9.8 Are current strategies to discourage smoking in Australia inequitable?

Last updated: March 2022 

Suggested citation: Greenhalgh, EM, Scollo, MM, & Pearce, M. 9.8  Are population-wide strategies to discourage smoking in Australia inequitable? 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/9-8-are-current-strategies-to-discourage-smoking-i 

 

As described in Section 9.1, smoking rates among those living in the most disadvantaged areas of Australia are double those living in the most advantaged areas. While smoking has declined in all socioeconomic groups over the past several decades, progress has varied.1 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—see Section 9.2). 

An important consideration in the development of public health policy is whether tobacco control strategies are as effective in reaching low socio-economic and other vulnerable groups as they are in reducing smoking among more advantaged people.2-6 Carefully designed population-level interventions have the capacity to reduce smoking-related disparities; however to avoid inadvertently widening inequalities, strategies need to be cognisant of systemic biases, individual and environmental influences on smoking, and existing inequities.6-8 For example, larger investment in tobacco control in California compared to the rest of the US appears to have been most effective at reducing smoking among non-Hispanic White people. While reductions in the prevalence of smoking were not as large there has been a notable reduction in consumption among African Americans in California.9 Researchers have identified 24 constructs encompassing individual, environmental and structural factors associated with smoking among racial/ethnic minority and lower-income groups and developed a diagram showing how these factors influence each other:

 

Figure 9.8.1

Figure 9.8.1 Causal loop diagram of smoking with individual, environmental and fundamental factors

 

Source: Mills et al.8

 

Much of the gain in reducing smoking prevalence is attributable to tobacco control policies, such as high taxes, public education campaigns and increasingly widespread smokefree regulations. These policies serve to promote public health (for both smokers and for those exposed to secondhand smoke) and change social norms, whereby smoking becomes increasingly less affordable and acceptable.10 In Australia, reducing socio-economic disparities in smoking is a high priority for tobacco control policy units, health promotion organisations, and social marketing campaigns. One of the key priority areas of Australia’s 2012–18 National Tobacco Strategy was strengthening efforts to reduce smoking among populations with a high prevalence of smoking. It outlines a number of aims to achieve this, including population-based approaches such as social marketing campaigns, tax increases, and smokefree legislation, as well as ensuring access to individual cessation support.11 Reducing disparities and disadvantage is also subject of state-based tobacco control initiatives, such as the Cancer Council NSW Tackling Tobacco Program.12 The Victorian Health Promotion Foundation (VicHealth) has developed a framework as part of its Fair Foundations program that provides policy makers and practitioners with practical, evidence-based guidance on reducing inequities in health caused by tobacco use.13 Reducing smoking among disadvantaged groups is also a key priority for Quit Victoria.14

There is robust evidence that population-wide strategies such as graphic anti-smoking advertisements and increases in taxes on cigarettes have reduced smoking across all socio-economic groups. Research in Europe concluded that tobacco control policies, both price and non-price related, have helped to reduce the prevalence of smoking in the total population, particularly in lower socioeconomic groups. Such policies may therefore have contributed to a certain degree of narrowing in the gap between advantaged and disadvantaged groups.15 One review similarly concluded that increasing the price of tobacco through taxation polices and continuing anti-smoking mass media campaigns are the most effective strategies to reduce inequities in tobacco use,16 and another found that price/taxation measures and targeted cessation support had the strongest evidence for reducing disparities.17

This section summarises evidence about the relative impact of population-level tobacco control strategies on various socio-economic status (SES) groups:

9.8.1 Impact of mass media

A 2012 review of the impact of mass media campaigns on smoking cessation concluded that higher exposure appears to confer greater benefit on socioeconomically disadvantaged population subgroups, particularly messages that confer the negative health effects of smoking.18 It is difficult to assess the impact of population-level policies such as media campaigns through conventional meta-analyses, and such reviews19-21 have reported mixed findings.17, 22 Research in the US found that exposure to mass media campaigns was associated with smoking cessation behaviours among all SES groups: there were no differences by sociodemographic characteristics, thus the campaigns did not appear to exacerbate disparities in quitting.23-27 Media campaigns can however enhance equity if delivered via channels that have the greatest reach among smokers in priority groups.  For example, two population-based studies in the United States found that increasing the intensity of exposure of a general mass media campaign within these priority communities significantly boosted the communities’ campaign recall compared to communities receiving a standard campaign dose.28, 29 An evaluation of a national adult mass media campaign with increased campaign intensity also found quit attempts to be more likely among smokers with lower levels of education in higher-dose media markets than smokers with lower levels of education from standard dose media markets.28 See also, effects on uptake among young people, Section 9.8.6 below.

