Tobacco

Key findings

  • Tobacco smoking is the leading cause of preventable death in Australia.
  • Tobacco is the leading cause of cancer in Australia (22% of attributable burden).
  • Around 1 in 10 mothers smoked in the first 20 weeks of pregnancy.
  • There has been a long-term downward trend in daily tobacco smoking since 1991 (24% to 12% in 2016).
  • There has been an increase in the number of people choosing to never take up smoking (62% in 2016, up from 51% in 2001).
  • In 2016, around 1 in 3 (31%) current smokers aged 14 and over have ever used e-cigarettes.
  • 57% of daily smokers were aged over 40 in 2016.
  • 20% of daily smokers lived in Remote and Very remote areas of Australia.
  • Of the current smokers in secondary school aged 16–17, more than one quarter (26%) smoked daily.

Tobacco is made from the dried leaves of the tobacco plant and nicotine is the active ingredient responsible for its addictive properties. Tobacco is usually smoked in a cigarette, cigar or pipe, but it might also be snorted or chewed. Tobacco can now also be inhaled as a vapour through electronic nicotine delivery systems (refer to electronic cigarettes below). 

Tobacco use in Australia is legal; however, its supply and consumption are subject to strict regulations. The advertising of tobacco has been prohibited in Australia. In recent years, the restrictions have expanded to ban advertising at the point of sale and include the introduction of plain packaging.   

Smoking is also banned inside restaurants, bars and clubs, and around many public places such as near, children’s play equipment, in cars with children, swimming pools, public transport and in and around public buildings.

Availability

Retailing laws in each jurisdiction regulate the packaging, advertising and display of tobacco products, e-cigarettes and accessories, non-tobacco smoking products and ban the supply of these products to children.

Industry data indicates that the number of cigarettes and cigars and the amount of tobacco sold between 2015 and 2016 has decreased (Table S2.1), however the value of retail sales of tobacco products has increased (Table S2.2).

Consumption

Smoking rates in Australia compare favourably with those of other Organisation for Economic Co-operation and Development (OECD) countries [1] (Table S2.16). There has been a long-term downward trend in tobacco smoking in Australia. The National Drug Strategy Household Survey (NDSHS) showed that between 1991 and 2016:

  • the proportion of persons smoking daily halved (from 24% to 12.2%)
  • the proportion of ex-smokers fluctuated between 21% in 1991, up to 26% in 2004 and has since declined to 23% in 2016
  • the proportion of persons who have never smoked has increased by 13 percentage points to the highest levels seen over the 25-year period (from 49% to 62%) [2] (Figure TOBACCO1).
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However, between 2013 and 2016 the proportion of daily smokers only decreased slightly from 12.8% to 12.2%. This long-term decline in daily smoking has largely been driven by people never taking up smoking rather than smokers quitting (Table S2.14).

Data from the National Health Survey (NHS) also show a statistically significant decline in the number of daily smokers over the last 10 years, down from 18.9% in 2007–08 to 14.5% in 2014–15 [3]. Refer to Box TOBACCO1 for more information the differences between the NDSHS and the NHS.

The  National Wastewater Drug Monitoring Program (NWDMP), measures the presence of substances in sewerage treatment plants across Australia. The most recent data indicates that nicotine was among the most commonly consumed substances monitored by the program [4].

Box TOBACCO1. National data sources on smoking rates

A number of nationally representative data sources are available to analyse recent trends in tobacco smoking and alcohol consumption. The National Drug Strategy Household Survey (NDSHS) and the ABS National Health Survey (NHS) both collect data on tobacco smoking and alcohol consumption from people aged 18 years or over. Both surveys have large sample sizes and use self-report data. However, data from the NDSHS and NHS show variations in estimates, yet comparison of trends over time are consistent between the two surveys. Differences in scope, collection methodology and design may account for this variation and comparisons between collections should be made with caution. For example:

  • the NHS is collected via a face-to-face method whereas the NDSHS is a self-complete drop and collect questionnaire
  • The questions asked in the surveys also differ and therefore results from the surveys are not directly comparable.
  • Survey implementation/collection method: NHS uses a Face to face survey versus the NDSHS self-complete drop-and-collect questionnaires [2,3].

Data from the NDSHS indicates that among adult smokers, the proportion of people who smoked manufactured cigarettes declined between 2013 and 2016 (from 89% to 86%). In contrast, smoking roll-your-own cigarettes significantly increased from 32% in 2013 to 36% in 2016 [2].

