HEALTH RISK FACTORS


Smoking

Tobacco smoking is the most preventable cause of ill-health and early death in Australia[1]. Smoking is linked to chronic diseases such as cardiovascular disease, type 2 diabetes and various cancers, as well as reproductive problems in women[2].

In 2014–15, just under two in five (39%) Aboriginal and Torres Strait Islander people aged 15 years and over were daily smokers. A further 3% were smokers who smoked less than daily, and 22% were ex-smokers. Males were more likely than females to be daily smokers (42% compared with 36%), and people in remote areas were more likely than those in non-remote areas to smoke on a daily basis (47% compared with 37%) (Table 1 and Table 12).

The daily smoking rates for Aboriginal and Torres Strait Islander people aged 15 years and over decreased by 10 percentage points between 2002 and 2014–15. In 2002, almost half (49%) of Aboriginal and Torres Strait Islander people aged 15 years and over were daily smokers, with rates declining to 45% in 2008, and to 39% in 2014–15 (Table 1).

The decline in the daily smoking rate has been similar for Aboriginal and Torres Strait Islander males and females. In 2002, 51% of males were daily smokers. The daily smoking rate for males then declined to 46% in 2008, and to 41% in 2014–15. The daily smoking rate for females declined from 47% in 2002, to 43% in 2008, and to 36% in 2014–15 (Figure 7.2.1).

Figure 7.2.1. Daily smokers(a), by sex — 2002 to 2014–15


While the daily smoking rates for Aboriginal and Torres Strait Islander people aged 15 years and over have been declining in both non-remote and remote areas, most of the change has occurred in non-remote areas. The proportion of daily smokers in non-remote areas decreased from 48% in 2002 to 37% in 2014–15 (11 percentage points). In comparison, there has been a decrease of three percentage points in remote areas, from 50% to 47% over the same period (Figure 7.2.2 and Table 1).

Figure 7.2.2. Daily smokers(a), by remoteness — 2002 to 2014–15


In 2014–15, the proportion of daily smokers was lowest among Aboriginal and Torres Strait Islander people aged 15–24 years, and those aged 55 years and over (both 31%), while for other age groups, it was around 46%. Between 2008 and 2014–15, the proportion of young Aboriginal and Torres Strait Islander people who were smoking daily has decreased significantly — from 39% to 31% for 15–24 year olds, and from 53% to 45% for 25–34 year olds. This suggests that fewer young people are starting to smoke, than was previously the case.

The proportion of males who were daily smokers was higher than that for females, across all age groups. However, the difference between the daily smoking rates for males and females was only statistically significant for age groups 15–24 years (34% of males compared with 26% of females), and 45–54 years (51% of males compared with 41% of females) (Figure 7.2.3 and Table 4).

Figure 7.2.3. Daily smokers(a), by age and sex — 2014–15


After adjusting for differences in age structure between the two populations, Aboriginal and Torres Strait Islander people aged 15 years and over were almost three times as likely as non-Indigenous people to be daily smokers (rate ratio of 2.8) (Table 1).

Exposure to passive smoking

In 2014–15, six in 10 (60%) Aboriginal and Torres Strait Islander people aged 15 years and over were living in a household in which there was at least one daily smoker (Table 16). This has decreased from 68% in 2008. Over the same period, there has also been a decrease in the proportion of Aboriginal and Torres Strait Islander children aged 0–14 years living in these types of households — 63% in 2008 compared with 57% in 2014–15 (Table 8).

Almost one in five (19%) Aboriginal and Torres Strait Islander people aged 15 years and over and 13% of children were living in a household in which someone smoked inside. This was more common in remote areas (25% and 17%, respectively) than in non-remote areas (17% and 13%, respectively) (Table 16 and Table 8).

Alcohol consumption

Consuming high levels of alcohol increases the risk of alcohol-related injury, as well as the risk of developing health problems throughout the life course. The National Health and Medical Research Council (NHMRC) has released guidelines for reducing the health risks associated with the consumption of alcohol. The 2009 NHMRC Guidelines state that, for healthy men and women, 'drinking no more than two standard drinks on any day reduces the lifetime risk of harm from alcohol-related disease or injury'[3]. The guidelines also recognise that on a single occasion of drinking, the risk of alcohol-related injury increases with the amount consumed, and advises that for healthy men and women, 'drinking no more than four standard drinks on a single occasion reduces the risk of alcohol-related injury arising from that occasion'[3]. A single occasion of drinking refers to a person consuming a sequence of drinks without their blood alcohol concentration reaching zero in between.

In 2014–15, more than one-third (38%) of Aboriginal and Torres Strait Islander people aged 15 years and over did not drink alcohol, or drank on one day or less, in the previous 12 months. The proportion of females who drank alcohol on one day or less in the previous 12 months was 47%, compared with 29% of males (Table 12).

Lifetime risk

The proportion of Aboriginal and Torres Strait Islander people aged 15 years and over who exceeded the lifetime risk guidelines[3] for alcohol consumption decreased between 2008 and 2014–15. In 2008, almost one in five people (19%) consumed more than two standards drinks per day, on average, compared with 15% in 2014–15. The overall change is largely due to a decrease in non-remote areas (from 19% in 2008 to 14% in 2014–15) (Table 1).

