9.2 Trends over time in smoking among priority populations in Australia

Last updated: September 2021     

Suggested citation: Greenhalgh, EM, Scollo, MM, & Pearce, M. 9.2 Socio-economic disparities in tobacco exposure and use: are the gaps widening? In 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/9-2-socioeconomic-disparities-in-tobacco-exposure-

 

While it is clear that the prevalence of smoking is higher among disadvantaged than among advantaged groups in Australia, researchers have also sought to examine whether there has been progress in reducing smoking among groups with traditionally high smoking rates. The extent of progress appears to vary over time, as well as depend on the indicator of disadvantage (e.g., education level, vs. socioeconomic status, vs. type of employment) and the sex of the smoker.

Population-wide tobacco-control strategies that reduce smoking at a similar rate of decline in low and high education groups may still (mathematically) result in increasing disparities. Some experts argue that disparity research should focus on maximising reductions in the most disadvantaged group, rather than reducing disparities per se. 1

The following section presents data on trends since 1980 in smoking among certain priority populations in Australia, including by socioeconomic status, educational attainment, employment status, and type of occupation. In sum, the prevalence of smoking has generally declined over time among all groups, regardless of the indicator.

It also summarises trends in cessation, consumption, and exposure to secondhand smoke.  

Smoking rates among other priority populations can be found elsewhere – see our sections on smoking among Aboriginal and Torres Strait Islander Peoples, pregnant women, people with mental illness, single parents, people experiencing homelessness, the prison population, users of other drugs, and the LGBTQI population.

9.2.1 Changes in the prevalence of smoking among adults in various socio-economic groups

Trends over time in smoking prevalence among different social groups can be difficult to interpret because of changing social and economic conditions. With increasing school retention in Australia and introduction of financial assistance for tertiary students in the mid-1970s, a much more diverse group of people today are achieving higher levels of formal educational qualification compared with people who undertook tertiary education in the late 1960s and early 1970s. In 2017, 27% of Australians had a university degree, compared with 7% in 1982. 2

In a period of low unemployment and a buoyant job market, the unemployed in the mid-2000s on the other hand may be less socially diverse than groups who were unemployed during times of low job vacancies in the 1980s and 1990s. Towards the end of the last decade, the unemployment rate had steadily declined to 4.2% (in 2008); however, as a result of the global financial crisis in the latter part of 2008, unemployment in Australia rose to 5.6% in 2009. 3 In 2017, the unemployment rate was about the same at 5.5%. 4

Rates of school retention have increased substantially over time. 5 Thus, current high smoking rates among those who have not completed Year 12 could be partly attributable to early school leavers becoming a group increasingly characterised by social and economic disadvantage. The proportion of young people continuing education through to Year 12 has increased from 45% in 1984 to 84% in 2016. 6

Inconsistencies in methods of collecting data and in socioeconomic categories over time make long-term analysis difficult. To get a reliable picture of trends in smoking, it is therefore useful to look at changes across several socio-economic indicators.

9.2.1.1 Trends over time in smoking and socioeconomic status

Figure 9.2.1 shows the prevalence of regular smoking by socio-economic indexes for areas (SEIFA) quintiles from 2001 to 2019 using data from the National Drug Strategy Household Surveys. Over this period, regular smoking declined linearly among all quintiles (controlling for age and sex). For the period of 2013–16, the greatest (and only significant) reduction in prevalence occurred among the most disadvantaged smokers, while for the most recent period of 2016–19 prevalence declined only among the fourth and fifth quintiles (i.e., the least disadvantaged). 

Figure 9.2.1 Prevalence of regular* smokers† in Australia, persons 18 years and over, 2001 to 2019‡, by socio-economic index for area
* Includes those reporting that they smoke ‘daily’ or ‘at least weekly’.
† Includes persons smoking any combination of cigarettes, pipes or cigars.
‡ All data weighted to the Australian population appropriate for each survey year and may vary slightly from data presented in previous edition.
Source: Centre for Behavioural Research in Cancer analysis of National Drug Strategy Household Survey data from 2001 to 2019. 7-13
The data are grouped in quintiles calculated using one of the socio-economic indexes for areas (SEIFA) developed by the Australian Bureau of Statistics.  The ABS’s Index of Advantage/Disadvantage is based on a continuum of advantage to disadvantage.