In a pattern consistent with decreased consumption, the Household Expenditure Survey showed that the proportion of household costs spent on tobacco has decreased over time from 1.6% in 1984 to 0.9% in 2015–16 [5]. On average, Australians spend $13 per week on tobacco products and this remained stable between 2009–10 and 2015–16 (Table S2.4). This estimate however is for all Australians and is likely to be higher for people who are regular smokers.

Tobacco smoking by age and sex

  • Men are more likely to smoke than women (Figure TOBACCO2):
    • The 2016 NDSHS found that 17.1% of men aged 14 years and over and 12.8% of women were current smokers (smoking either daily, weekly or less than weekly) (Table S2.15).
  • Young people are less likely to smoke daily than older people
    • The majority of daily smokers in 2016 were people aged 40 and over (57% compared with 43% for people under 40 (Figure TOBACCO2).
    • Younger people are also starting smoking later, with the average age when a person had their first full cigarette has increased over time, from 14.2 years in 2001 to 16.3 years in 2016 [2]
    • Of the current smokers in secondary school aged 16–17 more than one quarter (26%) smoked daily. This was lower for those aged 12–15 (18.5%) [6].

These trends are consistent with findings from the National Health Survey [3].

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Geographic trends

Similar to the national trend, most jurisdictions reported slight but non-significant declines in the daily smoking rate between 2013 and 2016 [2]. Data from the NWDMP showed that the consumption of nicotine (including tobacco products and nicotine replacement products, such as patches and gum) varies across regional areas and capital cities, with consumption typically higher in regional areas [4].

The 2016 NDSHS also shows that people living in Remote and Very Remote areas of Australia (21%) are more likely to smoke daily than people living in Inner Regional areas (17.1%) and Major Cities (13.6%). Similarly, Australians living in the most disadvantaged socioeconomic areas were 2.7 times more likely than those in the most advantaged socioeconomic areas to smoke daily (17.7% compared with 6.5%) [2] (Figure TOBACCO3).

The ACT continues to have the lowest adult daily smoking rate even though this rate did not change between 2013 and 2016 (9.9% in both years).

The largest decline in adult daily smoking rates was in the Northern Territory (18.5% in 2016 compared with 22.2% 2013) and South Australia (11.4% in 2016 compared with 13.6% in 2013).

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Explore state and territory data on tobacco smoking in Australia.

Smoking cessation

The addictive nature of nicotine means that successful cessation may take many attempts over several years.

Between 2013 and 2016, the NDSHS showed that the proportion of smokers who succeeded in giving up smoking for at least a month in the 12 months prior to completing the survey declined from 20% to 17.2% (Table S2.21).

The main reasons current smokers do not want to quit were because they enjoy it (59%) or because it relaxes them (40%). About 1 in 5 (21%) current smokers said they do not intend to quit because they are addicted to nicotine and 1 in 6 (17%) said they had tried to quit before but it had not worked (Table S3.29).

A pack-a-day smoker is considered to be someone who smokes 20 or more cigarettes per day. 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 [2].

The main reasons smokers gave for trying to quit or change their smoking behaviour was because it was costing too much money (52%) or it was affecting their health (44%) [2].

Electronic cigarettes

Electronic cigarettes (also known as e-cigarettes, electronic nicotine delivery systems, or personal vaporisers) are devices designed to produce a vapour that the user inhales. Most e-cigarettes contain a battery, a liquid cartridge and a vaporisation system and are used in a manner that simulates smoking [7]. It is currently illegal to sell e-cigarettes that contain nicotine in any form [8].

In 2016, current use of e-cigarettes was relatively low in the general population with only 1.2% of people aged 14 or older reporting that they currently use e-cigarettes (Table S2.19). More specifically, in 2016:

  • almost one-third (31%) of smokers had tried e-cigarettes in their lifetime (Table S2.18)
  • 1 in 20 (4.4%) smokers currently used e-cigarettes and only 1.5% used them daily (Table S2.19)
  • 1.2% of ex-smokers currently used e-cigarettes and only 0.6% of never smokers used e-cigarettes (Table S2.19)
  • 49% of smokers aged 18–24 had tried an e-cigarette in their lifetime compared with 6.8% of smokers aged 60–69. Similarly, 18.7% of smokers aged 18–24 had recently tried an e-cigarette compared with only 2.9% of smokers aged 60–69 (Table S2.18)

The most common reason for trying e-cigarettes was curiosity (55%) but people’s reasons varied by age (Table S2.20). People aged under 30 were about 3 times as likely to nominate curiosity as people aged 60 or older. Older people (aged 50 or older) were more likely to use e-cigarettes as a cessation device with more than half specifying that they used them to help them quit smoking. About 1 in 5 (19%) used e-cigarettes because they thought they were less harmful than regular cigarettes [2].