Taking into account all of the available evidence (not just randomised controlled trials and cohort studies) the National Cancer Institute concluded in 2017 that campaigns with: high exposure, targeted media efforts; additional tobacco-related program components; or language-appropriate and/or culturally tailored messaging can be effective and may reduce potential communication inequalities that lead to gaps in tobacco-related knowledge. Additionally, campaigns with graphic and emotionally arousing messages can also stimulate quitting among racial/ethnic minorities and low-SES groups.21 Such campaigns may also be most effective they form part of a comprehensive tobacco control program that includes comprehensive smokefree legislation, tax increases, and targeted cessation support.18, 30, 31 Given the enormous changes in the media environment over the past decade, including an increasing shift to digital and online viewing and social media, researchers have highlighted the importance of future research that examines how best to reach and influence smokers, especially those in high prevalence populations.32

A detailed discussion on the impact of mass media can be found in Chapter 14, Section 14.4

9.8.1.1 Impact of mass media in reducing disparities in smoking-related knowledge

In Australia, television advertising has been extremely effective in raising awareness of the health effects of smoking among blue collar and less educated groups. In the mid-1980s, people with limited formal education and blue collar workers were much more likely than people with post-school qualifications and white collar workers to believe that no illnesses were caused by smoking, and that some illnesses were helped by smoking.33, 34 However, studies monitoring the impact of the Quit Campaign introduced in Victoria in 198535 and the National Tobacco Campaign introduced across Australia in 199736-39 indicate a steady increase in knowledge among people with all levels of education about the health effects of smoking—such as emphysema, heart disease, stroke, and macular disease—which were the subject of television commercials used in the campaigns (see Chapter 14, sections 14.3.1.2 and 14.4.4 for a detailed discussion on the impact of the National Tobacco Campaign in Australia).

Data from wave 5 (2006) of the International Tobacco Control Four Country Survey indicated that over 90% of people reported having noticed publicity on television on smoking in the last six months, with no differences in level of awareness between groups with various levels of educational attainment.40

However, disparities are more pronounced in the case of health conditions that have not been the subject of television commercials. Data from wave 5 of the International Tobacco Control Policy Four Country Survey evaluation study indicated, for instance, that Australians with a university education were only 4% more likely than people who had not finished high school to agree with the proposition that smoking causes stroke (a subject of anti-smoking television campaigns in NSW and Victoria in 2007).40 However, they were 15% more likely to agree that smoking causes impotence, a topic which, although covered in newspaper articles, has never been the subject of a television commercial or package health warning in Australia (Figure 9.8.2).

 

Figure 9.8.2 Proportion of smokers 18 years and over agreeing that smoking causes stroke (subject of TV advertisement) and impotence (subject of newspaper stories but not TV advertising), Australia, 2006, by educational attainment

 

Source: Data file provided to Michelle Scollo of the Tobacco Control Unit, Cancer Council Victoria, by Cooper J and Borland R: responses to fifth wave of the International Tobacco Control Four-country Survey, by educational attainment and income adjusted for household size, unpublished data, 2008

 

Data from Wave 8 (2010–11) of the International Tobacco Control Four-Country Survey provides a comparison to the earlier findings of Wave 5 (2006). Although health knowledge appears to have decreased somewhat— particularly so in relation to respondents agreeing that smoking causes impotence—trends by education have remained relatively consistent between survey waves—see Figure 9.8.3.

For a timeline of Australian social marketing campaigns see Chapter 14, Section 14.3.

 

Figure 9.8.3 Proportion of smokers 18 years and over agreeing that smoking causes stroke and impotence, Australia, 2010–11, by educational attainment

 

Source: Data file provided to Merryn Pearce of the Tobacco Control Unit, Cancer Council Victoria, by Partos T, and Borland R. Knowledge Building Team, Cancer Council Victoria. Melbourne. Responses to eighth wave of the International Tobacco Control Four-country Survey, smoking causes stroke and impotence, unpublished data, 2012.

* Note: University education referred to as ‘some university’ in Wave 8 data.

