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Last updated: June 2022
Suggested citation: Greenhalgh, EM, van der Sterren, A, Knoche, D, & Winstanley, MH 8.7 Morbidity and mortality caused by smoking among Aboriginal and Torres Strait Islander peoples. In Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2022. Available from http://www.tobaccoinaustralia.org.au/8-7-morbidity-and-mortality-caused-by-smoking-amon
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This section discusses the major tobacco related disease groups leading to illness and death among Aboriginal and Torres Strait Islander peoples. The health consequences of smoking are discussed in detail in Chapter 3. National figures on morbidity and mortality due to smoking are provided in Chapter 3, Section 3.30.
8.7.1 Causes of mortality and morbidity among Aboriginal and Torres Strait Islander peoples
The health of Aboriginal and Torres Strait Islander peoples is affected by complex and inter-related factors that reflect the ongoing experience and mechanisms of colonisation, including experiences of marginalisation, socioeconomic disadvantage, family dislocation, racism, disconnection from land, loss of traditional diet and lifestyle, and the subsequent adoption and adaption of Western habits and practices.1, 2 The 2020 Aboriginal and Torres Strait Islander Health Performance Framework report highlights that the health of Aboriginal and Torres Strait Islander peoples has improved on a number of measures over the past decade, including decreases in the proportion of low birthweight babies, the rate of avoidable deaths, and death rates for cardiovascular disease, diabetes and kidney disease. The prevalence of smoking—a key health risk factor—has also continued to decline. However, child death rates and the prevalence of diabetes have not improved, and the prevalence of obesity and rates of death from cancer and suicide have increased.3
The latest Australian Burden of Disease study reports that in 2018, Aboriginal and Torres Strait Islander peoples lost a total of 240,000 years of healthy life (‘disability-adjusted life years’ or DALYs) due to living with illness and injury (53% of total burden) and dying prematurely (47% of total burden). The largest disease group contributors to total burden were mental and substance use disorders (23% of total burden), followed by injuries (12%), cardiovascular diseases (10%), cancer (9.9%) and musculoskeletal conditions (8.0%). Overall, the health of Aboriginal and Torres Strait Islander peoples had improved over the 15-year period from 2003 to 2018. After adjusting for population growth and ageing, there was a 15% decline in total burden, driven by a substantial decline in fatal rather than non-fatal burden.4
8.7.2 Morbidity and mortality attributable to tobacco use
The Australian burden of disease study provides details on the burden attributable to the leading risk factors for Aboriginal and Torres Strait Islander peoples. In 2018, tobacco use accounted for 11.9% of the burden of disease, more than any other risk factor. After taking into account population growth and ageing, the age-standardised rate of burden attributable to tobacco use decreased 11% between 2003 and 2018 (from 65.8 per 100,000 to 58.8 attributable DALYs). More than 800 deaths (23% of all deaths) were attributed to tobacco use in 2018. Tobacco use contributed to the burden for nine disease groups, including 47% of respiratory diseases, 37% of cancers, 34% of cardiovascular diseases, 13% of infectious diseases and 10% of endocrine disorders. The overall burden attributable to tobacco use increased with age, and became the leading risk factor contributing to disease burden among both men and women after age 45.4
A number of studies have attempted to quantify deaths due to smoking among Aboriginal and Torres Strait Islander peoples.5-9 Research published in 2021 estimated that that smoking causes 37% of all deaths, and 50% of deaths at age 45 years and over, in Aboriginal and Torres Strait Islander peoples. This equates to more than 10,000 preventable premature deaths between 2009 and 2018. Compared with current smokers, those who had never smoked were about twice as likely to live to age 75, and had on average more than ten extra years of life expectancy. In line with existing evidence (see Section 18.3), smoking 1–14 cigarettes per day—so called ‘light smoking’—carried a three-fold higher mortality risk than never smoking, while quitting prior to age 45 reduced a person’s mortality risk to that of a never smoker (see also Section 7.1). Those who quit between the ages of 45 and 54 had a mortality risk half that of current smokers and double that of never smokers. These findings highlight the critical role that ongoing reductions in smoking prevalence (see Section 8.3) will have in substantially reducing premature deaths among Aboriginal and Torres Strait Islander peoples.8, 9
Researchers have also considered the current stage of the smoking epidemic among Aboriginal and Torres Strait Islander peoples, and the short- and long-term implications. They suggest that the Aboriginal and Torres Strait Islander population is at an earlier stage of the tobacco epidemic than the total Australian population, at Stage 3 versus Stage 4 (see Section 1.3.3), and that the burden of smoking-attributable mortality is likely to remain high. The burden of tobacco-related cardiovascular disease will likely decline in the short term as smoking prevalence continues to decline. The burden of lung cancer may peak within the next decade—assuming that peak smoking prevalence occurred at or before 1994—which reflects the long lag time between smoking behaviour and the onset of tobacco-related cancer mortality.10
8.7.3 Diseases and conditions related to smoking
Tobacco is a causal, contributing or complicating factor in many diseases and conditions disproportionately experienced by Aboriginal and Torres Strait Islander peoples. This sub-section considers some of the specific diseases and conditions related to smoking: cardiovascular diseases, cancers, respiratory diseases, diabetes, and pregnancy-related conditions.