Illicit tobacco

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 [2]. According to the 2016 NDSHS:

  • About 1 in 3 smokers were aware of unbranded tobacco in 2016 and this proportion did not change from 2013 (33% and 34%, respectively).
  • Between 2013 and 2016, there was no change in the proportion of smokers who smoked unbranded tobacco in their lifetime (16.5% for both years) or who currently use it (3.6% in 2013 and 3.8% in 2016). However, lifetime and current use has declined since 2007 (27% and 6.1%, respectively) (Table S2.22).

Illicit branded tobacco includes tobacco products that are smuggled into Australia without payment of the applicable customs duty [2]. The 2016 NDSHS showed that:

  • Fewer current smokers had seen tobacco products without plain packaging in the previous 3 months (decline from 18.5% in 2013 to 13.0% in 2016) and fewer smokers had purchased these products (from 9.6% in 2013 to 5.5%) (Table S2.23).
  • Of those smokers that had seen these products, less than half (44%) had purchased them and about 1 in 10 (11.3%) bought 15 or more of these packets (Table S2.24).
  • 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 [2] (Table S2.23).

Harms

Tobacco is the leading preventable cause of morbidity and mortality in Australia. In 2011, tobacco smoking was responsible for 9% of the total burden of disease and injury.

Tobacco use contributed to the burden for five disease groups including 36% of respiratory diseases, 22% of cancers, 12% of cardiovascular diseases and 3.5% of endocrine disorders [9] (Table S2.58).

The total burden attributable to tobacco use was only slightly lower in 2011 than in 2003. Over this period, there was an increase in the burden of tobacco for cancer and respiratory diseases, and a large decrease in the burden for cardiovascular diseases. This is likely to be due to health improvements from reductions in tobacco use taking longer to become apparent in cancer and chronic respiratory diseases than in cardiovascular diseases [10 as cited in 9].

Tobacco smoking in pregnancy

Tobacco smoking is the most common preventable risk factor for pregnancy complications, and is associated with poorer perinatal outcomes, including low birthweight, being small for gestational age, pre-term birth and perinatal death [11].

The AIHW’s National Perinatal Data Collection indicates that rates of smoking during pregnancy in Australia have fallen over time, with statistically significant reductions for both Indigenous and non-Indigenous mothers between 2009 and 2016 [11] (Figure TOBACCO4). In 2016, 9.9% of mothers who gave birth smoked at some time during their pregnancy, a decrease from 14.6% in 2009 (Table S2.59). Overall, the rate of smoking during pregnancy was 42.8% compared with 11.6% for non-Indigenous mothers (age-standardised per cents) [11].

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Exposure to second-hand smoke

The inhalation of other people’s tobacco smoke can be harmful to health. Secondhand 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. Secondhand 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 secondhand smoke exposure is associated with psychological distress [12].

Results from the 2016 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 2.8% in 2016. There was also a statistically significant decline from 3.7% in 2013 [2] (Table S2.60).

Between 2013 and 2016, the proportion of adult non-smokers exposed to tobacco inside the home remained unchanged at 2.9% but was significantly lower than the 2010 rate of 5.1% [2] (Table S2.61).

Treatment

The 2016–17 Alcohol and Other Drug Treatment Services National Minimum Dataset (AODTS NMDS) showed that nicotine was a drug of concern (principal or additional) in 19% of closed treatment episodes, but was only a principal drug of concern in 1.3% of closed treatment episodes (Table S2.76).

Possible reasons for the low proportion of episodes in which nicotine was the principal drug of concern in the AODTS include the wide availability of support and treatment for nicotine use in the community, such as through general practitioners pharmacies, helplines or web services [13].

  • Client demographics:
    • Where nicotine was the principal drug of concern, over half of clients were male (56%), and nearly 1 in 7 were Indigenous (13%) (Figure TOBACCO5).
  • Referral to treatment:
    • The most common source of referral for treatment episodes where nicotine was the principal drug of concern was a health service (38%), followed by self/family (23%) (Table S2.80).
  • Type of treatment:
    • Where nicotine was the principal drug of concern, assessment only was the most common treatment type (31%), followed by counselling (30%) (Table S2.81).
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At-risk groups

Despite large reductions in tobacco smoking over time, there are challenges associated with addressing the inequality of smoking rates between some populations and the broader community.

