Volatile substance use (VSU) involves sniffing substances that give off fumes at room temperature such as petrol, paint, glue or deodorants [48063]. They are also called ‘inhalants’ because of the way people use them by inhaling the fumes through the nose or mouth. Absorbing these substances into the lungs affects different parts of the body such as the kidneys, the brain and the heart [48063][41612].

Most volatile substances such as solvents and aerosol sprays, are depressant drugs that slow down the central nervous system [41612]. Short-term effects include slurred speech, lack of coordination, dizziness and euphoria [48063][41611]. Sniffing volatile substances, particularly butane, propane and aerosols, can cause sudden death [30967]. This is known as sudden sniffing death, a syndrome where a lack of oxygen and an unexpected event that stimulates an adrenalin release causes heart failure [41611][30967]. Sudden sniffing death can happen to a first-time user who is otherwise healthy. VSU can also cause a person to lose consciousness, increasing the risk of death by suffocation.

Unlike other forms of drug use, the products used in VSU are readily available in common household and commercial products, posing a particular risk for young people [41611]. Typically, use of volatile substances is initiated at a young age (around 12 years, and sometimes younger), which has implications for the developing brain and long-term health [38141][32216]. Sniffing volatile substances repeatedly is also associated with damage to the peripheral nervous system (resulting in numbness and limb weakness), as well as damage to the respiratory system, injury to the digestive tract, kidney damage and anaemia [41612]. Exposure to toluene[1] through sniffing petrol in adolescence has been shown to be associated with impaired growth for both height and weight and a ‘failure to thrive’ [32216]. Excessive harmful inhalant use can also lead to permanent acquired brain injury [32216][29075][24947].

Extent of VSU use among Aboriginal and Torres Strait Islander people

The 2022-2023 National Drug Strategy Household Survey (NDSHS), reported that 94% of Aboriginal and Torres Strait Islander people had never used inhalants [48572]. The 2018-19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) found that 0.9% of Aboriginal and Torres Strait Islander people aged 15 years and over reported using petrol and other inhalants in the last 12 months[2] [42101].

In 2022-23, 0.7% of Aboriginal and Torres Strait Islander clients aged 10 years and over identified volatile solvents as the main drug they sought treatment for in publicly funded alcohol and other drugs (AOD) services [43453].The jurisdiction with the highest proportion of Aboriginal and Torres Strait Islander clients aged 10 years and over who identified volatile solvents as the main drug they sought treatment for was the NT (6.42%), followed by Qld (0.24%), the ACT (0.23%), Vic (0.06%), NSW (0.04%), and WA, SA and Tas (all 0%).

An overall decline in VSU in communities has been reported, with one study showing that in 17 Aboriginal communities, the total number of people sniffing petrol has fallen, from 647 in 2005-06 to 78 in 2013-14, a reduction of 88% [31839]. This decrease in prevalence of sniffing has been associated with the replacement of regular unleaded petrol with low aromatic fuel (LAF)[3].

A follow-up study on the effects of LAF found that in 25 Indigenous communities, for which there is comparable data, the total estimated number of people sniffing petrol fell from 453 in 2006 to 22 in 2018, a decline of 95% [38141]. The number of people sniffing petrol in these communities represented just under 1% of the estimated Aboriginal and Torres Strait Islander populations in the respective communities aged 5-39 years.

While overall the number of people using volatile substances is small, the issue of VSU remains a potential for concern in some regions where opportunistic or casual sniffing of petrol and use of other volatile substances such as deodorants have been reported [38141].

Hospitalisation

In 2017-19, the crude hospitalisation rate for Aboriginal and Torres Strait Islander people due to volatile solvent use (based on principal diagnosis) was 0.1 per 1,000 [42101]. The crude rates of hospitalisation for Aboriginal and Torres Strait Islander people due to mental and behavioural disorders from the use of volatile substances and poisoning due to the toxic effect of volatile solvents were both 0.1 per 1,000 [42101].

Mortality

The systematic collection of VSU associated mortality data is very limited due to the practice of listing the medical explanation for death rather than the use of volatile substances as a cause [4642]. For example, the death of someone who sniffs petrol chronically may be recorded as ‘end-stage renal failure’, not ‘petrol sniffing’. This practice has most likely resulted in VSU mortality and morbidity rates being underestimated.

