Tobacco use is the single largest cause of cancer globally and the predominant cause of lung cancer.1 The risk of developing lung cancer due to tobacco smoking increases with the duration of smoking and the numbers of cigarettes smoked per day.2 Tobacco use is the major risk factor for cancer among Aboriginal and Torres Strait Islander people 4, 5 and smoking-related cancers make up the majority of cancers affecting Aboriginal and Torres Strait Islander people.3
Charts
About this measure
Smoking prevalence is an important cancer control measure as tobacco use is estimated to be attributable to 22% of the cancer burden on the Australian population.5 Between 2003 and 2007, lung cancer was the leading cause of cancer deaths for Aboriginal and Torres Strait Islander people (both males and females). An annual average of 54 lung cancer deaths recorded for Aboriginal and Torres Strait Islander males (28% of all Aboriginal and Torres Strait Islander male cancer deaths) and 38 for Aboriginal and Torres Strait Islander females (22% of Aboriginal and Torres Strait Islander female cancer deaths).6 While, the most recent national data shows that current smoking rates among Aboriginal and Torres Strait Islander peoples are high. Recent data from 2018-19 showed that 50.7% (50.2% males and 51.2% females) of Aboriginal and Torres Strait Islander people attempted to quit smoking over the last 12-months. There have also been positive improvements over the past twenty years, with a significant decline in people age 18 years and over smoking rates from 55% in 1994 to 45% in 2014–15.5,6
Tobacco smoking also causes cancers of the oral cavity, pharynx, nasal cavity and accessory sinuses, larynx, oesophagus, stomach, pancreas, colon and rectum, liver, kidney, ureter, bladder, cervix and ovary, and myeloid leukaemia.1 An association between tobacco smoking and female breast cancer has also been reported by the International Agency for Research on Cancer (IARC) and this finding is supported by a recent meta-analysis of nearly 32,000 breast cancer cases.7 The risk of developing cancer from tobacco smoking has been shown to increase with duration of smoking and the numbers of cigarettes smoked per day.
The data in this measure show proportions of Aboriginal and Torres Strait Islander people aged 15 years and over reporting that they are not smoking and those reporting cigarette smoking on a daily basis.
For a comparison with the broader Australian community see the NCCI ‘Smoking prevalence’.
Current status
In 2018-19, 59.9% of Aboriginal and Torres Strait Islander people (57.3% of males and 61.6% of females) aged 15 years and over reported that they did not smoke, whilst 37.4% (39.1% of males and 35.9% of females) reported smoking on a daily basis.3 Smoking prevalence was lower among persons aged 15-17 years, with 88.2% of Aboriginal and Torres Strait Islander people reporting they did not smoke, and higher among those aged 18 years and over, ranging between 50.3% to 64.0% of persons reporting not smoking.3
Remoteness
In 2018-19, the proportion of Aboriginal and Torres Strait Islander people smoking daily was lower among those living in Non-remote areas (34.6%) compared to those living in Remote areas (49.3%).3 This pattern was similar for Aboriginal and Torres Strait Islander people reporting not smoking across areas of remoteness. In Non-remote areas 63.3% of persons reported not smoking compared to 43.5% of persons in Remote areas.3
Trends
The prevalence of smoking among young Aboriginal and Torres Strait Islander people aged 15-17 years has decreased over time. This is reflected in the finding that, from 2012- 13 to 2018-19:
- the proportion of Aboriginal and Torres Strait Islander people reporting that they did not smoke increased from 81.0% (74.3% of males and 79.2% of females) to 88.2% (84.8% of males and 91.4% females). 3
- daily smoking rates for Aboriginal and Torres Strait Islander people aged 15-17 years decreased from 17.6% (20.4% of males and 14.6% of females) to 9.7% (11.7% of males and 7.8% of females to 9.7%). 3
