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4722.0.55.004 - Tobacco Smoking - Aboriginal and Torres Strait Islander people: A snapshot, 2004-05  
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NOTES


INTRODUCTION

This snapshot presents an overview of the prevalence of tobacco smoking among adults in the Aboriginal and Torres Strait Islander population. It also outlines the relationship between smoking and selected health and socioeconomic factors.

Unless otherwise stated, data in this article are for Indigenous people aged 18 years and over. 'Current daily smokers' or 'regular smokers' are those people who reported currently smoking, on average, one or more cigarettes (or cigars or pipes) per day at the time of interview.


DATA SOURCES

This article draws on information from the 2004-05 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS), the 2004-05 National Health Survey (NHS) and the 2002 National Aboriginal and Torres Strait Islander Social Survey (NATSISS).


INQUIRIES

For further information, please contact the Assistant Director, National Centre for Aboriginal and Torres Strait Islander Statistics on (02) 6252 6301 or visit www.abs.gov.au


TOBACCO SMOKING

Tobacco smoking was responsible for the greatest burden of disease and injury in Australia in 2003, followed by high blood pressure, high body mass, physical inactivity, and high blood cholesterol (Begg et al. 2007). Smoking tobacco increases the risk of numerous cancers, heart and vascular diseases, respiratory diseases and a variety of other conditions. It is responsible for around 20% of all cancer deaths, 80% of all lung cancer deaths, and 21% of all heart disease in Australia (DoHA 2006, 2006a). Tobacco use is of particular concern for the health of Aboriginal and Torres Strait Islander peoples, amongst whom smoking prevalence is more than double that of the non-Indigenous population (DoHA 2006).


PREVALENCE OF SMOKING

  • In 2004-05, half of the adult Indigenous population (50%) were current daily smokers (ABS 2006).
  • While smoking rates have decreased slightly for the total Australian population over the ten years to 2004-05 (ABS 2006a), there has been no significant change in smoking rates for the Indigenous population in this period (ABS 2006).
  • One in five Indigenous adults (20%) were ex-smokers (footnote 1) and 28% of Indigenous adults reported that they had never smoked (footnote 2) (ABS 2006).
  • Rates of current daily smoking were similar for Indigenous men and women (51% and 49%) (ABS 2006).
  • Indigenous people living in remote and non-remote areas also reported similar rates of current daily smoking (52% and 49%) (footnote 3) (ABS 2006).
  • Indigenous men in remote areas were more likely than those in non-remote areas to smoke on a daily basis (58% compared with 49%) (ABS 2006).
  • In the Aboriginal and Torres Strait Islander population, rates of regular smoking were high in younger age groups (reaching 57% for men aged 35-44 years and 54% for women aged 25-34 years and 35-44 years) and lower among those aged 55 years and over. Rates of smoking in the non-Indigenous population followed a similar pattern by age, although at considerably lower levels.
  • In 2004-05, the rate of regular smoking among Indigenous men was around twice that of non-Indigenous men (51% compared with 24%) and the rate for Indigenous women was around two-and-a-half times that of non-Indigenous women (49% compared with 18%).
Current daily smokers, Males(a) - 2004-05
Graph: Current daily smokers, Males(a)—2004–05


Current daily smokers, Females(a) -
2004-05
Graph: Current daily smokers, Females(a)—2004–05



SOCIOECONOMIC STATUS

Aboriginal and Torres Strait Islander people experience disadvantage across a range of socioeconomic indicators including education, employment, income and housing (ABS & AIHW 2005). There is strong evidence from Australia and other developed countries that low socioeconomic status is associated with poor health and increased exposure to health risk factors, including tobacco smoking (Blakely, Hales and Woodward 2004; Turrell & Mathers 2000).
  • In 2004-05, Indigenous adults who had completed Year 12 were less likely to be regular smokers than were those who had completed Year 11 or below (34% compared with 55%).
  • Daily smoking was less common among employed Indigenous adults (45%) than among those who were unemployed (66%) or not in the labour force (53%).
  • Indigenous people who lived in dwellings that were owned or being purchased by the occupants were less likely to smoke regularly than were those who lived in rented dwellings (36% compared with 55%).
  • Indigenous adults with access to higher household incomes were less likely than those in low income households to be regular smokers (40% compared with 55%).
  • Similarly, in the non-Indigenous population, lower rates of regular smoking were reported by people who had characteristics associated with socioeconomic advantage (i.e. higher education levels, employment, home ownership or access to higher household incomes).
  • After adjusting for age differences (footnote 4) between the Indigenous and non-Indigenous populations, Indigenous adults with these characteristics were still around twice as likely as non-Indigenous adults to be current daily smokers.