8.7.3.1 Cardiovascular diseases
People who smoke have an increased risk of most types of cardiovascular disease (CVD; a broad term for a range of diseases affecting the heart and blood vessels), and deaths are substantially higher among smokers (see Section 3.1). In 2018–19, 15% of Aboriginal and Torres Strait Islander peoples reported having cardiovascular disease. More than half (56%) of those aged 55+ years reported having CVD.11 In 2020, ischaemic heart disease was the leading specific cause of deaths in NSW, Qld, WA, SA and the NT combined, and cerebrovascular diseases were the sixth leading specific cause of deaths.12
In 2018, CVD was responsible for 10% of the total burden of disease among Aboriginal and Torres Strait Islander peoples. The leading specific cause of burden was ischaemic heart disease, while stroke was the 16th leading specific cause. Encouragingly, between 2003 and 2018, there was a decrease for cardiovascular diseases in age-standardised burden rates of 40 DALYs per 1,000 people, the largest change for any disease group.4
The high prevalence of smoking, diabetes, obesity and sedentary lifestyle, high blood pressure and cholesterol, and poor nutrition in the Aboriginal and Torres Strait Islander populations contributes to the incidence of cardiovascular diseases in their communities. National13 and regional14-17 studies have shown a high incidence of multiple risk factors for heart disease among Aboriginal and Torres Strait Islander peoples, especially smokers.18 A consensus statement was released in 2020 recommending that Aboriginal and Torres Strait Islander peoples begin having CVD risk assessment screening from the age of 18 years because of early disease onset.19
8.7.3.2 Cancers
In 2012–16, the age-standardised incidence rate of all cancers combined for Aboriginal and Torres Strait Islander peoples living in NSW, Vic, Qld, WA and the NT was 523 per 100,000 population, the most common being lung cancer, breast cancer, bowel cancer, and prostate cancer. These types of cancers relate to both modifiable risk factors, such as smoking and alcohol consumption, as well as relatively low uptake of diagnostics testing and national population-based screening programs (such as those for breast, cervical, and bowel cancer).20 Longitudinal research has found that liver/bile duct and lung are the most common cancer sites among Aboriginal and Torres Strait Islander adults living in remote communities. Overall cancer incidence was significantly higher in Torres Strait Islander than Aboriginal people.21
The five-year relative survival among Aboriginal and Torres Strait Islander peoples for all cancers combined was 47% in 2012–16; for lung cancer it was 10%.20 In 2020, cancer of the trachea, bronchus and lung was the fourth highest cause of death overall for Aboriginal and Torres Strait Islander peoples living in NSW, Qld, WA, SA and the NT.12
In 2018, cancer accounted for 9.9% of the total burden of disease among Aboriginal and Torres Strait Islander peoples, and of the disease groups made the fourth highest contribution to total burden. Between 2003 and 2018, there was a decrease in both the total burden attributable to all cancers of 4.0 DALYs per 1,000 people (age-standardised) and to lung cancer of 0.8 DALYs (age-standardised).4
A study published in 2018 followed a cohort of 2,273 Aboriginal and Torres Strait Islander adults from 26 remote communities in far North Queensland over 15 years, who were initially free of cancer. Findings showed that at follow-up, smokers had a 60% higher risk for all cancers combined and a fourfold risk for lung cancers compared to non-smokers, regardless of age, sex and ethnicity.21
8.7.3.3 Respiratory diseases
Aboriginal and Torres Strait Islander peoples experience high rates of respiratory diseases including asthma, chronic obstructive pulmonary disease (COPD), and pneumonia,22 all of which are caused by smoking.23 In 2018–19, 29% of Aboriginal and Torres Strait Islander people reported having a long-term respiratory condition, including asthma (16%), chronic obstructive pulmonary disease (COPD; 3.4%), and chronic sinusitis (7.4%).11 Prevalence is substantially higher among current and ex-smokers,18 and other contributing factors to respiratory and lung disease among Aboriginal and Torres Strait Islander peoples include living in dusty regions, or exposure to smoke from wood fires.24 In 2020, chronic lower respiratory disease was the third highest cause of death overall for Aboriginal and Torres Strait Islander peoples living in NSW, Qld, WA, SA and the NT.12
