9.1 Smoking prevalence and exposure to secondhand smoke among priority populations in Australia

Last updated: September 2021

Suggested citation:  Greenhalgh, EM, Scollo, MM, & Pearce, M. 9.1 Smoking prevalence and exposure to secondhand smoke among priority populations in Australia. 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/chapter-9-disadvantage/9-1-socioeconomic-position-and-disparities-in-toba 

 

There is a consistent inverse dose–response relationship between cigarette smoking and income level (i.e., the lower the income the higher the prevalence of smoking), worldwide and across subgroups.1 Increased risks of smoking-related harm begin before birth, with higher likelihood of pregnant women from low socioeconomic status backgrounds smoking and being exposed to secondhand smoke, and continue through childhood, adolescence, and adulthood.

This section discusses current smoking prevalence, consumption, and duration of smoking by socioeconomic status, educational attainment, and employment status among adults, and also among pregnant women and young people. It also summarises exposure to secondhand smoke among children and in the workplace, home, and in institutions.

Section 9.2 provides a detailed overview of trends over time in smoking and exposure to secondhand smoke among these groups. Smoking rates among other priority populations can be found elsewhere – see our sections on smoking among Aboriginal and Torres Strait Islander Peoples, people with mental illness, single parents, people experiencing homelessness, the prison population, users of other drugs, and the LGBTQI population.

9.1.1 Smoking prevalence among adults by socioeconomic status

Consistent with findings from the US,2, 3 UK,4 Canada,5 New Zealand6 and other developed and developing countries,1 data from recent Australian surveys7, 8 show a clear social gradient in smoking behaviour among adults, with rates of smoking significantly higher in lower socio-economic groups.

Figures 9.1.1 and 9.1.2 set out Australian data from the 2017–18 National Health Survey published by the Australian Bureau of Statistics.7

  

Figure 9.1.1 
Prevalence of daily smoking, Australians 18 years and over by socio-economic and labour force status, 2017‒18

Source: Australian Bureau of Statistics 2018 7

Figure 9.1.2 shows smoking status by level of social disadvantage. The proportion of ex-smokers is almost identical among people living in the least and most disadvantaged areas; differences in smoking prevalence appear to be largely attributable to fewer socially advantaged people taking up smoking in the first place. 

Figure 9.1.2 
Smoking status by quintile of relative social disadvantage, persons 18 years and older, Australia, 2017–18

Source:  Australian Bureau of Statistics Table Builder,9 using data from the National Health Survey 2017–187

The 2019 National Drug Strategy Household Survey tells a similar story. In 2019, about half of those in the most disadvantaged areas or those who had completed up to year 11 or less had never smoked. Among the least disadvantaged or those with a university education, more than two-thirds had never smoked. Table 9.1.1 shows smoking status among those of varying levels of social disadvantage, employment status, and education level. 

Table 9.1.1 
Socio-economic characteristics by smoking status, persons 18 years and older, Australia, 2019

Source: Centre for Behavioural Research in Cancer analysis of National Drug Strategy Household Survey data 2019.10

* Never smoked more than 100 cigarettes or the equivalent tobacco in their life 
† Smoked at least 100 cigarettes or the equivalent tobacco in their life, and no longer smoke 
‡ Smoked daily, weekly or less than weekly

9.1.2 Reported cigarette consumption

In addition to being more likely to have ever smoked and to be current smokers, those in disadvantaged groups also generally report smoking a greater number of cigarettes each day.11-13 Table 9.1.2 shows the average number of cigarettes smoked per day among adult smokers by social characteristics in Australia in 2019. 

Table 9.1.2 
Mean number of cigarettes smoked per day, (self-reported) current smokers aged 18 years and older, by social characteristics, by sex, Australia, 2019

Source: Centre for Behavioural Research in Cancer analysis of National Drug Strategy Household Survey data 201910

9.1.3  Duration of smoking

Among people who have quit smoking, those with lower levels of occupation, income and education are likely to have smoked for longer periods of time prior to quitting. An analysis of data from the 2001 NDSHS found that among ex-smokers, those whose income was less than $300 per week smoked for an average of 35 years, compared with 18 years for those whose income was $800 or more per week.14, 15 Table 9.1.3 sets out the mean number of years spent smoking prior to quitting for people who reported being ex-smokers in the 2019 National Drug Strategy Household Survey.