Proportions of people with selected socioeconomic characteristics(a), who smoke regularly - 2004-05

Current daily smokers
Age-standardised
rate ratio(b)

Indigenous
Non-Indigenous

Highest year of school completed(c)
Year 12 %
34.3
16.1
1.9
Year 11 or below %
54.8
25.2
1.7
Labour force status
Employed %
45.2
22.1
1.9
Unemployed %
66.3
40.0
1.9
Housing tenure
Home owner/purchaser %
36.2
15.6
2.1
Renter %
55.1
33.6
1.6
Household income(d)
Third income quintile and above %
39.7
20.1
1.9
First and second quintile %
55.4
22.8
1.9
Persons aged 18 years and over %
50.0
20.9
2.2
'000
129.2
3 084.5
. .

. . not applicable
(a) Aged 18 years and over.
(b) Indigenous to non-Indigenous rate ratios are calculated by dividing the proportion of Indigenous people with a particular characteristic by the proportion of non-Indigenous people with the same characteristic.
(c) Excludes persons still attending school.
(d) Gross weekly equivalised cash household income. For further information see Appendix 7 in the National Aboriginal and Torres Strait Islander Health Survey: Users' Guide 2004-05 (cat. no. 4715.0.55.004).
National Aboriginal and Torres Strait Islander Health Survey 2004-05, National Health Survey 2004-05

STRESSFUL LIFE CIRCUMSTANCES
  • Indigenous adults who had experienced more than one life stressor in the last 12 months (footnote 5) had higher rates of current daily smoking (54%) than did those who reported that they had experienced one or no stressful circumstances (46%).
  • Indigenous people who reported that they had experienced financial stress in the past year (footnote 6) were more likely to be daily smokers than were those whose household had not experienced financial stress (58% compared with 41%).


HEALTH STATUS

Tobacco smoking is associated with a variety of diseases and health conditions and is the major contributor to drug-related hospitalisations and deaths (AIHW 2006). Peoples' self-assessment of their health status is therefore likely to be related to whether or not they smoke.
  • In 2004-05, Aboriginal and Torres Strait Islander people who had never smoked were more likely to report being in excellent or very good health (47%) than were ex-smokers (41%) or current daily smokers (35%).
  • Correspondingly, Indigenous people who were current daily smokers or ex-smokers were more likely than those who had never smoked to report being in fair or poor health (27% compared with 17%).
  • Similarly, non-Indigenous people who were current daily smokers or ex-smokers were more likely than those who had never smoked to report being in fair or poor health (20% and 19% compared with 13%).
Self-assessed health status by smoker status(a) - 2004-05
Graph: Self-assessed health status by smoker status(a)—2004–05

  • In 2004-05, Aboriginal and Torres Strait Islander people who smoked daily were one-and-a-half times as likely as those who had never smoked to report high/very high levels of psychological distress (32% compared with 20%) (footnote 7).
  • In 2002, Indigenous people who were current daily smokers were more likely than those who had never smoked to report having a disability or long-term health condition (40% compared with 31%) (footnote 8). They were also more likely than those who had never smoked to report a profound or severe core activity restriction (9% compared with 6%) (footnote 9).