Aboriginal and Torres Strait Islander people

  • Tobacco use (12.8%) was the greatest contributor to burden of disease for Indigenous Australians in 2011. It was also the risk factor contributing the most to the gap in disease burden between Indigenous and non-Indigenous Australians (accounting for 23% of the gap) [9].
  • In 2014–15, 45% of Aboriginal and Torres Strait Islander peoples aged 14 years or over were smokers, compared with 16% of non-Indigenous Australians (Table S3.4).
  • Almost 1 in 2 Indigenous mothers reported smoking at some time during pregnancy in 2016 – 42.8% compared with 11.6% of non-Indigenous mothers (age-standardised) [11].

Policy context

There has been a long-term commitment to addressing the harms associated with tobacco smoking in Australia, through a range of measures such as taxation on tobacco products, restrictions on advertising, and the prohibition of smoking in certain locations.

There is a high level of support among the Australian general population for measures aimed at reducing tobacco-related harm. According to the 2016 NDSHS, stricter enforcement of the law and penalties for supplying cigarettes to minors received the highest levels of support (86% and 84%, respectively) [2].

Figure TOBACCO6 shows that the daily smoking rate and key national tobacco policy implementation points over time. In 1991, 24% of the population aged 14 years and over smoked daily, this rate halved to 12.2% in 2016. The decrease was greater for younger people (aged between 14 to 39 years) decreasing from 29% in 1991 to 12% in 2016.

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National Tobacco Smoking Strategy 2012–2018

The National Tobacco Smoking Strategy 2012–2018 was developed as a sub-strategy under the National Drug Strategy 2010–2015. It sets out a national policy framework for the Australian Government and state and territory governments to work together with non-government organisations (NGOs) 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.

The objectives of the strategy are to:

  • prevent uptake of smoking
  • encourage and assist as many smokers as possible to quit as soon as possible, and prevent relapse
  • reduce smoking among Aboriginal and Torres Strait Islander people, groups at higher risk from smoking, and other populations with a high prevalence of smoking
  • eliminate harmful exposure to tobacco smoke among non-smokers
  • reduce harm associated with continuing use of tobacco and nicotine products
  • ensure that tobacco control in Australia is supported by focused research and evaluation
  • ensure that all of the above contribute to the continued de-normalisation of smoking [15].

Resources and further information

References

  1. OECD (Organisation for Economic Co-operation and Development) 2018. Health statistics 2018: frequently requested data. Viewed 12 September 2018.
  2. Australian Institute of Health and Welfare (AIHW) 2017a. National drug strategy household survey 2016: detailed findings. Drug statistics series no. 31. Cat. no. PHE 214. Canberra: AIHW. Viewed 14 December 2017.
  3. Australian Bureau of Statistics (ABS) 2015. National health survey: first results, 2014-15. Cat. no. 4364.0.55.001. Canberra: ABS. Viewed 12 October 2017.
  4. Australian Criminal Intelligence Commission (ACIC) 2018. National wastewater drug monitoring program, report 5. Canberra: ACIC. Viewed 10 October 2018.
  5. ABS 2017. Household expenditure survey, Australia: summary of results, 2015-16. Cat. no. 6530.0. Canberra: ABS. Viewed 4 January 2018.
  6. White V & Williams T 2016. Australian secondary school students’ use of tobacco, alcohol, and over-the-counter and illicit substances in 2014. Victoria: Centre for Behavioural Research.
  7. ACT Department of Health 2017. Electronic Cigarettes. Viewed 31 January 2018. 
  8. Cancer council 2017. National cancer control policy: position statement – electronic cigarettes. Viewed 13 June 2018.
  9. AIHW 2016. Australian burden of disease study: Impact and causes of illness and death in Australia 2011. Series no.3. BOD 4. Canberra: AIHW. Viewed 18 October 2017.
  10. CDC (Centers for Disease Control and Prevention) 2015. Health effects of cigarette smoking. Viewed 10 February 2016.
  11. AIHW 2018a. Australia’s mothers and babies 2016 – in brief. Perinatal statistics series no. 34. Cat. No. PER 97. Canberra: AIHW.
  12. Campbell MA, Ford C & Winstanley MH 2017. The health effects of secondhand smoke, 4.0 background. In Scollo MM & Winstanley MH (eds). Tobacco in Australia: facts and issues. Melbourne: Cancer Council Victoria. Viewed 23 November.
  13. AIHW 2018b. Alcohol and other drug treatment services in Australia 2016–17. Drug treatment services no. 31. Cat. no. HSE 207. Canberra: AIHW
  14. Department of Health 2017. Tobacco control timeline. Department of Health website, viewed 20 April 2018.
  15. Commonwealth of Australia 2012. National tobacco strategy 2012-2018. Canberra: Intergovernmental Committee on Drugs. Viewed 3 January 2018.