In 2018, COPD was the second leading specific cause of total disease burden among Aboriginal and Torres Strait Islander peoples, and asthma the 11th. Between 2003 and 2018, there was an overall decrease in the total burden attributable to respiratory diseases of 4.1 DALYs per 1,000 people (age-standardised), as well as to COPD of 5.4 DALYs per 1,000 people (age-standardised). For asthma, there was an increase of 3.1 DALYs over time (age-standardised).4
8.7.3.4 Diabetes
Smoking is a cause of diabetes23 – a chronic condition in which blood glucose levels become too high due to the body producing little or no insulin, or being unable to use insulin properly.25 As well as being life threatening in its own right, diabetes mellitus (also known as type 2 diabetes) can lead to a range of other serious health problems, including coronary heart disease, stroke, peripheral vascular disease, kidney disease, eye disease,26 and complications in pregnancy and childbirth.27 Smokers with diabetes are also at increased risk of illness and premature death, mainly through the development of cardiovascular disease.28 Aboriginal and Torres Strait Islander peoples,13 and particularly smokers,18 may experience a number of risk factors for developing diabetes, including being overweight, having an unbalanced diet and lack of physical activity.13, 18, 29, 30
In 2018–19, 13% of Aboriginal and Torres Strait Islander adults had diabetes and/or were at risk of developing diabetes (i.e., had high glucose levels).11 In 2020, diabetes was the second leading cause of death for Aboriginal and Torres Strait Islander peoples in NSW, Qld, SA, WA and the NT. The age-standardised death rate decreased for diabetes between 2011–15 and 2016–20.12
In 2018, type 2 diabetes was the fourth leading specific cause of total disease burden among Aboriginal and Torres Strait Islander peoples. Between 2003 and 2018, there was a decrease in the total burden attributable to type 2 diabetes of 10.7 DALYs per 1,000 people (age-standardised).4
8.7.3.5 Smoking in pregnancy, and maternal and child health outcomes
About two in five Aboriginal and Torres Strait Islander women report smoking during pregnancy, with higher rates again among women in remote and very remote areas. However, this proportion has decreased over time—see Section 8.3.7. The proportion of Aboriginal and Torres Strait Islander pregnant women attending antenatal visits has also notably increased.31
Smoking in pregnancy is a major risk factor for preterm delivery, complications in childbirth, foetal growth restriction, stillbirth, low birthweight and infant mortality (see Section 3.7).32 Poorer health outcomes in pregnancy—low birthweight, premature birth, and stillbirth or death in the first four weeks of life (perinatal deaths)—are more prevalent among Aboriginal and Torres Strait Islander women than non-Indigenous women.13, 33 However, decreasing smoking rates in pregnancy and increasing rates of antenatal care visits among Aboriginal and Torres Strait Islander pregnant women has led to some improvements over time. Between 2007 and 2017 there was a significant decline in the low birthweight rate (excluding multiple births) from 11.3% to 10.7% of babies born to Aboriginal and Torres Strait Islander women.3 However, the low birthweight rate for Aboriginal and Torres Strait Islander babies (i.e., looking at the Indigenous status of the baby rather than the mother) did not change significantly between 2013 and 2019.34
