Tobacco smoking is the leading cause of preventable diseases and death in Australia. Successful public health strategies over many decades have resulted in a significant decline in daily smoking proportions, with Australia now having one of the lowest daily smoking proportions among Organisation for Economic Co-operation and Development countries. Despite these positive changes, the harm from tobacco smoking continues to affect current smokers and ex-smokers, as well as non-smokers through their exposure to second-hand smoke (AIHW 2019).

How many people smoke?

The latest data from the National Drug Strategy Household Survey (NDSHS) estimated that 11.6% of adults smoked daily in 2019. This daily smoking rate has declined from an estimated 12.8% in 2016 and has halved since 1991 (25%) (2020b) (Figure 1a).

Similarly, data from the National Health Survey (NHS) 2017–18 show that smoking rates declined steadily over the nearly 3 decades to 2017–18 and, after adjusting for age, the proportion of adults who are daily smokers has halved since 1989–90 (ABS 2019a, 2019b) (Figure 1b).

Data sources

A number of nationally representative data sources are available to analyse recent trends in tobacco smoking. The NDSHS and NHS have collected data on tobacco smoking for a number of years. Data presented on this page are from the 2019 NDSHS and the 2017–18 NHS, as this was latest smoking data available.

Comparisons of data from the NDSHS and NHS show variations in estimates for tobacco smoking but similar long-term trends.

For more information on tobacco smoking from the 2019 NDSHS go to National Drug Strategy Household Survey 2019.

Figure 1a shows the decline in daily smoking proportion from 2001 to 2019 for the National Drug Strategy Household Survey. The proportion of male daily smokers declined from 21.8% in 2001 to 12.8% in 2019. The proportion of female daily smokers has declined from 18.3% in 2001 to 10.4% in 2019.

Figure 1b shows the decline in daily smoking proportion from 1989–90 to 2017–18 from the ABS National Health Survey. The proportion of male daily smokers has declined from 32.1% in 1989–90 to 16.5% in 2017–18. The proportion of female daily smokers has declined from 24.7% in 1989–90 to 11.1% in 2017–18.

Figure 1 data table (135KB XLSX)

How many cigarettes do adults smoke?

In 2019, the NDSHS reported current smokers aged 18 and over smoked an average of 12.9 cigarettes per day, a decrease from 15.9 cigarettes in 2001. Men and women smoked a similar number of cigarettes per day in 2019—average of 13.1 and 12.9 cigarettes per day, respectively (AIHW 2020b).

In 2019, the proportion of pack-a-day (20 cigarettes or more) smokers increased with age—2 in 5 people (approximately 40%) in age groups 40 and over smoked more than 20 cigarettes per day, compared with 1 in 5 (approximately 20%) people aged 18–39 (AIHW 2020b).

Trends

The 2019 NDSHS found that people in their 40s and 50s had the highest daily smoking proportions (15.8% and 15.9% respectively)—different from the situation in 2001, when people in their 20s and 30s were the most likely to smoke daily.

Between 2016 and 2019, the proportion of people who smoked daily fell for people in their 20s and 30s but there was no change for people in their 40s, 50s and 60s. Over the period of 2001 to 2019, for people aged 18–39, the proportion smoking daily has halved but there has been little improvement among people in their 50s and 60s (AIHW 2020b). 

The proportion of adults aged 18 and over who never smoked increased from 48% in 2001 to 60% in 2016 and remained stable at 61% in 2019 (AIHW 2020b). Similarly, findings from the NHS show the proportion of adults who have never smoked is increasing over time, from 52.6% in 2014–15 to 55.6% in 2017–18 (or from 52.9% in 2014–15 to 56.1% in 2017–18, after adjusting for age) (ABS 2019b).

In 2019, adolescents aged 14–17 and young adults aged 18–24 were more likely to have never smoked than any other age group (97% and 80%, respectively). This proportion remained fairly stable since 2016 (96% and 79%, respectively) and represents an increase in the proportion of adolescents and young adults who never smoked since 2001 (82% and 58%, respectively). Of the young adults aged 18–24, nearly 8 in 10 (77%) men reported they never smoked in 2019; this has remained stable since 2013 (76%) but has increased since 2001 (56%). More than 8 in 10 (83%) women aged 18–24 reported in 2019 that they had never smoked, an increase from 59% in 2001 and similar to 2016 (79%) (AIHW 2020b).

Age and sex

In 2019, among those aged 18 and over, men were more likely than women to smoke daily (12.8% compared with 10.4%). The proportion of women who smoke daily has remained stable between 2016 and 2019 (11.2% compared with 10.4%), while the proportion of men who smoke daily has decreased from 14.6% in 2016 to 12.8% in 2019. The greatest difference between the sexes was among 40–49 year olds, with more men (18.4%) smoking daily than women (13.4%) in 2019 (Figure 2).
 

This chart compares the proportion of current daily smokers in 2019 by age and sex. There is a higher proportion of male current daily smokers compared to females in all age groups. Males aged 40–49 had the highest proportion of current daily smokers (18.4%), while the highest proportion for females were aged 50–59 (15.2%).

