Current levels of smoking among disadvantaged groups

Australian smoking rates are among the lowest in the world. (11) In 2010 the daily smoking rate for Australians aged 14 years and older was 15.1%, a reduction from 24.3% in 1991.(1) However, the picture is not the same for all Australians and reductions have been slower among groups facing multiple personal and social difficulties and challenges.(8, 12) Findings from a range of Australian studies show high smoking rates among sole parents, Aboriginal and/or Torres Strait Islander peoples, people with mental health disorders (including mild, moderate and severe), people who are homeless, people with substance use disorders and prisoners (see Table 1).

Table 1: Estimates of smoking rates in different population groups, Australia

Group	Percentage who smoke	Source
AUSTRALIAN GENERAL POPULATION	15.1	1
PEOPLE IN LOW SOCIO-ECONOMIC GROUPS	24.6	1
PEOPLE EXPERIENCING UNEMPLOYMENT	27.6	1
PEOPLE WITH A MENTAL ILLNESS	32.4	13
SOLE PARENTS	36.9	1
ABORIGINAL AND TORRES STRAIT ISLANDERS	47.7	14
PEOPLE LIVING WITH PSYCHOSIS	66	15
PRISONERS	74	16
PEOPLE EXPERIENCING HOMELESSNESS	77	17
YOUNG PEOPLE IN CUSTODY	79	18
PEOPLE WITH SUBSTANCE USE DISORDERS	85	2

*Note: this data are from a range of different studies from different years. Different research methods have been used therefore meaningful comparisons cannot be made between the different groups.

As well as higher smoking rates, people from disadvantaged groups also tend to have higher levels of dependency on nicotine,(19) report smoking a greater number of cigarettes each day,(20) smoke more intensively and also smoke for more years than the general population.(21) Tobacco-related disparities exist between population groups in exposure to tobacco smoke at all points on the continuum of tobacco use.(22) This includes higher foetal exposure to tobacco smoke (women from disadvantaged groups are more likely to smoke during pregnancy),(23-25) exposure to second-hand smoke in childhood, and people’s exposure to tobacco throughout life in the communities in which they live.(22)

The link between disadvantage and higher smoking rates

There is a relationship between increased disadvantage and increased smoking prevalence.(51) This is illustrated in a study from the UK that found that for every indicator of disadvantage added (for example being unemployed, a sole parent, living in poor housing) smoking increased by 5% per indicator up to four indicators. The difference in smoking rates increased at a higher rate between four and five indicators (10%) and by an additional 15% between five and six or more indicators.(52)

In fact, many social and economic factors across people’s life course from childhood to old age combine to entrench smoking in the lives of those facing multiple disadvantage. (37, 51, 53) 
For example, a study of women in the UK showed they were at increased odds of being a heavy smoker if they experienced childhood disadvantage, left school aged 16 or less, were a mother at age 22 or younger, or if they experienced severe disadvantage as an adult compared to non-smokers and that the relationship between smoking and disadvantage is cumulative: 53 as the number of experiences of disadvantage accrue smoking rates increase.(51, 53, 54)

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. Population based surveys do not capture, for example, people who are experiencing homelessness, without phone access, or who are mentally or physically unable to respond to surveys.