The Aboriginal and Torres Strait Islander infant mortality rate declined by 34% between 2006 and 2019 (from 9.4 to 5.8 per 1,000 live births).34 Medical care improvements such as access to hospital birthing facilities, improved neonatal and paediatric care, and the establishment of pre-natal screening for congenital abnormalities have likely contributed to this decrease.35 However, the infant mortality rate did not change significantly over the decade from 2010 to 2019.34 For the period 2015–19, the most common causes of death for Aboriginal and Torres Strait Islander infants were conditions originating in the perinatal period (57%) such as birth trauma, foetal growth disorders, complications of pregnancy, and respiratory and cardiovascular disorders specific to the perinatal period. The third leading cause of death was signs, symptoms and ill-defined conditions (14%), including SIDS.34 The risks of both these categories are elevated by smoking during pregnancy. Other than smoking, factors that affect maternal and child health outcomes include socio-economic circumstances, access to healthcare facilities, and the mother’s age during pregnancy.36 Although Aboriginal and Torres Strait Islander girls are overrepresented among teen mothers in Australia, this proportion has declined over the past decade.31
A limited number of studies have specifically looked at birth outcomes in relation to smoking during pregnancy among Aboriginal and Torres Strait Islander women. In 2019, 13.9% of Aboriginal and Torres Strait Islander babies born to a mother who smoked during pregnancy had a low birthweight, compared with 5.7% of Aboriginal and Torres Strait Islander babies born to a mother who did not smoke during pregnancy. For the period 2017–2019, an estimated 37% of low birthweight Aboriginal and Torres Strait Islander births were attributable to smoking.34 A South Australian study published in 2001 concluded that about 20% of preterm births, 48% of babies being born small for their gestational age, and 35% of babies with low birthweight could be attributed to smoking after 20 weeks in this population group.37 A larger and more recent study conducted in Western Australia found that of babies born to Aboriginal and Torres Strait Islander women 9% of preterm births, 28% of babies small for their gestational age and 19% of perinatal deaths could be attributed maternal smoking during any stage of gestation.38 A Queensland study investigating the effect of smoking on preterm births and low birthweight found that both Indigenous and non-Indigenous smokers had poorer birth outcomes than non-smokers; there was no significant difference in birth outcomes between Indigenous and non-Indigenous smokers.39 Other studies of Aboriginal and Torres Strait Islander birth outcomes have found significant associations between smoking and small for gestational age,40, 41 kidney injury,42 low birthweight,22, 43-45 and ‘poor birth outcomes’ (low birthweight and/or preterm).41, 46 A Western Australian study found that the risk of sudden infant death syndrome for babies born to Aboriginal and Torres Strait Islander women who smoke is nearly three times greater than for babies of non-smoking Indigenous women.47 Aboriginal and Torres Strait Islander infants whose mothers smoked during pregnancy also had a 42% increased risk of hospitalisation from a respiratory syncytial virus (RSV) infection.48
While the use of smokeless tobacco is relatively rare among Australians, the use of wild tobacco plants called pituri is more common among some Aboriginal and Torres Strait Islander communities in central Australia, including among pregnant women49 (see Section 8.5.3). Recent research on tobacco use among Central Australian Aboriginal women found that more than half (57%) of the infants were exposed to maternal tobacco use (26% smokeless tobacco use, 31% cigarette use). Women who used chewing tobacco had the lowest placental weight, while smokers had the lowest placental size. Newborns of women who used smokeless tobacco were more likely to be admitted to the Special Care Nursery.50 Another study with the same group of women found that tobacco chewers had a higher rate of combined pre-existing and pregnancy-related elevated glucose concentrations.51 These studies highlight the importance of screening for and addressing smokeless tobacco use among pregnant Aboriginal and Torres Strait Islander women.
8.7.4 Exposure to secondhand smoke and its health effects
Secondhand tobacco smoke also poses a major health risk. Babies and children exposed to cigarette smoke in the home experience higher rates of sudden infant death syndrome, exacerbation of asthma, a greater risk of developing acute lower respiratory tract infections such as bronchitis and pneumonia, and increased risk of middle ear infections. Adults exposed to secondhand smoke are more likely to develop a range of diseases including coronary heart disease, lung cancer and other respiratory problems.52 (See Chapter 4).