The prevalence of smoking among Aboriginal and Torres Strait Islander people aged 15 years and over has decreased over time. This is reflected in the finding that, from 2012- 13 to 2018-19:
- the proportion of Aboriginal and Torres Strait Islander people reporting that they did not smoke increased from 57% (55.4% of males and 58.6 % of females) to 59.5% (57.3% of males and 61.6% females).3
- the proportion of Aboriginal and Torres Strait Islander people reporting that smoking on a daily basis decreased from 41.0% (42.6% of males and 39.4% of females) to 37.4% (39.1% of males and 35.9% females).3
Remoteness
From 2012-13 to 2018-19 the proportion of Aboriginal and Torres Strait Islander people reporting that they did not smoke decreased slightly in Remote areas from 47.6% to 43.5% and increased slightly in Non-remote areas from 59.7% to 63.3% and.3
From 2012-13 to 2018-19 daily smoking rates for Aboriginal and Torres Strait Islander people decreased in Non-remote areas, from 38.5% in to 34.6% and remained stable in Remote areas from 49.8% to 49.3%.3
Barriers and opportunities
Tobacco smoking remains a major public health problem in Australia and internationally. Cigarette smoking often becomes established in adolescence, and young people who begin smoking at an earlier age are more likely to develop long-term nicotine addiction.8, 9 Reducing smoking prevalence involves supporting existing smokers to quit and preventing smoking initiation.
The impact of colonisation led initially to tobacco use among Aboriginal and Torres Strait Islander peoples. Tobacco was often used in first encounters between colonisers and Aboriginal and Torres Strait Islander peoples as a gesture of goodwill and to help form relationships10, 11, 12 and later introduced as payment for labour.12 Additionally, colonisation led to ongoing trauma, stress, racism and exclusion from economic structures, and these factors are all associated with tobacco use today.
A long-term Australian Government initiative is the Tackling Indigenous Smoking (TIS) program, which is designed to improve the health of Aboriginal and Torres Strait Islander peoples by reducing tobacco use.13 The program has a multi-level approach at a community base, designed to provide accessible culturally appropriate educational resources and tools to support the reduction of smoking prevalence amongst Aboriginal and Torres Strait Islander peoples.13
Additionally, the establishment of the first National Tobacco Campaign in 1997 is likely to have contributed to a decline in smoking prevalence within Ausrtalia,14,15 and this was complemented by promotion of other tobacco control initiatives at the Commonwealth and state and territory level. This includes: graphic health warnings on cigarette packs, tobacco excise increases and the introduction of plain packaging.2
About the data
Smoking prevalence has been measured in terms of the proportion of the population aged 15 years and older reporting not smoking, and the proportion of the population aged 15 years and older reporting daily smoking. The proportion of persons not smoking is the sum of persons who are ex-smokers, and persons who have never smoked.
Definitions
Daily smoker was defined as smoking one or more cigarettes, cigars or pipes per day.
Ex-smoker is defined as not currently smoking, but had regularly smoked daily, or had smoked at least 100 cigarettes in their lifetime, or smoked pipes, cigars etc. at least 20 times.
Never smoked is defined as having never regularly smoked and smoked less than 100 cigarettes in their lifetime and had smoked pipes, cigars, etc. less than 20 times.
Methodology
Remoteness
The Australian Statistical Geography Standard (ASGS) was used to allocate participants to a remoteness area based on their area of usual residence.
Non-remote areas combine Major Cities, Inner Regional and Outer Regional remoteness areas and are used for comparing with Remote areas.
Remote areas combine Remote and Very Remote areas and is used for comparing with Non-remote areas.