Among both men and women, there was a significant linear decline in smoking prevalence among all quintiles (controlling for age; see Figures 9.2.2 and 9.2.3).

 

Figure 9.2.2 Prevalence of regular* smokers† in Australia, men aged 18+, 2001 to 2019‡, by socio-economic index for area

Source and notes: See Figure 9.2.1

Figure 9.2.3 Prevalence of regular* smokers† in Australia, women aged 18+, 2001 to 2019‡, by socio-economic index for area

Source and notes: See Figure 9.2.1

9.2.1.2 Trends over time in smoking and formal education

Increasing education levels are associated with decreased likelihood of smoking. Figure 9.2.4 sets out the prevalence of current smoking among people with various levels of education between 1980 and 2019 using data collected in surveys conducted by the Anti-Cancer Council of Victoria (ACCV; now Cancer Council Victoria) until 1998, and the National Drug Strategy Household Survey (NDSHS) from 1998 to 2019.

As is evident from Figure 9.2.1, the decline in prevalence of smoking for the total 39-year period covered by these surveys was greatest among those with a university-level education, but was also substantial among all other groups. Analysis of data from the NDSHS shows that between 2001 and 2019, there has been a significant linear decline in regular smoking within each education group (controlling for age and sex). Smoking among most groups remained steady between 2016 and 2019, with prevalence declining only among those who had completed year 12 or equivalent.

Figure 9.2.4 Prevalence of regular* smokers† in Australia aged 18+, 1980 to 1998 (ACCV data) and 1998 to 2019‡ (NDSHS data)—by educational achievement
* Anti-Cancer Council of Victoria (ACCV) data includes those describing themselves as ‘current smokers’ with no frequency specified; National Drug Strategy Household Survey (NDSHS) data includes those reporting that they smoke ‘daily’ or ‘at least weekly’. Note that in the 1998 NDSHS, secondary school education attainment was asked in a different format to 2001 onwards.
†Includes persons smoking any combination of cigarettes, pipes or cigars
‡ Anti-Cancer Council data weighted to 2001 census population data, standardised by age and sex; NDSHS survey data weighted to the Australian population appropriate for each survey year and is not standardised
Source: Hill and Gray 1982, 14 1984, 15 Hill 1988, 16 Hill, White and Gray 1991, 17 Hill and White 1995, 18 Hill, White and Scollo 1998, 19   and Centre for Behavioural Research in Cancer, analysis of data from the National Drug Strategy Household Survey since 1998 7-13

 

Table 9.2.1 shows these trends over time for men and women. In 2019, as with earlier years, smoking prevalence was significantly higher among men than women of all education levels (controlling for age). 

Table 9.2.1 Prevalence (%) of regular* smoking among Australian adults (18+ years) by educational level and sex— 2001 to 2019‡
Note: Certificates III-IV have replaced the previous system of trade certificates
* Smoked daily or weekly
Includes persons smoking any combination of cigarettes, pipes or cigars
All data weighted to the appropriate Australian population and may vary slightly from data presented in previous edition.
Source: Centre for Behavioural Research in Cancer, analysis of data from the National Drug Strategy Household Surveys since 2001 7-13  

 

A person’s age also plays an important role in the relationship between smoking prevalence and education level. As the proportion of Australians completing high school to the end of Year 12 and those attaining post-school qualifications have increased over time, 2, 6 it is likely that higher educational achievement rates have contributed to the overall decline in smoking among the Australian population.

As shown in table 9.2.2, smoking prevalence has significantly declined over time among young adults (18–39 years) within each education group (controlling for gender). Among middle-aged people (40–59 years), prevalence declined among those with year 12 or higher, but not among those who did not complete high school, and among the oldest age group (60+) there has only been a decline in smoking among those with the highest level of education.

