9.5 Smoking and intergenerational poverty

Last updated: October 2022

Suggested citation:
Greenhalgh, EM, Scollo, MM, & Pearce, M. 9.5 Smoking and intergenerational poverty. 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/chapter-9-disadvantage/9-5-smoking-and-intergenerational-poverty


Families where one or more parent uses tobacco not only suffer more immediate financial stress (see Section 9.4), but also less long-term financial security and a greater likelihood of poverty.

Spending on tobacco products, absenteeism from work and school, and loss of income due to smoking-related disease and premature death of breadwinners substantially reduce the capacity of a household to accumulate assets such as a family home, to insure against losses, to save for retirement, and to pass on assets to the next generation (Figure 9.5.1).

Figure 9.5.1

Figure 9.5.1
Socio-economic influences on cardiovascular disease from a life-course perspective

Source: National Public Health Partnership 2001 1
Note: Adapted by M Scollo from Figure 6 in Preventing chronic disease: a strategic framework background paper 1

9.5.1 Spending on tobacco products and its impact on financial security and wealth accumulation

Higher rates of smoking and longer average times until cessation2 mean that lower socio-economic status (SES) smokers are more likely to suffer both financial stress and compromised living standards than smokers who are more advantaged; smoking both causes and exacerbates financial stress and poverty.3, 4 A UK report concluded that while about one million, or one in five (21%), smoking households were living below the poverty line, when tobacco expenditure was included in the assessment of poverty this increased to nearly one-third (32%), equivalent to 1.5 million households. That is, the inclusion of tobacco costs moves an extra half a million households into poverty.3

Spending on tobacco can create ‘smoking-induced deprivation’—whereby the smoker has reported spending money on tobacco rather than on household essentials.5, 6 Being unable to afford or access adequate food (termed ‘food insecurity’) is also more common among people who smoke.7-14 Households where one or more adults smoke are also less likely to have funds for discretionary spending on items such as house and contents insurance, motor vehicle insurance, and health insurance.15, 16 Expenditure on health-risk behaviours are also more likely in smoking households— one Australian study found odds of reporting expenditure on alcohol, drinking at licensed premises, and gambling were 100%, 50%, and 40% greater for smoking than for non-smoking households.16

Multiple studies have found associations between smoking, financial stress, and housing insecurity.17, 18 Further, low-income families where at least one person smokes are less likely to be able to save a house deposit, so they are much less likely to own their own home.19 This is likely increasingly the case as the price of tobacco products has increased (see Section 13.3) alongside decreasing housing affordability.20  Data from the Household Income and Labour Dynamics in Australia survey showed evidence of an association between being a smoking household (defined as having one smoker in the household) and having inadequate housing.21 Issues of poor housing quality—including pest infestations, water leaks, lack of air conditioning or heating, and mould—are also common among low-income smokers, and can compound poor mental and physical health outcomes for these households.22

Low-income families where one or more adults smoke may also be less likely to invest in superannuation, life insurance, and insurance against loss of income.15 This translates to less security of income in older age, and less wealth to financially assist or leave inheritance for adult children. Smokers are also more likely to report a higher level of perceived income inequality, lower perception of relative material wellbeing, and living in a community with a lower degree of trust and safety.23

9.5.2 The long-term effects of smoking during pregnancy for children

Smoking during pregnancy and exposure to secondhand smoke increases the risk of a range of poor health outcomes for pregnant women and their infants. This heightened risk of health problems continues throughout childhood and adolescence, with potential lifelong consequences (see Sections 3.73.8 and 4.164.17). As smoking during pregnancy and exposure to secondhand smoke are more common among those experiencing disadvantage (see Section 7.11), children from these households are more likely to experience both poor short- and long-term health concerns, which further compound long-term financial insecurity.  

9.5.3 Exposure to secondhand smoke and school absence

Children who suffer asthma and frequent respiratory disease (which can be caused or exacerbated by exposure to secondhand smoke—see Chapter 4) miss more time at school than healthier children. Exposure to secondhand smoke reduces school attendance24 and in turn decreases the productivity of parents who need to miss work to care for children.25 Poor school attendance is a strong predictor of academic failure.26

Exposure to secondhand smoke may still reduce academic performance even where it does not affect school attendance. A longitudinal analysis of educational achievement in children in the UK found that young people exposed to secondhand smoke at home were more likely to fail standardised achievement tests.27 This finding held regardless of prenatal exposure, school attendance, and SES.

