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 is 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, in cars with children and around many public places such as near children’s play equipment, swimming pools, public transport, 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).

Data on the availability of illicit tobacco in Australia are limited. However, the level of illicit trade of tobacco in Australia is considered to be low (Scollo & Bayly 2019). The Australian Tax Office (ATO) estimated that the amount of lost excise revenue from illicit tobacco in 2017–18 ($647 million) was 5% of the amount of collectable tobacco excise (ATO 2019).

Consumption

Daily smoking rates in Australia are around the lowest among Organisation for Economic Cooperation and Development (OECD) countries—11.2% for Australians aged 15 and over in 2019 (Table S2.15) compared with the average of 17.8% in 2019 (or nearest year) for OECD countries  (for more information see Interactive data: Tobacco).

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 2019:

• the proportion of persons aged 14 and over smoking daily more than halved (from 24% to 11.0%)
• the proportion of ex-smokers aged 14 and over fluctuated from 21% in 1991, up to 26% in 2004 and has since declined to 23% in 2019
• the proportion of persons aged 14 and over who have never smoked has increased by 14 percentage points to the highest levels seen over the 25-year period (from 49% to 63%) (Table S2.14; Figure TOBACCO1).

Between 2013 and 2016 the proportion of daily smokers aged 14 and over only decreased slightly from 12.8% to 12.2%. However, in 2019 the proportion of daily smokers declined significantly to 11.0% (Table S2.14).  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 trend is consistent for daily smokers aged 18 or older (Table S2.15).

While there are differences in the estimates derived for the proportion of daily smokers, data from the National Health Survey (NHS) show a similar pattern to the NDSHS data over time. The proportion of adult daily smokers (aged 18 or older) declined steadily over the nearly 3 decades to 2017–18, and after adjusting for age, has halved from 27.7% in 1989–90 to 14.0% in 2017–18. Over recent years the proportion of adult daily smokers only declined slightly from 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. The consumption of nicotine was substantially higher in regional areas compared to capital city sites. The population-weighted average consumption of nicotine increased in capital cities from December 2019 to April 2020 and decreased in regional areas (ACIC 2020). However, wastewater analysis cannot distinguish between nicotine intake from cigarettes, e-cigarettes and replacement products (such as gums and patches) (ACIC 2020).

Types of tobacco products consumed

Data from the NDSHS indicates that the proportion of people who smoked manufactured cigarettes declined between 2007 and 2019 (from 93% to 85%). In contrast, smoking roll-your-own cigarettes increased from 26% in 2007 to 36% in 2016 and 45% in 2019. The rise was greatest among young adult smokers aged 18–24 (up from 28% in 2007 to 63% in 2019), the age group most likely to smoke these cigarettes (AIHW 2020c; Table S2.17).

This is supported by 2017 Industry Sales Figures (Scollo & Bayly 2019), which indicate the volume of roll-your-own tobacco increased while the volume of cigarettes, cigars and pipe tobacco have all declined.

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 2018a) 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

 Findings from the 2019 NDSHS (Figure TOBACCO2; Table S2.15) showed that:

• people aged 40–49 (15.8%) and 50–59 (15.9%) were the most likely to smoke daily
• in people aged 14 and over, males (12.2%) were more likely to smoke daily than females (9.9%), however, the gap has narrowed slightly since 2016 due to a significant decrease in the proportion of males who were daily smokers (down from 13.8% in 2016; this compares with a non-significant decrease of 10.7% for females)
• significant decreases in the proportion of daily smokers aged 25–29 (11.3%, down from 15.5% in 2016), 30–39 (11.6%, down from 14%) and 70+ (4.6%, down from 6%) were largely driven by decreases in the proportion of male daily smokers in these age groups
• young adults aged 18–24 years were more likely to have never smoked than any other adult age group and this has increased since 2001
• there was a significant increase in the proportion of females who had never smoked in the age groups 25–29 (from 72% in 2016 to 77% in 2019) and 30–39 (from 62% in 2016 to 67% in 2019).

The average age at which younger people (aged 14–24 years) had their first full cigarette has increased from 14.3 years in 2001 to 16.6 years in 2019 (AIHW 2020c). There was a significant increase in the age in which younger females first smoked a full cigarette between 2016 (16.0 years) and 2019 (16.6 years) (AIHW 2020c).

People aged 40 and over smoked a greater number of cigarettes per day and were more likely to be pack-a-day (20 cigarettes or more) smokers when compared with those aged under 40 years (AIHW 2020c).

These trends are consistent with the results from the 2017–18 NHS, for example:

• people aged 45–54 years (16.9%) had the highest proportion for daily smoking (Table S2.16)
• a higher proportion of men (16.5%) smoked than women (11.1%) and this was consistent across all age groups—the greatest difference between the sexes was among 25–34 year olds with almost twice as many males smoking than females (19.0% and 10.6%, respectively) (ABS 2018b; Table S2.16)
• 75% of 18–24 year olds reporting never smoking in 2017–18, up from 67% in 2011–12 (ABS 2012, ABS 2018b)
• the number of cigarettes smoked per day increased with age—30% of smokers aged 45 years and over smoked more than 20 cigarettes per day, compared to only 17.8% of smokers aged 18–44 years (ABS 2018b).

Geographic trends

Since 2001, the proportion of people aged 14 and over who smoked daily has declined across all jurisdictions. Most jurisdictions reported slight but non-significant declines in the daily smoking rate between 2016 and 2019, however, the decline was significant for New South Wales (from 11.5% to 9.5%) (AIHW 2020c).

