1.10 Prevalence of smoking in other high-risk sub-groups of the population

Last updated: December 2017
Suggested citation: Greenhalgh, EM, Bayly, M, & Winstanley, MH. 1.10 Prevalence of smoking in other high-risk sub-groups of the population. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2017. Available from http://www.tobaccoinaustralia.org.au/chapter-1-prevalence/1-10-prevalence-of-smoking-in-other-high-risk-sub-

Discussion of general trends in smoking prevalence in Australia overlooks population sub-groups that have much higher smoking rates, or for whom smoking causes unique or disproportionate problems. Individuals with lower socio-economic status or lower educational attainment are more likely to smoke, as discussed in Section 1.7. Aboriginal and Torres Strait Islander peoples, discussed in the preceding section and in detail in Chapter 8, also show substantially higher smoking rates than the rest of the population, as do members of some other culturally and linguistically diverse communities (see Section 1.8). The following is a brief discussion about other population groups among whom smoking prevalence is either higher than overall Australian prevalence, or for whom smoking poses greater than usual health risks.

1.10.1 Smoking in pregnancy

Addressing smoking during pregnancy is of particular importance since tobacco use harms both the mother and the foetus.1

The Australian Institute of Health and Welfare’s National Perinatal Data Unit (NPDU) reports data on births in Australia. It collects information concerning both the mother (including demographic profile and matters relating to the pregnancy and birth) and the baby (such as sex, birth-weight and other health indicators).2–5

The NPDU reports that in 2015, 10% of women who gave birth smoked during pregnancy, down from 13% in 2012 and 17.4% in 2005. About 1 in 4 (23%) women who reported smoking during the first 20 weeks of pregnancy did not continue to smoke after 20 weeks of pregnancy.5  

There are significant variations in the prevalence of smoking during pregnancy in certain sub-populations, reflecting smoking behaviour in these groups within the wider population. For example, women who were most disadvantaged were about six times more likely to smoke in the first 20 weeks of their pregnancy than women who were least disadvantaged (18% compared to 3%). Those living in very remote areas were also more than four times more likely to smoke than women in major cities (37% compared to 8%). Women with Aboriginal or Torres Strait Islander backgrounds were almost four times more likely to smoke during the first 20 weeks of pregnancy than non-Indigenous women (44% compared with 12%). The likelihood of smoking during pregnancy decreased with maternal age. Thirty-five per cent of women and girls who became pregnant before the age of 20 smoked during the first half of pregnancy.5  

Other research has shown that women without a partner, the less educated,6 those with lower socio-economic status6,7 and women with a psychiatric disorder8 are more likely to smoke during pregnancy.

The health consequences of smoking and exposure to secondhand smoke during pregnancy are discussed in Chapter 3 and Chapter 4 respectively. For information on issues related to quitting smoking during pregnancy, refer to Section 7.11.

1.10.2 Smoking and mental illness

Mental health problems are common within the Australian population, with 17.5% of Australians reporting having a mental or behavioural condition in 2014–15.9   Individuals with mental health conditions have a substantially higher prevalence of smoking and those who smoke tend to smoke more heavily than the general population.10, 11 . Data from the 2016 National Drug Strategy Household Survey showed that Australian adults who reported having been diagnosed or treated for mental illness in the past year were more than twice as likely to be a regular smoker than those who had not been diagnosed or treated in the past year (25.9% vs. 12.3%).12 These excessive smoking rates contribute to higher levels of tobacco-caused morbidity and mortality among people with mental illness.13 For a detailed overview of smoking and quitting among people with mental illness, see Section 7.12

1.10.3 Single parents

In Australia in 2017, 14% of all families were one-parent families, the vast majority (83%) of which were single female-headed families.14  

In 2016, 31% of people aged 14+ years from single-parent households with dependent children were current smokers, compared to 13% among households with two parents and dependent children15—see Section 1.7. Single parenthood is associated with social and economic disadvantage,16 and is discussed further in Section 7.19.4 and Chapter 9.

1.10.4 The homeless

Homelessness is defined as lacking adequate access to safe and secure housing. The 2011 Australian National Census showed that there were about 105,000 homeless people in Australia at that time.17  

Individuals experiencing homelessness have a poorer health status than the general population, with those who are ‘street homeless’ (those usually dwelling on streets or in parks, in derelict buildings or other temporary shelters) being the worst affected.18 Melbourne-based research has shown a greatly elevated prevalence of smoking among homeless people (77%), with those who are street homeless reporting higher rates of 93%.18 For further discussion refer to Section 7.19.3 and Chapter 9.