[1] Toluene is the primary volatile solvent in misused products.

[2] This estimate has a high margin of error and should be interpreted with caution [42101].

[3] LAF is a type of fuel with less aromatic hydrocarbons than regular unleaded petrol, that does not cause intoxication when inhaled.

Illicit drug use describes the use of drugs that are illegal to possess (e.g., cannabis, heroin, cocaine and methamphetamine), and the non-medical use of prescribed drugs such as painkillers [48572]. Illicit drug use is associated with an increased risk of mental illness, poisoning, self-harm, infection with blood borne viruses from unsafe injection practices, chronic disease and death [22491][44827][35898].

Extent of illicit drug use among Aboriginal and Torres Strait Islander people

Surveys consistently show that most Aboriginal and Torres Strait Islander people report they do not use illicit drugs [50170][48574]. The two most recent national surveys to collect this data, the 2022-23 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) and the 2022-2023 National Drug Strategy Household Survey (NDSHS), found that 72% of Aboriginal and Torres Strait Islander people aged 15 years and over (NATSIHS) and 72% aged 14 years and over (NDSHS) reported either they had never used illicit drugs or had not used illicit drugs in the last 12 months (Derived from [50170][48574]).

The 2022-23 NATSIHS found that 27% of Aboriginal and Torres Strait Islander people aged 15 years and over reported using illicit drugs in the last 12 months [50170]. Cannabis (marijuana, hashish or cannabis resin) was the most commonly used illicit drug, used by 22% of Aboriginal and Torres Strait Islander people aged 15 years and over in the previous 12 months. The next most commonly used illicit drugs were ‘other drugs’ (including heroin, ecstasy or other designer drugs, hallucinogens) (4.9%), cocaine (4.2%), analgesics and sedatives for non-medical use (3.6%) and amphetamines, ice or speed (3.0%) (Figure 2).

Figure 2. Proportion of Aboriginal and Torres Strait Islander people who reported illicit drug use in the last 12 months, 2022-23

Notes:

• ‘Other’ includes heroin, ecstasy or other designer drugs, hallucinogens.
• Analgesics and sedatives for non-medical use, includes painkillers, tranquilisers and sleeping pills.

Source: ABS, 2024 [50170]

In 2022-23, a greater proportion of Aboriginal and Torres Strait Islander males reported having used an illicit drug in the previous 12 months compared with females (34% and 20% respectively) [50170]. This was consistent across all drug types. Three times as many males as females had used amphetamines (4.7% compared with 1.5%). The proportion of respondents who had used illicit substances in the last 12 months was higher among younger age-groups: 15-29 years (35%), followed by 30-44 years (28%) and 45 years and over (18%). In 2022-23, by jurisdiction (excluding the ACT), the proportion of respondents aged 18 years and over who reported using substances for non-medical purposes in the last 12 months was highest in SA[1] (32%), followed by Qld (31%), Vic (28%), WA (26%), Tas (24%), the NT (23%) and NSW (22%). Use of illicit drugs in the previous 12 months was similar for people aged 15 years or over living in non-remote areas and remote areas in 2022-23 (27% and 24% respectively).

In 2022-23, 18% of clients who accessed treatment for their own alcohol and other drugs (AOD) use from general AOD treatment services were Aboriginal and Torres Strait Islander people aged 10 years and over [43453]. Of the Aboriginal and Torres Strait Islander clients who accessed treatment, there was a greater proportion of males (59%) than females (38%)[2]. After alcohol, the most common principal drugs of concern that Aboriginal and Torres Strait Islander people sought treatment for were amphetamines (25% of clients), cannabis (23% of clients) and heroin (5.2% of clients). The greatest proportion of clients who accessed treatment among Aboriginal and Torres Strait Islander people were in the 30-39 years age-group (30%), followed by the 20-29 years age-group (28%), 40-49 years age-group (19%), 10-19 years age-group (12%), 50-59 years age-group (8.7%), and 60 years and over age-group (2.3%).

By jurisdiction, the highest proportions of Aboriginal and Torres Strait Islander clients who accessed treatment for their own AOD use in 2022-23 were in the NT (72% of clients), followed by WA (22%), NSW (20%), Qld (19%), SA (17%), Tas and the ACT (both 13%) and Vic (9.8%) [43453].

