Latest information and statistics on tobacco and e-cigarette use

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].