Table 9.1.3 
Average duration of smoking (years), ex-smokers aged 18+, by social characteristics, Australia, 2019

Source: Centre for Behavioural Research in Cancer analysis of National Drug Strategy Household Survey data 201910
Note: Duration calculated by subtracting responses to ‘At what age did you first start smoking daily?’ from ‘About what age were you when you stopped smoking daily?’

In the US, there also appear to be marked differences in the duration of smoking between racial and socio-economic groups. One study found that most minority racial groups were likely to smoke for longer periods and individuals living in poverty smoked on a daily basis for 18 years longer than those with a family income about three times above the poverty line.16

Cohort patterns in smoking uptake and quitting are discussed further in Section 9.7.

9.1.4 Smoking during pregnancy

Disadvantage across a woman’s life course increases her risk of being a smoker during pregnancy.17 Women without a partner, the less educated,18, 19 those of lower socio-economic status,18, 20 those living in a deprived neighbourhood21 and women with a psychiatric disorder22 are more likely to smoke during pregnancy. In 2019, 18% of pregnant women living in the lowest socioeconomic areas in Australia smoked during pregnancy, compared with 21% in 2012.23 Smoking during pregnancy among women living in very remote areas remained fairly steady over time (from 36% in 2012 to 35% in 2019). About two in five (43%) Aboriginal and Torres Strait Islander women reported smoking during pregnancy in 2019, down from 50% in 200923—see Section 8.3.7. Disadvantaged women may also be more likely to take up smoking during pregnancy or in the early postpartum period,24 and are less likely to quit and more likely to start smoking in their second pregnancy.25  

9.1.5  Smoking behaviours among young people

In 2017, among Australian students aged 12–15, those living in areas with relatively greater socioeconomic disadvantage (first quintile) were significantly more likely to report current smoking (in the past week) than those who lived in relatively less disadvantaged areas (fifth quintile). Among 16–17 year olds, current smoking did not vary significantly with socioeconomic status.26 Figure 9.1.3 shows these proportions by age group.

Figure 9.1.3 Proportion reporting smoking a least weekly, secondary-school students aged 12–15 and 16–17 years by Index of Socio-economic Disadvantage of place of residence, Australia, 2017

Source:  Bain, E., Guerin, N., & White, V. 2019. 26

9.1.6 Exposure to secondhand smoke

People in more disadvantaged groups are more likely to be exposed to secondhand smoke both in their homes and workplaces.27-29

9.1.6.1 Children’s exposure to secondhand smoke

Children from disadvantaged families are far more likely to be exposed to secondhand smoke at home. Lower household income, lower parental education level, and living with multiple adult smokers are predictive of children’s exposure to smoking in the home.30-32

Data from the National Drug Strategy Household Survey show that in 2019, about 27% of households with at least one child under 15 reported having a household member that smokes at least once per day (see Table 9.1.4). Within these households (i.e., households that include someone who smokes) with children, 10% in the most disadvantaged areas reported that the smoker smokes inside the home. Among all households with children, about 4% of these highly disadvantaged children live in a household where someone smokes indoors at least once a day.

Table 9.1.4 
Percentage of households with children under 15 years that allow indoor smoking, by quintile of disadvantage*, Australia, 2019

Source: Centre for Behavioural Research in Cancer analysis of National Drug Strategy Household Survey data 201910

* Based on socio-economic indexes for areas, Australian Bureau of Statistics 

Although some children of low socio-economic status (SES) smokers are exposed to tobacco smoke in the home, legislative developments, such as Australia-wide bans on smoking in cars carrying children (see Section 15.7.2.3), and bans in some states/territories on smoking in close proximity to schools and playgrounds, help reduce the number of areas where children may be exposed to secondhand smoke. Widespread smokefree legislation means that children of non-smoking parents might only very rarely be exposed to environmental tobacco smoke.