LONG-TERM HEALTH CONDITIONS

This section presents associations between smoking and selected long-term health conditions from the 2004-05 NATSIHS. The relationship between smoking and chronic health conditions is complex and may be affected by the presence of other risk factors such as overweight/obesity and by some people quitting smoking after being diagnosed with a long-term health condition. To reduce the effect of age differences on smoking behaviour and health conditions, this section focuses on Indigenous people aged 35 years and over.
  • In 2004-05, among Indigenous people aged 35 years and over, similar proportions of current daily smokers (89%), ex-smokers (94%) and people who had never smoked (90%) had at least one long-term health condition.
  • Indigenous people aged 35 years and over who were current daily smokers were less likely than ex-smokers to report heart and circulatory diseases (30% of current smokers compared with 37% of ex-smokers). However, ex-smokers with heart and circulatory diseases were one-and-a-half times more likely than current daily smokers with these conditions to be overweight/obese (footnote 10).
  • Indigenous people aged 35 years and over who were current daily smokers were half as likely as ex-smokers to report diabetes/high sugar levels (13% compared with 26%). However, overweight/obesity rates were twice as high among ex-smokers with diabetes/high sugar levels than among current daily smokers with these conditions.
  • Similar proportions of current daily smokers and ex-smokers reported respiratory diseases (34% and 37%) or kidney disease (3% and 5%).


RISK FACTORS

Diet and exercise
  • In 2004-05, Indigenous people who smoked regularly were almost twice as likely as non-smokers (includes ex-smokers and people who had never smoked) to report that they did not eat fruit on a daily basis (19% compared with 10%).
  • Indigenous smokers were also less likely than non-smokers to meet the nutritionally recommended daily intake of two serves of fruit per day (footnote 11). In non-remote areas, around one-third (30%) of Indigenous current daily smokers met the recommended daily intake of fruit compared with around half (51%) of those who did not smoke.
  • Similar proportions of regular smokers and non-smokers reported that they did not consume vegetables on a daily basis (7% and 5%).
  • Over half of Indigenous regular smokers (55%) living in non-remote areas reported a sedentary lifestyle (footnote 12) compared with 42% of those who did not smoke.

Weight
  • Among Indigenous people who reported their height and weight in 2004-05, 40% of current daily smokers were in the healthy weight range compared with 31% of non-smokers (includes ex-smokers and people who had never smoked).
  • While a similar proportion of smokers and non-smokers reported that they were overweight (29% and 30%), smokers were less likely than non-smokers to report that they were obese (26% compared with 36%).

Alcohol and substance use
  • In 2004-05, Aboriginal and Torres Strait Islander people who smoked regularly were more than twice as likely as non-smokers (includes ex-smokers and people who had never smoked) to report long-term risky/high risk levels of alcohol consumption (23% compared with 9%) (footnote 13).
  • Similarly, Indigenous current daily smokers were more than twice as likely as non-smokers to have consumed alcohol at short-term risky/high-risk levels (footnote 14) at least once per week in the 12 months prior to interview (26% compared with 11%).
Risky/high risk alcohol consumption by smoker status(a) - 2004-05
Graph: Risky/high risk alcohol consumption by smoker status(a)—2004–05

  • In non-remote areas, Indigenous smokers were twice as likely as non-smokers to report illicit substance use (footnote 15). Half of regular smokers in the 18-34 year age group had used illicit substances in the last 12 months compared with one-quarter (25%) of non-smokers.
  • Marijuana use was much more prevalent among Indigenous smokers than non-smokers. In non-remote areas, 46% of regular smokers aged 18-34 years had used marijuana, hashish or cannabis resin in the last 12 months, compared with 16% of non-smokers.


AGE COMMENCED DAILY SMOKING
  • In 2004-05, around one in ten Indigenous adults who were current daily smokers or ex-smokers had begun smoking regularly before the age of 13 years.
  • More than two-thirds of Indigenous current daily smokers and ex-smokers (68%) had begun smoking regularly before the age of 18 years.
  • Indigenous people living in non-remote areas tended to commence regular smoking earlier, with 11% starting before the age of 13 years compared with 5% in remote areas.
  • In 2004-05, 5% of non-Indigenous current daily smokers and ex-smokers had begun smoking before the age of 13 years and 54% reported having commenced regular smoking before the age of 18 years.
  • Indigenous women were around twice as likely as non-Indigenous women to report having begun smoking regularly before the age of 13 years (9% compared with 4%).


