Alcohol, tobacco & other drugs in Australia

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. Nicotine 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 while the value of retail sales of tobacco products has increased (Table S2.1), the number of cigarettes and cigars and the amount of tobacco sold between 2015 and 2016 has decreased (Table S2.2). The estimated number of cigarettes (ready-made and roll-your-own) cleared through customs declined from 22 billion sticks in 2011 to 16.9 billion in 2017 (a decrease of 23%) (Scollo 2019).

Consumption

Daily smoking rates in Australia are around the lowest among Organisation for Economic Cooperation and Development (OECD) countries (for more information see International health data comparisons, 2018).

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 aged 14 or older smoking daily halved (from 24% to 12.2%)
• the proportion of ex-smokers aged 14 or older fluctuated between 21% in 1991, up to 26% in 2004 and has since declined to 23% in 2016
• the proportion of persons aged 14 or older who have never smoked has increased by 13 percentage points to the highest levels seen over the 25-year period (from 49% to 62%). This included a significant increase between 2013 and 2016 (AIHW 2017a) (Figure TOBACCO1).

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). This is a consistent trend for daily smokers aged 18 or older (AIHW 2017a).

Data from the National Health Survey (NHS) show a statistically significant decline in the number of adult daily smokers (aged 18 or older) over the last 10 years, after adjusting for age, down from 19.1% in 2007–08 to 14.0% in 2017–18. However, over recent years the daily smoking rate has remained similar (14.7% in 2014–15) (Table S2.16; age standardised). Refer to Box TOBACCO1 for more information about 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 (ACIC 2019). However, it should be noted that wastewater analysis cannot distinguish between nicotine intake from cigarettes, e-cigarettes and replacement products (such as gums and patches) (ACIC 2019).

Types of tobacco products consumed

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 increased from 32% in 2013 to 36% in 2016 (AIHW 2017a). This is supported by 2017 Industry Sales Figures (Scollo & Bayly 2019), which indicate the volume of roll-your-own tobacco increased in 2016 while the volume of cigarettes, cigars and pipe tobacco have all declined since 2015. In 2017, 73% of students aged 12–17 who had smoked in the past month used roll-your-own tobacco at least once (Guerin & White 2018).

Volume of tobacco products consumed

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 (ABS 2017). 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.

Estimates of expenditure on tobacco published in National Accounts data (ABS 2018b) also suggest continuing declines in consumption. Adjusting for increasing prices of tobacco products (so that all prices are expressed in current-day terms), expenditure estimates have declined from $44 billion in 1990 to $32 billion in 2000 and $17.2 billion in 2018 (Bayly & Scollo 2019).

Tobacco smoking by age and sex

In general, men aged 18 years and over were more likely to smoke than women aged 18 and over. More specifically:

• 2016 NDSHS findings showed 18.0% of men aged 18 years and over and 13.4% of women were current smokers (smoking either daily, weekly or less than weekly) (Table S2.15).
• 2017–18 NHS results showed about 1 in 7 people aged 18 and over (13.8%) smoked daily. Overall, a higher proportion of men (16.5%) smoked than women (11.1%) (ABS 2018a; Table S2.16).
• Results from the 2017–18 NHS indicated among all age groups more men smoke than women. The greatest difference between the sexes was among 25–34 year olds with almost twice as many men smoking than women (19.0% compared with 10.6% for women) (ABS 2018a; Table S2.16).

In general, smoking rates varied by age group, peaking in middle age and decreasing with age. More specifically:

• 2016 NDSHS found people aged 45–54 years had the highest daily smoking rate in 2016 (16%) (AIHW 2017a). This is consistent with recent data from the NHS (16.9% for people aged 45–54 years in 2017–18) (ABS 2018a).
• Younger people are starting smoking later, with the average age when a person had their first full cigarette increasing from 14.3 years in 2001 to 16.3 years in 2016 (AIHW 2017a).
• Young adults aged 18–24 years were more likely to have never smoked than any other adult age group. This has increased since 2001. The NHS results are similar with 75% of 18–24 year olds reporting never smoking in
  2017–18, up from 67% in 2011–12 (ABS 2011, ABS 2018a).
• 2017–18 NHS results indicated among older people, daily smoking rates decreased with age and were lowest at age 85 and over—2.2% for men and 1.7% for women (ABS 2018a; Table S2.16).

The 2017–18 NHS collected data for the first time on usual number of days smoked cigarettes in a week, usual number of cigarettes smoked per day and usual number of cigarettes smoked per week.

