Smoking & Disadvantage Evidence Brief

Page last updated: 16 June 2013

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This Evidence Brief forms part of the Australian National Preventive Health Agency's Evidence Brief Series which aims to disseminate information and inform dialogue relating to high priority preventive health issues.

© Commonwealth of Australia 2013

This work is copyright. Apart from any use permitted under the Copyright Act 1968, no part may be reproduced by any process without prior permission from the Australian National Preventive Health Agency.

Published by the Australian National Preventive Health Agency

Enquiries about the content of this report should be directed to:
Tobacco Control at email:

This evidence brief was prepared by Cancer Council Victoria for the Australian National Preventive Health Agency.


Smoking rates among some of our most disadvantaged population groups remain much higher - in some case five times higher - than the general population, contributing to poorer health, higher death rates and increased financial stress. It is also a major contributor to the health gap between Indigenous and non-Indigenous Australians and the difference in mortality between the least and most advantaged people in Australia.

The Agency has developed this Evidence Brief to provide further information about smoking among population groups with high smoking rates.

Smoking and Disadvantage Evidence Brief - PDF printable version (PDF 595 KB)

The evidence reviewed in this document indicates that:
    • A number of population groups in Australia have higher smoking rates than the general population. This includes people who are unemployed, are sole parents, have a mental health issue, have a substance use problem, are in prison, are experiencing homelessness or are Aboriginal and/or a Torres Strait Islander.
    • High smoking rates are contributing to health and financial inequalities in the most disadvantaged groups in our communities.
    • Current surveys and monitoring tools are not adequately capturing or monitoring smoking rates in disadvantaged populations in Australia and trend data are not routinely collected for these groups.
    • There are numerous psychological, social, economic and cultural factors that influence smoking rates in disadvantaged population groups.
    • Social disadvantage and smoking rates are intrinsically linked. As levels of disadvantage accumulate, smoking rates increase.
    • People from disadvantaged groups are more likely to encounter social environments where smoking remains the norm and where little support is provided for quit attempts. It is important to understand the role that smoking plays in the lives of disadvantaged smokers.
    • There is a systematic reinforcement of smoking behaviour in disadvantaged groups among service providers. Disadvantaged clients are less likely to be asked about their smoking, or asked if they would like to quit.
    • Tax increases, mass media anti-smoking campaigns and smoke-free legislation reduce smoking rates in all population groups and play a vital role in reducing smoking-related disparities.
    • Assistance to quit smoking through the use of pharmacotherapies, cessation counselling, brief interventions and smoke-free policies are efficacious in disadvantaged groups and can increase smoking cessation rates.
    • There is merit in tailoring cessation services to the different needs of disadvantaged groups and delivering cessation strategies within organisations that are already accessed by these groups.
    • Social and community service providers have an important role to play in tobacco control.

Implications of Smoking and Disadvantage Evidence Brief

The Agency’s Expert Committee on Tobacco considered the evidence presented in this Smoking and Disadvantage Evidence Brief has identified a number of implications for policy development, practice and future research.

Smoking rates among Australian adults have been steadily declining over many years as a result of a broad range of tobacco control strategies. Smoking as a social norm however continues to exist among many of our most disadvantaged groups—contributing to much higher rates of tobacco related illness than in the general population and a large life expectancy gap, such as for those living with a mental illness. The need to strengthen efforts to reduce smoking among disadvantaged groups is underpinned by the Preventative Health Taskforce’s report Australia: the healthiest country by 2020 and identified as a key priority in the National Tobacco Strategy 2012-2018.

The evidence summarised in the evidence brief Smoking and Disadvantage has important implications for policy makers and practitioners. Critical to reducing the high smoking uptake among disadvantaged groups is maintaining whole-of-population approaches to tobacco control, such as mass media campaigns, tobacco price increases and smoke-free policies. Complementing these approaches should be targeted strategies—inside and outside institutional settings—which ensure hard to reach groups are given the appropriate access to information, treatment and support that will enable them to reduce smoking or quit altogether.

Actions for policy

  • Maintain whole-of-population approaches (i.e. tobacco price increases, continuous broadcasting of mass media campaigns and implementation of smoke-free policies) that assist in reducing smoking uptake and promote quitting among low income and disadvantaged groups.
  • Mandate that all government funded organisations and services (e.g. prisons, mental health services etc.) are smoke-free.
  • Encourage leadership and partnerships across government and the mental health, community and social services sectors with the aim of denormalising smoking among disadvantaged groups.
  • Ensure that NRT and other pharmacotherapies are affordable and accessible to all for whom it is clinically appropriate.

Actions for practice

  • Effectively promote smoking cessation information and support to different population groups and the services that support them to increase use of evidence-based methods.
  • Consider developing a national training resource for staff in social and community services in brief interventions, cessation strategies and referral mechanisms.
  • Integrate smoking cessation support into social and community service settings. Quit smoking interventions should become part of routine service to prompt and support more quit attempts. This would include having smoking cessation advice and treatment in all clients’ case management plans.
  • Introduce comprehensive smoke-free policies in social and community services to provide supportive environments for quitting and quit attempts.
  • Increase collaboration between social and community services and smoking cessation services to support these services in responding to tobacco issues for their clients. This would include referral arrangements to Quitline, training in brief interventions and advice on smoke free policies.

Actions for research

  • Explore the cost effectiveness of providing free NRT to disadvantaged groups as an incentive to use cessation services.
  • Commission further research to explore the effectiveness (including cost) of providing cessation support in social and community settings. This should include efficacy of client-centred, case worker delivered cessation support, the uptake of support in these settings and the effectiveness of this approach in increasing cessation and reducing prevalence.
  • Invest in appropriate research and evaluation to build the evidence base around what works in addressing tobacco use in disadvantaged populations.
  • Improve monitoring and surveillance of smoking rates in high prevalence groups through existing surveillance tools and through mining other currently underutilised databases.

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