Figure 2 data table (135KB XLSX)

Variation between population groups

See Health risk factors among Indigenous Australians for information on tobacco smoking among Aboriginal and Torres Strait Islander people.

Although there has been a large reduction in smoking rates over time, smoking remains a major risk factor contributing to the health, social and economic inequalities experienced by certain population groups in Australia. While some improvements are being made, the 2019 NDSHS shows daily smoking continues to be more commonly reported among people living in the lowest socioeconomic areas, people living in Outer regional or Remote and very remote areas, people who are unable to work or unemployed, and people who completed Year 11 or below and people with a Certificate III or IV (Figure 3). See Health across socioeconomic groups and Rural and remote health.
 

The chart shows that the proportion of persons who were daily smokers in 2019 varied by demographic characteristics; main language spoken at home, socio-economic area, remoteness area, employment status, and highest level of educational attainment. Within these groups the largest proportion of persons who were daily smokers were—persons whose main language spoken at home was English (12.2%), persons in the lowest socio-economic area (20.0%), persons living in Outer regional (18.1%) and Remote and very remote (21%) areas, unable to work (30%) and unemployed persons (22%) and persons with an educational attainment of year 11 or below and Certificate III or IV (both 17.8%).

Figure 3 data table (135KB XLSX)

Electronic cigarettes

Electronic cigarettes (also known as e-cigarettes, e-cigs, electronic nicotine delivery systems, electronic non-nicotine delivery systems, alternative nicotine delivery systems, personal vaporisers, e-hookahs, vape pens or vapes) 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 can contain nicotine, but also flavourings and other chemicals.

Importing e-cigarettes or nicotine liquid refills into Australia without a medical prescription from a general practitioner became illegal from 1 January 2021. On 21 December 2020, the Therapeutic Goods Administration (TGA) announced a decision that from 1 October 2021, the importation of nicotine e-cigarettes and liquid nicotine for vaping will require a valid prescription. Consumers can import nicotine e-cigarettes legally through the TGA Personal Importation Scheme, with a doctor's prescription (TGA 2021).
 

Australian governments have taken a precautionary approach to the marketing and use of e‑cigarettes in view of the risks these products pose to tobacco control and population health. This approach is underpinned by the current state of evidence regarding: the direct harms e‑cigarettes pose to human health, their impacts on smoking initiation and cessation, uptake among youth and dual use with conventional tobacco products (Byrne et al. 2018; Gotts et al. 2019; Kennedy et al. 2019). 

New questions about the frequency and duration of e‑cigarette use were added to the NDSHS in 2016. According to the NDSHS in 2019:

  • current use of e‑cigarettes reported by people aged 18 and over increased from 1.2% in 2016 to 2.6% in 2019
  • among current smokers aged 18 and over, almost 2 in 5 (38%) had tried e‑cigarettes in their lifetime (an increase from 31% in 2016) and 9.6% currently use them (an increase from 4.4% in 2016)
  • among non‑smokers aged 18 and over, 6.8% had tried e‑cigarettes in their lifetime (an increase from 4.7% in 2016) and 1.4% currently use them (an increase from 0.6% in 2016)
  • e‑cigarette use was higher among younger age groups with 64% of smokers aged 18–24 trying an e‑cigarette in their lifetime, compared with 26% of smokers aged 60–69 (AIHW 2020b).

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

The most common reason for trying e‑cigarettes for people aged 18 and over was curiosity (53%), but people’s reasons varied by age (AIHW 2020b).  

Burden of disease

Smoking was responsible for 9.3% of the total burden of disease in Australia in 2015, making it the leading risk factor contributing to disease burden. Almost three-quarters (73%) of the burden due to smoking was fatal—that is, due to premature death. In 2015, smoking was responsible for more than 1 in every 8 (21,000) deaths.

Cancers accounted for 43% of the burden of disease from smoking, and almost two-thirds of this was from lung cancer (28% of total burden). Chronic obstructive pulmonary disease (COPD) accounted for 30% of the burden, followed by cardiovascular diseases (17%) primarily related to coronary heart disease (10%) and stroke (3.1%) (AIHW 2019).

Tobacco use has remained the leading risk factor, but the disease burden from smoking fell from 10.5% of total burden to 9.3% between 2003 and 2015. After adjusting for age, the rate of disease burden from smoking showed a decrease of 24% between 2003 and 2015, with a greater decrease in males than females. The burden also fell for all 6 of the leading diseases that are linked to smoking (COPD, lung cancer, coronary heart disease, stroke, oesophageal cancer and asthma). However, while the burden linked to current smoking decreased, the burden linked to past smoking (ex-smokers) rose. This is likely to be because some diseases associated with smoking, such as lung cancer and COPD, can take many years to develop. As a result, the effects of past smoking are expected to continue to have an impact on disease burden in the near future, even if smoking rates continue to decrease (AIHW 2019). See Burden of disease.