Use of amphetamines is associated with risky behaviour such as injecting drug use [34107]. A 2024 report on the Needle Syringe Program (NSP) found that stimulants and hallucinogens (mainly methamphetamine) were the most commonly injected drugs reported by attendees of NSPs [50228]. Of the people attending NSPs in 2024, 23% identified as Aboriginal and/or Torres Strait Islander.

Hospitalisation

In 2018-19, the most common drug-related conditions resulting in hospitalisation for Aboriginal and Torres Strait Islander people were ‘poisoning’ and ‘mental and behavioural disorders’ [42032]. The crude hospitalisation rate for Aboriginal and Torres Strait Islander people from poisoning due to drug use was 3.0 per 1,000 population and for mental and behavioural disorders due to drug use 4.7 per 1,000. In 2017-19, the leading drugs of concern that Aboriginal and Torres Strait Islander people were hospitalised for (based on principal diagnosis) were methamphetamines (1.9 per 1,000), followed by cannabinoids (1.1 per 1,000), and antidepressants and antipsychotics (0.9 per 1,000) [42101].

By jurisdiction, the highest crude rates of hospitalisation related to drug use (based on principal diagnosis) among Aboriginal and Torres Strait Islander people in 2017-19 were in SA (11 per 1,000), followed by the ACT (9.8 per 1,000), WA (8.2 per 1,000), Vic (8.0 per 1,000), NSW (7.8 per 1,000), Qld (6.8 per 1,000), the NT (4.9 per 1,000) and Tas (3.2 per 1,000) [42101].

For 2017-19, crude hospitalisation rates related to drug use were higher for Aboriginal and Torres Strait Islander people in non-remote areas (7.7 per 1,000) compared with remote areas (4.3 per 1,000) [42101].

Mortality

In 2018, 224 deaths (6.2% of all deaths) among Aboriginal and Torres Strait Islander people were attributed to illicit drug use [44827]. In the period 2018-2022, there were 599 unintentional drug-induced deaths among Aboriginal and Torres Strait Islander people [49719]. In the same five year period, aggregated data for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT showed that the leading drug types involved in unintentional drug-induced deaths were opioids (involved in 46% of deaths), followed by stimulants (involved in 45% of deaths) and benzodiazepines (involved in 24% of deaths).

In 2014-2018, age-standardised rates of drug-induced deaths were higher for Aboriginal and Torres Strait Islander males (17 per 100,000) than for females (11 per 100,000) [42032]. For the same period, SA recorded the highest age-standardised rate of drug-induced deaths for Aboriginal and Torres Strait Islander people (20 per 100,000), followed by NSW (18 per 100,000) and WA (17 per 100,000).

Burden of disease

Illicit drug use was the fourth leading risk factor contributing to the burden of disease among Aboriginal and Torres Strait Islander people in 2018 [44827]. It contributed to 6.9% of the total burden and was responsible for 5.1% of non-fatal burden and 8.9% of fatal burden. Among the different illicit drug types, the greatest contributors to the burden were opioids (2.2%), amphetamines (1.9%), and cannabis (1.6%). Illicit drug use contributed to the total burden of disease for multiple disease groups, particularly injuries (28%), gastrointestinal (16%), and mental disorders (12%).

Between the sexes, illicit drug use consistently contributed more to the burden of disease among males than females [44827]. This was seen across age-groups, with illicit drug use contributing to 14% of disease burden among males aged 15-24 years compared with 11% among females in the same age-group; 16% and 9.5% of burden respectively among males and females aged 25-44 years; and 5.4% of burden for males aged 45-64 years (illicit drug use did not appear in the top 10 causes of disease burden for females in this age-group).

Illicit drug use was the second leading risk factor causing total burden among Aboriginal and Torres Strait Islander people aged 15-24 years and 25-44 years (13% of total DALY among both age-groups) [44827].

[1] The proportion for SA has a high margin of error and should be used with caution.

[2] Indigenous status not stated or another term (2.9%).