9.8.1.2 Impact of mass media campaigns on smoking prevalence across socio-economic groups in Australia

There is strong evidence that exposure to mass media campaigns reduces tobacco uptake and promotes quitting.41 Quit campaigns in Australia have targeted media placement (both in terms of timing and program and program type) and pre-tested advertisements among low-SES groups to ensure that they are equally effective among such groups.42-47

Several Australian studies have examined the effects of mass media campaigns on disadvantaged groups. An examination of trends in smoking prevalence over the course of Australia’s first major National Tobacco Campaign showed an equal impact across socio-demographic groups, suggesting a more pronounced effect on those with blue-collar occupations (who had a much higher smoking prevalence).39 Victorian research also suggests that an accelerated decrease in the prevalence of regular smoking among low SES people may be attributable to increases to tobacco taxation as well as increased funding for social marketing campaigns.48

Two Australian studies have found that exposure to anti-smoking advertisements increased quitline calls by the same degree across each socioeconomic group.38, 49 Further, one found that there were substantially greater increases in calls to quitline from low socioeconomic groups when higher emotion narrative ads were on air.49

Emotionally evocative ads, and ads that contain personal stories about the effects of smoking and quitting, appear to be particularly effective among lower income groups.49, 50 An Australian study examined the impact of anti-smoking advertisements evoking different emotions on advertisement effectiveness among different socioeconomic groups. It found that evoking multiple negative emotions (fear, guilt, and/or sadness), but not evoking hope, may be particularly useful in motivating those living in lower socioeconomic areas to quit. Fear messages alone were similarly effective across both socioeconomic groups.51 Another study found that fear-evoking tobacco control campaigns in Australia were equally effective across socioeconomic groups in increasing smokers' perceptions of family and friends' disapproval of their smoking.52

See Chapter 14, sections 14.3 and 14.4 for a detailed discussion on the impact of mass media led campaigns across socio-economic groups in Australia and internationally.

9.8.2 Impact of price increases on low-income groups in Australia

Before April 2010, excise and customs duty on tobacco products had not increased in real terms in Australia since November 1999. On 30 April 2010, the Australian Government raised the excise on tobacco products by 25%, and further annual increases of 12.5% commenced in 2013, making Australian cigarettes among the most expensive in the world (see Section 13.3). Research on the impact of price increases on prevalence has generally found higher responsiveness to price among lower socio-economic groups,20, 22, 53-63 and several major reviews provide strong evidence that increased tobacco price via tax is the intervention with the greatest potential to reduce socioeconomic inequalities in smoking.17, 20, 21, 57, 64-67 Among people who were still smoking at the end of the first phase of the National Tobacco Campaign in Australia (May 1997 to November 1999), the prevalence of smoking decreased more among blue than white collar groups during the second phase of the campaign (November 1999 to November 2002) when prices of tobacco products increased significantly. Smoking declined by 6.1% in blue collar groups and increased by 0.9% in white collar groups.68

An analysis of smoking prevalence in response to changes in cigarette prices in Australia between 1991 and 2006 similarly found a strong association between price increases on cigarettes and declines in prevalence, which was more pronounced in lower-income groups. One Australian dollar increase in cigarette price was associated with declines of 2.6%, 0.3% and 0.2% in the prevalence of smoking in low, medium, and high-income groups, respectively.69 Victorian research also suggests that an accelerated decrease in the prevalence of regular smoking among low SES people may be attributable to increases to tobacco taxation (as well as increased funding for social marketing campaigns).48

In 2010, an 25% increase in tobacco tax was implemented in Australia, followed by a series of four 12.5% annual tobacco tax increases from 2013 onward. A study examining month-to-month changes in prevalence of current smoking associated with these measures found that both were effective in the short- and longer-term. There was a larger immediate reduction in smoking among the lower SES group in response to the 2010 tax than the higher SES group; however the results also showed an increase in the use of roll-your-own tobacco among lower SES smokers. This indicates that price-sensitive smokers may have switched to using a cheaper product in response to the tax increases, and highlights the need for taxes to be harmonised across products (See Section 13.3.1.4).70

A detailed discussion on the impact of tobacco price increases on low-income groups can be found in Chapter 13, Section 13.11.

