9.2 Trends over time in smoking among priority populations in Australia

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 (SES), vs. type of employment) and the sex of the person who smokes.

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 It is also important to consider intersectional patterns in smoking prevalence; that is, the ways in which health behaviours are shaped by combinations of individual and social factors. The risk of smoking tends to be higher among people who belong to multiple priority groups.² For example, research examining smoking among employed Australians found that daily smoking prevalence was highest among low SES workers from regional or remote areas and lowest among high SES workers from metropolitan locations.³ 

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 2023, 32% of Australians aged 15–74 had a university degree,⁴ compared with 7% in 1982.⁵

Rates of school retention have increased substantially over time.⁶ 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 about four in five in 2023.^7,8

In a period of low unemployment and a buoyant job market, the unemployed in the 2020s may similarly be less socially diverse than groups who were unemployed during times of high unemployment and low job vacancies in the early 1980s (when unemployment peaked at about 10%).⁹ Towards the end of the 2000s, 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 2009.¹⁰ In September 2024, the unemployment rate had declined to 4.1%.⁹

Inconsistencies in methods of collecting data and in socioeconomic categories over time may also increase the difficulty of long-term analysis. 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 among persons, males, and females by socio-economic indexes for areas (SEIFA) quintiles from 2001 to 2022 using data from the National Drug Strategy Household Surveys.¹¹ For all persons aged 18+ over this period, regular smoking declined linearly among all quintiles (controlling for age and sex). For the most recent period of 2019 to 2022–2023 prevalence declined among all but the most advantaged quintile (i.e., among quintiles 1 to 4).¹² Among both males and females, there was a significant linear decline in smoking prevalence among all quintiles (controlling for age).

9.2.1.2 Trends over time in smoking and formal education

Increasing education levels are associated with decreased likelihood of smoking. Figure 9.2.2 sets out the prevalence of current smoking among people with various levels of education between 1980 and 2022–2023 using data collected in surveys conducted by the Anti-Cancer Council of Victoria (ACCV; now Cancer Council Victoria) until 1998^13-18 and the National Drug Strategy Household Survey (NDSHS) from 1998 to 2022–2023.^12,19-25

As is evident from Figure 9.2.1, the decline in prevalence of smoking for the total 42-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 2022–2023, there has been a significant linear decline in regular smoking within each education group (controlling for age and sex). Between 2019 and 2022–2023, prevalence declined only among those who had obtained year 12, a trade, or university qualifications.

Table 9.2.1 shows these trends over time for all persons, men and women.

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,^5,7 it is likely that higher educational achievement rates have contributed to the overall decline in smoking among the Australian population. Table 9.2.2 shows smoking prevalence over time by education level and age group.  

In 2022–2023, within the oldest age group, there were no differences between those who did or did not finish high school—smoking prevalence was only significantly lower among those who attended university (controlling for sex). 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 group²⁶ than the oldest age group, who completed their education when leaving school early was much more common.²⁷ Within both younger age groups, those who did not complete year 12 were significantly more likely to be regular smokers in 2022–2023. Those aged 18–39 who had not finished high school were more than three and a half times 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).¹² Research in the US²⁸ and China²⁹ has similarly found that disparities in smoking behaviours by educational attainment have widened in recent birth cohorts.

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.³⁰ Nonetheless, as shown in Figure 9.2.3, regular smoking has significantly declined over time within all employment status groups (controlling for age and sex). For the most recent period of 2019 to 2022–23, there was only a significant decline in regular smoking among those who were currently employed or engaged in home duties (with no significant changes among the other groups).

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

Figure 9.2.4 sets out smoking prevalence between 1980 and 2019 for all occupational levels using ACCV data (1980–1998)^13-18 and NDSHS data (1998–2022–2023)^12,19-25 for adults aged 18 years and over.

The decline in prevalence of smoking has been substantial across groups. Overall, prevalence of smoking among upper white-collar workers declined by about 84%, while among lower blue-collar workers, prevalence dropped by about 66%.

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 2022–2023, regular smoking declined linearly among all occupation levels (controlling for age and sex), and in the most recent period of 2019–2022–2023, smoking prevalence declined only among white collar workers.

In 2022–2023, 5% of individuals in upper white-collar employment reported smoking, compared with 17% of those working in lower blue-collar employment, 14% of upper-blue-collar workers, and 10% of lower-white-collar workers.

Table 9.2.3 shows trends in smoking prevalence by occupation level and gender between 2001 and 2022–2023. Although differences have fluctuated over time, in 2022–2023 there were no differences in smoking prevalence between men and women within any occupation group.

9.2.2 Differential uptake or differential cessation?

In any population, smoking prevalence reduces due to a combination of fewer people taking up smoking, more people quitting, and more smokers than non-smokers dying prematurely. The material below shows changes over time in proportions of Australians in each area-based socio-economic group who have never taken up smoking and—among those that have ever smoked—the proportions who have quit smoking.