9.5.4 Parental example and smoking uptake: the cycle continues

Children who grow up in households where adults smoke are more likely to take up smoking. As discussed in detail in Chapter 5, smoking by one or both parents is a strong predictor of uptake among children,28, 29 while parents’ smoking cessation reduces the chances of children taking up smoking.30 Research in the UK suggests that the relationship between disadvantage and smoking uptake can largely be explained by parental modelling of smoking. That is, reducing disadvantaged children’s exposure to smoking may largely reduce future disparities in tobacco use.31

Consistent with trends in other countries,32, 33 Australian teenagers are much more likely to experiment and to smoke regularly if one or both of their parents smoke than if neither of their parents smoke. Figures 9.5.2 and 9.5.3 show smoking status among secondary school students in 2011 in Victoria according to parental smoking status. Among 12–15 year olds, the likelihood of smoking increased alongside the number of parents who smoked. Among older students, students who had a smoking parent were more likely to report smoking compared with those who did not, regardless of whether it was one or both parents.34

Figure 9.5.2
Proportion of Victorian students aged 12–15 years who were never smokers, experimental smokers or current smokers among students with no parent smoking, one, or two parents smoking, Australia, 2011

Figure 9.5.3
Proportion of Victorian students aged 16–17 years who were never smokers, experimental smokers or current smokers among students with no parent smoking, one, or two parents smoking, Australia, 2011

Source: Department of Health, 2013 30

The effects of parental smoking on their children’s smoking appear to be lasting. Among Australian secondary school students interviewed in 1985, compared to their peers who reported neither parent smoking, younger teenage boys who reported that both parents smoked were 50% more likely and younger teenage girls were 100% more likely to still be smokers 20 years later.29

Both genetic and environmental influences can increase the risk of smoking uptake in adolescent children of parents who smoke. Parenting style and attitudes, parental supervision, and smoking bans in the home can all affect the likelihood that a young person will take up smoking—see Section 5.7 for a detailed discussion.


Relevant news and research

For recent news items and research on this topic, click  here. ( Last updated August 2022)



1. National Public Health Partnership. Preventing Chronic Disease: A Strategic Framework. Background Paper. Melbourne 2001. Available from: https://commed.vcu.edu/Chronic_Disease/2015/NPHPProject.pdf

2. 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

3. Action on Smoking and Health. Estimates of poverty in the UK adjusted for expenditure on tobacco – 2021 update. ASH,  2021. Available from: https://ash.org.uk/information-and-resources/reports-submissions/reports/smoking-and-poverty/

4. Nguyen MN, Nguyen AN, Bui HT, and Vu LH. Impoverishing effect of tobacco use in Vietnam. Tobacco Control, 2022. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35896377

5. Siahpush M, Borland R, and Yong HH. Sociodemographic and psychosocial correlates of smoking-induced deprivation and its effect on quitting: findings from the International Tobacco Control Policy Evaluation Survey. Tobacco Control, 2007; 16(2):e2–e. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17400932

6. Siahpush M, Borland RON, Yong H-H, Cummings KM, and Fong GT. Tobacco expenditure, smoking-induced deprivation and financial stress: Results from the International Tobacco Control (ITC) Four-Country Survey. Drug and Alcohol Review, 2012; 31(5):664–71. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22404640

7. Armour B, Pitts M, and Lee C-W. Cigarette smoking and food insecurity among low-income families in the United States, 2001. American Journal of Health Promotion, 2008; 22(6):386–93. Available from: www.ncbi.nlm.nih.gov/pubmed/18677878

8. Cutler-Triggs C, Fryer GE, Miyoshi TJ, and Weitzman M. Increased rates and severity of child and adult food insecurity in households with adult smokers. Arch Pediatr Adolesc Med, 2008; 162(11):1056–62. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18981354

9. Bergmans RS, Coughlin L, Wilson T, and Malecki K. Cross-sectional associations of food insecurity with smoking cigarettes and heavy alcohol use in a population-based sample of adults. Drug and Alcohol Dependence, 2019; 205:107646. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31677489

10. Farrelly MC and Shafer PR. Comparing Trends Between Food Insecurity and Cigarette Smoking Among Adults in the United States, 1998 to 2011. American Journal of Health Promotion, 2017; 31(5):413–6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27493199

11. Kim-Mozeleski JE and Pandey R. The Intersection of Food Insecurity and Tobacco Use: A Scoping Review. Health Promotion Practice, 2020; 21(1_suppl):124S–38S. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31908208

12. Mayer M, Gueorguieva R, Ma X, and White MA. Tobacco use increases risk of food insecurity: An analysis of continuous NHANES data from 1999 to 2014. Preventive Medicine, 2019; 126:105765. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31260724

13. Veldheer S, Lovelace C, Zickgraf H, Stefano E, and Rigby A. The Co-occurrence of Food Insecurity, Smoking and Obesity in U.S. Adults: National Health and Nutrition Examination Survey (NHANES), 2013–2014 (P04-088-19). Current Developments in Nutrition, 2019; 3(Supplement_1). Available from: https://www.ncbi.nlm.nih.gov/pubmed/31225379

14. Wysota CN, Sherman SE, Vargas E, and Rogers ES. Sociodemographic Correlates of Food Insecurity Among New York City Tobacco Users. American Journal of Health Promotion, 2020; 34(6):664–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32030990

15. Siahpush M. Unpublished analysis of 1998 National Drug Strategy Household Survey. Melbourne: VicHealth Centre for Tobacco Control, 2002.

