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

Tier 2—Health behaviours—2.15 Tobacco use

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?:

Estimates of the burden of disease and injury among Aboriginal and Torres Strait Islander peoples attribute 12% of the total burden to tobacco smoking. Smoking was identified as the top risk factor contributing to the burden of disease for Indigenous Australians (Vos et al. 2007). In the Australian population, 8% of the burden of disease was attributable to tobacco smoking (Begg et al. 2007).

The health impact of smoking is evident in the incidence of a number of diseases, including chronic lung disease, cardiovascular disease and many forms of cancer. Smoking is responsible for an estimated 35% of the burden of disease from cancers and 33% of the burden from cardiovascular disease for Aboriginal and Torres Strait Islander peoples (Vos et al. 2007). In addition, environmental tobacco smoke has adverse health effects for others who are in close proximity to a smoker (AIHW 2002a) (see measure 2.03).

The National Tobacco Strategy 2004–2009 noted that "encouraging and finding ways to support smokers to quit successfully is probably the single most effective thing that could be done to improve child and maternal health, to reduce chronic diseases and some communicable diseases and to reduce financial stress" (Ministerial Council on Drug Strategy 2004b).

Findings:

In 2008, 47% of Indigenous Australians aged 15 years and over reported that they were current smokers, a reduction from an estimated 51% in 2002 and 52% in 1994. Current smokers include daily smokers (45%) and those who smoked but not daily (2%). After accounting for differences in the age profile of the two populations, Indigenous Australians were 2.2 times more likely to be smokers than other Australians. Smoking rates for males (49%) were higher than females (45%). Smoking rates were highest in the 25–34 year age group (56%) and lowest in the 15–17 year age group (22%) and the 55 years and over age group (32%). Indigenous Australians in remote areas smoked at higher rates (53%) than those in non-remote areas (45%).

A 2008 study found that 23% of 12–15 year old Indigenous students had smoked in the past year and that 12% were current smokers. This compares to 13% of all 12–15 year old students having smoked in the past year and 5% who were current smokers (White et al. 2010b).

A study of the The National Aboriginal and Torres Strait Islander Survey (NATSIS) (1994), National Aboriginal and Torres Strait Islander Social Survey (NATSISS) (2002 & 2008) and National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) (2004–05) found that while overall rates of smoking are declining among Aboriginal and Torres Strait Islander peoples, smoking rates among Aboriginal and Torres Strait Islander women living in remote communities have remained steady (Thomas 2012).

There is strong evidence that smoking status is associated with socioeconomic factors and that smoking rates are highest for Indigenous Australians in the most socially disadvantaged circumstances (Thomas et al. 2008). In 2008, Indigenous Australians aged 18 years and over who were either in the highest household income quintiles; were in the most advantaged SEIFA quintiles; were employed; had non-school qualifications; or had completed Year 12 were more likely to report being a non-smoker. Being a non-smoker was also associated with better self assessed health status. Social, cultural and family factors also play important roles (Johnston et al. 2008; Hearn et al. 2011). People reporting having been removed from one’s natural family, or not having support in a time of crisis, were more likely to be smokers compared to those who had not been removed and those who reported having support.

Less Indigenous Australians have never smoked (31%) compared with non-Indigenous Australians (52%) and less were ex-smokers (24% and 28% respectively).

Implications:

Tobacco smoking is influenced by a range of factors, including normalisation of smoking in peer groups and families, positive attitudes towards smoking, adult smoking and other factors such as overcrowding (Carson et al. 2012). The influence of these factors varies across the different community settings and social environments in which Aboriginal and Torres Strait Islander peoples live (Johnston et al. 2008). Consequently, it is important that strategies to reduce Indigenous smoking rates acknowledge the social exchange that often occurs when smoking, the important role of family, and the high rates of stress experienced by Aboriginal people (Hearn et al. 2011). Programs need to be “culturally valid, responsive to local needs and controlled by the community” (Ministerial Council on Drug Strategy 2004a). A review of smoking cessation intervention studies in Indigenous populations internationally found limited rigorous evidence to evaluate which interventions would be effective in reducing tobacco use. There was some limited evidence supporting behavioural interventions through culturally appropriate health messages delivered by health professionals or through text messages and the use of pharmacotherapies (nicotine patches and bupropion). A multifaceted approach addressing cessation and prevention from various sources simultaneously, and targeted to the population, appeared more likely to increase success together with evaluations to assess applicability and effectiveness (Carson et al. 2012).

