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Tobacco smoking is a leading risk factor for chronic disease and death, including many types of cancer, respiratory disease and heart disease and is the major cause of cancer, accounting for about 20–30% of cancer cases (AIHW & AACR 2012). In Australia in 2004–05, about 15,000 deaths per year were attributable to smoking (Collins & Lapsley 2008).
Strategies to minimise the harm that tobacco smoking causes have been in place for a number of decades. The National Tobacco Strategy (NTS) 2012–2018 sets out a national framework to reduce tobacco-related harm in Australia, with the goal 'to improve the health of all Australians by reducing the prevalence of smoking and its associated health, social and economic costs, and the inequalities it causes'. (IGCD 2013). It is a policy framework for the Australian Government and state and territory governments to work together and in collaboration with non-government agencies to improve health and reduce the social and economic costs that tobacco use causes.
In this chapter, information is presented on: changes to smoking patterns over time; age and sex comparisons; use of tobacco products and unbranded tobacco; and environmental exposure to tobacco smoke. All data presented in this chapter is available through the online tobacco tables.
Please refer to Chapter 8 'Specific population groups' for information on tobacco use among: Indigenous people; pregnant women; people who identified as being homosexual/bisexual; people with mental health conditions; and state and territory results and other geographical breakdowns.
National, state, territory and local governments, together with national and international tobacco control organisations, are continually working on new ways to reduce the harms associated with smoking.
Australia has some of the strongest and most innovative legislation and tobacco control measures in the world. See Box 3.1 for measures at the national level and Box 3.2 for measures at the state and territory level.
At the national level, the comprehensive set of national tobacco control measures includes:
At the state and territory level, measures include:
Further information on tobacco control and national anti-smoking campaigns is available at www.health.gov.au/internet/main/publishing.nsf/Content/tobacco and www.quitnow.gov.au.
Tobacco smoking in Australia continues to decline. More specifically:
Figure 3.1: Tobacco smoking status, people aged 14 or older, 1991–2013 (per cent)
Source: Online Table 3.1.
The proportion of both males and females aged 14 or older who smoked daily declined between 2010 and 2013 (Online Table 3.2). As in previous years, females were less likely than males to have smoked, at any frequency, and were more likely to have never taken up smoking.
Figure 3.2 shows that in 2013:
Figure 3.2: Tobacco smoking status, people aged 12 or older, by age, 2013 (per cent)
Note: Estimates of smoking prevalence in younger people (younger than 18) are limited due to low smoking prevalence and small sample sizes in this age group.
Source: Online Table 3.3.
While there has been a steady decline in daily smoking over the past 12 years, there is a large variation in the decline by age. People aged 18–49 were far less likely to smoke daily than they were 12 years ago; however, the decline is less pronounced for older people with little change in daily smoking seen among people aged 60 or older. Figure 3.3 shows that:
Figure 3.3: Daily smokers, people aged 12 or older, by age, 2001 to 2013 (per cent)
Source: Online Table 3.4
Note: The 2001 survey did not include those aged 12–13; the 2001 total for people aged 12 or older is for people aged 14 or older.
Most people first try smoking tobacco during adolescence. As people who begin smoking early are more likely to continue smoking, tobacco use among young people is a key predictor of adult smoking (Tyas & Pederson 1998). One of the objectives of the National Drug Strategy 2010–2015 is to prevent the uptake and delay the onset of drug use, including tobacco (MCDS 2011).
Progress towards quitting smoking often involves reducing the number of cigarettes smoked each day. Similarly, the costs of cigarettes may also cause smokers to reduce their use. In 2013:
There was variation in the number of cigarettes smoked per week between age groups. Smokers aged 50–69 remained the most likely to smoke the largest number of cigarettes per week (about 120), 60% higher than those in their 20s (about 75).
A heavy smoker is considered to be someone who smokes 20 or more cigarettes per day. In 2013, 3 in 10 (33%) smokers were considered heavy smokers and heavy smoking was highest among people aged 50–69 with more than 4 in 10 (44%) smoking 20 or more cigarettes per day (Figure 3.4).
Figure 3.4: Average number of cigarettes smoked per week, by age, 2010 and 2013
Source: Online tables 3.7 and 3.8.
Tobacco smokers choose to smoke a variety of tobacco products including cigarettes, cigars and cigarillos. In 2013:
The 2013 survey was the first time that respondents were asked about their use of battery operated electronic cigarettes, also known as e-cigarettes, e-cigs or electronic nicotine delivery systems. Electronic cigarettes are devices for creating aerosols which contain nicotine and/or flavouring agents, the aerosol then being inhaled. The visual, physio-sensory and behavioural aspects of electronic cigarettes simulate the act of tobacco smoking.