16. Siahpush M, Borland R, and Scollo M. Is household smoking status associated with expenditure on food at restaurants, alcohol, gambling and insurance? Results from the 1998-99 Household Expenditure Survey, Australia. Tobacco Control, 2004; 13(4):409–14. Available from: http://tc.bmjjournals.com/cgi/content/abstract/13/4/409

17. Widome R, Joseph AM, Hammett P, Van Ryn M, Nelson DB, et al. Associations between smoking behaviors and financial stress among low-income smokers. Preventive Medicine Reports, 2015; 2:911–5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26844167

18. Baggett TP, Rigotti NA, and Campbell EG. Cost of Smoking among Homeless Adults. New England Journal of Medicine, 2016; 374(7):697–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26886544

19. Siahpush M. Socioeconomic status and tobacco expenditure among Australian households; results from the 1998–99 Household Expenditure Survey. Journal of Epidemiology and Community Health, 2003; 57(10):798–801. Available from: http://jech.bmj.com/cgi/content/abstract/57/10/798

20. Raynor K, Dosen I, and Otter C. Housing affordability in Victoria. Parliamentary Library & Information Service 2017. Available from: https://www.parliament.vic.gov.au/publications/research-papers/summary/36-research-papers/13840-housing-affordability-in-victoria

21. Jamsen K, Siahpush M, and Simpson JA. Smoking and inadequate housing: results from an Australian national survey. Public Health, 2008; 122(9):873–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18490038

22. Garg R, McQueen A, Wolff JM, Skinner KE, Kegler MC, et al. Low housing quality, unmet social needs, stress and depression among low-income smokers. Preventive Medicine Reports, 2022; 27:101767. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35321214

23. Siahpush M, Borland R, Taylor J, Singh GK, Ansari Z, et al. The association of smoking with perception of income inequality, relative material well-being, and social capital Social Science & Medicine 2006; 63(11):2801–12. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16971030

24. Charlton A and Blair V. Absence from school related to children's and parental smoking habits. British Medical Journal, 1989; 298(6666):90–2. Available from: https://www.ncbi.nlm.nih.gov/pubmed/2493304

25. Gilliland FD, Berhane K, Islam T, Wenten M, Rappaport E, et al. Environmental tobacco smoke and absenteeism related to respiratory illness in schoolchildren. American Journal of Epidemiology, 2003; 157(10):861–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/12746237

26. Zubrick S, Silburn S, Gurrin L, Teoh H, Shepherd C, et al. Western Australian Child Health Survey: Education, Health and Competence. Perth, Western Australia: Australian Bureau of Statistics and the TVW Telethon Institute for Child Health Research, 1997. Available from: http://trove.nla.gov.au/work/153144358?q&versionId=217785299

27. Collins BN, Wileyto EP, Murphy MF, and Munafo MR. Adolescent environmental tobacco smoke exposure predicts academic achievement test failure. The Journal of Adolescent Health, 2007; 41(4):363–70. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17875462

28. Rainio S, Rimpelä A, Luukkaala T, and Rimpelä M. Evolution of the association between parental and child smoking in Finland between 1977 and 2005. Preventive Medicine, 2008; 46(6):565–71. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18289657

29. Paul SL, Blizzard L, Patton GC, Dwyer T, and Venn A. Parental smoking and smoking experimentation in childhood increase the risk of being a smoker 20 years later: the Childhood Determinants of Adult Health Study. Addiction, 2008; 103(5):846–53. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18412765

30. Farkas A, Distefan J, Choi W, Gilpin E, and Pierce J. Does parental smoking cessation discourage adolescent smoking? Preventive Medicine, 1999; 28(3):213–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10072737

31. van Wouwe JP, Taylor-Robinson DC, Wickham S, Campbell M, Robinson J, et al. Are social inequalities in early childhood smoking initiation explained by exposure to adult smoking? Findings from the UK Millennium Cohort Study. PLoS One, 2017; 12(6):e0178633. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28575096

32. Audrain-McGovern J, Rodriguez D, Tercyak KP, Neuner G, and Moss HB. The impact of self-control indices on peer smoking and adolescent smoking progression. J Pediatr Psychol, 2006; 31(2):139–51. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16467314

33. Pan J and Han W. Exploring the intergenerational persistence of health behaviour: an empirical study of smoking from China. BMC Public Health, 2017; 17(1):557. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28595640

34. Department of Health. Victorian secondary school students’ use of licit and illicit substances in 2011: Results from the 2011 Australian Secondary Students’ Alcohol and Drug (ASSAD) Survey.  2013.