Tobacco use imposes one of the largest public health risks worldwide, killing more than 8 million people a year, including around 1.2 million deaths estimated from exposure to second-hand smoke.1
In Australia in 2018, 8.6% of the total disease burden was attributed to tobacco use, making it the leading risk factor for disease burden and death.
About this measure
Tobacco use imposes one of the largest public health risks worldwide, killing more than 8 million people a year, including around 1.2 million deaths estimated from exposure to second-hand smoke.1
In Australia in 2018, 8.6% of the total disease burden was attributed to tobacco use, making it the leading risk factor for disease burden and death. Tobacco use is considered responsible for over 76% of the disease burden due to lung cancer, 73% of the COPD burden and laryngeal cancer burden, and over 50% of the burden from oesophageal cancer.2
Tobacco use contributed most to the fatal burden, with almost 20,500 deaths (13% of all deaths) attributed to tobacco in 2018. Tobacco use was found to be causally linked to the burden of 41 individual diseases, including 19 types of cancer comprising those with a primary site of lung, oesophagus, breast, lip and oral cavity, pharynx, nasal cavity and accessory sinuses, larynx, stomach, pancreas, colon and rectum, liver, kidney, ureter, bladder, cervix and ovary, and myeloid leukaemia.2-3
The prevalence of tobacco use among adolescents is high, particularly among 15-year-olds, and approximately 90% of tobacco use is initiated among persons aged less or equal to 18 years.4-5 Those starting smoking during their early adolescent years are more likely to smoke daily later in life.6
Current status
In 2022, 86.5% of adolescents (88.0% of males and 85.3% of females) aged 12-17 years reported that they had never smoked.
A higher proportion of adolescents aged 12-15 years reported never smoking than applying to ages 16-17 years (89.5% vs 79.6%, respectively).7
Trends
Over the last three decades, the proportion of adolescents who reported that they had never smoked increased substantially from 41.9% of persons in 1996 to double at 82% of persons (82% of males and 83% of females) in 2017. This rate continued to increase from 2017 to 2022-23, reaching 86.5 % (88.0% of males and 85.3% of females).7-8
Between 2017 and 2022-23, the proportion who reported that they had never smoked in the older ages of 16-17 years increased from 68.6% to 79.6%, but with marginal increase occurring in ages 12-15 years from 88.5% to 89.5%.7-8 However, caution should be taken comparing 2022-23 ASSAD reports with earlier ones. (see About the data).
Current smoking in the past week declined among adolescents aged 12-15-year in the late 1980s, before increasing to the early 1990s. After 1996, prevalence rates significantly declined to 2014 and to 3% in 2017. Among older students (aged 16 and 17 years), this rate declined from 1999 to 2014 and with a marginal decrease to 9% in 2017.8
The increasing trend in adolescents of those who reported they have never smoke was also reported by the AIHW – National Drug Strategy Household Survey 2022-23 report, indicating that the proportion of adolescents aged 14-17 years who reported never smoking increased from 81.7% in 2001 to 97.5% in 2022-23.9-10
Similarly, trends in current daily smoking rates for secondary school students aged 12-17 years decreased from 26.0% of persons (27.0% of males and 26.0% of females) in 2011, to 22.0% of persons (23.0% of males and 21.0% of females) in 2017.8
No data on daily smoking were publicly reported in the ASSAD 22/23 report for comparison. However, daily smoking in adolescents aged 14-17 years was reported to have reduced substantially from 2001 to 2023, as indicated in the AIHW – National Drug Strategy Household Survey 2022-23 reports.9-10
A downward trend since 1996 in smoking among adolescents is thought to reflect the positive outcomes of Australian tobacco control strategies and public health initiatives, especially the launching of the first National Tobacco Campaign in 1997 and the promotion of other tobacco control initiatives at the Commonwealth and State and Territory level, together with comprehensive public policy efforts such as increasing tobacco taxes, introduction of smokefree environments, and stricter enforcement of regulations relating to sales to minors and smokefree areas and mass media campaigns.11-16
About the data
This measure comprises the proportions of Australian adolescents aged 12-17 years who indicated that they never smoked, or reported smoking on a daily basis.
Numerator: Secondary students aged 12 to 17 years reporting that they never smoked or reported smoking on a daily basis.
Denominator: Secondary students aged 12 to 17 years surveyed across Australia at schools which were randomly sampled and weighted so as to represent the geographic and educational dispersion of the population.
The Australian School Students Alcohol and Drug Survey (ASSAD) survey is a triennial national survey since 1984. This is the largest national survey of adolescent substance use in Australia. It is administered on school premises (i.e., without parental involvement), which has been shown to result in more accurate estimates of smoking and vaping compared to other survey methods.19 The ASSAD survey sampled secondary school students aged 12 to 17 years with representation across all Australian states and territories (including metropolitan and regional areas).
