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 9A.3.6, 9A.5 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 September 2023)  

 

References

1. Casetta B, Videla AJ, Bardach A, Morello P, Soto N, et al. Association between cigarette smoking prevalence and income level: A systematic review and meta-analysis. Nicotine & Tobacco Research, 2017; 19(12):1401–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27679607

2. Centers for Disease Control and Prevention. Burden of tobacco use in the US. 2017. Available from: https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-states.html

3. Garrett BE, Martell BN, Caraballo RS, and King BA. Socioeconomic differences in cigarette smoking among sociodemographic groups. Preventing Chronic Disease, 2019; 16:E74. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31198164

4. NHS Digital. Statistics on smoking, England - 2017. 2017. Available from: http://digital.nhs.uk/catalogue/PUB24228

5. Statistics Canada. Smoking, 2016. 2017. Available from: https://www.statcan.gc.ca/pub/82-625-x/2017001/article/54864-eng.htm

6. Ministry of Health. Annual update of key results 2016/17: New Zealand health survey. 2017. Available from: https://www.health.govt.nz/publication/annual-update-key-results-2016-17-new-zealand-health-survey

7. Australian Bureau of Statistics. National Health Survey 2017–18: First results.  2018. Available from: https://www.abs.gov.au/statistics/health/health-conditions-and-risks/national-health-survey-first-results/2017-18.

8. Australian Institute of Health and Welfare. National Drug Strategy Household Survey 2019. Drug Statistics series no. 32 Cat. no. PHE 270 Canberra: AIHW, 2020. Available from: https://www.aihw.gov.au/getmedia/3564474e-f7ad-461c-b918-7f8de03d1294/aihw-phe-270-NDSHS-2019.pdf.aspx?inline=true.

9. Australian Bureau of Statistics. Tablebuilder. Available from: http://www.abs.gov.au/websitedbs/d3310114.nsf/home/about+tablebuilder

10. Australian Institute of Health and Welfare. National Drug Strategy Household Survey, 2019. ADA Dataverse, 2021. Available from: http://dx.doi.org/10.26193/WRHDUL.

11. Siahpush M and Borland R. Sociodemographic variations in smoking status among Australians aged 18 years and over: Multivariate results from the 1995 National Health Survey. Australian and New Zealand Journal of Public Health, 2001; 25(2):438–42. Available from: http://www3.interscience.wiley.com/journal/118996678/abstract

12. Siahpush M. Smoking and social inequality. Australian and New Zealand Journal of Public Health, 2004; 28(3):297. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15707179

13. Pennanen M, Broms U, Korhonen T, Haukkala A, Partonen T, et al. Smoking, nicotine dependence and nicotine intake by socio-economic status and marital status. Addictive Behaviors, 2014; 39(7):1145–51. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24727110

14. Australian Institute of Health and Welfare. 2001 National Drug Strategy Household Survey: Detailed findings. Drug statistics series no. 11, AIHW cat. no. PHE 41.Canberra: AIHW, 2002. Available from: https://www.aihw.gov.au/reports/alcohol-other-drug-treatment-services/2001-ndshs-detailed-findings/contents/table-of-contents.

15. Siahpush M, Heller G, and Singh G. Lower levels of occupation, income and education are strongly associated with a longer smoking duration: Multivariate results from the 2001 Australian national drug strategy survey. Public Health, 2005; 119(12):1105–10. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16085150

16. Siahpush M, Singh G, Jones P, and Timsina L. Racial/ethnic and socioeconomic variations in duration of smoking: Results from 2003, 2006 and 2007 tobacco use supplement of the current population survey. Journal of Public Health, 2009; 32(2):210–8. Available from: http://jpubhealth.oxfordjournals.org/content/32/2/210.full

17. Graham H, Hawkins SS, and Law C. Lifecourse influences on women's smoking before, during and after pregnancy. Social Science & Medicine, 2010; 70(4):582–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19932931

18. Lu Y, Tong S, and Oldenburg B. Determinants of smoking and cessation during and after pregnancy. Health Promotion International, 2001; 16(4):355–65. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11733454

19. Higgins ST, Heil SH, Badger GJ, Skelly JM, Solomon LJ, et al. Educational disadvantage and cigarette smoking during pregnancy. Drug and Alcohol Dependence, 2009; 104 Suppl 1(suppl 1.):S100–5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19442460

20. Mohsin M and Bauman A. Socio-demographic factors associated with smoking and smoking cessation among 426,344 pregnant women in New South Wales, Australia. BMC Public Health 2005; 5:138. Available from: http://www.biomedcentral.com/content/pdf/1471-2458-5-138.pdf

21. Sellström E, Arnoldsson G, Bremberg S, and Hjern A. The neighbourhood they live in - does it matter to women's smoking habits during pregnancy? Health & Place, 2007; 14(2):155–66. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17616477

22. Flick L, Cook C, Homan S, McSweeney M, Campbell C, et al. Persistent tobacco use during pregnancy and the likelihood of psychiatric disorders. American Journal of Public Health 2006; 96(10):1799−807. Available from: http://www.ajph.org/cgi/content/abstract/96/10/1799

23. 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.