In 2014–15, about 58% of Aboriginal and Torres Strait Islander children aged 0–14 lived with a daily smoker: a significant decrease from 63% in 2008. About 13% of Aboriginal and Torres Strait Islander children lived with someone who smoked inside the home. These proportions increased with remoteness, such that children in remote areas were significantly more likely to live with a daily smoker, and to live with a daily smoker who smoked indoors, than those in non-remote areas.53 In terms of older children and adults, 60% of Aboriginal and Torres Strait Islander people aged 15 years and over were living in a household in which there was at least one daily smoker in 2014–15, down from 68% in 2008. Almost one in five (19%) were living in a household in which someone smoked inside.54
Aboriginal and Torres Strait Islander women are more likely than non-Indigenous women to be exposed to secondhand smoke during pregnancy, and this may affect birth outcomes (see Section 4.16). A study of pregnant Aboriginal women in Western Australia reported an association between exposure to secondhand smoke and an increased risk of having low birthweight and/or preterm babies.46 Similarly, a 2015 study detected serum cotinine (which indicates exposure to cigarette smoke) in just over half of a sample of pregnant Aboriginal and Torres Strait Islander women, and this was negatively associated with birth weight and gestational age at delivery.55 In a study of maternal smoking in the Northern Territory, 31% of the households of the pregnant participants included people who smoked inside during the pregnancy. Importantly, the birth of the child was associated with many of these households becoming smokefree indoors, with 12% reporting smoking indoors at one month after the birth, and 16% at seven months.56 In a 2013 qualitative study, Aboriginal and Torres Strait Islander participants described avoiding smoking if children were present, and often limited the household areas where they smoked in an attempt to protect babies and children. Some also reported showering or changing clothes after having a cigarette.57
Smaller regional studies have also reported exposure to secondhand smoke among babies born to Aboriginal and Torres Strait Islander families. Research from Western Australia in the late 1990s found that 80% of Indigenous babies in a sample studied in Perth were regularly exposed to tobacco smoke.58 A study from Queensland found that 40% of Aboriginal and Torres Strait Islander infants were exposed to smoke in the home, compared to 20% of non-Indigenous babies.59 Research from three remote top end (north Northern Territory) communities reported that 98% of Indigenous primary or high school-aged children lived with at least one smoker, and 43% lived with five or more smokers.60 Aboriginal and Torres Strait Islander children have more than three times the incidence of ear and hearing problems of non-Indigenous children,13 for which secondhand smoke is likely to be at least partially responsible. A Western Australian study found that exposure to secondhand smoke was a significant predictor of otitis media (middle ear infection) in Aboriginal children,61 which is common and frequently severe in Indigenous children,62 and is likely one of the key determinants of the high rates of disability and learning difficulties among this population.63 A study conducted in the Royal Darwin Hospital found exposure to household smoke more than doubled the likelihood of Aboriginal and Torres Strait Islander infants who were admitted to the hospital for bronchiolitis being re-admitted in the next six months.64
The comparatively high smoking rates among Aboriginal and Torres Strait Islander adults, to which colonisation contributed, means that many Aboriginal and Torres Strait Islander children live in households where smoking is normalised. This can affect both their health and their likelihood of taking up smoking—see Section 8.4.3.
Relevant news and research
For recent news items and research on this topic, click here. ( Last updated December 2021)
References
1. Dudgeon P and Walker R. Decolonising Australian Psychology: Discourses, Strategies, and Practice. Journal of Social and Political Psychology, 2015; 3(1):276–97. Available from: https://jspp.psychopen.eu/index.php/jspp/article/view/4857
2. Freemantle J, Officer K, McAullay D, and Anderson I, Australian Indigenous Health—Within an International Context. Darwin, Australia: Cooperative Research Centrefor Aboriginal Health; 2007. Available from: https://trove.nla.gov.au/work/34941450?q&versionId=221227725.
3. Australian Institute of Health and Welfare. Aboriginal and Torres Strait Islander Health Performance Framework 2020 summary report. Cat. no. IHPF 2 Canberra: AIHW 2020. Available from: https://www.indigenoushpf.gov.au/
4. Australian Institute of Health and Welfare. Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2018. Australian Burden of Disease Study series no. 26. Cat. no. BOD 32 Canberra: AIHW, 2022. Available from: https://www.aihw.gov.au/reports/burden-of-disease/illness-death-indigenous-2018/summary
5. Measey M, d'Espaignet E, and Cunningham J. Adult morbidity and mortality due to tobacco smoking in the Northern Territory 1986-1995 Darwin, Australia: Northern Territory Government Department of Health and Community Services, 1998. Available from: http://digitallibrary.health.nt.gov.au/dspace/bitstream/10137/109/1/mortality_morbidity_smoking_1986.pdf
6. Unwin C, Thomson N, and Gracey M. The impact of tobacco smoking and alcohol consumption on Aboriginal mortality and hospitalisation in Western Australia: 1983–1991., Perth: Health Department of Western Australia, 1994.