References
Activity in this area
Data
Australian Bureau of Statistics. 4715.0 - National Aboriginal and Torres Strait Islander Health Survey, 2018-19. Canberra: ABS; 2019; [Accessed May 2020]; Available at: https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4715.0Main+Features12018-19?OpenDocument
National Drug Strategy Household Survey 2016. Australian Institute of Health and Welfare 2017. Canberra AIHW. Available at: https://www.aihw.gov.au/reports/illicit-use-of-drugs/ndshs-2016-key-findings/contents/summary
Social Health Atlases of Australia: Prevalence of selected health risk factors (estimates), 2020; [Accessed January 2022]; Available at: https://phidu.torrens.edu.au/social-health-atlases/indicators-and-notes-on-the-data/social-health-atlases-of-australia-contents#prevalence-of-selected-health-risk-factors-estimates
Policy
Cancer Australia. National Aboriginal and Torres Strait Islander Cancer Framework. 2015 Available from: https://canceraustralia.gov.au/publications-and-resources/cancer-australia-publications/overlay-context=affected-cancer/aboriginal-and-torres-strait-islander-people/national-aboriginal-and-torres-strait-islander-cancer-framework
Cancer Australia. Optimal Care Pathway for Aboriginal and Torres Strait Islander people with cancer. 2018 Available from: https://canceraustralia.gov.au/publications-and-resources/cancer-australia-publications/optimal-care-pathway-aboriginal-and-torres-strait-islander-people-cancer
Tackling Indigenous Smoking
https://www.health.gov.au/initiatives-and-programs/tackling-indigenous-smoking
Tackling Indigenous Smoking Resource and Information Centre
http://tacklingsmoking.org.au/about-the-tackling-indigenous-smoking-resource-information-centre/
National Tobacco Campaign. http://www.quitnow.gov.au/internet/quitnow/publishing.nsf/Content/home
National Tobacco Strategy 2012-2018. Australian Government Department of Health. http://www.health.gov.au/internet/main/publishing.nsf/Content/tobacco-strategy
References
1. 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.
2. Stewart BW, Wild CP editors. World cancer report. Lyon: International Agency for Research on Cancer, WHO; 2014.
3. Australian Bureau of Statistics. 4715.0 - National Aboriginal and Torres Strait Islander Health Survey, 2018-19. Canberra: ABS; 2019; [Accessed May 2020]; Available at: https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4715.0Main+Features12018-19?OpenDocument
4. Cancer Australia, 2015. National Aboriginal and Torres Strait Islander Cancer Framework, Cancer Australia, Surry Hills, NSW.
5. Australian Institute of Health and Welfare 2019. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015. Australian Burden of Disease series no. 19. Cat. no. BOD 22. Canberra: AIHW.
6. Australian Institute of Health and Welfare. 2015. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2015. Cat. no. IHW 147. Canberra: AIHW.
7. Cancer Australia 2015. Position Statement: Lifestyle risk factors and the primary prevention of cancer. Surry Hills, NSW: Cancer Australia.
8. Centers for Disease Control and Prevention 1994. Preventing tobacco use among young people: a report of the Surgeon General (Executive Summary). MMWR; 43(No. RR-4).
9. Heris CL, Eades SJ, Lyons L, Chamberlain C, Thomas DP. Changes in the age young Aboriginal and Torres Strait Islander people start smoking, 2002–2015. Public Health Res Pract. 2019 https://doi.org/10.17061/phrp29121906
10. Axelsson P. Kukutai, T. & Kippen R (2016). The field of Indigenous health and the role of colonisation and history. Journal of Population Research 33(1): 1-7.
11. Paradies Y (2016). Colonisation, racism and Indigenous health. Journal of Population Research 33(1): 83–96.
12. Colonna E. Maddox R. Cohen R. Marmor A. Doery K, Thurber K A. Thomas D. Guthrie J. Wells S. Lovett R (2020) Review of tobacco use among Aboriginal and Torres Strait Islander peoples. Australian Indigenous HealthBulletin: 20(2).
13. Department of Health. Tackling Indigenous Smoking [Accessed May 2020]; Available at https://www.health.gov.au/initiatives-and-programs/tackling-indigenous-smoking
14. Hill D, White V and Effendi Y (2002) Changes in the use of tobacco among Australian secondary students: results of the 1999 prevalence study and comparisons with earlier years. Aust N Z J Public Health; 26(2):156–63.
15. Scollo MM, Winstanley MH 2018. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria. [Accessed May 2019]; www.TobaccoInAustralia.org.au