• Current adult daily smokers smoked 12.3 cigarettes per day on average, with men smoking more than women (13.0 cigarettes compared to 11.4) (ABS 2018a).
• The 2016 NDSHS also showed that males smoked a greater number of cigarettes than females—the mean number of cigarettes smoked by all male smokers aged 18 and over per week (97.8) was larger than that for all female smokers aged 18 and over (89.2) (AIHW 2017a).
• The number of cigarettes smoked per day increased with age—30% of smokers aged over 45 years smoked more than 20 cigarettes per day, compared to only 17.8% of smokers aged 18–44 years (ABS 2018a).  This is similar to findings from the NDSHS.

Geographic trends

Similar to the national trend, most jurisdictions reported slight but non-significant declines in the daily smoking rate between 2013 and 2016 (AIHW 2017a). Data from the NWDMP showed that the average consumption of nicotine (including tobacco products and nicotine replacement products, such as patches and gum) varies across regional areas and capital cities, with average consumption typically higher in regional areas (ACIC 2019).

The 2016 NDSHS also shows that people aged 14 or older 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 aged 14 or older 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%) (AIHW 2017a) (Figure TOBACCO3).

The ACT continues to have the lowest adult (aged 18 or older) 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).

In general, people who lived in disadvantaged areas were more likely to smoke daily than those living in the most advantaged areas. More specifically:

• 2016 NDSHS results indicated people living in the most disadvantaged areas of Australia are almost three times as likely to smoke daily as those who live in the most advantaged areas (17.7% compared to 6.5%) (AIHW 2017a).
• 2017–18 NHS findings showed adults living in the most disadvantaged  areas of the country were around 3.2 times as likely to smoke daily as those living in the highest socioeconomic group (22.8% compared with 7.0%; age standardised) (ABS 2019; age standardised proportions; Table S2.16).
• Results from the 2017–18 NHS also found adults (aged 18 or older) in Outer regional and remote areas were around 1.5 times as likely to be daily smokers as those in Major cities (19.6%  compared with 12.8%; age standardised).

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).

Among those smokers who report not planning to quit (about 33% of current daily smokers), the main reasons for not planning 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 (AIHW 2017a).

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%) (AIHW 2017a).

Electronic cigarettes

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 (Greenhalgh & Scollo 2018). Most e-cigarettes contain a battery, a liquid cartridge and a vaporisation system and are used in a manner that simulates smoking (ACT Department of Health 2017). The liquid solution used in e-cigarettes usually contains propylene glycol, glycerol, and flavourings, which may or may not contain nicotine (Cancer Council 2017). It is currently illegal to sell e-cigarettes that contain nicotine in any form (Cancer Council 2017).

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)
• Among secondary school students aged 16–17, 1 in 5 (21%) in 2017 had tried e-cigarettes (Guerin & White 2018).

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 (AIHW 2017a).

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 (AIHW 2017a). 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 (AIHW 2017a). 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 (AIHW 2017a) (Table S2.23).

Harms

Tobacco is the leading preventable cause of morbidity and mortality in Australia. In 2015, tobacco smoking was responsible for 9.3% of the total burden of disease and injury.  Estimates of the burden of disease attributable to tobacco use showed that cancers accounted for 43% of this burden (AIHW 2019e).

Tobacco use contributed to the burden for eight disease groups including 41% of respiratory diseases, 22% of cancers, 12% of cardiovascular diseases, 6.8% of infections 3.7% of endocrine disorders (AIHW 2019c) (Table S2.58).

The total burden attributable to tobacco use was only slightly higher in 2015 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 due to health improvements from reductions in tobacco use taking longer to become apparent in cancer and chronic respiratory diseases than in cardiovascular diseases (AIHW 2019c).

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 (AIHW 2019d).

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 2017 (AIHW 2019d) (Figure TOBACCO4). In 2017, 9.9% (or 29,267) 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 44.3% compared with 11.8% for non-Indigenous mothers in 2017 (age-standardised per cents) (AIHW 2019d).

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 (Campbell, Ford & Winstanley 2017).

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 (AIHW 2017a) (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% (AIHW 2017a) (Table S2.61).

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).  

Treatment

The 2017–18 Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS) showed that nicotine was a principal drug of concern in 1.4% of closed treatment episodes. Nicotine (along with cannabis) were the most commonly reported additional drugs of concern (both 16% of closed 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 (AIHW 2019a).