International research shows the same associations between deprivation and the likelihood of secondhand smoke exposure among children, with parental smoking habits, household poverty, and lower parental educational levels being common predictors of exposure.30-34

9.1.6.2  Workplace exposure to secondhand smoke

Since the mid-1980s in Australia, when smoking was banned in the federal public service offices and then, increasingly in big and then smaller companies (see Section 15.4), people in white collar occupations have been more likely to work in places with total bans on smoking. While most workplaces since the late 1980s have restricted smoking to at least some degree, research in the late 1990s found that blue collar workers were three times more likely to work in environments with no restrictions on smoking (21%, compared with 8% of white collar and 7% of professional workers).35

With legislation mandating smokefree policies in hospitality venues and in enclosed workplaces in all Australian jurisdictions (with some exemptions, such as high-roller rooms), disparities in workplace exposure to environmental tobacco smoke are no doubt much less pronounced in more recent times. Data collected from annual population surveys in Victoria showed for instance, that the proportion of indoor workers reporting total smoking restrictions at their usual area of work increased significantly between 1998 and 2007, from 91% to 95%. The data indicated there was a relatively uniform increase in workplace smoking bans across all socio-economic groups for this period. However, there was still some disparity between smokefree workplaces, with 91% of warehouse, workshop, and factory workers reporting a smokefree workplace compared to the average of 95% of all indoor workplaces.36

More recent Victorian data showed that in 2016, many Victorians were still reporting being exposed to secondhand smoke in the workplace, with the highest levels of exposure among blue collar workers. Those working in upper blue-collar jobs (such as tradespeople and construction workers) were most likely to report having been exposed to secondhand smoke at work, with almost half (45%) reporting exposure, compared with about one-third of those working in upper white (32%) or lower white (33%) collar jobs, There were no significant differences among workers from difference SES areas or with differing levels of education37—see Figure 9.1.4.

 

Figure 9.1.4 
Proportion or workers who report exposure to secondhand smoke at work, Victoria, 2016

Source:  Bain & Hayes 201837

With legislation mandating smokefree policies in hospitality venues and in enclosed workplaces in all Australian jurisdictions (with some exemptions, such as high-roller rooms), disparities in workplace exposure to environmental tobacco smoke are no doubt much less pronounced in more recent times. Data collected from annual population surveys in Victoria showed for instance, that the proportion of indoor workers reporting total smoking restrictions at their usual area of work increased significantly between 1998 and 2007, from 91% to 95%. The data indicated there was a relatively uniform increase in workplace smoking bans across all socio-economic groups for this period. However, there was still some disparity between smokefree workplaces, with 91% of warehouse, workshop, and factory workers reporting a smokefree workplace compared to the average of 95% of all indoor workplaces. 31    

9.1.6.3  Exposure to secondhand smoke in the home

In the 2019 National Drug Strategy Household Survey, among households with a smoker, about 17% reported that the smoker smoked daily inside the home. Looking at education level and socioeconomic status, about one in five (19%) households with a smoker in the most disadvantaged areas, and a similar proportion (21%) of those who had completed up to year 11 or less, reported daily smoking in the home—see Figure 9.1.5.

Figure 9.1.5 
Proportion of households with a smoker that allow smoking indoors by SEIFA and education level, Australia, 2019

Source:  Centre for Behavioural Research in Cancer analysis of National Drug Strategy Household Survey data 2019.10

9.1.6.4 Exposure to secondhand smoke in institutional settings

People spending time in institutions such as correctional facilities, psychiatric hospitals, and drug treatment centres are among the most disadvantaged groups in Australia. Given the much-higher-than-average rates of smoking among residents and clients of such facilities and services, high levels of smoking among staff,38, 39 and fears about the impact of restricting smoking on attendance, treatment, and behaviour,40 it is only in recent times that such institutions have begun to introduce comprehensive smokefree policies. For example, all states and territories except Western Australia and the ACT have introduced complete smoking bans in prisons, and many inpatient psychiatric settings have implemented smokefree policies. Poor adherence and low levels of support in such settings may, however, limit their effectiveness, resulting in levels of exposure to secondhand smoke among highly disadvantaged clients in such facilities much higher than in the general population.41 See Sections 7.12.6, 9.6.6 and 15.4.4.2 for further discussion of these policies.

 

Relevant news and research

For recent news items and research on this topic, click  here. ( Last updated May 2021)  

 

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