Explore state and territory data on tobacco smoking in Australia.

The 2019 NDSHS shows that people aged 14 or older living in Remote and very remote areas of Australia (19.6%) are more likely to smoke daily than people living in Inner regional areas (13.4%) and Major cities (9.7%) (AIHW 2020c; Table S2.12; Figure TOBACCO3). These findings were still apparent after adjusting for differences in age (AIHW 2020c). 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) (ABS 2019a).

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

• 2019 NDSHS results indicated people aged 14 and over living in the most disadvantaged areas of Australia are over 3 times as likely to smoke daily as those who live in the most advantaged areas (18.1% compared with 5.0%) (AIHW 2020c; Table S2.13). This finding was still apparent after adjusting for differences in age (AIHW 2020c).
• 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 2019a; age standardised proportions; Table S2.16).

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 2020).

Smoking cessation

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% (Table S2.21).

About 3 in 10 smokers reported they did not intend to quit. 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 (Table S3.29).

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 2020c).

The main reasons smokers gave tried 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 2020c).

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 Health 2019). 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), however, it may be lawful for people to import up to 3 months’ personal supply of nicotine for personal therapeutic use in e-cigarettes with a written authorisation from a doctor, subject to state and territory laws (TGA 2019).

The 2019 NDSHS shows lifetime use of e-cigarettes increased significantly from 8.8% in 2016 to 11.3% in 2019 (Table S2.18). More specifically, for those people aged 14 and over, in 2019:

• almost 2 in 5 (39%) smokers had tried e-cigarettes in their lifetime (Table S2.18), 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%; Table S2.18)
• 3.2% of current smokers used e-cigarettes  daily, a significant increase since 2016 (1.5%) (Table S2.19)
• 2.2% of ex-smokers used e-cigarettes daily, a significant increase since 2016 (0.8%) (Table S2.19)
• 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%) (Table S2.18).

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 2020c).

The most common reason for trying e-cigarettes was curiosity (54%), but people’s reasons varied by age (Table S2.20). 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 2020c; Table S2.20).

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.

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 2020c). 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) (Table S2.22).

Illicit branded tobacco includes tobacco products that are smuggled into Australia without payment of the applicable customs duty (AIHW 2020c). 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) (Table S2.23)
• 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 (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 (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 2019b).

Tobacco use contributed to the burden for 8 disease groups including 41% of respiratory diseases, 22% of cancers, 12% of cardiovascular diseases, 6.8% of infections 3.7% of endocrine disorders (AIHW 2019a) (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 2019a).

Tobacco smoking in pregnancy

Tobacco smoking during pregnancy 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 2020b).

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 2018 (AIHW 2020b). In 2018, 9.6% (or 28,219) of all mothers who gave birth smoked at some time during their pregnancy, a decrease from 14.6% in 2009 (Table S2.59).

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 (Table S2.60).

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% (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 2018–19 Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS) showed that nicotine was a principal drug of concern for a client’s own drug use 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 (AIHW 2020a).

• Client demographics where nicotine was the principal drug of concern:
  • Almost 2 in 3 clients were male (60%) (Table S2.77) and about 1 in 10 were Indigenous (11.6%) (Table S2.78; Figure TOBACCO4).
• Source of referral for treatment:
  • The most common source of referral for treatment where nicotine was the principal drug of concern was diversion (34% of treatment episodes), followed by a health service (28%) (Table S2.79).
• Treatment type:
  • Where nicotine was the principal drug of concern, assessment only was the most common treatment type (35%) followed by counselling (28%) (Table S2.80).

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.

The proportion of current smokers is disproportionately high among Aboriginal and Torres Strait Islander people. See also: Tobacco smoking in the Aboriginal and Torres Strait Islander people section.

People aged 50–59 were one of the age groups most likely to smoke daily in 2019. The highest proportion of smokers who were not planning to quit smoking were aged 70 and over. See also: Tobacco smoking in the Older people section.

People with mental health conditions or high psychological distress are twice as likely to smoke daily as people without mental health conditions and those with low distress. See also: Tobacco smoking in the People with mental health conditions section.

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 2019 NDSHS, stricter enforcement of the law against supplying minors and penalties for sale or supplying cigarettes to minors received the highest levels of support (85% and 83%, respectively) (AIHW 2020c). However, the level of support for these measures has fallen since 2016 (86% and 84%, respectively). Conversely, there was increased support for restrictions on the use of e-cigarettes in public places (69% compared with 65% in 2016) and the sale of e‑cigarettes to people under 18 years (79% compared with 77% in 2016) (AIHW 2020c).

Figure TOBACCO5 shows 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 11.0% in 2019.

National Tobacco Strategy 2012–2018

The National Tobacco Strategy 2012–2018, which is currently being updated, was developed as a sub-strategy under the previous 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).

Tobacco control will also be a key component of the Australian Government’s 10-year National Preventive Health Strategy (NPHS). As part of the NPHS, the Australian Government has announced a new target of reducing smoking rates to below 10 per cent by 2025 (Hunt 2019).

Resources and further information

• National Tobacco Strategy 2012 – 2018
• Department of Health - Policy and Programs
• Comprehensive resource on tobacco smoking in Australia – Cancer Council
• Department of Health - About e-cigarettes
• Department of Health - Illicit tobacco
• Inquiry to illicit tobacco