1.10.5 The prison population

Traditionally, the prevalence of smoking in the prison population has been far higher than among the general population,19,20 with tobacco use commonly accepted as part of prison life.21 Tobacco was often used as currency in gambling or other trade.21

In 2015, 74% of prison entrants reported being current smokers, and of these almost all (93%) were daily smokers. The average age of taking up smoking was 14, although several prisoners reported that they began smoking as young as five.22 The elevated smoking rates in the prison population reflect the overwhelmingly disadvantaged backgrounds of inmates. Indigenous people, those from low socioeconomic backgrounds, drug users, and the less educated are substantially over-represented in the prison system, as are those suffering mental illness.20, 21 As noted elsewhere in this chapter, each of these factors predicts higher smoking rates.

In 2011, the National Preventative Health Strategy23 identified the prison population as a priority area for future interventions (see Chapters 7 and 9). As of 2017, all Australian states and territories have introduced or announced intentions to introduce complete smoking bans in prisons, except Western Australia. Such bans lead to a clear reduction in smoking among prisoners, and such reductions may flow through to the community. Dischargees from prisons with smoking bans report lower intentions to smoke post-release than those from prisons in which smoking is allowed.22

For an overview of interventions tailored to prison populations, see Section 7.19.10

1.10.6 Other drug use

Tobacco use commonly co-exists with other drug use.  Data from the National Drug Strategy Household Survey describes the prevalence of drug use among adult smokers and non-smokers in 2016—see Table 1.10.1. Controlling for age and sex, current smokers were more than six times more likely to have used marijuana in the past 12 months than non-smokers, and almost four and a half times more likely to have used any illicit drug (including marijuana) in the year prior to the survey. In 2014, of the secondary school students who reported having used marijuana, amphetamines, hallucinogens or ecstasy, more than a third said that they had used tobacco concurrently (41%, 40%, 36% and 46%, respectively).24  

Most individuals with substance use disorders smoke tobacco as well.21 International10 and Australian10, 25, 26  research shows that in this population, smoking rates range from 68%10 to 90%25 (see also Section 7.12). A 2015 international systematic review found that smoking rates among people in addiction treatment are more than double those of people with similar demographic characteristics.27 The relationship between tobacco and other drug use is complex, and may be subject to genetic and neurobiological determinants, as well as psychological and social influences.28, 29 Cessation interventions tailored to the needs of people with substance use disorders are discussed in Section

Table 1.10.1
Past year use of other drugs among current smokers‡ and non-smokers*‡: by sex for Australians aged 18+ years, 2016

‡ Smoked daily, weekly or less than weekly
# Includes ex-smokers and never smokers (never smoked 100 cigarettes (manufactured and/or roll-your-own) or the equivalent amount of tobacco)

Source: Centre for Behavioural Research in Cancer analysis of 2016 National Drug Strategy Household Survey data.12


Recent news and research

For recent news items and research on this topic, click here.(Last updated March 2018) 


1.    US Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/index.htm .

2.    Laws P, Abeywardana S, Walker J, and Sullivan E. Australia’s mothers and babies 2005. Perinatal statistics series no. 20, AIHW cat. no. PER 40.Sydney: Australian Institute of Health and Welfare National Perinatal Statistics Unit, 2007. Available from: https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies-2005/contents/table-of-contents

3.    Laws P, Grayson N, and Sullivan E. Smoking and pregnancy. AIHW cat. no. PER 33.Sydney: Australian Institute of Health and Welfare National Perinatal Statistics Unit, 2006. Available from: http://www.npsu.unsw.edu.au/NPSUweb.nsf/resources/AMB_2004_2008/$file/Smoking+and+pregnancy+for+web.pdf .

4.    Hilder L, Zhichao Z, Parker M, Jahan S, and Chambers GM. Australia’s mothers and babies 2012. Perinatal statistics series no. 30. Cat. no. PER 69, Canberra: AIHW, 2014. Available from: http://www.aihw.gov.au/publication-detail/?id=60129550033 .

5. Australian Institute of Health and Welfare, Australia’s mothers and babies 2015—in brief. Perinatal statistics series no. 33. Cat no. Per 91 Canberra: AIHW; 2017. Available from: https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies-2015-in-brief/contents/table-of-contents.

6. Lu Y, Tong S, and Oldenburg B. Determinants of smoking and cessation during and after pregnancy. Health Promotion International, 2001; 16(4):355–65. Available from: http://heapro.oxfordjournals.org/cgi/content/full/16/4/355

7. Mohsin M and Bauman A. Socio-demographic factors associated with smoking and smoking cessation among 426,344 pregnant women in New South Wales, Australia. BMC Public Health, 2005; 5:138. Available from: http://www.biomedcentral.com/content/pdf/1471-2458-5-138.pdf

8. Flick L, Cook C, Homan S, McSweeney M, Campbell C, et al. Persistent tobacco use during pregnancy and the likelihood of psychiatric disorders. American Journal of Public Health, 2006; 96(10):1799−807. Available from: http://www.ajph.org/cgi/content/abstract/96/10/1799

9. Australian Bureau of Statistics. 4364.0.55.001 - National Health Survey: First results, 2014-15 2015. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4364.0.55.001Main+Features12014-15?OpenDocument

10. Lasser K, Boyd L, Woolhandler S, Himmelstein S, McCormick D, et al. Smoking and mental illness: A population-based prevalence study. Journal of the American Medical Association, 2000; 284(2):2606–10. Available from: http://jama.ama-assn.org/cgi/content/full/284/20/2606

11. McNeill A. Smoking and mental health: A review of the literature. London: Smokefree London Programme, 2001. Available from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=

12. Australian Institute for Health and Welfare, National Drug Strategy Household Survey, 2016 [computer file]. Canberra: Australian Data Archive, The Australian National University; 2017.