Students were asked if they had ever smoked - even just part of a tobacco cigarette (‘lifetime (ever) smoking’), smoked tobacco cigarettes in the last twelve months (‘past year smoking’), or smoked tobacco cigarettes in the last four weeks (‘past month smoking’).7
Caution should be taken when interpreting trends over time due to7:
(i) Changes in the national survey methodology for 2022/2023 (e.g., shift from pen-and-paper to online survey mode, and providing schools with the option of having classroom teachers administer the survey in place of research staff in some jurisdictions).
(ii) The additional time lag between the COVID-delayed 2022/2023 survey round and the previous ASSAD survey round in 2017 (i.e., five years instead of three years).
(iii) Data collection being spread across two academic school years for the most recent survey round (compared with a single academic school year for all previous survey rounds).
(iv) The smaller number of schools and students included in the final sample for 2022/2023. This would have reduced the precision of the prevalence estimates (i.e., the confidence intervals around each estimate would be larger).
Data sources
Australian data: Cancer Council Victoria, Tobacco and alcohol use among Australian secondary school students (ASSAD), 1984-2017. https://www.cancervic.org.au/research/behavioural/major-topics-projects/tobacco/australian-secondary-student-smoking-behaviours.html
The ASSAD data for surveys in 1984, 1987, 1990, 1993, 1996, 1999, 2002, 2005, 2008, 2011, 2014, 2017 and 2022-2023 were reported separately. Examples are as follows:
- Hill D, Willcox S, Gardner G, and Houston J. Tobacco and alcohol use among Australian secondary schoolchildren. Medical Journal of Australia, 1987; 146(3):125–30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3494905
- Hill D, White V, Pain M, and Gardner G. Tobacco and alcohol use among Australian secondary school students in 1987. Medical Journal of Australia, 1990; 152(3):124–30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2300011
- Hill D, White V, Williams R, and Gardner G. Tobacco and alcohol use among Australian secondary school students in 1990. Medical Journal of Australia, 1993; 158(4):228–34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8426543
- Hill D, White V, and Segan C. Prevalence of cigarette smoking among Australian secondary school students in 1993. Australian Journal of Public Health, 1995; 19(5):445–9. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1753-6405.1995.tb00408.x/full
- Hill D, White V, and Letcher T. Tobacco use among Australian secondary students in 1996. Australian and New Zealand Journal of Public Health, 1999; 23(3):252–9. Available from: http://www3.interscience.wiley.com/journal/120141556/abstract
- Hill D, White V, and Effendi Y. Changes in the use of tobacco among Australian secondary students: results of the 1999 prevalence study and comparisons with earlier years. Aust NZ J Public Health, 2002; 26:156–63. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1467-842X.2002.tb00910.x/abstract
- White V and Hayman J. Smoking behaviours of Australian secondary school students in 2002. National Drug Strategy monograph series no. 54, Canberra: Australian Government Department of Health and Ageing, 2004. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/content/mono54
- White V and Hayman J. Smoking behaviours of Australian secondary students in 2005. National Drug Strategy Monograph series no. 59, Canberra: Drug Strategy Branch, Australian Government Department of Health and Ageing, 2006. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/mono59
- White V and Smith G. 3. Tobacco use among Australian secondary students (PDF 87 KB) in Australian secondary school students’ use of tobacco, alcohol, and over-the-counter and illicit substances in 2008. Canberra: Drug Strategy Branch Australian Government Department of Health and Ageing; 2009. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/school08
- White V and Bariola E. 3. Tobacco use among Australian secondary students in 2011, in Australian secondary school students’ use of tobacco, alcohol, and over-the-counter and illicit substances in 2011. Canberra: Drug Strategy Branch Australian Government Department of Health and Ageing; 2012. Available from: http://darta.net.au/wordpress-content/uploads/2017/01/ASSAD-2011.pdf
- White V and Williams T, Australian secondary school students’ use of tobacco in 2014. Centre for Behavioural Research in Cancer, Cancer Council Victoria; 2015. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/BCBF6B2C638E1202CA257ACD0020E35C/File/Tobacco%20Report%202014.PDF
- Guerin N and White V. Statistics & Trends: Australian Secondary Students’ Use of Tobacco, Alcohol, Over-the-counter Drugs, and Illicit Substances, Second edition. Cancer Council Victoria, 2020. Available from: https://www.health.gov.au/resources/publications/trends-in-substance-use-among-australian-secondary-school-students-1996-2017
- Scully M, Bain E, Koh I, Wakefield M, and Durkin S. Centre for Behavioural Research in Cancer. Cancer Council Victoria. Prepared for Australian Government Department of Health and Aged Care. ASSAD 2022–2023: Australian secondary school students’ use of tobacco and e-cigarettes. Available from: https://www.health.gov.au/sites/default/files/2023-11/secondary-school-students-use-of-tobacco-and-e-cigarettes-2022-2023.pdf
References
Data:
Centre for Behavioural Research in Cancer. Cancer Council Victoria. Prepared for Australian Government Department of Health and Aged Care. Australian secondary school student smoking behaviours. Since 1984. Accessed May 2024; https://www.cancervic.org.au/research/behavioural/major-topics-projects/tobacco/australian-secondary-student-smoking-behaviours.html
Policy:
Australian Government. Department of Health. National Tobacco Campaign. Canberra. Accessed May 2024; https://www.health.gov.au/initiatives-and-programs/national-tobacco-campaign
Australian Government. Department of Health. National Tobacco Strategy. Canberra. Accessed May 2024; https://www.health.gov.au/our-work/national-tobacco-strategy
Australian Government. Department of Health. Tobacco control enforcement policy. Canberra. Accessed May 2024; https://www.health.gov.au/resources/publications/tobacco-control-enforcement-policy
Department of Health and Aged Care, ‘Tobacco control timeline’. Accessed May 2024; https://www1.health.gov.au/internet/publications/publishing.nsf/Content/tobacco-control-toc~timeline
References
- WHO 2022. Tobacco. Accessed May 2024; https://www.who.int/news-room/fact-sheets/detail/tobacco
- Australian Institute of Health and Welfare 2021. Australian Burden of Disease Study 2018: Interactive data on risk factor burden. Accessed May 2024; https://www.aihw.gov.au/reports/burden-of-disease/abds-2018-interactive-data-risk-factors/contents/tobacco-use
- International Agency for Research on Cancer. Personal Habits and Indoor Combustions. Volume 100E. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Lyon: IARC, 2012.