ENVIRONMENTAL TOBACCO SMOKE

Environmental tobacco smoke, or passive smoking, is a significant cause of morbidity and mortality, having been shown to increase a non-smoker's risk of lung cancer and ischaemic heart disease (DoHA 2006). Environmental tobacco smoke increases an infant's risk of developing asthma, and is associated with increased risk of respiratory diseases, coronary heart disease and lung cancer in adults (AIHW 2004).
  • In 2004-05, 111,800 households with Indigenous residents (62%) had at least one regular smoker. Of these households with a regular smoker, 45% had at least one resident who regularly smoked indoors.
  • Two-thirds (66%) of Aboriginal and Torres Strait Islander children aged 0-14 years lived in households with one or more regular smokers and 28% lived in households in which at least one resident regularly smoked indoors.
  • Around one-third of non-Indigenous children aged 0-14 years (35%) lived in households with a regular smoker and 9% lived in households in which at least one resident regularly smoked indoors.
Children's exposure to environmental tobacco smoke(a) - 2004-05
Graph: Children's exposure to environmental tobacco smoke(a)—2004–05



FOOTNOTES

1. In the 2004-05 NATSIHS, an 'ex-smoker' was defined as a person who did not currently smoke, but had at some time in their life smoked on average one cigarette per day, or had smoked at least 100 cigarettes in their lifetime, or had smoked pipes, cigars or other tobacco products at least 20 times in their lifetime. Back

2. In the 2004-05 NATSIHS, the smoker status 'never smoked' refers to persons who reported that they did not currently smoke, had never smoked on average at least one cigarette per day, had smoked less than 100 cigarettes in their lifetime, or had smoked pipes, cigars or other tobacco products less than 20 times in their lifetime. Back

3. 'Non-remote' is comprised of Major Cities of Australia, Inner Regional Australia and Outer Regional Australia, while 'Remote' is comprised of Remote Australia and Very Remote Australia. For further information refer to Statistical Geography: Volume 1, Australian Standard Geographical Classification (ASGC) 2006 (cat. no. 1216.0). Back

4. Some results in this article have been age-standardised to account for differences in the age structure between the Indigenous and non-Indigenous populations. For further information refer to the Glossary of the National Aboriginal and Torres Strait Islander Health Survey 2004-05 (cat. no. 4715.0). Back

5. In the 2004-05 NATSIHS, 'stressor(s)' were defined as one or more events or circumstances which a person considers to have been a problem for themselves or someone close to them in the last 12 months. For further information refer to the Glossary of the National Aboriginal and Torres Strait Islander Health Survey 2004-05 (cat. no. 4715.0). Back

6. In the 2004-05 NATSIHS, 'financial stress' was defined as whether or not any member of the household could obtain $2000 in an emergency. For further information refer to the National Health Survey and National Aboriginal and Torres Strait Islander Health Survey 2004-05: Data Reference Package (cat. no. 4363.0.55.002). Back

7. The 2004-05 NATSIHS used a modified five-item version of the Kessler Psychological Distress Scale (known as the K5) to measure non-specific psychological distress. Low/moderate distress represents a K5 score of 5-11 and high/very high distress represents a score of 12-25. For further information on the social and emotional wellbeing module refer to the National Health Survey and National Aboriginal and Torres Strait Islander Health Survey 2004-05: Data Reference Package (cat. no. 4363.0.55.002). Back

8. In the 2002 NATSISS, 'disability or long-term health condition' was defined as a limitation, restriction, impairment, disease or disorder which had lasted, or was likely to last, for six months or more, and which restricted a person's ability to perform everyday activities. Back

9. In the 2002 NATSISS, 'core activity restriction' was defined as a limitation in the performance of one or more core activities such as self care; mobility or communication. For further information refer to the Glossary of the National Aboriginal and Torres Strait Islander Social Survey 2002 (cat. no. 4714.0). Back