In 2019, within the oldest age group, there were no differences between those who did or did not finish high school—smoking levels were only significantly lower among those who attended university. Finishing year 12 becomes increasingly important for adults under 60 years in terms of smoking prevalence, which is likely because younger adults who have not attained year 12 reflect a far more disadvantaged group 20 than the oldest age group, who completed their education when leaving school early was much more common. 21 Within both younger age groups, those who did not complete year 12 were significantly more likely to be regular smokers in 2019. Those aged 18–39 who had not finished high school were more than twice as likely to smoke than those who had attained year 12 or equivalent and more than six times more likely to smoke than those with a university-level education (adjusting for sex). 

Table 9.2.2 Prevalence of regular* smoking among Australian adults (18+ years) by educational level and age group—2001 to 2019‡
Note: Certificates III-IV have replaced the previous system of trade certificates
* Smoked daily or weekly
Includes persons smoking any combination of cigarettes, pipes or cigars
All data weighted to the appropriate Australian population and may vary slightly from data presented in previous edition.
Source: Centre for Behavioural Research in Cancer, analysis of data from the National Drug Strategy Household Surveys since 2001 7-13  

9.2.1.3 Trends over time in smoking and employment status

A person’s employment status is strongly related to their overall health. In general, people who are unemployed experience poorer health and have higher mortality rates than those who are employed. 22 Nonetheless, as shown in figure 9.2.5, regular smoking has significantly declined over time within all employment status groups (controlling for age and sex). For the most recent period of 2016 to 2019, there was only a significant decline in regular smoking among those who were currently employed (with no significant changes among the other groups).

Figure 9.2.5 Prevalence of regular *  smokers in Australia aged 18+ years , 2001 to 2019 —by employment status

* Smoked daily or weekly
Includes persons smoking any combination of cigarettes, pipes or cigars
All data weighted to the Australian population appropriate for each survey year and may vary slightly from data presented in previous edition
Source: Centre for Behavioural Research in Cancer, analysis of data from the National Drug Strategy Household Surveys since 2001 7-13  

9.2.1.4 Trends over time in smoking and occupation level (blue vs. white collar)

Figure 9.2.6 sets out smoking prevalence between 1980 and 2019 for all occupational levels using ACCV data (1980–1998) and NDSHS data (1998–2019) for adults aged 18 years and over.

Figure 9.2.6 Prevalence of regular* smokers† in Australia aged 18+, 1980 to 1998 (ACCV data) and 1998 to 2019‡ (NDSHS data)—by occupation level

Source and notes: See Figure 9.2.4

 

The decline in prevalence of smoking has been substantial across groups. Overall, prevalence of smoking among upper white-collar workers declined by about 76%, while among lower blue-collar workers, prevalence dropped by about 60%.

Smoking rates over the 1980s and early 1990s declined roughly equally in absolute terms among these occupational groups. Progress appears to have slowed in the mid-1990s among blue collar workers before the downward trend in smoking resumed in all four occupational groups. Between 1998 and 2019, regular smoking declined linearly among all occupation levels (controlling for age and sex), and in the most recent period of 2016–19, smoking prevalence declined among all groups except upper blue-collar workers.

In 2019, 8% of individuals in upper white-collar employment were smokers, compared with 21% of those working in lower blue-collar employment, 17% of upper-blue-collar workers, and 13% of lower-white-collar workers.

Table 9.2.3 shows trends in smoking prevalence by occupation level and gender between 2001 and 2019. Although differences have fluctuated over time, in both 2001 and 2019 there were no differences in smoking prevalence between men and women within any occupation group.

