Latest information and statistics on tobacco

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 2022-2023 National Drug Strategy Household Survey (NDSHS)[1] found 20% of Aboriginal and Torres Strait Islander people aged 14 years and over reported smoking daily, declining from 25% in 2019, 27% in 2016 and 32% in 2013 [48574].

The 2018-19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) found 37% of Aboriginal and Torres Strait Islander people aged 15 years and over reported they were smoked daily [39231], a reduction from levels reported in the 2012-13 Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS) (41%). 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].

When comparing smoking prevalence between the 2018-19 NATSIHS and the 2012-13 AATSIHS, the highest reductions in daily smoking were found in the younger age-groups [39231]. Daily smoking prevalence among the 15-17 years age-group decreased from 18% in 2012-13, to 9.7% in 2018-19. Similarly, in the same period there was a reduction in daily smoking prevalence among the 18-24 years age-group (decreasing from 42% to 36%) and the 25-34 years age-group (decreasing from 52% to 44%). 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 2018-19, the proportion of Aboriginal and Torres Strait Islander males aged 15 years and over who smoked daily (39%) was higher than the proportion for females (36%) [39231]. A greater proportion of Aboriginal and Torres Strait Islander males than females reported smoking daily across all age-groups, most notably in the 25-34 years age-group (47% for males compared with 41% for females). For Aboriginal and Torres Strait Islander people, the age-group with the highest proportion of people who smoked daily was 35-44 years (47%).

In 2018-19, Aboriginal and Torres Strait Islander people living in remote areas reported a higher proportion of people aged 15 years and over who smoked daily (49%) compared with those living in non-remote areas (35%) [39231]. While there was a decrease in current daily smoking prevalence for non-remote areas between 2012-13 and 2018-19 (down from 39% to 35%), the overall proportion of people who smoked daily in remote areas had only a minor decrease (from 50% in 2012-13 to 49% in 2018-19). 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.

In 2021, 42% of Aboriginal and Torres Strait Islander mothers reported smoking during pregnancy (down from 50% in 2011) [43321]. In the same year, approximately 1 in 8 Aboriginal and Torres Strait Islander mothers quit smoking during pregnancy (40% reported smoking in the first 20 weeks of pregnancy and 36% reported smoking after 20 weeks).

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 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 [46045]. 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.

The 2022-2023 NDSHS [2] found that 31% of Aboriginal and Torres Strait Islander respondents aged 14 years and over had ever used an e-cigarette [48574]. The proportion of Aboriginal and Torres Strait Islander respondents who reported vaping daily was 6.5%, while 7.1% reported that they vaped occasionally (e.g. weekly, monthly or less than monthly). The majority of respondents (69%) reported that they had never used an e-cigarette.

In the 2018-19 NATSIHS, 8.1% of Aboriginal and Torres Strait Islander adults self-reported having ever used e-cigarettes and 1.3% reported that they were currently using e-cigarettes either daily or weekly [40033].

The highest proportion of current e-cigarette users in the 2018-19 NATSIHS were younger Aboriginal and Torres Strait Islander adults [40033]. Among the 18-24 years age-group, 2.0% were current e-cigarette users, followed by the 25-44 years age-group (1.6%), and the 45 years and over age-group (0.6%). Similarly, ever use of e-cigarettes was also highest among the younger age-groups (18-24 years age-group: 14%, 25-44 years age-group: 8.6%, 45 years and over age-group: 4.2%). A study conducted from 2013 to 2014 among Aboriginal and Torres Strait Islander people who smoked tobacco, found that 21% had also used e-cigarettes [35294]. 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.

Self-reported current e-cigarette use in the 2018-19 NATSIHS was similar for both male and female adults in 2018-19 (males: 1.9%, females: 0.8%), as was ever use (males: 9.7%, females: 6.5%) [40033]. 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 prevalence of ever having used an e-cigarette among Aboriginal and Torres Strait Islander adults in 2018-19 was higher in major cities (10%) and regional areas (8.7%) of Australia compared with remote areas (2.6%) [40033].

[1] Due to the small sample size, caution should be taken when interpreting results. Data collected in 2019 from eight remote communities in the NT were not included so comparisons from previous surveys could be observed.

[2] Due to the small sample size, caution should be taken when interpreting results. Data collected in 2019 from eight remote communities in the NT were not included so comparisons from previous surveys could be observed.