13. Lawrence D, Holman C, and Jablensky A, Duty to care.  Preventable physical illness in people with mental illness. Perth: The University of Western Australia; 2001  

14. Australian Bureau of Statistics. 6224.0.55.001 - labour force, Australia: Labour force status and other characteristics of families, June 2017. 2017. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/6224.0.55.001Main%20Features5June%202017?opendocument&tabname=Summary&prodno=6224.0.55.001&issue=June%202017&num=&view=

15. Australian Institute of Health and Welfare. National Drug Strategy Household Survey (ndshs) 2016 key findings data tables. Canberra: AIHW, 2017. Available from: https://www.aihw.gov.au/reports/illicit-use-of-drugs/2016-ndshs-detailed/data

16. Australian Bureau of Statistics. 4102.0 Australian social trends, 2007. Canberra: ABS, 2008. Last update: Viewed Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/3550D34DA999401ECA25748E00126282?opendocument.

17. Australian Bureau of Statistics. 2049.0 - census of population and housing: Estimating homelessness, 2011 Available from: http://abs.gov.au/ausstats/abs@.nsf/Latestproducts/2049.0Main%20Features22011

18. Kermode M, Crofts N, Miller P, Speed B, and Streeton J. Health indicators and risks among people experiencing homelessness in Melbourne, 1995−1996. Australian and New Zealand Journal of Public Health, 1998; 22(4):464–70. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9659774

19. Awofeso N, Testaz R, Wyper S, and Morris S. Smoking prevalence in New South Wales correctional facilities. Tobacco Control, 2001; 10(1):84–5. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1763990&blobtype=pdf

20. Belcher J, Butler T, Richmond R, Wodak A, and Wilhelm K. Smoking and its correlates in an Australian prisoner population. Drug and Alcohol Review, 2006; 25(4):343–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16854660

21. Baker A, Ivers R, Bowman J, Butler T, Kay-Lambkin F, et al. Where there's smoke, there's fire: High prevalence of smoking among some sub-populations and recommendations for intervention. Drug and Alcohol Review, 2006; 25:85−96. Available from: http://www.informaworld.com/smpp/content~content=a741424195~db=all~order=page

22. Australian Institute of Health and Welfare, The health of australia’s prisoners 2015. Cat. no. PHE 207. Canberra: AIHW; 2015. Available from: https://www.aihw.gov.au/reports/prisoners/health-of-australias-prisoners-2015/contents/table-of-contents.

23. Preventative Health Taskforce. Australia: The healthiest country by 2020. National preventative health strategy. Canberra: Commonwealth of Australia, 2009. Available from: http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/national-preventative-health-strategy-1lp.

24. White V and Williams T, Australian secondary school students’ use of tobacco, alcohol, and over-the-counter and illicit substances in 2014. Centre for Behavioural Research in Cancer: Cancer Council Victoria; 2016. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/E9E2B337CF94143CCA25804B0005BEAA/%24File/National-report_ASSAD_2014.pdf.

25. Reichler H, Baker A, Lewin T, and Carr V. Smoking among in-patients with drug-related problems in an Australian psychiatric hospital. Drug and Alcohol Review, 2001; 20(2):231–7. Available from: http://www.informaworld.com/smpp/content~content=a713659508~db=all~order=page

26. Degenhardt L and Hall W. The relationship between tobacco use, substance-use disorders and mental health: Results from the national survey of mental health and well-being. Nicotine & Tobacco Research, 2001; 3(3):225–34. Available from: http://www.informaworld.com/smpp/content~db=all?content=10.1080/14622200110050457

27. Guydish J, Passalacqua E, Pagano A, Martínez C, Le T, et al. An international systematic review of smoking prevalence in addiction treatment. Addiction, 2015. Available from: http://dx.doi.org/10.1111/add.13099

28. Williams J and Ziedonis D. Addressing tobacco among individuals with a mental illness or an addiction. Addictive Behaviors, 2004; 29(6):1067–83. Available from: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VC9-4C82B3T-9&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_version=1&_urlVersion=0&_userid=10&md5=8095f68eba25b9b133e7794633a4511f

29. Kalman D, Morissette S, and George T. Co-morbidity of smoking in patients with psychiatric and substance use disorders. American Journal on Addictions, 2005; 14(2):106–23. Available from: http://www.informaworld.com/smpp/content~db=all?content=10.1080/10550490590924728


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