Table 9.2.3 Prevalence of regular*  smoking† by occupational level and sex among employed Australian adults (aged 18+ years)—2001 to 2016‡

Upper white collar: includes professionals, business owners, executives, farm owners, semi-professionals
Lower white collar: includes sales, other white collar
Upper blue collar: includes skilled workers
Lower blue collar: includes semi-skilled, unskilled, farm workers.
Note: classifications changed in 2010 such that some occupations that would have been classed as Upper Blue in 2007 may be classified as Lower Blue in 2010. Tradepersons are classified as Upper Blue in 2010 but would have been classified as Lower White in previous years. For more information see the ABS website. 23
* Smoked daily or weekly
Includes persons smoking any combination of cigarettes, pipes or cigars
All data weighted to the appropriate Australian population and may vary slightly from data presented in previous edition
Source: Centre for Behavioural Research in Cancer, analysis of data from the National Drug Strategy Household Surveys since 2001 7-13

9.2.2 Differential uptake or differential cessation?

In the general population, smoking prevalence has reduced due to a combination of fewer people taking up smoking, more people quitting, and more smokers than non-smokers dying prematurely. Figure 9.2.7 shows the proportion of persons who identified as never smokers, across SEIFA quintiles between 2001 and 2019.

Figure 9.2.7 Percentage never smokers in Australia, persons 18 years and over, 2001 to 2019‡, by socio-economic index for area
Source and notes: see Figure 9.2.1.

 

The proportion of never smokers in the most disadvantaged group was 45% in 2001 and 54% in 2019, while almost 53% of those in the least disadvantaged group were never smokers in 2001 and this increased to about 68% by 2019. Since 2001, there has been a significant linear increase in the proportion of never smokers within each quintile (controlling for age and sex), and between 2016 and 2019 there was a significant increase among the least disadvantaged (4 th and 5 th quintiles), and a significant decrease among the most disadvantaged (1 st quintile).

The proportion of men identifying as never smokers significantly increased between 2001 and 2019, across all quintiles (controlling for age; see Figure 9.2.8). In the most recent period of 2016 to 2019, the proportion of never smokers remained steady within all quintiles.

Figure 9.2.8 Percentage never smokers in Australia, males 18 years and over, 2001 to 2019‡, by socio-economic index for area
Source and notes: see Figure 9.2.1

 

Figure 9.2.9 shows the proportion of women who identified as never smokers, across SEIFA quintiles between 2001 and 2019. Proportions of never smoking women have significantly increased since 2001 across all quintiles (controlling for age). There was a significant increase in never smokers between 2016 and 2019 among the least disadvantaged women (4 th and 5 th quintiles), and a significant decrease among the most disadvantaged (1 st quintile).

Figure 9.2.9 Percentage never smokers in Australia, females 18 years and over, 2001 to 2016‡, by socio-economic index for area  
Source and notes: see Figure 9.2.6

 

Figure 9.2.10 shows quit proportions (i.e., the proportion of ever smokers who have quit) among adults across SEIFA quintiles. While the proportion of adults quitting smoking since 2001 has significantly increased among the second through fifth quintiles, there has been a significant linear decrease in quit proportions among the most disadvantaged smokers (controlling for age and sex).  

 

Figure 9.2.10 Percentage of ever smokers who have quit in Australia, persons 18 years and over, 2001 to 2019, by socio-economic index for area
Source and notes: see Figure 9.2.1

 

Figure 9.2.11 shows quit proportions among men by SEIFA quintiles. There has been a significant increase in the proportion of men who have quit only among the least disadvantaged groups (4 th and 5 th quintiles), while there has been a significant decrease in the proportion of the most disadvantaged men quitting (controlling for age).

Figure 9.2.11 Percentage of ever smokers who have quit in Australia, males 18 years and over, 2001 to 2019‡, by socio-economic index for area
Source and notes: see Figure 9.2.1

 

Figure 9.2.12 shows quitting proportions among women by SEIFA quintile. There has been no significant change over time in quit proportions among the most disadvantaged women, while there has been a significant increase among each of the other quintiles (controlling for age).

 

Figure 9.2.12 Percentage of ever smokers who have quit in Australia, females 18 years and over, 2001 to 2019 ‡ , by socio-economic index for area
Source and notes: see Figure 9.2.1

9.2.3 Changes in consumption of cigarettes

9.2.3.1 Trends over time in consumption and socioeconomic status

Figure 9.2.13 shows the average number of cigarettes smoked per day among regular smokers between 2001 and 2019 by SEIFA quintile. Since 2001, there has been a significant linear decline in consumption among all quintiles (controlling for age and sex); however, there were no changes between the most recent two survey years.