9.8.3 Impact of smokefree policies

Smokefree workplace policies reduce the amount of tobacco smoked, reduce exposure to secondhand smoke, increase rates of quitting, and reduce the chance of a quitter relapsing.71 The initial introduction of smokefree policies generally resulted in greater benefits for higher income and educational groups,57 likely because such policies were adopted earlier in white collar environments. While smokefree legislation reduces social inequalities in secondhand smoke exposure at work,72 and reduces smoking-related mortality in lower socioeconomic groups,73, 74 evidence on their effectiveness for reducing socioeconomic inequalities in smoking prevalence is mixed. Some research has concluded that smoking bans are more effective in promoting quitting and reducing smoking among more advantaged groups, and can therefore widen socioeconomic inequalities,17, 57, 75-79 while others find that smokefree legislation can contribute to a reduction in inequalities by encouraging quitting,80-83 the adoption of smokefree homes,84 an reductions in exposure to secondhand smoke85 among those with a lower socioeconomic status. There may also be differences in the effects of smokefree laws between specific racial/ethnic minorities.86 Several studies have also found comprehensive smokefree laws to be equally effective across all socioeconomic groups.87, 88 A 2016 Cochrane review of legislative smoking bans found some evidence of reductions in smoking prevalence among lower socioeconomic groups, but notes the inconsistency of the findings.73 More recent research in Europe found that smokefree policies were more strongly related to lower smoking prevalence among older people with lower rather than higher levels of education.61

All Australian states and territories have now implemented bans on smoking in enclosed workplaces, including in hospitality venues (see Chapter 15). Many Australian states and territories have extended smokefree policies to cars carrying children, and to outdoor areas, such as playgrounds and outdoor dining areas (see Section 15.7). Victorian research found that significantly more persons in the lower socio-economic group (measured by educational attainment) reported smoking less after the introduction of smokefree hospitality venues compared to those of higher socio-economic status (40% compared with 24%).83  Overall, national, comprehensive smokefree policies are more effective at reducing inequities than voluntary, regional, and partial policies.22, 89

People on lower incomes are more likely to allow smoking inside their home (see Section 9.1). Government tobacco control policies appear to have positive flow-on effects for the adoption of smokefree policies in people’s homes, with European research finding a positive association between the strength of national policies and in-home smoking bans.90 The increasing introduction of smokefree policies in apartment buildings may also be particularly effective in reducing secondhand smoke exposure among disadvantaged groups (see Section 15.6). 91

See also Section 15.9.3.3 for a discussion of the effects of smokefree legislation on reducing socioeconomic disparities in smoking

9.8.4 Impact of pictorial health warnings

Pictorial health warnings appear to be at least as effective among disadvantaged as more advantaged smokers,22, 57 and are more effective than text-only warnings.92 This may be due to a greater ease of understanding, as well as their emotionally evocative content, which is a particularly effective strategy among disadvantaged groups.92

Results from the International Tobacco Control Four-country Survey showed that pictorial health warnings introduced in Australia in 2006 were noticed more frequently among less educated smokers than among smokers with a university education (see Figure 9.8.4).

 

Figure 9.8.4 Percentage of smokers rarely and frequently reading new pictorial health warnings on cigarette packets, smokers 18 years and over, Australia 2006, by level of educational attainment

 

Source: Data file of responses to the fifth wave of the International Tobacco Control Four-country Survey, by educational attainment and income adjusted for household size, provided to Michelle Scollo of the Tobacco Control Unit, Cancer Council Victoria, by J Cooper and R Borland Cancer Council Victoria, 2008.

 

The proportion of smokers who noticed the new warnings often or very often was 10% higher among those who had not finished high school than among those smokers with a university education. While low-SES smokers were no more likely than high-SES smokers to report thinking about the harms of smoking as a result of looking at the warnings, they were more likely to report forgoing cigarettes. Graphic warnings may therefore be somewhat more effective among lower than higher SES groups in prompting quitting behaviours. Data from Wave 8 (July 2010­–May 2011) of the International Tobacco Control (ITC) Four-country Survey show that, although less pronounced, those with lower education levels were still slightly more likely to report noticing the health warnings often or very often (see Figure 9.8.5).

 

Figure 9.8.5 Percentage of smokers reporting reading or looking closely at the health warnings on cigarette packets in the past month, smokers 18 years and over, Australia, July 2010–May 2011, by educational attainment

 

Source: Data file of responses eighth wave of the International Tobacco Control Four-country Survey, provided to Merryn Pearce of the Tobacco Control Unit, Cancer Council Victoria, by T Partos and R Borland, Cancer Council Victoria, 2012.