Aboriginal and Torres Strait Islander males were almost three times as likely as females to have exceeded the lifetime risk guidelines (22% compared with 8%). This pattern was evident in all age groups (Figure 7.2.4 and Table 4).

Figure 7.2.4. Exceeded the lifetime risk guidelines for alcohol consumption(a)(b), by age and sex — 2014–15


Single occasion risk

In 2014–15, around one in three (30%) Aboriginal and Torres Strait Islander people aged 15 years and over exceeded the single occasion risk guidelines for alcohol consumption[3], a decrease from 38% in 2008. Similar to the decrease in the proportion of those who had exceeded the lifetime risk guidelines, this was largely due to a change in the rate for non-remote areas (from 39% in 2008 to 30% in 2014–15) (Table 1).

Aboriginal and Torres Strait Islander males were almost twice as likely as females to have exceeded the single occasion risk guidelines (39% compared with 21%). The difference between male and female rates was statistically significant for all age groups (Table 4).

Nutrition

Poor nutrition contributes to overweight and obesity, as well as nutrient deficiencies and associated conditions. Poor nutrition is also a significant risk factor for many chronic diseases, including cardiovascular disease, type 2 diabetes and various types of cancer. Fruit and vegetables are a rich source of many essential nutrients, such as dietary fibre, vitamins and minerals. The current National Health and Medical Research Council (NHMRC) guidelines on daily fruit and vegetable intake were released in 2013[4]. The data presented below reflect, as closely as possible, these guidelines.

In 2014–15, less than half (46%) of Aboriginal and Torres Strait Islander people aged 15 years and over were eating an adequate amount of fruit each day, and 6% were eating an adequate amount of vegetables each day. Less than one in twenty (4%) Aboriginal and Torres Strait Islander people aged 15 years and over met the recommended guidelines for daily intake of both fruit and vegetables[4] (Table 12).

Aboriginal and Torres Strait Islander females aged 15 years and over were more likely than males to be eating an adequate amount of vegetables each day (9% compared with 3%). This was also the case for daily fruit consumption (47% compared with 44%), however the difference was not statistically significant (Table 12).

In non-remote and remote areas, the proportions of Aboriginal and Torres Strait Islander people aged 15 years and over who had an adequate daily intake of fruit (45% compared with 50%) and vegetables (6% for both) were not significantly different (Table 12).

After adjusting for differences in the age structure of the two populations, Aboriginal and Torres Strait Islander people aged 15 years and over were significantly less likely than non-Indigenous people to be meeting the guidelines for daily fruit intake (rate ratio of 0.9). The rate ratio for adequate daily vegetable intake was 0.9, however the difference in rates between the non-Indigenous and Aboriginal and Torres Strait Islander populations was not statistically significant.

Substance use

In the 2014–15 NATSISS, Aboriginal and Torres Strait Islander people aged 15 years and over were asked whether they had used illicit substances in the last 12 months, and the types of illicit substances they had used during that period. Approximately 9% of respondents chose not to answer this set of questions, and have been excluded from this analysis.

Almost one-third (30%) of Aboriginal and Torres Strait Islander people aged 15 years and over reported having used illicit substances in the last 12 months, up from 22% in 2008. Males were significantly more likely than females to have used illicit substances (34% compared with 27%), as were people in non-remote areas compared with those in remote areas (33% compared with 21%) (Table 12).

Marijuana use in the last 12 months was reported by 19% of Aboriginal and Torres Strait Islander people (25% of males compared with 14% of females). The non-medical use of analgesics and sedatives (such as painkillers, sleeping pills and tranquilisers) was also relatively common (13%), with females (15%) being more likely than males (11%) to have used analgesics and sedatives. In addition, one in twenty (5%) Aboriginal and Torres Strait Islander people aged 15 years and over reported having used amphetamines or speed in the last 12 months (6% of males compared with 3% of females) (Figure 7.2.5 and Table 12).

Figure 7.2.5. Use of selected substances in last 12 months(a), by sex — 2014–15



Endnotes

1 Australian Institute of Health and Welfare (AIHW), 2012. Risk factors contributing to chronic disease, Canberra: Australian Institute of Health and Welfare. <http://www.aihw.gov.au/publication-detail/?id=10737421466>; last accessed 19/04/2016.

2 US Department of Health and Human Services, 2014. The health consequences of smoking—50 years of progress: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Centre for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, <http://www.surgeongeneral.gov/library/reports/50-years-of-progress/>

3 National Health and Medical Research Council (NHMRC), 2009. Australian guidelines to reduce health risks from drinking alcohol, Canberra: NHMRC. <http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/ds10-alcohol.pdf>; last accessed 19/04/2016.

4 National Health and Medical Research Council (2013) Australian Dietary Guidelines. Canberra: National Health and Medical Research Council. <https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n55_australian_dietary_guidelines.pdf >; last accessed 19/04/2016.