Figure 9.2.13 Self­-reported cigarettes smoked (number per day) by Australian adult regular smokers, 2001 to 2019‡, by SEIFA quintiles
Source and notes: see Figure 9.2.1

9.2.3.2 Trends over time in consumption and formal education

People with higher education levels are less likely to be smokers. In addition, among those who do smoke, higher education levels are also associated with lower levels of consumption. Since 2001, average daily consumption has decreased among all education levels (controlling for age and sex), although between the two most recent survey years, consumption only decreased among those who had completed year 12 and it increased among those who had completed only up to year 10/11. In 2019, regular smokers who had left school in year 9 or earlier smoked an average of 21 cigarettes per day – about one pack per day—see Figure 9.2.14.  

Figure 9.2.14 Daily consumption among regular* smokers in Australia aged 18+ years, 2001 to 2019 —by education level

* Smoked daily or weekly
Includes persons smoking factory made cigarettes and/or roll-you-own
All data weighted to the Australian population appropriate for each survey year and may vary slightly from data presented in previous edition
Source: Centre for Behavioural Research in Cancer, analysis of data from the National Drug Strategy Household Surveys 2001–2019 7-13

9.2.3.3 Trends over time in consumption and employment status

Although people who are retired are less likely to smoke (see Section 1.7), those who do smoke appear to consume the greatest number of cigarettes per day. Nonetheless, consumption has declined among people of all employment statuses since 2001 (controlling for age and sex), although remained stable in recent years for all groups except retirees, whose consumption increased between 2016 and 2019. Figure 9.2.15 shows these trends over time.

Figure 9.2.15 Daily consumption among regular* smokers in Australia aged 18+ years, 2001 to 2019 —by employment status
* Smoked daily or weekly
Includes persons smoking factory made cigarettes and/or roll-you-own
All data weighted to the Australian population appropriate for each survey year and may vary slightly from data presented in previous edition
Source: Centre for Behavioural Research in Cancer, analysis of data from the National Drug Strategy Household Surveys 2001–2019 7-13

9.2.3.4 Trends over time in consumption and occupation level

Among people who are employed, consumption differs by occupation level. People in blue collar occupations are more likely to smoke (see Section 9.1), and to smoke more heavily than people in white collar occupations.

Figure 9.2.16 illustrates consumption levels among smokers of varying occupational levels between 1980 and 2019 using ACCV data (1980–1998) and NDSHS data (2001–2019). Analysis of NDSHS data from 2001 onward shows that average consumption significantly declined in all occupation groups (controlling for age and sex). Between 2016 and 2019, there was a significant decline in consumption only among upper white-collar workers.

Figure 9.2.16 Self­-reported cigarettes smoked (number per day) by Australian adult smokers*, 1980 to 1998 (ACCV data) and 2001 to 2019‡ (NDSHS data), by occupational level
Source and notes: see Figure 9.2.4

9.2.4 Changes in the prevalence of smoking among students in schools in areas of varying levels of disadvantage

Higher levels of uptake among disadvantaged groups have traditionally been even more significant than lower levels of cessation as a driver of socio-economic disparities in smoking in Australia. Data on smoking rates among secondary school students of different socio-economic backgrounds can provide an indication of what future smoking disparities may look like.

Figure 9.2.17 shows current smoking (at least weekly) among Australian students aged 16 and 17 years between 1987 and 2017 according to the level of disadvantage of the neighbourhood in which they lived. Declines in student smoking rates have been substantial across all quartiles since the late nineties and early 2000s. For the first half of the 2000s, smoking rates appear to follow a social gradient, with the lowest proportion of smokers in the least disadvantaged group. Since then, there is no clear pattern of smoking by socioeconomic status among students aged 16 and 17 years. In 2017 current smoking did not vary significantly with socioeconomic status. 24