24. Webb DA, Culhane JF, Mathew L, Bloch JR, and Goldenberg RL. Incident smoking during pregnancy and the postpartum period in a low-income urban population. Public Health Rep, 2011; 126(1):50–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21337931

25. Tran DT, Roberts CL, Jorm LR, Seeho S, and Havard A. Change in smoking status during two consecutive pregnancies: A population-based cohort study. BJOG, 2014; 121(13):1611–20. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24735217

26. Bain E, Guerin N, and White V. ASSAD 2017: The association between smoking and socioeconomic status among secondary school students in Australia. Melbourne: Centre for Behavioural Research in Cancer, Cancer Council Victoria, 2019.

27. Shastri SS, Talluri R, and Shete S. Disparities in secondhand smoke exposure in the United States: National health and nutrition examination survey 2011-2018. JAMA Internal Medicine, 2021; 181(1):134–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33226402

28. Santero M, Melendi S, Hernandez-Vasquez A, and Irazola V. Socio-economic inequalities in smoking prevalence and involuntary exposure to tobacco smoke in argentina: Analysis of three cross-sectional nationally representative surveys in 2005, 2009 and 2013. PLoS One, 2019; 14(6):e0217845. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31173615

29. Kang SY, Lim MK, and Cho HJ. Trends in the socioeconomic inequalities related to second-hand smoke exposure as verified by urine cotinine levels among nonsmoking adults: Korea national health and nutrition examination survey 2008 - 2018. Nicotine & Tobacco Research, 2021. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33764416

30. King K, Martynenko M, Bergman MH, Liu Y-H, Winickoff JP, et al. Family composition and children's exposure to adult smokers in their homes. Pediatrics, 2009; 123(4):e559–64. Available from: http://pediatrics.aappublications.org/cgi/content/full/123/4/e559

31. Alwan N, Siddiqi K, Thomson H, and Cameron I. Children's exposure to second-hand smoke in the home: A household survey in the north of England. Health Soc Care Community, 2010; 18(3):257–63. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20050935

32. Merianos AL, Jandarov RA, Choi K, and Mahabee-Gittens EM. Tobacco smoke exposure disparities persist in US children: Nhanes 1999-2014. Preventive Medicine, 2019; 123:138–42. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30902698

33. Mantziou V, Vardavas CI, Kletsiou E, and Priftis KN. Predictors of childhood exposure to parental secondhand smoke in the house and family car. International Journal of Environmental Research and Public Health, 2009; 6(2):433–44. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19440392

34. Bolte G, Fromme H, and Group GMES. Socioeconomic determinants of children's environmental tobacco smoke exposure and family's home smoking policy. European Journal of Public Health, 2009; 19(1):52–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19033356

35. Adhikari P and Summerill A. 1998 National Drug Strategy Household Survey: Detailed findings. Drug statistics series no. 6, AIHW cat. no. PHE 27.Canberra: Australian Institute of Health and Welfare, 1999. Available from: https://www.aihw.gov.au/reports/alcohol-other-drug-treatment-services/1998-ndshs-detailed-findings/contents/table-of-contents.

36. Germain D, McCarthy M, and Durkin S. Smoking bans in Victorian workplaces: Reduced disparities in exposure to secondhand smoke, 1998 to 2007. CBRC Research Paper Series No. 35, Melbourne, Australia: Centre for Behavioural Research in Cancer, Cancer Council Victoria, 2008. Available from: http://www.cancervic.org.au/cbrc-smoking-bans-vic-workplaces.html.

37. Bain E and Hayes L. Second-hand smoke exposure among Victorians: Findings from the Victorian smoking and health survey 2016. Melbourne, Australia: Centre for Behavioural Research in Cancer, Cancer Council of Victoria, 2017.

38. Guydish J, Passalacqua E, Tajima B, and Manser ST. Staff smoking and other barriers to nicotine dependence intervention in addiction treatment settings: A review. J Psychoactive Drugs, 2007; 39(4):423–33. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18303699

39. Johnson JL, Malchy LA, Ratner PA, Hossain S, Procyshyn RM, et al. Community mental healthcare providers' attitudes and practices related to smoking cessation interventions for people living with severe mental illness. Patient Education and Counseling, 2009; 77(2):289–95. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19398293

40. Ratschen E, Britton J, Doody GA, Leonardi-Bee J, and McNeill A. Tobacco dependence, treatment and smoke-free policies: A survey of mental health professionals' knowledge and attitudes. General Hospital Psychiatry, 2009; 31(6):576–82. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19892217

41. Stockings EA, Bowman JA, Bartlem KM, McElwaine KM, Baker AL, et al. Implementation of a smoke-free policy in an inpatient psychiatric facility: Patient-reported adherence, support, and receipt of nicotine-dependence treatment. International Journal of Mental Health Nursing, 2015; 24(4):342–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25970237