7. Unwin CE, Gracey MS, and Thomson NJ. The impact of tobacco smoking and alcohol consumption on aboriginal mortality in Western Australia, 1989-1991. Medical Journal of Australia, 1995; 162(9):475–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/7746204
8. Thurber KA, Banks E, Joshy G, Soga K, Marmor A, et al. Tobacco smoking and mortality among Aboriginal and Torres Strait Islander adults in Australia. Int J Epidemiol, 2021; 50(3):942–54. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33491081
9. Arnold-Reed DE, Holman CD, Codde J, and Unwin E. Effects of smoking and unsafe alcohol consumption on aboriginal life expectancy. Medical Journal of Australia, 1998; 168(2):95. Available from: https://www.ncbi.nlm.nih.gov/pubmed/9469197
10. Lovett R, Thurber KA, and Maddox R. The Aboriginal and Torres Strait Islander smoking epidemic: what stage are we at, and what does it mean? Public Health Research and Practice, 2017; 27(4). Available from: http://www.phrp.com.au/issues/october-2017-volume-27-issue-4/the-aboriginal-and-torres-strait-islander-smoking-epidemic-what-stage-are-we-at-and-what-does-it-mean/
11. Australian Bureau of Statistics. 4715.0 - National Aboriginal and Torres Strait Islander Health Survey, 2018-19. 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=
12. Australian Bureau of Statistics. Leading causes of death in Aboriginal and Torres Strait Islander people. 2021. Available from: https://www.abs.gov.au/statistics/health/causes-death/causes-death-australia/2020#leading-causes-of-death-in-aboriginal-and-torres-strait-islander-people
13. Australian Bureau of Statistics and Australian Institute of Health and Welfare. 4704.0. The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples, 2008. cat. no. AIHW 21.Canberra: ABS, 2008. Available from: http://abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4704.02008?OpenDocument
14. Leonard D, McDermott R, O'Dea K, Rowley K, Pensio P, et al. Obesity, diabetes and associated cardiovascular risk factors among Torres Strait Islander people. Australian and New Zealand Journal of Public Health, 2002; 26:144–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12054333
15. Guest CS, O'Dea K, Carlin JB, and Larkins RG. 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. Aust J Public Health, 1992; 16(4):397–402. Available from: https://www.ncbi.nlm.nih.gov/pubmed/1296789
16. Hoy WE, Norman RJ, Hayhurst BG, and Pugsley DJ. A health profile of adults in a Northern Territory aboriginal community, with an emphasis on preventable morbidities. Australian and New Zealand Journal of Public Health, 1997; 21(2):121–6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/9161065
17. Thompson P, Bradshaw P, Veroni M, and Wilkes E. Cardiovascular risk among urban Aboriginal people. Medical Journal of Australia, 2003; 179:143–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12885283
18. Australian Bureau of Statistics. 4722.0.55.004—Tobacco smoking—Aboriginal and Torres Strait Islander people: a snapshot, 2004–05 ABS, 2007. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/productsbyCatalogue/D030A9BD9BF14B08CA25730E0021BCE1?OpenDocument
19. Agostino JW, Wong D, Paige E, Wade V, Connell C, et al. Cardiovascular disease risk assessment for Aboriginal and Torres Strait Islander adults aged under 35 years: a consensus statement. Medical Journal of Australia, 2020; 212(9):422–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32172533
20. Australian Institute of Health and Welfare. Cancer in Australia 2021. Cancer series no. 133. Cat. no. CAN 144 Canberra: AIHW, 2021. Available from: https://www.aihw.gov.au/reports/cancer/cancer-in-australia-2021/summary
21. Li M, Roder D, and McDermott R. Diabetes and smoking as predictors of cancer in Indigenous adults from rural and remote communities of North Queensland - A 15-year follow up study. Int J Cancer, 2018; 143(5):1054–61. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29582412
22. Australian Health Ministers’ Advisory Council. Aboriginal and Torres Strait Islander Health Performance Framework 2014 Report. Canberra: AHMAC, 2015. Available from: https://www.pmc.gov.au/sites/default/files/publications/Aboriginal_and_Torres_Strait_Islander_HPF_2014%20-%20edited%2016%20June2015.pdf
23. U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Available from: http://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf
24. Environment Australia. Australia state of the environment report 2001. Fact sheet: Air quality, 2002, Department of the Environment and Heritage, Australian Government: Canberra. Available from: http://www.environment.gov.au/soe/2001/publications/fact-sheets/air.html.
25. Australian Institute of Health and Welfare, Diabetes: Australian facts 2008. Cat. no. CVD 40. Canberra: AIHW; 2008. Available from: http://www.aihw.gov.au/publication-detail/?id=6442468075.