Figure 9.2.17 Reported current smoking (smoking in the last week), secondary students in Australia aged 16 and 17 years, 1987–2017, ranked by quartiles of disadvantage by the area in which the student lived

Sources: E Bain and N Guerin, personal communication, using data from Hill, Willcox, Gardner and Houston; 25   Hill, White, Pain and Gardner 1990; 26 Hill, White, Williams and Gardner 1993; 27 Hill, White and Segan 1995; 28 Hill, White and Letcher 1999; 29 Hill, White and Effendi 2002; 30 White and Hayman 2004 31 and  2006; 32 White and Smith 2009; 33 White and Bariola 2012; 34 White and Williams 2015; 35 and Guerin and White 2018. 36

Figure 9.2.18 shows current smoking among Australian students aged 12–15 years between 1987 and 2017 according to the level of disadvantage of the neighbourhood in which they lived. Following a sharp increase in prevalence among the lowest SES students between 1990 and 1996, smoking appears to decline roughly equally among students at all levels of disadvantage until 2005. Prior to the most recent survey, smoking rates had converged among this age group, with 3% of students in each of the quartiles reporting weekly smoking in 2014. However, in 2017, those living in areas with relatively greater socioeconomic disadvantage (first quartile) were significantly more likely to report current smoking than those who lived in relatively less disadvantaged areas (fourth quartile). 24

 

Figure 9.2.18 Reported current smoking (smoking in the last week), secondary students in Australia aged 12–15 years, 1987–2017, ranked by quartiles of disadvantage by the area in which the student lived
Sources: see Figure 9.2.17

9.2.5 Changes in childhood exposure to smoking in the household 

The disparity in children living with a smoker has widened over time; in 2001, about half of the most disadvantaged households with a dependent child contained a smoker (51%) compared with about two in five in 2019 (42%). Comparatively, among the least disadvantaged households, the proportion of households with children and a smoker halved between 2001 (32%) and 2019 (16%). 

Encouragingly, the percentage of households with dependent children that also allow smoking indoors has decreased substantially since 2001 in all SEIFAs, but more so among disadvantaged groups (see Table 9.2.4). The difference in smokefree households between the most and least disadvantaged groups was only about 6% in 2019, compared with 16% in 2001 (and 23% in 2004).

In 2019, 88% of the most disadvantaged households with dependent children and at least one smoker reported keeping their home smokefree (that is, the smoker (or smokers) smoked only outdoors). The proportion of outdoor-only smoking in this group rose by about 37% from 2001 (see Table 9.2.4).

Table 9.2.4 Percentage of households with a smoker that reported only allowing smoking outdoors in the last 12 months, Australia, 2001 to 2019, socio-economic index for areas: households with dependent children
Source and notes: see Figure 9.2.6

9.2.6 International comparisons

Observations of smoking and its connection with socio-economic disadvantage are not confined to the Australian population. Survey data in the UK show more rapid declines in smoking among non-manual workers compared with manual workers since the 1970s, contributing to a widening of smoking prevalence between these groups. Smoking was nearly twice as common in routine and manual households as in managerial and professional households (28% compared to 15%). Smoking prevalence was particularly high among economically inactive people aged 16–59 years, whose last job was a routine or manual one; 50% of these people were smokers. 37 A more recent study in England found that, of a range of measures of socioeconomic status, housing tenure, social grade, educational qualifications, and income were the strongest predictors of smoking. 38

Observations on high smoking rates among people with lower income and educational attainment have also been made in research from Finland, 39 New Zealand, 40 Italy, 41, 42 the US, Canada, 43-45 France, 46 Kenya, 47 and Iran. 48

Similar to the picture in Australia, research in England between 1996 and 2006 found that children from more deprived households were most exposed to secondhand smoke, however across the 11-year research period exposure declined substantially. The most marked declines were observed immediately before the introduction of smokefree legislation in England and among children who were most exposed at the outset. 49 Similarly, several studies in the US have found that, despite some ongoing socioeconomic disparities, children’s exposure to secondhand smoke at home has markedly decreased over time. 50, 51

Relevant news and research

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