 

Since the 1 st of December 2012, cigarette packs sold in Australia must be drab, dark brown in colour and devoid of all brand design, and must carry larger, graphic health warnings. An experimental study prior to implementation of plain packaging found that plain packs were rated as significantly less appealing than branded packs among socioeconomically disadvantaged smokers, and such packs also reduced purchase intentions.93 Research post-implementation among Indigenous Australians found that plain packaging had reduced misperceptions that some brands are healthier than others. Compared with pre-plain packaging, younger Aboriginal and Torres Strait Islander peoples were less likely to view some brands as more prestigious than others.94 See InDepth 11A for a detailed discussion of plain packaging research.

9.8.5 Impact of bans on advertising, promotion and sponsorship

Controls on tobacco advertising, promotion, and marketing appear to be equally or more effective among disadvantaged groups.22 However, in the wake of bans on traditional forms of tobacco advertising, such as on TV and in magazines, the tobacco industry has found ways to circumvent such bans and continue to target current and potential smokers. For example, current laws in Australia fail to adequately prevent online promotion (see Section 11.11), or certain product- and price-related forms of marketing. As noted in Section 9.8.6, adolescents are particularly vulnerable to online advertising, and even more so when they are from a disadvantaged background.95-97 Ensuring that tobacco advertising bans are inclusive of Internet-based media is essential for preventing exposure and uptake among the most disadvantaged young people.95

Price-related marketing, such as discounts and price boards, particularly targets young and low-income smokers and undermines the effectiveness of tax increases.98, 99 Price-sensitive smokers are able to switch brands or products in order to minimise the effect of increases in excise tax. In order to reduce socioeconomic disparities in smoking prevalence, researchers have proposed a three-pronged strategy: substantial specific excise tax increases alongside minimum price laws and bans on coupons and price promotions.98

9.8.5.1 Impact of retail promotion and access

The display, advertising, and accessibility of tobacco products in retail outlets are associated with uptake, smoking, and relapse.100-102 While all Australian states and territories have banned tobacco marketing and display in retail outlets, such restrictions do not reduce the availability of tobacco products. There is a clear inverse association between SES and tobacco retailer density, such that the density of tobacco outlets tends to be higher in areas with lower average incomes.103, 104 Further, not all Australian states require tobacco retailers to obtain a license prior to selling. Across stores in 122 postcodes in metropolitan and regional areas, study auditors in NSW found that retailers in low-socioeconomic status (SES) areas were significantly more likely than those in less disadvantaged areas to be unlisted and to breach in-store retailing laws.105 Licensing of retailers could contribute to reducing tobacco related disparities by ensuring that retailers in disadvantaged areas comply with laws that aim to reduce smoking uptake and relapse. See Section 11.9 and InDepth 11B for a detailed discussion.

9.8.6 Reducing uptake among disadvantaged children in Australia

Along with increasing rates of cessation among adult smokers, preventing uptake among disadvantaged children forms an important part of reducing disparities in smoking prevalence. Encouragingly, over the 2000s, smoking rates have reduced among Australian school students across all socioeconomic groups, and generally show a convergence in prevalence (see Section 9.2).

There is very limited evidence internationally on the effectiveness of public education campaigns on disadvantaged young people.106-108 A 2016 review concluded that public education campaigns are generally effective in reducing tobacco use among young people, however there was insufficient to determine whether campaign outcomes differ by socioeconomic status.109 The 2012 US Surgeon General’s report on preventing tobacco use among young people concluded that the limited research has not found any systematic differences in responses to anti-tobacco ads by gender, race/ethnicity, or nationality. It notes that the characteristics of advertisements appear to be more important to campaign effectiveness than the characteristics of the audience.106 More recently however, US research found that exposure to an anti-smoking campaign was associated with the greatest reduction in youth smoking behaviours among those in lower socioeconomic status group.110