Figure 9.2.5 shows the proportion of persons, males and females who identified as never smokers, across SEIFA quintiles between 2001 and 2022–2023.

The proportion of never smokers in the most disadvantaged group was 45% in 2001 and 59% in 2022–2023, while almost 53% of those in the least disadvantaged group were never smokers in 2001 and this increased to about 68% by 2022–2023. Since 2001, there has been a significant linear increase in the proportion of never smokers within each quintile for all persons (controlling for age and sex) and both sexes (controlling for age). Between 2019 and 2022–2023 there was a significant increase among the most disadvantaged (1^st quintile) and the 3^rd quintile for all persons and for men, and no changes among the other quintiles. Among women, the only significant increase was among the 1^st (lowest) quintile.

Figure 9.2.6 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 increased among all but the most disadvantaged people who smoke (controlling for age and sex), for the most recent period of 2019 to 2022–2023 there was a significant increase among all quintiles. Among males, there was a significant increase between the two most recent surveys among quintiles 1 to 3, while for females there was an increase only among the 2^nd quintile

9.2.3 Changes in consumption of cigarettes

When interpreting data showing changes over time in consumption it is important to remember that average consumption among any group is affected not just by changes in the number of cigarettes smoked per day but also by differential levels of quitting among people with varying levels of consumption. Specifically, people who smoke more cigarettes per day are less likely to quit and more likely to continue to smoke than people who smoke fewer cigarettes per day.

9.2.3.1 Trends over time in consumption and socioeconomic status

Figure 9.2.7 shows the average number of cigarettes smoked per day among regular smokers between 2001 and 2022–2023 by SEIFA quintile. Since 2001, there has been a significant linear decline in consumption among all quintiles (controlling for age and sex). Between the two most recent surveys, there was a decline in consumption among both the lowest and highest quintiles.

9.2.3.2 Trends over time in consumption and formal education

People with higher education levels are less likely to smoke. In addition, among those who do smoke, higher education levels are associated with lower levels of consumption. Since 2001, average daily consumption has decreased among all education levels except for year 9 or less (controlling for age and sex). There were no changes in consumption among any education level between 2019 and 2022–2023. In 2022–2023, people who regularly smoked who had left school in year 9 or earlier smoked an average of 19 cigarettes per day—about one pack per day—see Figure 9.2.8.

9.2.3.3 Trends over time in consumption and employment status

In 2022–2023, people who were unemployed reported smoking the greatest number of cigarettes per day. Since 2001, consumption has declined among people of all employment statuses except those engaged in home duties (controlling for age and sex). Between 2019 and 2022–2023, the only significant decrease in consumption was among retirees. Figure 9.2.9 shows these trends over time.

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 9.2.10 illustrates consumption levels among smokers of varying occupational levels between 1980 and 2022–2023 using ACCV data (1980–1998)^13-18 and NDSHS data (2001–2022–2023).^12,19-25 Analysis of NDSHS data from 2001 onward shows that average consumption significantly declined in all occupation groups (controlling for age and sex). Between 2019 and 2022–2023, there were no declines in consumption.

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 9.2.11 shows current smoking (at least weekly) among Australian students aged 16 and 17 years between 1987 and 2022/23 according to the level of disadvantage of the neighbourhood in which they lived.^32-45 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 2022/23, current smoking did not vary significantly with socioeconomic status.⁴⁴

Figure 9.2.12 shows current smoking among Australian students aged 12–15 years between 1987 and 2022/2023 according to the level of disadvantage of the neighbourhood in which they lived.^32-45 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. By the mid-2010s, smoking rates had converged among this age group, with 3% of students in each of the quartiles reporting weekly smoking in 2014. 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),⁴⁵ while in 2022/2023 there were again no significant differences in smoking prevalence by socioeconomic status.⁴⁴

9.2.5 Changes in childhood exposure to smoking in the household 

Due to the higher prevalence of smoking, children in low socioeconomic groups are more likely to live with a person who smokes. While allowing smoking indoors is still more common among disadvantaged households with children, there have been substantial decreases over time. In 2022–2023, less than 5% of households with dependants in all groups reported that a household member smokes inside the home—see Figure 9.2.13.¹² Victorian data also encouragingly showed a significant decrease in secondhand smoke exposure at home (either indoors or outdoors) among people living in the most disadvantaged socioeconomic areas, from 24.5% in 2018 to 18.3% in 2022.⁴⁶

9.2.6 International comparisons

Observations of smoking and its connection with socioeconomic disadvantage are not confined to the Australian population. Research across low- and middle-⁴⁷ and high-income countries including the UK,^48-50 Finland,^{51, 52} Switzerland,⁵³ New Zealand,⁵⁴ Italy,^55,56 the US,^57-59 Canada,^60-62 France,⁶³ Kenya,⁶⁴ China,⁶⁵ and Iran⁶⁶ has similarly found large and often widening disparities in smoking behaviours based on income, education level, and occupation.

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.⁶⁷ 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.^68,69

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