5.10.1 Cultural background
5.10.1.1 Uptake of smoking among children from culturally and linguistically diverse environments
Australian research from the 1990s indicated that young people living in households where English is spoken were more likely to smoke than those living in households where a language other than English is the first language, however, little recent data is available.1,2 Research published in 2000 found3 that in a group of year 10 and 11 students in Sydney, those from an English-speaking background were much more likely to smoke (27%) than teenagers from Arabic (16%), Vietnamese or Southeast Asian backgrounds (8%). Teenagers from Vietnamese, Southeast Asian and Chinese backgrounds were also more likely to report that their families had rules at home about smoking, that they were usually supervised, and that they had lesser amounts of pocket money than other ethnic groups. Each of these factors independently correlates with a lower uptake of smoking (see Sections 5.7 and 5.12).
An earlier Sydney-based study also showed that young adolescents (aged 12–13) who spoke a language other than English (LOTE) at home were much less likely to smoke than children from an English-speaking background.1 The authors speculate that these lower rates may be due to stricter cultural attitudes opposing smoking among adolescents; students may be more likely to socialise with other children speaking the same LOTE at home and sharing the same cultural attitude, hence reducing the likelihood of peer smoking pressures; and/or that tobacco advertising had failed to reach these groups.
There is some evidence that acculturation (a process in which migrants adopt mainstream values and behaviours of their new culture) is associated with increased smoking rates among young people from Asian backgrounds living in Western countries.4 However, familial factors such as spending time with parents, having parents who do not smoke, and having parents who disapprove of smoking can protect against smoking among Asian youth in Western countries.5 Influence on smoking behaviour through remote acculturation was observed for Mexican adolescents exposed to American smoking culture via globalised mass media and the internet. A stronger orientation towards US culture was found to be a risk factor for smoking among Mexican adolescents, while a greater orientation towards Mexican culture was considered a potential preventative factor.6 An Australian longitudinal study published in 20187 concluded that the initially lower smoking prevalence among non-English speaking countries immigrants converges with that of native-born Australians after twenty years of residence. Immigrants (combined English speaking and non-English speaking) who arrived as children or adolescents and then subsequently spent 20 or more years living in Australia were significantly more likely to smoke than native-born Australians.7 In addition to acculturation, the concept of crossover (or convergence) has been identified as relevant to smoking uptake among people from culturally diverse backgrounds.8 This pattern describes how smoking prevalence among Black people in the United States is lower than that of White people during adolescence, but increases over time to equal or exceed White smoking rates in adulthood. The crossover effect typically occurs by around age 30.8
Prevention programs targeted for culturally and linguistically diverse populations in Australia are discussed in Section 9A.2.
5.10.1.2 Uptake of smoking among Aboriginal and Torres Strait Islander peoples
Smoking prevalence among Aboriginal and Torres Strait Islander young people has declined significantly.9,10 Between 1994 and 2018–19, there was a significant decline in current smoking prevalence for young adults aged 18–24 years from 55.4% in 1994 to 39.5% in 2018–19. This represents a 15.8 (8.6,23.1) percentage point decrease in smoking prevalence among Aboriginal and Torres Strait Islander young people and was consistent with declines in current daily smoking prevalence among the total Aboriginal and Torres Strait Islander population (50.0% to 40.2% between 2004–05 to 2018–19).11 In addition, the proportion of young people who had never smoked increased between 2012–13 to 2018–19 from 43% to 50% for Aboriginal and Torres Strait Islander people aged 18–24 years.10,12
Data from the Australian Secondary Students’ Alcohol and Drug Survey (ASSAD) showed most (70%) Aboriginal and Torres Strait Islander students in 2017 did not smoke, up from 49% in 2005.13 The ASSAD data showed that 7% of participants aged 12–15 years and 18% of people aged 16–17 years were currently smoking.13
Aboriginal and Torres Strait Islander children who do smoke, generally begin smoking at an earlier age than non-Indigenous children.14 However, Aboriginal and Torres Strait Islander children report similar influences on uptake of smoking to children everywhere. Being part of a peer group that smokes, smoking among family members and parents, and having a positive attitude towards smoking are strong predictors of smoking among both Aboriginal and Torres Strait Islander and non-Indigenous children.15,16 Offsetting boredom, stress relief and social pressures within the community17-19 are the most commonly cited reasons for taking up smoking among young Aboriginal Australians, as well as an expression of rebellion and a means of risk taking.18,20 Research from Western Australia shows that young Indigenous people are more likely to describe overt peer pressure in relation to taking up smoking, and to report smoking as a more normal occurrence among their non-Indigenous peers.20,21 Non-participation in the giving and sharing of tobacco within some communities can result in a sense of isolation.19 Australian research also suggests experimentation with other substances such as alcohol and cannabis also correlates with the adoption of smoking among Aboriginal and Torres Strait Islander and non-Indigenous primary school children.16 Other substance use, including cannabis and alcohol, has been shown to be an important risk factor for smoking for Indigenous and non-Indigenous Australian students alike. Tobacco and alcohol use association was weaker for Indigenous students. However, the prevalence of tobacco, alcohol and cannabis use in the past month was significantly higher among Indigenous than non-Indigenous students.22 A 2025 study analysed data from Aboriginal and Torres Strait Islander children (aged 12–15 years) participating in Wave 11 (2018) of the Longitudinal Study of Indigenous Children to identify protective factors against use of commercial tobacco. Most children had never used tobacco (81.3%), and of those who had, 51.3% reported use within the past year. Never use was significantly more likely among adolescents with peers who also had never used tobacco, no substance use (including e-cigarettes), supportive family and school environments, and no experiences of boredom, trouble with the police, or family experiences of racism.23