Drinking too much alcohol, both on single drinking occasions (binge drinking) and over a person’s lifetime can lead to harms including chronic diseases, injury and transport accidents, mental health disorders, intergenerational trauma and violence [33425][48572]. This affects individuals, families and the wider community. Many factors influence why people may drink too much alcohol, for example, socioeconomic disadvantage, stress and negative early life experiences [39347][39351]. With regard to Aboriginal and Torres Strait Islander people, as noted elsewhere in the Overview, it is important to understand the historical and social contexts of colonisation, the ongoing effects of dispossession of land and culture, economic exclusion and how these factors influence alcohol use [33425][34063].

Extent of alcohol use among Aboriginal and Torres Strait Islander people

Aboriginal and Torres Strait Islander people are less likely to drink alcohol than non-Indigenous people, but those who do drink are more likely to at levels that cause harm [48572][42101].

Abstinence or no consumption of alcohol in the last 12 months

The 2022-23 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) found that one in four (25%) Aboriginal and Torres Strait Islander adults reported they had either never consumed alcohol (7.3%) or had not done so for more than 12 months (18%) (Derived from [50170]). The proportion was higher for females (29%) than males (21%). The proportion was lowest among people aged 25-34 years (18%) and 35-44 years (20%), and highest in people aged 55 years and over (37%). For the different Australian jurisdictions (excluding the ACT), the proportion of respondents aged 18 years and over who had consumed alcohol 12 or more months ago was highest in the NT (27%), followed by WA (23%), Tas (19%), Qld (18%), SA (17%), NSW (16%), and Vic (12%). A greater proportion of people aged 15 years and over living in remote areas (44%) than non-remote areas (27%) reported that they had never consumed alcohol or had not done so for more than 12 months.

Did not exceed guideline

In the 2022-23 NATSIHS, 62% of people aged 18 years and over reported that they did not exceed the 2020 Australian adult alcohol guideline (see box above, Guideline 1) [50170]. A greater proportion of females (73%) did not exceed the guideline than males (51%). The age-group with the highest proportion of people who did not exceed the guideline was 55 years and over (70%), followed by those aged 45-54 years (63%). The proportion of respondents who did not exceed the guideline was similar in both remote and non-remote areas (63% and 65% respectively).

Exceeded guideline

In the 2022-23 NATSIHS, 36% of people aged 18 years and over reported exceeding the 2020 Australian adult alcohol guideline (see box above, Guideline 1) [50170]. This included those who had consumed more than 10 standard drinks in the week prior to the survey (22%) and/or had consumed 5 or more standard drinks on a single day at least 12 times in the last 12 months (32%). The proportion of males (48%) who exceeded the guideline was higher than that for females (25%). By jurisdiction (excluding the ACT), NSW had the highest proportion of respondents who had exceeded the guideline (40%), followed by WA (38%), Vic and Qld (both 34%), SA (31%), and Tas and the NT) (both 30%). The proportion of respondents who exceeded the guideline was similar in both remote and non-remote areas (35% and 34% respectively).

Alcohol and pregnancy

In 2022, 88% of pregnant Aboriginal and Torres Strait Islander women self-reported not consuming alcohol during the first 20 weeks of pregnancy (excluding NSW) [43321]. After 20 weeks of pregnancy, this increased to 93% of women.

Treatment

In 2022-23, 18% of people aged 10 years and over who accessed publicly funded AOD treatment services for their own substance use identified as being Aboriginal and/or Torres Strait Islander [43453]. Alcohol was the main drug of concern for 37% of Aboriginal and Torres Strait Islander clients who sought treatment for their own AOD use. A study conducted in 2019 among 775 Aboriginal and Torres Strait Islander people in SA (aged 16 years and over) found that 2.2% were likely dependent on alcohol (self-reported two or more dependence symptoms via the Grog Survey App) [42836].

Hospitalisation

In 2017-19, the crude rate of alcohol-related hospitalisations for Aboriginal and Torres Strait Islander people was 7.0 per 1,000 [42101]. The rate was higher for males than females (8.1 per 1,000 and 5.8 per 1,000 respectively). The highest crude rate of hospitalisations related to alcohol use for Aboriginal and Torres Strait Islander people was for mental and behavioural disorders at 6.3 per 1,000 (males: 7.3 per 1,000 and females: 5.3 per 1,000). Acute intoxication was the leading mental and behavioural disorder, with a crude hospitalisation rate of 4.2 per 1,000.