A major Australian study estimated that mortality from cardiovascular disease (CVD) is almost 3 times higher in current smokers than never smokers (Banks et al. 2019). Quitting smoking at any age substantially reduces a person’s risk of CVD, with those quitting by age 45 avoiding almost all of the excess risk (Banks et al. 2019).

Remoteness area

The burden of disease attributable to tobacco use is unequally distributed across Australia. In Remote and Very remote areas tobacco use was responsible for 10.7% of the total burden of disease, compared with 8.5% in Major cities in 2015. After adjusting for age, rates similarly showed that burden of disease attributable to tobacco use increases as remoteness increases, with Remote and very remote areas experiencing 1.8 times the burden of Major cities (AIHW 2019).

Socioeconomic area

There was a clear gradient of decreasing burden as socioeconomic position increased. In the lowest socioeconomic areas (those experiencing the highest socioeconomic disadvantage), tobacco use was responsible for 11.7% of the total burden of disease, compared with 6.5% in the highest socioeconomic areas (those experiencing the least disadvantage). After adjusting for age, rates similarly showed that burden of disease attributable to tobacco use was 2.6 times higher in the lowest socioeconomic areas than in the highest socioeconomic areas (AIHW 2019).

Second-hand smoke

Exposure to second-hand smoke affects people of all ages and can cause cardiovascular and respiratory diseases in adults, and in infants and children can cause low birthweight and sudden infant death syndrome, and induce and exacerbate a range of mild to severe respiratory effects (WHO 2018).

Results from the 2019 NDSHS show that parents and guardians are choosing to reduce their children’s exposure to smoke inside the home. The proportion of households with dependent children where someone smoked inside the home fell from 19.7% in 2001 to 2.8% in 2016 and to 2.1% in 2019 (AIHW 2020b). 

Between 2016 and 2019, the proportion of adult non-smokers exposed to tobacco smoke inside the home decreased from 2.9% to 2.4%, this was lower than in 2001 (10.6%) (AIHW 2020b).

Proportions of smoking during pregnancy in Australia have fallen over time, with fewer than 1 in 10 (9.6%, or 28,219) mothers who gave birth smoking at some time during their pregnancy in 2018, a decrease from 15% in 2009 (AIHW 2020a).

Social impact

Despite the decline in smoking proportions in Australia over recent decades, a significant health and economic burden is experienced by individuals and society. The total net cost of smoking in Australia in 2015–16 has been estimated at $136.9 billion, comprising $19.2 billion in tangible costs and $117.7 billion in intangible costs. The largest of these tangible costs was spending on tobacco by dependent smokers ($5.5 billion), followed by workplace costs ($5.0 billion) and the reduction in economic output due to premature mortality ($3.4 billion). Intangible costs were estimated using the value of life lost and pain and suffering caused by smoking-attributable ill health ($25.6 billion), and premature mortality ($92.1 billion) (Whetton et al. 2019).

Where do I go for more information?

For more information on tobacco smoking, see:

Visit Smoking for more on this topic

References

ABS (Australian Bureau of Statistics) 2019a. National health survey, first results, 2017–18. Cat. no. 4364.0.55.001. Canberra: ABS.

ABS 2019b. National Health Survey, 2017–18. Customised report. Canberra: ABS.

ACT Health 2019. Electronic cigarettes. Viewed 21 January 2020.

AIHW (Australian Institute of Health & Welfare) 2019. Burden of Tobacco Use in Australia: Australian Burden of Disease Study 2015. Cat. no. BOD 20. Canberra: AIHW.

AIHW 2020a. Australia’s mothers and babies 2018 — in brief. Perinatal statistics series no. 35. Cat. No. PER 100. Canberra: AIHW.

AIHW 2020b. National Drug Strategy Household Survey 2019. Drug statistics series no. 32. Cat. no. PHE 270. Canberra: AIHW.

Banks E, Joshy G, Korda RJ, Stavreski B, Soga K, Egger S et al. 2019. Tobacco smoking and risk of 36 cardiovascular disease subtypes: fatal and non-fatal outcomes in a large prospective Australian study. BMC Medicine 28(128):1–18.

Byrne S, Brindal E, Williams G, Anastasiou KM, Tonkin A, Battams S and Riley MD (2018). E-cigarettes, smoking and health. A Literature Review Update. CSIRO, Australia.

Gotts et al 2019. What are the respiratory effects of e-cigarettes? BMJ.

Greenhalgh EM & Scollo MM 2018. In Depth 18B: electronic cigarettes (e-cigarettes). In: Scollo MM and Winstanley MH (eds). Tobacco in Australia: facts and issues. Melbourne: Cancer Council Victoria. 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 5 November 2019.

Kennedy et al 2019. The cardiovascular effects of electronic cigarettes: A systematic review of experimental studies. Preventive Medicine.

TGA (Therapeutic Goods Administration) 2021. Nicotine e-cigarettes. Viewed 19 May 2021.

WHO (World Health Organization) 2018. Tobacco fact sheet.

Whetton S, Tait R, Scollo M, Banks E, Chapman J, Dey T et al. 2019. Identifying the social costs of tobacco use to Australia in 2015/16. Perth: National Drug Research Institute, Curtin University.