The effects of passive smoking are a focus of concern, particularly for children who may be exposed to tobacco smoke. Such exposure increases the risk of a range of health problems in children, including chest infections, ear infections, asthma and sudden infant death syndrome (Dunn et al. 2008).
Results from the survey show that parents and guardians are choosing to reduce their children's exposure to smoke at home. More specifically:
Figure 3.5: Proportion of households with children aged 15 and under where an adult reports smoking, 1995 to 2013 (per cent)
Source: Online Table 3.11.
Illicit tobacco includes both unbranded tobacco and branded tobacco products on which no excise, customs duty or Goods and Services Tax (GST) was paid.
Unbranded tobacco (commonly known as chop-chop) is finely cut, unprocessed loose tobacco that has been grown, distributed and sold without government intervention or taxation (ANAO 2002). The proportion of smokers aged 14 or older who were aware of unbranded tobacco declined between 2007 and 2013, from 48% to 34%, and the proportion who have smoked unbranded tobacco in their lifetime also fell from 27% to 16.5% in 2013 (Figure 3.6). The majority of the lifetime users of unbranded tobacco no longer smoke it with only 3.6% smoking unbranded loose tobacco at the time of the 2013 survey, declining from 6.1% in 2007. As a proportion of those aware of unbranded tobacco, there was no change in current use with 10.7% currently smoking unbranded tobacco, compared with 10.6% in 2010 and 12.7% in 2007.
Figure 3.6: Use of unbranded loose tobacco, people aged 14 or older, 2007 to 2013 (per cent)
Note: The survey questions relating to unbranded loose tobacco were modified in 2010 and only asked respondents about awareness and use of unbranded loose tobacco whereas in 2007 and 2013 respondents were asked about awareness and use of unbranded loose tobacco and unbranded cigarettes. This should be taken into account when comparing the 2010 results with the 2007 and 2013 results.
Source: Online Table 3.12.
Illicit branded tobacco is commonly defined as tobacco products (mostly cigarettes) that are smuggled into Australia without payment of the applicable customs duty. It should be noted that it may be easier for consumers to report whether they smoke 'unbranded' tobacco (refer previous section), but they may not necessarily know whether the branded tobacco that they have seen or purchased is actually illicit (Scollo et. al. 2014).
In relation to illicit branded tobacco, the 2013 survey asked whether, in the last 3 months, respondents had seen or purchased any packs of cigarettes or tobacco without plain brown packaging and graphic health warnings. While not being definitive characteristics of illicit tobacco, the absence of the required Australian health warnings on the tobacco product packaging, and packaging that does not comply with Australia's plain packaging legislation, could be an indication that the product is illicit.
Findings from 2013 showed that:
A wide variety of factors can influence a decision to change or reduce tobacco smoking including legislative, educational and economic factors. In 2013, more than 1 in 3 smokers reduced the amount of tobacco they smoked in a day and 1 in 5 had successfully given up for at least a month before the survey.
Other 2013 findings show:
Smokers who smoked fewer than 20 cigarettes per day were more likely to succeed at making changes to their smoking behaviour while heavy smokers were more likely to attempt changes without success (Figure 3.7).
Figure 3.7: Changes to smoking behaviour, smokers(a) aged 14 or older, by tobacco smoking intensity, 2013 (per cent)
Source: Online Table 3.15.
When looking at broad reasons for changes to smoking behaviour, the main reasons smokers attempted to quit or change their smoking behaviour in 2013 were because smoking was costing too much money or it was affecting people's health (Online Table 3.16). More smokers nominated cost as a factor in 2013 (47% compared with 36% in 2007) and this is now the reason most frequently reported. When looking at more specific reasons, the most common motivations for trying to quit smoking in 2013 were similar to 2010, except for:
Most smokers were motivated to change their behaviour for health reasons (Online Table 3.16); however, the type of health reason varied by age with younger people being more motivated by fitness, and older people more likely to be influenced by advice from their doctor (Online Table 3.17).
The vast majority of adult smokers (18 and over) bought cigarettes at shops/retailers (Online Table 3.18). As there are legal restrictions on the sale of tobacco products to minors, those aged 12–17 were far less likely to regularly buy cigarettes at shops, and more likely to obtain them from a friend, acquaintance or relative.
The majority of adult smokers purchased their tobacco products from major supermarkets (52%), followed by other retail outlets (such as the local convenience store or petrol station) and tobacconists (21% and 18% respectively).