Across age ranges, the highest age-specific alcohol-related hospitalisation rates among Aboriginal and Torres Strait Islander people in 2017-19 were for the 45-54 years age-group (22 per 1,000), followed by the 35-44 years age-group (17 per 1,000), 55-64 years age-group (15 per 1,000), 25-34 years age-group (7.3 per 1,000), 65 years and over age-group (4.6 per 1,000), 15-24 years age-group (3.0 per 1,000) and 0-14 years age-group (0.2 per 1,000) [42101]. The rankings by age-group were the same among females and males, except males in the 55-64 years age-group who had a higher hospitalisation rate than males in the 35-44 years age-group (20 per 1,000 and 19 per 1,000 respectively).

By jurisdiction, crude rates of alcohol-related hospitalisations in 2017-19 for Aboriginal and Torres Strait Islander people were highest in the NT (16 per 1,000), followed by SA (9.1 per 1,000), WA (8.6 per 1,000), Qld (7.6 per 1,000), the ACT (4.8 per 1,000), NSW (4.0 per 1,000), Vic (3.7 per 1,000) and Tas (2.8 per 1,000) [42101]. Males had higher crude rates of alcohol-related hospitalisation than females across all states and territories, except the NT (males: 15 per 1,000 and females: 17 per 1,000).

Hospitalisation rates related to alcohol use in 2017-19 varied by level of remoteness [42101]. Aboriginal and Torres Strait Islander people living in remote areas (excluding remote Vic) had the highest crude rates of hospitalisation related to alcohol use (15 per 1,000), followed by those in very remote areas (11 per 1,000). People in inner regional areas (3.1 per 1,000) and major cities (5.3 per 1,000) had the lowest crude rates of hospitalisation related to alcohol use.

Mortality

In 2018, 350 deaths among Aboriginal and Torres Strait Islander people (9.7% of all deaths) were attributable to alcohol use [44827]. For 2015-2019 in NSW, Qld, WA, SA and the NT, the crude rate for Aboriginal and Torres Strait Islander deaths related to alcohol use was 13 per 100,000 [42101]. The alcohol-related death rate for Aboriginal and Torres Strait Islander males was 2.1 times higher compared with females (17 per 100,000 and 8.1 per 100,000 respectively). The main cause of alcohol-related deaths was from alcoholic liver disease with a crude rate of 8.0 per 100,000.

Burden of disease

In 2018, alcohol use was the second leading risk factor contributing to the total burden of disease among Aboriginal and Torres Strait Islander people, accounting for 11% of the burden [44827]. For non-fatal burden of disease among Aboriginal and Torres Strait Islander people, 9.2% was attributable to alcohol use, the most of any risk factor.

Alcohol use disorders were the fourth leading group of diseases causing burden among Aboriginal and Torres Strait Islander people in 2018 (4.4% of total DALY) [44827]. Alcohol was a key contributor to burden of disease among males in particular, with alcohol use disorders ranked as the third leading cause of total burden, accounting for 6.2% of total DALY. Alcohol use was the leading risk factor contributing to the burden of disease for males in both the 15-24 years and 25-44 years age-groups, accounting for 26% and 23% of total disease burden respectively. For females, alcohol use disorders ranked 10^th among the causes of total burden (2.4% of total DALY). Alcohol use disorders were the leading cause of total burden among Aboriginal and Torres Strait Islander people aged 25-44 years (8.4% of total DALY) and the second leading cause among those aged 15-24 years (9.9% of total DALY).

Tobacco use has a number of health impacts, including increasing the risk of chronic disease, such as cardiovascular disease, many forms of cancer, and lung diseases, as well as a variety of other health conditions [42101]. Tobacco use is also a risk factor for complications during pregnancy and is associated with preterm birth, low birth weight (LBW) and perinatal death. Environmental tobacco smoke (second-hand smoke or passive smoking) is of concern to health, with children especially susceptible to resultant problems that include exacerbation of middle ear infections, asthma and increased risk of sudden infant death syndrome (SIDS). Third-hand smoke (the residue left from second-hand smoke on surfaces and in indoor dust) is also of concern to health, particularly for children due to spending more time near the floor and putting contaminated objects in their mouths [39920]. Third-hand smoke can interact with other chemicals in the environment that can form new carcinogens and toxic substances that can stay on surfaces for months or years.

