-pituri-use-133080 ).
1. Ivers R. Indigenous tobacco—a literature review. Darwin, Australia: Menzies School of Health Research and the Co-operative Research Centre for Aboriginal and Tropical Health, 2001. Available from: http://www.lowitja.org.au/files/crcah_docs/Indigenous_Australians_and_Tobacco.pdf
2. 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.
3. Australian Institute of Health and Welfare. 2001 National Drug Strategy Household Survey: Detailed findings. Drug statistics series no.11, cat. no. PHE 41.Canberra: AIHW, 2002. Available from: http://www.aihw.gov.au/publication-detail/?id=6442467418 .
4. Australian Institute of Health and Welfare. 2004 National Drug Strategy Household Survey: Detailed findings. Drug statistics series no.16, cat. no. PHE 66.Canberra: AIHW, 2005. Available from: http://www.aihw.gov.au/publication-detail/?id=6442467781 .
5. Australian Institute of Health and Welfare. 2007 National Drug Strategy Household Survey: Detailed findings. Drug statistics series no. 22, cat. no. PHE 107.Canberra: AIHW, 2008. Available from: http://www.aihw.gov.au/publications/index.cfm/title/10674.
6. Australian Institute of Health and Welfare. 2010 National Drug Strategy Household Survey: Survey report. Drug statistics series no. 25, AIHW cat. no. PHE 145.Canberra: AIHW, 2011. Available from: http://www.aihw.gov.au/publication-detail/?id=32212254712&libID=32212254712&tab=2 .
7. Australian Institute of Health and Welfare. National Drug Strategy Household Survey detailed report: 2013. Cat. no. PHE 183 Canberra: AIHW, 2014. Available from: http://www.aihw.gov.au/publication-detail/?id=60129549469&tab=3 .
8. Australian Bureau of Statistics. 4714.0. National Aboriginal and Torres Strait Islander Social Survey 2008. Canberra: ABS, 2009. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4714.02008?OpenDocument .
9. Thomas D, Fitz J, Johnston V, Townsend J, and Kneebone W. Wholesale data for surveillance of Australian Aboriginal tobacco consumption in the Northern Territory. Tobacco Control, 2011; 20:291–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21546515
10. McLennan W. 4395.0. National Aboriginal and Torres Strait Islander survey 1994: Health of Indigenous Australians. Canberra: Australian Bureau of Statistics, 1996. Available from: http://www.ausstats.abs.gov.au/ausstats/free.nsf/0/2EC91919851461CACA257225000495EF/$File/43950_1994.pdf.
11. Commonwealth Department of Human Services and Health. National Drug Strategy Household Survey: Urban Aboriginal and Torres Strait Islander people's supplement 1994. Canberra: CDHSH, 1994. Available from: http://www.health.gov.au/internet/wcms/publishing.nsf/content/health-pubhlth-publicat-stats.htm/$file/ndsatsi.pdf .
12. Panaretto K, Mitchell M, Anderson L, Gilligan C, Buettner P, et al. Tobacco use and measuring nicotine dependence among urban Indigenous pregnant women. Medical Journal of Australia, 2009; 191(10):554–7. Available from: http://www.mja.com.au/public/issues/191_10_161109/pan10395_fm.html
13. Johnston V, Thomas D, McDonnell J, and Andrews R. Maternal smoking and smoking in the household during pregnancy and postpartum: Findings from an Indigenous cohort in the Northern Territory. Medical Journal of Australia, 2011; 194(10):556–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21644912
14. Clough AR, Guyula T, Yunupingu M, and Burns C. Diversity of substance use in eastern Arnhem Land (Australia): Patterns and recent changes. Drug and Alcohol Review, 2002; 21:349–56. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12537704
15. Clough AR, Maclaren DJ, Robertson JA, Ivers RG, and Conigrave KM. Can we measure daily tobacco consumption in remote Indigenous communities? Comparing self-reported tobacco consumption with community-level estimates in an Arnhem Land study. Drug and Alcohol Review, 2010; 30:166–72. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21355927
16. Ivers R, Castro A, Parfitt D, Bailie R, D'Abbs P, et al. Evaluation of a multi-component community tobacco intervention in three remote Australian Aboriginal communities. Australia and New Zealand Journal of Public Health, 2006; 30(2):132–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16681333
17. Butler R, Chapman S, Thomas DP, and Torzillo P. Low daily smoking estimates derived from sales monitored tobacco use in six remote predominantly Aboriginal communities. Australian and New Zealand Journal of Public Health, 2010; 34(S1):S71–S5. Available from: http://dx.doi.org/10.1111/j.1753-6405.2010.00557
18. 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):116–20. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12054329
19. Briggs VL, Lindorff KJ, and Ivers RG. Aboriginal and Torres Strait Islander Australians and tobacco. Tobacco Control, 2003; 12(suppl. 2):ii5–8. Available from: http://tobaccocontrol.bmj.com/cgi/content/extract/12/suppl_2/ii5
20. Gilchrist D. Smoking prevalence among Aboriginal women. Aboriginal and Islander Health Worker Journal, 1998; 22(4):4–6. Available from: http://search.informit.com.au/documentSummary;dn=215154326331601;res=IELIND
21. Watson C, Fleming J, and Alexander K. A survey of drug use patterns in Northern Territory Aboriginal communities:1986−1987. Darwin, Australia: Northern Territory Department of Health and Community Services, 1988.
22. Sivyer G. Evidence for a large consumption of blackmarket processed-leaf-tobacco throughout the eastern states of Australia [letter]. Australian & New Zealand Journal of Public Health, 2000; 24:344−6.
23. Bittoun R. 'Chop chop' tobacco smoking [letter]. Medical Journal of Australia, 2002; 77:686–7. Available from: http://www.mja.com.au/public/issues/177_11_021202/bittoun_021202.pdf
24. Saunders J. 'Chop-chop' tobacco smoking. The Chronicle, 2009; 14(3):13. Available from: http://digitallibrary.health.nt.gov.au/dspace/bitstream/10137/419/2/Chronicle%20August%2009%20WEB.pdf
25. McDonald S, Maguire G, and Hoy W. Validation of self-reported cigarette smoking in a remaote Australian Aboriginal community. Australian and New Zealand Journal of Public Health, 2003; 27(1):57–60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14705268
26. The University of Queensland. Effects of chewing wild tobacco during pregnancy: Study. UQ News, 2011. Available from: http://www.uq.edu.au/news/?article=23592
27. Guest C, O'Dea K, Carlin J, and Larkins R. Smoking in Aborigines and persons of European descent in southeastern Australia: Prevalence and associations with food habits, body fat distribution and other cardiovascular risk factors. Australian Journal of Public Health, 1992; 16:397–402. Available from: http://www.ncbi.nlm.nih.gov/pubmed/1296789
28. National Cancer Institute and Centers for Disease Control and Prevention, Smokeless tobacco and public health: A global perspective. Nih publication no. 14-7983. Bethesda, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Institutes of Health, National Cancer Institute; 2014. Available from: http://nccd.cdc.gov/gtssdata/Ancillary/Publications.aspx .
29. Zhang X, Condon J, Dempsey K, and Garling L. Cancer incidence and mortality Northern Territory 1991–2005. Darwin, Australia: Department of Health and Families, 2008. Available from: http://digitallibrary.health.nt.gov.au/dspace/bitstream/10137/165/1/Cancer%20Incidence%20%26%20Mortality%20Report2008.pdf
30. Ratsch A and Bogossian F. Smokeless tobacco use in pregnancy: An integrative review of the literature. International Journal of Public Health, 2014; 59(4):599–608. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24794708