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The most recent data from the NWDMP show that the estimated population-weighted average consumption of nicotine (including tobacco products and nicotine replacement products, such as patches and gum) is typically higher in regional areas than capital cities (ACIC 2021b).
The addictive nature of nicotine means that successful cessation may take many attempts over several years. Between 2016 and 2019, the NDSHS showed that the proportion of smokers aged 14 and over who succeeded in giving up smoking for more than a month in the 12 months prior to completing the survey increased significantly from 17.2% to 21% (AIHW 2020, Table 2.39).
About 3 in 10 smokers reported they did not intend to quit (AIHW 2020, Table 2.46). The main reasons were because they enjoyed it (61%) or because it relaxes them (40%). A further 1 in 5 (20%) do not intend to quit because they are addicted to nicotine, and 1 in 6 had tried to quit before but it had not worked (AIHW 2020, Table 2.48).
Smokers who smoked fewer than 20 cigarettes per day were more likely to succeed at making changes to their smoking behaviour than pack-a-day smokers. Pack-a-day smokers were more likely to attempt changes without success (AIHW 2020).
The main reasons smokers gave for trying to quit or change their smoking behaviour was due to cost (58%, a significant increase from 52% in 2016) or it was affecting their health (45%) (AIHW 2020, Table 2.41).
Electronic cigarettes (also known as e-cigarettes, electronic nicotine delivery systems, or personal vaporisers) are devices designed to deliver nicotine and/or other chemicals via an aerosol vapour that the user inhales (DHAC 2021). Most e-cigarettes contain a battery, a liquid cartridge and a vaporisation system and are used in a manner that simulates smoking (ACT Health 2021). The solution used in e-cigarettes varies. Common e-liquids include propylene glycol, vegetable glycerol, and flavourings, and may contain nicotine in freebase or salt form (Banks et al. 2022). As of October 2021, a prescription from an Australian doctor is required to access e-cigarettes that contain nicotine, this also includes access via importing from overseas (TGA 2022, DHAC 2021).
The National Health Survey 2020–21 reported:
- Almost 1 in 10 (9.3%) people aged 18 years and over had used an e-cigarette or vaping device at least once. 2.2% reported currently using a device.
- Men were more likely than women to have used an e-cigarette or vaping device at least once (11.3% compared to 7.5%).
- Of people aged 18 years and over who currently smoke tobacco, 8.9% currently use an e-cigarette or vaping device (ABS 2022).
The 2019 NDSHS shows lifetime use of e-cigarettes increased significantly from 8.8% in 2016 to 11.3% in 2019 (AIHW 2020, Table 2.19). More specifically, for those people aged 14 and over, in 2019:
- almost 2 in 5 (39%) smokers had tried e-cigarettes in their lifetime (AIHW 2020, Table S2.19), a significant increase since 2016 (31%)
- there was a significant increase in the proportion of non-smokers who had tried e-cigarettes in their lifetime (from 4.9% to 6.9%; AIHW 2020, Table S2.19)
- 3.2% of current smokers used e-cigarettes daily, a significant increase since 2016 (1.5%) (AIHW 2020, Table 2.22)
- 2.2% of ex-smokers used e-cigarettes daily, a significant increase since 2016 (0.8%) (AIHW 2020, Table 2.22)
- there were significant increases in the lifetime use of e-cigarettes across most age groups between 2016 and 2019, in particular for those aged 18–24 (from 19.2% to 26%) and 25–29 (from 14.8% to 20%) (AIHW 2020, Table 2.19).
More than two-thirds (69%) of e-cigarette users were current smokers when they first tried an e-cigarette. Nearly 1 in 4 (23%) considered themselves to be a ‘never smoker’ at that time. Higher proportions of younger people reported being a ‘never smoker’ (65% of 14–17 year olds and 39% of 18–24 year olds compared with proportions lower than 10% for people in age categories for those 40 and over (AIHW 2020).
The most common reason for trying e-cigarettes was curiosity (54%), but people’s reasons varied by age (AIHW 2020, Table 2.31). People aged under 30 were more likely to nominate curiosity while people aged 50 or older were more likely to use e-cigarettes as a cessation device. Almost 1 in 4 (23%) used e-cigarettes because they thought they were less harmful than regular cigarettes (AIHW 2020, Table 2.31).