Extent of tobacco use among Aboriginal and Torres Strait Islander people

Prevalence

The 2022-23 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) found that 29% of Aboriginal and Torres Strait Islander people aged 15 years and over reported that they smoked daily, a reduction from levels reported in the 2018-19 NATSIHS (37%) [50170][39231]. The National Preventive Health Strategy 2021-2030 set a target to reduce daily smoking rates among Aboriginal and Torres Strait Islander people aged 15 years and over to 27% or less by 2030 [44397].

In 2022-23, the proportion of Aboriginal and Torres Strait Islander males aged 15 years and over who smoked daily (31%) was higher than the proportion of females (27%) [50170]. A greater proportion of males than females reported smoking daily across all age-groups, with the exception of the 45-54 years age-group (42% for females compared with 32% for males). Daily smoking rates for males and females in non-remote areas were 27% and 24% respectively. While in remote areas, the proportion of males who smoked daily was 51% compared with 42% of females.

When comparing smoking prevalence between the 2022-23 NATSIHS and the 2018-19 NATSIHS, the highest reductions in daily smoking were found in the younger age-groups [50170][39231]. Daily smoking prevalence among the 18-24 years age-group decreased from 36% in 2018-19 to 20% in 2022-23, while the daily smoking prevalence among the 25-34 years age-group decreased from 44% to 33% in the same period. The age-group with the highest proportion of people who smoked daily was 35-44 years (39%). A 2017 survey among Aboriginal and Torres Strait Islander students aged 12-17 years found that 10% had reported smoking tobacco in the past week, declining from 21% in 2005 [40944]. It also found that 70% of the students had never smoked tobacco, a significant increase from 49% in 2005.

In 2022-23, by jurisdiction (excluding the ACT), smoking rates among people aged 18 years and over were highest in the NT (44%), followed by Qld (36%), Vic (33%), SA (32%), Tas (31%), WA (30%), and NSW (25%)[1] [50170].

An analysis of the 2018-19 NATSIHS smoking data found that smoking prevalence varied greatly between regions. By Indigenous Region, the lowest daily smoking prevalence in 2018-19 was in the ACT (25%), while the highest was in Nhulunbuy, NT (55%) [45680]. Smoking prevalence is influenced by the broader social determinants of health in regions. Seven of the eight Indigenous Regions with a daily smoking prevalence of over 50% in 2018-19, were the same regions in the lowest quintiles for education and employment outcomes in the Closing the Gap targets.

According to the 2022-23 NATSIHS, there was a higher proportion of Aboriginal and Torres Strait Islander people aged 15 years and over living in remote areas who reported smoking daily (46%) compared with those living in non-remote areas (26%) [50170]. Daily smoking rates for people aged 18 years and over, categorised by the remoteness of where they live within specific jurisdictions, were available for three states: Qld (remote areas: 54% compared with non-remote areas: 32%); SA[2] (remote areas: 40% compared with non-remote areas: 33%); and WA (remote areas: 47% compared with non-remote areas: 20%).

In 2022, 40% of Aboriginal and Torres Strait Islander mothers reported smoking during pregnancy (down from 48% in 2012) [43321]. The smoking rate was lower after 20 weeks of pregnancy (33%) compared with the first 20 weeks (39%).

In 2018-19, the NATSIHS found 57% of Aboriginal and Torres Strait Islander children aged 0-14 years lived in households with a person who smoked daily, of which 15% reported someone smoked at home indoors [42101]. Overall, 8.6% of Aboriginal and Torres Strait Islander children aged 0-14 years reported living in households where someone smoked indoors.

The Tackling Indigenous Smoking (TIS) program is an Australia-wide initiative to reduce smoking rates among Aboriginal and Torres Strait Islander people through a population health promotion approach. A 2021 study, including 8,549 Aboriginal and Torres Strait Islander participants (aged 16 years and over), sought to examine differences in smoking-related attitudes and behaviours among people residing in TIS-funded areas of Australia compared with those in non-TIS funded areas [44061]. The study found that there was a 15% lower prevalence of smoking inside the home in TIS-funded areas compared with non-TIS areas. Among people who currently smoked, there was a significantly lower prevalence in TIS-funded areas compared with non-TIS funded areas of smoking 21 or more cigarettes per day and smoking a cigarette within five minutes of waking (both of which are indicators of nicotine dependence).