An evaluation of the NSW SmokeCheck program showed that health professionals’ confidence and ability to deliver brief smoking cessation interventions increased significantly after attending training on delivering tailored smoking cessation advice to Aboriginal clients (Hearn et al. 2011).

In May 2008, the Australian Government announced $14.5 million over four years from 2008–09 until 2011–12 for the Indigenous Tobacco Control Initiative to identify innovative approaches to addressing the high rates of tobacco smoking in the Indigenous population. A review is being undertaken to identify and showcase the lessons learnt from the Indigenous Tobacco Control Initiative projects that may be transferable to other communities.Top of Page

Under the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, governments have agreed to address high Indigenous smoking rates. The Australian Government is investing to:
  • Recruit and train a National Network of Regional Tackling Smoking and Healthy Lifestyle Teams across 57 regions nationally.
  • Work with communities to design and deliver locally relevant health promotion and social marketing campaigns and activities tackling smoking.
  • Implement training for health workers and community educators, with 200 trained in 2010–11.
  • Develop resources to support the workforce such as the guide to Nicotine Replacement Therapy ‘Medicines to help Aboriginal and Torres Strait Islander People Stop Smoking: A Guide for Health Workers’.
  • Enhance Quitlines to provide a more culturally sensitive, accessible and appropriate service for Aboriginal and Torres Strait Islander peoples.
The More Targeted Approach campaign, announced on 29 April 2010, includes $27.8 million over four years from 2010–11 aimed at reducing smoking prevalence among high risk and hard to reach groups. On 30 April 2010, tobacco excise was increased by 25 per cent.

The Tobacco Plain Packaging Act 2011 received Royal Assent on 1 December 2011. The legislation and associated regulations specify plain packaging requirements for tobacco products which are designed to reduce the attractiveness and appeal of tobacco products to consumers; particularly young people; increase the noticeability and effectiveness of mandated health warnings; and reduce the ability of the packaging to mislead consumers about the harms of smoking; and through the achievement of these aims in the long term, as part of a comprehensive suite of tobacco control measures, contribute to efforts to reduce smoking rates. All tobacco products manufactured or packaged in Australia for domestic consumption will be required to be in plain packaging by 1 October 2012, and all tobacco products will be required to be sold in plain packaging by 1 December 2012.

Graphic health warnings on tobacco products have been updated and expanded in the Competition and Consumer (Tobacco) Information Standard 2011, which commenced on 1 January 2012. Under the Standard, the size of graphic health warnings will increase to 75% of the front of the pack for cigarettes and cartons, up from 30%, with the current 90% warnings for the back of packs retained. The size of graphic health warnings for most other smoked tobacco products will increase to 75% of both the front and back of the pack. All tobacco products are required to display the new warnings by 1 December 2012, in line with plain packaging.Top of Page
Figure 122—Proportion of Aboriginal and Torres Strait Islander peoples aged 15 years and over reporting they are a current smoker, 1994, 2002 and 2008
Figure 122—Proportion of Aboriginal and Torres Strait Islander peoples aged 15 years and over reporting they are a current smoker, 1994, 2002 and 2008
Source: ABS and AIHW analysis of the 1994 NATSIS, 2002 and 2008 NATSISS
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Table 35—Estimated proportion of Aboriginal and Torres Strait Islander peoples that are current smokers by sex, age, remoteness area and jurisdiction, 2004–05 and 2008
Sex (18 years and over)
2004-05
2008
Male
53
53
Female
51
47
Persons
51
50
Age
2004-05
2008
15-17
na
22
18-24
52
53
25-34
56
56
35-44
59
53
45-54
51
48
55+
31
32
Remoteness Area (18 years and over)Top of Page
2004-05
2008
Major Cities
46
45
Inner Regional
47
50
Outer Regional
50
52
Remote
47
52
Very Remote
51
56
State/Territory (18 years and over)
2004-05
2008
NSW
53
52
Vic.
52
50
Qld
51
47
WA
48
47
SA
56
51
Tas.
51
49
ACT
44
38
NT
56
55
Source: ABS and AIHW analysis of the 2008 NATSISS and the and 2007–08 NHS
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Figure 123—Proportion of population aged 15 years and over reporting they are a current smoker, by Indigenous status and age, 2008
Figure 123—Proportion of population aged 15 years and over reporting they are a current smoker, by Indigenous status and age, 2008
Source: ABS and AIHW analysis of the 2004–05 NATSIHS and 2008 NATSISS
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