A large study of adolescents across 29 European countries found that tobacco prices were effective in decreasing smoking among boys, regardless of their socioeconomic status.111 Another European study similarly found that stronger tobacco control policies were associated with lower smoking rates, with no significant difference in this association between high- and low-SES adolescents.112 As with adults, in Australia, socio-economic trends in smoking prevalence among children appear to reflect overall levels of tobacco-control funding and taxation policy. A study of smoking among school children between 1987 and 2005 indicated that smoking prevalence decreased in all SES groups.113 However, the level of funding tobacco-control mass media education campaigns affected the consistency of change across different SES groups, particularly in teenagers aged 12–15 years, the period of peak smoking uptake. As indicated in Table 9.8.1, in the period of low tobacco-control media campaign funding and activity in Australia (1992–1996), smoking prevalence increased among students aged 12–15 years, with the greatest increase among low-SES students. In a period of high tobacco-control media campaign funding (1997–2005), by contrast, smoking decreased quite sharply and reductions were consistent across SES groups.

Table 9.8.1 Absolute changes in reported smoking prevalence among students aged 12–15 years during high and low periods of tobacco-control media campaign funding, Australia, 1987–1990, 1990–1996 and 1996–2005, in schools in various socio-economic status quartiles

Socio-economic status quartiles

Absolute change

1987–90

1990–96 low activity

1996–2005 high activity

Phase 1 (%)

Phase 2 (%)

Phase 3 (%)

Monthly smokers

Lowest

–1

+6

–12

Second

–2

+3

–10

Third

0

+1

–12

Highest

–1

+1

–13

Current smokers (smoked in past week)

Lowest

–1

+5

–11

Second

–2

+2

–9

Third

–1

+1

–10

Highest

+1

–1

–11

Committed smokers (smoked on three days in past week)

Lowest

0

+2

–7

Second

–1

+2

–6

Third

0

0

–7

Highest

–1

0

–7

Source: White, Hayman and Hill 2008 113

Young people are particularly vulnerable to tobacco advertising, and it can differentially affect those in priority populations.  Australian research examining exposure to Internet-based tobacco advertising and branding among young people found that participants from lower socioeconomic status were more likely to report exposure,95 and marketing and promotions can be particularly influential in promoting tobacco use among at-risk teenagers.96, 97 Reducing young people’s ability to access tobacco products is also an important component of reducing uptake (see Section 5.21). In the US, Tobacco 21 (T21) was legislation implemented in 2019, raising the minimum age for sale of tobacco products from 18 to 21 years. The national law helped to address disparities in coverage, whereby local T21 laws were less common in lower socioeconomic areas.114 Nonetheless, a recent study assessed compliance with T21 laws among retailers and found that lower compliance was recorded in more impoverished neighbourhoods, regardless of the level of awareness of the policy. In order to avoid exacerbating disparities, the authors highlight the need for additional resources and surveillance in low-income areas.115 Research in Europe has also found that proxy sales (i.e., using an adult to buy cigarettes for an underage person) are a common method of obtaining cigarettes among disadvantaged young people.116

Adolescents with weak bonds to parents, school and other community institutions are at increased risk of engaging in risky behaviours, including smoking,117-123 and the prevention of educational failure in children has been cited as a critical step in preventing smoking uptake.  In Australia, children who predict that they will complete Year 12 are much less likely to have ever tried smoking.124 Young people who do well at school are more likely to understand health risks, and are more likely to feel connected to school and to feel hopeful about their future. This increases the possibility of further education and higher occupation status, which are associated with lower levels of smoking (see Section 9.2). Research in Britain estimated that reducing adverse childhood experiences and improving educational attainment are almost as effective in reducing premature mortality as reduced smoking in adulthood.125 Government initiatives that address educational disparities, such as universal, high quality early-childhood education and funding and policies that promote equity in the Australian school system, are likely to reduce educational disadvantage and in turn may reduce smoking. Increasing social cohesion and improving disadvantaged neighbourhoods may also reduce smoking among young people.126-129

See Chapter 5 for a detailed discussion of influences on the uptake and prevention of smoking, and Section 8.4.3 for a discussion of influences on smoking behaviour among Aboriginal and Torres Strait Islander young people.

9.8.7 Summary of factors that could help to reduce tobacco related disparities

Figure 9.8.6 provides an overview of social policies and tobacco strategies that can reduce uptake among disadvantaged children, in turn reducing socioeconomic disparities in smoking.  Figure 9.8.6 also includes interventions that could potentially reduce disparities in cessation behaviour and adult smoking prevalence. These are discussed further in Section 9.9.

 

Figure 9.8.6 Interventions that could balance the factors promoting SES differentials in tobacco use

 

 

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