All Australian governments have agreed to the policy and regulatory approach to e-cigarettes in Australia. Further information about e-cigarettes can be found on the Department of Health’s website and the health advice from the National Health and Medical Reseach Council.
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 illicit tobacco includes finely cut, unprocessed loose tobacco that has been grown, distributed and sold without government intervention or taxation (AIHW 2020). According to the 2019 NDSHS:
- About 1 in 3 smokers were aware of unbranded tobacco in 2019, a similar proportion to 2016 (34% and 33%, respectively).
- Between 2016 and 2019, there was little change in the proportion of smokers who smoked unbranded tobacco in their lifetime (16.5% and 17.7%, respectively) or who currently use it (3.8% in 2016 and 4.9% in 2019). However, lifetime and current use has declined since 2007 (27% and 6.1%, respectively) (AIHW 2020, Table 2.55).
Illicit branded tobacco includes tobacco products that are smuggled into Australia without payment of the applicable customs duty (AIHW 2020). The 2019 NDSHS showed that:
- More current smokers had seen tobacco products without plain packaging in the previous 3 months (15.2% compared with13.0% in 2016) and more smokers had purchased these products (6.2% compared with 5.5% in 2016) (AIHW 2020, Table 2.56).
- Of those smokers that had seen these products, less than half (42%) had purchased them and about 1 in 10 (13.4%) bought 15 or more of these packets (AIHW 2020, Table 2.57).
- Of smokers who purchased these products, 37% said they bought them from a supermarket, convenience or grocery store and one-quarter (25%) purchased them from a tobacconist; a further 23% did not know where they were purchased from (AIHW 2020, Table 2.56).
Burden of disease and injury
Tobacco is the leading preventable cause of morbidity and mortality in Australia. The Australian Burden of Disease Study 2018, found that tobacco smoking was responsible for 8.6% of the total burden of disease and injury. Estimates of the burden of disease attributable to tobacco use showed that cancers accounted for 44% of this burden (AIHW 2021b).
Tobacco use contributed to the burden for 8 disease groups including 39% of respiratory diseases, 22% of cancers, 11% of cardiovascular diseases, 6.2% of infections and 3.2% of endocrine disorders (AIHW 2021b, Table 6.3).
The total burden attributable to tobacco use has been declining since 2003. There was a 32% decline in the age-standardised rate (from 2003 to 2018), and the proportion of total burden due to tobacco use fell from 10.4% in 2003, to 9.0% in 2015, to 8.6% in 2018 (AIHW 2021b).
Tobacco smoking in pregnancy
Tobacco smoking during pregnancy is the most common preventable risk factor for pregnancy complications and support to stop smoking is widely available through antenatal clinics. Smoking is associated with poorer perinatal outcomes, including low birth weight, being small for gestational age, pre-term birth and perinatal death (AIHW 2022b).
The AIHW’s National Perinatal Data Collection indicates that the proportion of mothers who smoke during pregnancy has fallen over time in Australia. In 2020, 9.2% (or 26,466) of all mothers who gave birth smoked at some time during their pregnancy, down from 13.7% in 2010. The proportion of mothers who smoked during pregnancy declined for both Indigenous and non-Indigenous mothers (AIHW 2022b).
Exposure to second-hand smoke
The inhalation of other people’s tobacco smoke can be harmful to health. Second-hand smoke causes coronary heart disease and lung cancer in non-smoking adults, and induces and exacerbates a range of mild to severe respiratory effects in infants, children and adults. Second-hand smoke is a cause of sudden infant death syndrome (SIDS) and a range of other serious health outcomes in young children. There is increasing evidence that second-hand smoke exposure is associated with psychological distress (Campbell, Ford & Winstanley 2017).
Results from the 2019 NDSHS show that parents and guardians are choosing to reduce their children’s exposure to tobacco smoke at home. The proportion of households with dependent children where someone smoked inside the home has fallen from 31% in 1995 to just 2.1% in 2019. There was also a statistically significant decline from 2.8% in 2016 (AIHW 2020, Table 2.36).
Between 2016 and 2019, the proportion of adult non-smokers exposed to tobacco inside the home also declined significantly from 2.9% to 2.4% (AIHW 2020, Table 2.38).
Results from the 2014–15 NATSISS found over half (63% or 85,768) of young Indigenous people aged 15–24 reported there was a daily smoker in their household (AIHW 2018). Less than one-fifth (15% or 21,155) of young Indigenous people resided in a household where someone smoked indoors (AIHW 2018).