26. Diabetes Australia. Staying well with diabetes. Talking diabetes no. 35. 2010. Available from: https://s3-ap-southeast-2.amazonaws.com/dv-resources/OrchestraCMS/a1f90000003H78GAAS.pdf
27. Taylor R and Davison JM. Type 1 diabetes and pregnancy. British Medical Journal, 2007; 334(7596):742–5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17413175
28. Haire-Joshu D, Glasgow RE, Tibbs TL, and American Diabetes A. Smoking and diabetes. Diabetes Care, 2003; 26 Suppl 1(suppl. 1):S89–90. Available from: https://www.ncbi.nlm.nih.gov/pubmed/12502627
29. Schulze M and Hu F. Primary prevention of diabetes: what can be done and how much can be prevented? Annual Review of Public Health, 2005; 26:445–67. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15760297
30. Diabetes Australia. What is diabetes? Talking Diabetes no. 42, 2010, Diabetes Australia: Canberra. Available from: http://www.nevdgp.org.au/info/diabetes/2011/What_is_diabetes_diabetesvic.pdf.
31. Australian Institute of Health and Welfare. Australia's mothers and babies. Canberra: AIHW, 2021. Available from: https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies
32. US Department of Health and Human Services. The health consequences of smoking. A report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Office of the Surgeon General, 2004. Available from: http://www.surgeongeneral.gov/library/smokingconsequences/
33. Laws P, Li Z, and Sullivan E. Australia's mothers and babies 2008. Perinatal statistics series no.24 cat. no. PER 50.Canberra: Australian Institute of Health and Welfare, 2010. Available from: http://www.aihw.gov.au/publication-detail/?id=6442472399
34. Australian Institute of Health and Welfare. Aboriginal and Torres Strait Islander Health Performance Framework – Updates. 2022. Available from: https://www.indigenoushpf.gov.au/resources/data-resources/updates
35. Li SQ, Gray N, Guthridge S, Pircher S, Wang Z, et al. Avoidable mortality trends in Aboriginal and non-Aboriginal populations in the Northern Territory, 1985-2004. Australian and New Zealand Journal of Public Health, 2009; 33(6):544–50. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20078572
36. Lewis LN, Hickey M, Doherty DA, and Skinner SR. How do pregnancy outcomes differ in teenage mothers? A Western Australian study. Medical Journal of Australia, 2009; 190(10):537–41. Available from: http://www.mja.com.au/public/issues/190_10_180509/lew11058_fm.html
37. Chan A, Keane R, and Robinson J. The contribution of maternal smoking to preterm birth, small for gestational age and low birthweight among Aboriginal and non-Aboriginal births in South Australia. Medical Journal of Australia, 2001; 174(8):389–93. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11346081
38. Gibberd AJ, Simpson JM, Jones J, Williams R, Stanley F, et al. A large proportion of poor birth outcomes among Aboriginal Western Australians are attributable to smoking, alcohol and substance misuse, and assault. BMC Pregnancy Childbirth, 2019; 19(1):110. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30940112
39. Wills R and Coory M. Effect of smoking among Indigenous and non-Indigenous mothers on preterm birth and full-term low birthweight. Medical Journal of Australia, 2008; 189(9):490–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18976189
40. Romero R and Mazor M. Infection and preterm labor. Clin Obstet Gynecol, 1988; 31(3):553–84. Available from: https://www.ncbi.nlm.nih.gov/pubmed/3066544
41. McInerney C, Ibiebele I, Ford JB, Randall D, Morris JM, et al. Benefits of not smoking during pregnancy for Australian Aboriginal and Torres Strait Islander women and their babies: a retrospective cohort study using linked data. BMJ Open, 2019; 9(11):e032763. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31753897
42. Sutherland MR, Chatfield MD, Davison B, Vojisavljevic D, Kent AL, et al. Renal dysfunction is already evident within the first month of life in Australian Indigenous infants born preterm. Kidney Int, 2019; 96(5):1205–16. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31563332
43. Humphrey M and Holzheimer D. A prospective study of gestation and birthweight in Aboriginal pregnancies in far north Queensland. Aust N Z J Obstet Gynaecol, 2000; 40(3):326–30. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11065042
44. Gibberd AJ, Simpson JM, McNamara BJ, and Eades SJ. Maternal fetal programming of birthweight among Australian Aboriginal infants: a population-based data linkage study. The Lancet Global Health, 2019; 7(4):e523–e32.
45. Khalidi N, McGill K, Houweling H, Arnett K, and Sheahan A, Closing the Gap in Low Birthweight Births between Indigenous and Non-Indigenous Mothers. Queensland: Health Statistics Centre; 2012. Available from: https://www.health.qld.gov.au/hsu/pdf/statbite/statbite46.pdf.