10. Body Mass Index (BMI) was calculated from reported height and weight information, using the formula weight (kilograms) divided by the square of the height (metres). For further information, see the Glossary of the National Aboriginal and Torres Strait Islander Health Survey 2004-05 (cat. no. 4715.0). Back

11. For further information refer to the National Aboriginal and Torres Strait Islander Health Survey: Users' Guide 2004-05 (cat. no. 4715.0.55.004). Back

12. The 2004-05 NATSIHS collected information relating to the frequency, intensity (ie. walking, moderate exercise and vigorous exercise) and duration of exercise (for recreation, sport or fitness) undertaken by Indigenous people living in non-remote areas in the two weeks prior to the interview. The exercise level 'sedentary' refers to the range from no exercise up to less than 100 minutes of exercise. For further information refer to the Glossary of the National Aboriginal and Torres Strait Islander Health Survey 2004-05 (cat. no. 4715.0). Back

13. Long-term alcohol risk levels for the 2004-05 NATSIHS were derived from the daily consumption of alcohol in the seven days prior to interview. Risk levels were based on the National Health and Medical Research Council (NHMRC) guidelines for risk of harm in the long-term. Risky/high risk equates to 50ml or more of alcohol per day for men and 25ml or more per day for women. Back

14. Short-term alcohol risk levels for the 2004-05 NATSIHS were derived from questions on the frequency of consuming five (for females) or seven (for males) or more standard drinks on any one occasion in the last 12 months. These risk levels equate to NHMRC guidelines for risk of harm in the short-term. For further information refer to the National Health Survey and National Aboriginal and Torres Strait Islander Health Survey 2004-05: Data Reference Package (cat. no. 4363.0.55.002). Back

15. In the 2004-05 NATSIHS, Indigenous people aged 15 years and over were asked about their substance use in the 12 months prior to the interview and their substance use to date. The use of substances for non-medical purposes includes: analgesics; tranquillisers; amphetamines; marijuana; heroin; cocaine; hallucinogens (both synthetic and naturally occurring); ecstasy and other designer drugs; petrol and other inhalants; and kava. This data is available only for non-remote areas and for respondents who voluntarily accepted the substance use questionnaire form. Back


LIST OF REFERENCES

Australian Bureau of Statistics (ABS) 2006, National Aboriginal and Torres Strait Islander Health Survey 2004–05, ABS cat. no. 4715.0, ABS, Canberra.

ABS 2006a, Tobacco Smoking in Australia: A Snapshot 2004–05, ABS cat. no. 4831.0.55.001, ABS, Canberra.

Australian Bureau of Statistics and Australian Institute of Health and Welfare 2005, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples, ABS cat. no. 4704.0, AIHW cat. no. IHW14, AIHW, Canberra.

Australian Institute of Health and Welfare (AIHW) 2004, Tobacco smoking, http://www.aihw.gov.au/riskfactors/smoking.cfm, December 2004.

AIHW 2006, Australia's Health 2006, AIHW cat. no. AUS73, AIHW, Canberra.

Begg, S, Vos, T, Barker, B, Stevenson, T, Stanley, L & Lopez, A 2007, The Burden of Disease and Injury in Australia 2003, AIHW, Canberra.

Blakely, T, Hales, S & Woodward, A 2004, Poverty: Assessing the Distribution of Health Risks by Socioeconomic Position at National and Local Levels, WHO Environmental Burden of Disease Series, no. 10, WHO, Geneva.

Department of Health and Ageing (DoHA) 2006, Aboriginal and Torres Strait Islander Health Performance Framework - 2006 Report, DOHA, Canberra.

DoHA 2006a, Health Effects of Smoking, http://www.healthinsite.gov.au/content/internal/page.cfm?ObjID=0007918F-0B6A-1D2D-81CF83032BFA006D&CFID=11694254&CFTOKEN=97612010, December 2006.

Turrell, G & Mathers, C 2000, Socio-economic status and health in Australia, Medical Journal of Australia, 172:434-438.


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