Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012

Tier 2—Environmental factors—2.03 Environmental tobacco smoke

The HPF was designed to measure the impact of the National Strategic Framework for Aboriginal and Torres Strait Islander Health (NSFATSIH) and will be an important tool for developing the new National Aboriginal and Torres Strait Islander Health Plan (NATSIHP).

Page last updated: 15 November 2012

Why is it important?:

Environmental tobacco smoke, or passive smoking, is now firmly established as a significant cause of morbidity and mortality. The first evidence of harm to children from passive smoking emerged in the early 1970s, (Colley 1974; Harlap et al. 1974; Leeder et al. 1976) and the first evidence of increased lung cancer risk in 1981 (Hirayama 1981). By 1986 the US Surgeon General (U.S. Department of Health and Human Services 2006) and the Australian National Health and Medical Research Council (NHMRC 1986; NHMRC 1997) were able to conclude without doubt that passive smoking was harmful (VicHealth Centre for Tobacco Control 2001).

Environmental tobacco smoke is a significant contaminant of indoor air. There is strong and consistent evidence that passive smoking increases a non-smoker's risk of lung cancer and ischaemic heart disease. Passive smoking is also associated with increased risk of respiratory disease in adults (NHMRC 1997), and increased risk of respiratory conditions such as asthma (Thomson et al. 2012) and ear infections such as otitis media in children (Jacoby et al. 2008) (see measure 1.15). Smoking of tobacco around a new-born child is considered to be one of the major risk factors for sudden infant death syndrome (see measure 1.21) (AMA 1999).

The home is the most likely setting for exposure to environmental tobacco smoke for pregnant women and young children—all of whom are particularly vulnerable. Over­crowding in housing (see measure 2.02) increases the risk of such exposure and developing asthma. Smoking in cars is also an important environment for child exposure to second-hand smoke (Freeman et al. 2008).

A study of 145 pregnant Aboriginal and Torres Strait Islander women in Far North Qld found that significantly more smokers than non-smokers believed that 'if you are exposed to a lot of smoke from other people you might as well keep smoking yourself,' indicating the significant role that exposure to environmental tobacco smoke can play in reinforcing smoking behaviour (Gilligan et al. 2009) (see measure 2.15).

The benefits of reducing exposure to environmental tobacco smoke include reducing the incidence of short-, medium- and long-term health effects in non-smokers, and reducing the uptake of smoking in children of smokers (VicHealth Centre for Tobacco Control 2001).

Findings:

In 2008, there were around 122,000 Aboriginal and Torres Strait Islander children aged 0–14 years living in households with a current daily smoker, repre­senting 65% of all Aboriginal and Torres Strait Islander children in this age range. In comparison, 32% of non-Indigenous children within the same age range lived in households with a current daily smoker.

Aboriginal and Torres Strait Islander children were also three times as likely to live in households with a current daily smoker who smoked at home indoors (22% of children) compared with non-Indigenous children (7% of children).

Between 2004–05 and 2008 the proportion of Aboriginal and Torres Strait Islander children aged 0–14 years living in households with a regular smoker fell from 68% to 65%, however, this change is not statistically significant. For non-Indigenous children there was a significant reduction from 37% in 2004–05 to 32% 2007–08.

In 2008, the proportions of Aboriginal and Torres Strait Islander children aged 0–14 years that were exposed to environmental smoke ranged from 59% in inner-regional areas to 77% in very remote areas.

The proportion of Aboriginal and Torres Strait Islander children aged 0–14 years living in households with a regular smoker ranged from 53% in the ACT to 77% in the NT. The proportion of Aboriginal and Torres Strait Islander children aged 0–14 years who lived in households with a regular smoker who smoked at home, indoors, ranged from 13% in the ACT to 29% in Tasmania.

In a short-term study of 73 Aboriginal children admitted to Alice Springs Hospital, almost two-thirds (64%) were exposed to tobacco smoke at home, and those who were exposed had almost three times the risk for a regular cough (Hudson et al. 2009).status and remoteness, 2008 and 2007–08.Top of page

Implications:

The policy implications for addressing the dangers of environmental tobacco smoke are similar to those for tobacco smoking in general (see measure 2.15) and tobacco smoking during pregnancy (see measure 2.21). Exposure to environmental tobacco smoke should be monitored in conjunction with those measures. In May 2008, the Australian Government announced the new Indigenous Tobacco Control Initiative which aims to support reductions in tobacco smoking by investing $14.5 million over four years from 2008–09 until 2011–12. This Initiative complements the comprehensive national approach for reducing Aboriginal and Torres Strait Islander smoking rates through the Tackling Smoking measure under the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes. A major part of the Tackling Smoking measure is establishing a Tackling Smoking Workforce across 57 regions nationally. The Tackling Smoking Workforce is being rolled out in a team based approach, with the Regional Tackling Smoking and Healthy Lifestyle Teams having national coverage. The role of the teams includes working with communities to design and deliver locally tailored health promotion and social marketing campaigns and activities addressing smoking. This includes promoting an understanding of the importance of smoke-free environments and compulsory smoke-free policies for all host organisations.

A successful outcome would reduce the high proportion of children who are exposed to environmental tobacco smoke in their households. More information about current smoking initiatives is provided under measures see 2.15 and 2.21.
Table 27—Children aged 0–14 years living in households with current daily smoker(s), by Indigenous status of children, 2008 and 2007–08
Current daily smoker in household
AnswerIndigenous aged 0-14 (%)Non-Indigenous children aged 0-14 (%)
No34.9*67.8*
Yes65.1*32.2*
Whether any regular smokers smoke at home indoors
AnswerIndigenous aged 0-14 (%)Non-Indigenous children aged 0-14 (%)
No78.4*93.4*
Yes21.6*6.6*
*Difference between Indigenous/non-Indigenous groups is statistically significant at the p<.05 level.Source: ABS and AIHW analysis of 2008 NATSISS and 2007–08 NHS
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Figure 87—Proportion of children aged 0–14 years who live in households with current daily smoker(s), by remoteness and Indigenous status, 2004–05, 2008 and 2007–08

Figure 87—Proportion of children aged 0–14 years who live in households with current daily smoker(s), by remoteness and Indigenous status, 2004–05, 2008 and 2007–08

Source: ABS and AIHW analysis of 2004–05 NATSIHS, 2008 NATSISS, 2004–05 NHS, and 2007–08 NHS

Figure 88—Children aged 0–14 years living with current daily smoker(s), by Indigenous status and remoteness, 2008 and 2007–08

Figure 88—Children aged 0–14 years living with current daily smoker(s), by Indigenous status and remoteness, 2008 and 2007–08
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Figure 89—Children aged 0-14 years living with a current daily smoker who smokes at home indoors, by Indigenous status and remoteness, 2008 and 2007-08

Figure 89—Children aged 0-14 years living with a current daily smoker who smokes at home indoors, by Indigenous status and remoteness, 2008 and 2007-08
Source: ABS and AIHW analysis of 2008 NATSISS and 2007–08 NHS
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