- WHO 2020. Smoking still a core challenge for child and adolescent health reveals WHO report. https://www.who.int/europe/news/item/05-06-2020-smoking-still-a-core-challenge-for-child-and-adolescent-health-reveals-who-report
- Centers for Disease Control and Prevention (CDC). Tobacco use and usual source of cigarettes among high school students--United States, 1995. MMWR Morb Mortal Wkly Rep. 1996 May 24;45(20):413-8. PMID: 8614397
- Australian Institute of Health and Welfare 2017. National Drug Strategy Household Survey 2016: detailed findings. Cat. PHE 214. Accessed May 2024; Canberra: AIHW https://www.aihw.gov.au/reports/illicit-use-of-drugs/2016-ndshs-detailed/data
- Scully M, Bain E, Koh I, et al. Centre for Behavioural Research in Cancer. Cancer Council Victoria. Prepared for Australian Government Department of Health and Aged Care. ASSAD 2022–2023: Australian secondary school students’ use of tobacco and e-cigarettes. Accessed May 2024; https://www.health.gov.au/sites/default/files/2023-11/secondary-school-students-use-of-tobacco-and-e-cigarettes-2022-2023.pdf
- Guerin, N., White, V. ASSAD 2017 Statistics & Trends: Australian Secondary Students’ Use of Tobacco, Alcohol, Over-the-counter Drugs, and Illicit Substances. Second Edition. Cancer Council Victoria. Accessed May 2024; https://www.health.gov.au/sites/default/files/documents/2020/07/secondary-school-students-use-of-tobacco-alcohol-and-other-drugs-in-2017.pdf
- Australian Institute of Health and Welfare 2024. National Drug Strategy Household Survey 2022–2023: Alcohol, tobacco & other drugs in Australia. Accessed May 2024; https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/drug-types/tobacco#consumption
- Australian Institute of Health and Welfare 2024. National Drug Strategy Household Survey 2022–2023: Tobacco smoking in the NDSHS. Accessed May 2024; https://www.aihw.gov.au/reports/smoking/tobacco-smoking-ndshs
- Australian Government. Department of Health. National Tobacco Campaign. Canberra. Accessed May 2024; https://www.health.gov.au/initiatives-and-programs/national-tobacco-campaign
- Australian Government. Department of Health. National Tobacco Strategy. Canberra. Accessed May 2024;https://www.health.gov.au/our-work/national-tobacco-strategy
- Australian Government. Department of Health. Tobacco control enforcement policy. Canberra. Accessed May 2024; https://www.health.gov.au/resources/publications/tobacco-control-enforcement-policy
- Department of Health and Aged Care, ‘Tobacco control timeline’. Accessed May 2024; https://www1.health.gov.au/internet/publications/publishing.nsf/Content/tobacco-control-toc~timeline
- Hill D and Hassard K. Overview, in Australia’s National Tobacco Campaign. Evaluation Report Volume One. Hassard K, Editor Canberra: Commonwealth Department of Health and Aged Care; 1999. Accessed May 2024; http://webarchive.nla.gov.au/gov/20140801095025/http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-publicat-document-metadata-tobccamp.htm#.
- White V, Warne C, Spittal M, Durkin S, Purcell K, et al. What impact have tobacco control policies, cigarette price and tobacco control program funding had on Australian adolescents' smoking? Findings over a 15-year period. Addiction, 2011; 106(8):1493–502. Accessed May 2024; http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03429.x/pdf
- Barrett, E.M., Maddox, R., Thandrayen, J. et al. Clearing the air: underestimation of youth smoking prevalence associated with proxy-reporting compared to youth self-report. BMC Med Res Methodol 22, 108 (2022).