Mortality

In 2018, 835 deaths (23% of all deaths among Aboriginal and Torres Strait Islander people) were attributable to tobacco use [44827].

A 2021 prospective study conducted among 1,388 Aboriginal and Torres Strait Islander people in NSW determined that smoking was the cause of 50% of deaths for people aged 45 years and over, and 37% of deaths among all ages [42338]. However, it was found that quitting smoking at any age was beneficial compared with continuing to smoke. The study is the first to give direct estimates of deaths attributable to smoking for Aboriginal and Torres Strait Islander people by analysing linked questionnaire and mortality data from 2006-2009 to mid-2019. The Aboriginal and Torres Strait Islander participants were part of a larger longitudinal study tracking the health of 267,153 people from the NSW general population.

Burden of disease

In 2018, tobacco use was the overall leading risk factor contributing to the burden of disease among Aboriginal and Torres Strait Islander people, responsible for 12% of the total burden of disease (11.5% directly from tobacco use and 0.4% from second-hand smoke) [44827]. It was the leading risk factor contributing to the burden of disease among people aged 45 years and over. In the same year, 5.5% of non-fatal burden and 19% of fatal burden among Aboriginal and Torres Strait Islander people was attributable to tobacco use. Tobacco use was the leading risk factor contributing to the fatal burden of disease for both males and females [43959]. The use of tobacco contributed to the total burden of the following disease groups: respiratory diseases (47%), cancer and other neoplasms (37%), CVD (34%), infectious diseases (13%), endocrine disorders (10%), musculoskeletal conditions (4.5%), neurological conditions (2.5%), gastrointestinal disorders (1.0%), and hearing and vision disorders (0.4%) [44827].

E-cigarette use (vaping)

E-cigarette use (also known as vaping) is an emerging global issue in tobacco control [46823]. E-cigarettes have been associated with a range of health impacts including injuries (poisoning, burns and seizures), lung injury, nicotine addiction, dual use with tobacco smoking, and increased uptake of tobacco smoking among non-smokers [46823]. There are also impacts on the environment such as indoor air pollution and waste.

In the 2022-23 NATSIHS, 24% of people aged 15 years and over self-reported having ever used e-cigarettes and 8.3% reported that they were currently using e-cigarettes [50170]. Three-quarters (76%) of respondents had never used an e-cigarette. In the 2017 Australian Secondary Students’ Alcohol and Drug (ASSAD) Survey conducted among students aged 12-17 years, of the 1,097 Aboriginal and Torres Strait Islander respondents, 22% self-reported having ever used an e-cigarette [45903]. Among those who had ever used e-cigarettes, 72% had also tried smoking tobacco, while 28% had never smoked.

Similar proportions of males (9.5%) and females (7.5%) aged 15 years and over reported currently using an e-cigarette in the 2022-23 NATSIHS [50170]. Likewise, 26% of males reported ever using an e-cigarette compared with 22% of females. In the 2017 ASSAD Survey, a higher proportion of males aged 12-17 years self-reported having ever used an e-cigarette (26%) compared with females (18%) [45903].

The highest proportion of current e-cigarette users in the 2022-23 NATSIHS were younger Aboriginal and Torres Strait Islander adults [50170]. Among the 18-24 years age-group, 16% were current e-cigarette users, followed by the 25-34 years age-group (12%), and the 35-44 years age-group (7.9%). Similarly, ever use of e-cigarettes was also highest among the younger age-groups (18-24 years age-group: 40%, 25-34 years age-group: 35%, 35-44 years age-group: 24%).

The rates of having ever used an e-cigarette among people aged 18 years and over varied among jurisdictions (excluding the ACT) in the 2022-23 NATSIHS [50170]. The highest proportions were found in SA and Vic (both 34%), followed by NSW and WA (both 25%), Qld (23%), Tas (21%), and the NT (8.5%).

In the 2022-23 NATSIHS, the proportion of people aged 18 years and over who had ever used an e-cigarette was higher in non-remote areas (27%) compared with remote areas (11%) [50170]. Similarly, a greater proportion of people in non-remote areas reported currently using an e-cigarette (9.7%) compared with those in remote areas (2.6%).

[1] Proportions for SA and Tas have a high margin of error and should be used with caution.

[2] Proportions for SA have a high margin of error and should be used with caution [50170].