• Client demographics:
  • Where nicotine was the principal drug of concern, over half of clients were male (58%), and about 1 in 6 were Indigenous (16.4% or 450 clients) (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 (37%), followed by diversion (30%) (Table S2.80).
• Type of treatment:
  • Where nicotine was the principal drug of concern, counselling and assessment only (both 28%) were the most common treatment types (Table S2.81).

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) (AIHW 2016).
• 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 2017 – 44.3% compared with 11.8% of non-Indigenous mothers (age-standardised) (AIHW 2019d).

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) (AIHW 2017a).

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.

National Tobacco Strategy 2012–2018

The National Tobacco 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 (Commonwealth of Australia 2012).

Resources and further information

• National Tobacco Strategy 2012 – 2018
• Department of Health - Policy and Programs
• Comprehensive resource on tobacco smoking in Australia – Cancer Council

References

ABS (Australian Bureau of Statistics) 2012. Australian Health Survey: First Results, 2011–12. ABS cat. no. 4364.0. Canberra: ABS.

ABS 2017. Household expenditure survey, Australia: summary of results, 2015–16. ABS cat. no. 6530.0. Canberra: ABS. Viewed 4 January 2018.

ABS 2018a. National health survey, first results, 2017–18. ABS cat. no. 4364.0.55.001. Canberra: ABS. Viewed 21 December 2018.

ABS 2018b. Australian System of National Accounts, 2017-18. ABS cat. no. 5204.0. Canberra: ABS.

ABS 2019. Microdata: National Health Survey, 2017-18, expanded confidentialised unit record file, DataLab. ABS cat no. 4324.0.55.001. Canberra: ABS.

ACT Department of Health 2017. Electronic Cigarettes. Viewed 31 January 2018.

ACIC (Australian Criminal Intelligence Commission) 2019. National wastewater drug monitoring program, report 8. Canberra: ACIC. Viewed 28 October 2019.

AIHW (Australian Institute of Health and Welfare) 2017a. National drug strategy household survey 2016: detailed findings. Drug statistics series no. 31. Cat. no. PHE 214. Canberra: AIHW. Viewed 14 December 2017.

AIHW 2018. Aboriginal and Torres Strait Islander adolescent and youth health and wellbeing 2018. Cat. no. AIHW 202. Canberra: AIHW.

AIHW 2019a. Alcohol and other drug treatment services in Australia 2017–18. Drug treatment services no. 33. Cat. no. HSE 230. Canberra: AIHW. Viewed 25 July 2019.

AIHW 2019b. Alcohol and other drug treatment services in Australia 2017–18: key findings. Web Report. Viewed 17 April 2019.

AIHW 2019c. Australian burden of disease study: Impact and causes of illness and death in Australia 2015. Series no.19. BOD 22. Canberra: AIHW. Viewed 13 June 2019.

AIHW 2019d. Australia’s mothers and babies 2017 – in brief. Perinatal statistics series no. 35. Cat. No. PER 100. Canberra: AIHW.

AIHW 2019e. Burden of tobacco use in Australia: Australian Burden of Disease Study 2015. Australian Burden of Disease series no. 21. Cat. no. BOD 20. Canberra: AIHW.

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 19 February 2019.

Cancer Council 2017. National cancer control policy: position statement – electronic cigarettes. Viewed 13 June 2018.

CDC (Centers for Disease Control and Prevention) 2015. Health effects of cigarette smoking. Viewed 10 February 2016.

Commonwealth of Australia 2012. National tobacco strategy 2012-2018. Canberra: Intergovernmental Committee on Drugs. Viewed 3 January 2018.

Department of Health 2017. Tobacco control timeline. Department of Health website, viewed 20 April 2018.

Greenhalgh EM & Scollo MM. In Depth 18B: Electronic cigarettes (e-cigarettes). In Scollo MM and Winstanley MH (eds). Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2018. Viewed 12 June 2019.

Guerin N & White V 2018. Australian Secondary Students’ Use of Tobacco, Alcohol, Over-the-counter Drugs, and Illicit Substances in 2017. Victoria: Centre for Behavioural Research in Cancer. Viewed 11 March 2019.

Scollo M 2019. Dutiable tobacco products as an estimate of tobacco consumption. In Scollo MM and Winstanley MH (eds). Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria. Viewed 12 June 2019.

Scollo M & Bayly M 2019. Retail value and volume of the Australian tobacco market. In Scollo MM & Winstanley MH (eds). Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria. Viewed 30 May 2019.