While the factors related to the uptake of smoking are similar for Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians, colonisation and its ongoing impact provides vital context for understanding smoking related behaviours among the Aboriginal and Torres Strait Islander population.24 The introduction and active entrenchment of tobacco through colonisation led to widespread use and the normalisation of tobacco by Aboriginal and Torres Strait Islander peoples.24 As a result, indigeneity is frequently used as a proxy for a constellation of factors that influence tobacco use.25 The ongoing trauma, racism, stress and exclusion from employment and education caused by colonisation and government policies, including but not limited to tobacco being used as a form of payment and issuing of tobacco as rations on missions are implicated with tobacco use.24,26-28
The higher prevalence of smoking in Aboriginal and Torres Strait Islander adults, to which colonisation contributed, means that many young Indigenous people live in settings in which smoking is the norm. It is also likely that factors such as poorer school connectedness and lower levels of education play a role.24,27
Smoking among Aboriginal and Torres Strait Islander children and teenagers, including influences on smoking behaviour, is discussed in greater detail in Chapter 8, Section 8.4. Policies for advancing tobacco control programs among Aboriginal and Torres Strait Islander peoples can be found in Section 8.13.
5.10.2 Socio-economics
Smoking and disadvantage is discussed in detail in Chapter 9 and InDepth 9A.
In Australia, the prevalence of smoking has traditionally been higher among young people with lower socio-economic status (SES). In the late 1990s and early 2000s, there was a clear social gradient in smoking, with higher smoking rates among the most disadvantaged Australian school students. These gaps have narrowed over time among older students, and in 2017 there was no difference in current smoking between the most and least disadvantaged 16 and 17-year-olds. Among younger students, however, despite a convergence in smoking rates in 2014, in 2017 12–15 year olds living in areas with relatively greater socioeconomic disadvantage were significantly more likely to report current smoking than those who lived in relatively less disadvantaged areas.29 (see Section 9.2.4).
Higher smoking prevalence among lower-SES adolescence in earlier years may be partly due to lower SES adolescents modelling the behaviour and attitudes of lower SES adults, who are more likely to smoke.30 Disadvantaged children are also more likely to be exposed to other influences that can affect smoking rates, such as local community factors (including prevailing beliefs and attitudes, smoking policies, availability of tobacco, and quality of health education) and a perceived lack of opportunity for advancement.31 As well as an increased likelihood of experiencing stress and negative life events.30
Research has shown that during a period of low tobacco-control funding and activity in Australia (1992–1996), including minimal mass media anti-smoking advertising, smoking prevalence increased among young people aged 12 to 15 years old, with the greatest increase among the lowest SES group. While in periods of high tobacco-control activity, such as 1987-1990 and 1997-2005, smoking prevalence decreased consistently across all SES groups.32 The 2017 data showing disparities in smoking between the most and least disadvantaged 12–15 year olds29 also came in the wake of an absence of ongoing government investment in mass media campaigns.33
The likelihood of having a smokefree home—which can deter uptake among children—increases alongside socio-economic status (SES) (see Section 9.2.5).34,35 Findings from the International Tobacco Control Four Country Survey in Australia, Canada, the US and the UK indicated that high-SES persons who smoke were more likely than low-SES persons who smoke to either have, or to introduce, a total ban on smoking within the home. High SES persons who smoke were also more likely than low-SES persons who smoke to uphold a household smoking ban while continuing to smoke themselves.35 An Australian study analysed data from the HILDA study (between 2001 and 2019) to investigate smoking initiation among adolescents (aged 15–18 years) living in social housing. Adolescents in social housing had a 1.80 times greater risk (95% CI: 0.95, 2.66) of smoking five years later compared to adolescents living in privately rented or owned housing, after adjusting for household income, household smoking and other relevant factors.36
Studies have consistently shown that young people with access to discretionary spending money are more likely to smoke.3,15,37,38 Research from New Zealand has shown that while young people’s use of large amounts of money is usually monitored by parents, they generally experienced freedom in spending small amounts. Young people commonly have access to money from a number of sources, including pocket money, lunch money and borrowing from friends and family, that allow them to buy cigarettes from retailers or via their social networks.39 Research from Scotland found that students from low-SES backgrounds had greater access to cheaper informal sources of tobacco, either through family and friends or via the illicit market.40 By contrast, young people in higher-SES areas looking to purchase tobacco may be restricted by the full retail price.40
For discussion on how affordability of cigarettes affects uptake of smoking in children, see Section 5.12. along with a discussion of pricing policy as a means of tobacco control, and in greater detail in Chapter 13, Section 13.4.
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References
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