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).
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).