46. Eades S, Read AW, Stanley FJ, Eades FN, McCaullay D, et al. Bibbulung Gnarneep ('solid kid'): causal pathways to poor birth outcomes in an urban Aboriginal birth cohort. J Paediatr Child Health, 2008; 44(6):342–6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18476926
47. Freemantle J, Stanley F, Read A, and de Klerk N. The first research report: patterns and trends in mortality of Western Australian infants, children and young people 1980-2002. Perth: Advisory Council on the Prevention of Deaths of Children and Young People, Department for Community Development, Government of Western Australia, 2004.
48. Homaira N, Mallitt KA, Oei JL, Hilder L, Bajuk B, et al. Risk factors associated with RSV hospitalisation in the first 2 years of life, among different subgroups of children in NSW: a whole-of-population-based cohort study. BMJ Open, 2016; 6(6):e011398. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27357197
49. 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
50. Ratsch A, Bogossian F, Burmeister EA, and Steadman K. Central Australian Aboriginal women's placental and neonatal outcomes following maternal smokeless tobacco, cigarette or no tobacco use. Australian and New Zealand Journal of Public Health, 2022; 46(2):186–95. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34821425
51. Ratsch A, Bogossian F, and Steadman K. Central Australian Aboriginal women's pregnancy, labour and birth outcomes following maternal smokeless tobacco (pituri) use, cigarette use or no-tobacco use: a prospective cohort study. BMC Public Health, 2021; 21(1):814. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33910555
52. US Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006. Available from: http://www.surgeongeneral.gov/library/secondhandsmoke/
53. Australian Institute of Health and Welfare. The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples 2015. Cat. no. IHW 147. Canberra: AIHW, 2015. Available from: http://www.aihw.gov.au/publication-detail/?id=60129550168
54. Australian Bureau of Statistics. 4714.0 - National Aboriginal and Torres Strait Islander Social Survey, 2014–15. 2016. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4714.02014-15?OpenDocument
55. Pringle KG, Rae K, Weatherall L, Hall S, Burns C, et al. Effects of maternal inflammation and exposure to cigarette smoke on birth weight and delivery of preterm babies in a cohort of indigenous Australian women. Frontiers in Immunology, 2015; 6:89. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25806032
56. Johnston V, Thomas DP, McDonnell J, and Andrews RM. 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: https://www.ncbi.nlm.nih.gov/pubmed/21644912
57. Gould GS, Munn J, Avuri S, Hoff S, Cadet-James Y, et al. "Nobody smokes in the house if there's a new baby in it": Aboriginal perspectives on tobacco smoking in pregnancy and in the household in regional NSW Australia. Women Birth, 2013; 26(4):246–53. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24011470
58. Eades SJ and Read AW. Infant care practices in a metropolitan aboriginal population Bibbulung Gnarneep Team. J Paediatr Child Health, 1999; 35(6):541–4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/10634979
59. Wills R-A and Coory M. A preliminary look at the rates of cigarette smoking among mothers giving birth in Queensland. Information circular 77, Brisbane: Health Statistics Centre Queensland Government Department of Health, 2008. Available from: https://www.health.qld.gov.au/__data/assets/pdf_file/0030/144669/info77.pdf
60. 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
61. Jacoby PA, Coates HL, Arumugaswamy A, Elsbury D, Stokes A, et al. The effect of passive smoking on the risk of otitis media in Aboriginal and non-Aboriginal children in the Kalgoorlie-Boulder region of Western Australia. Medical Journal of Australia, 2008; 188(10):599–603. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18484936
62. Morris PS, Leach AJ, Silberberg P, Mellon G, Wilson C, et al. Otitis media in young Aboriginal children from remote communities in Northern and Central Australia: a cross-sectional survey. BMC Pediatrics, 2005; 5:27. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16033643
63. DiGiacomo M, Davidson PM, Abbott P, Delaney P, Dharmendra T, et al. Childhood disability in Aboriginal and Torres Strait Islander peoples: a literature review. International Journal for Equity in Health, 2013; 12:7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23327694
64. McCallum GB, Morris PS, Grimwood K, Maclennan C, White AV, et al. Three-weekly doses of azithromycin for indigenous infants hospitalized with bronchiolitis: a multicentre, randomized, placebo-controlled trial. Front Pediatr, 2015; 3:32. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25954737