This section examines:
by socioeconomic status, educational attainment, and employment status among adults, and also among young people.
It also summarises exposure to secondhand smoke among children and in the workplace, home, and in institutions. Section 9.2 provides a detailed overview of trends over time in smoking and exposure to secondhand smoke among these groups. Smoking rates among other priority populations can be found elsewhere – see our sections on smoking among Aboriginal and Torres Strait Islander Peoples, people with mental illness, single parents, people experiencing homelessness, the prison population, users of other drugs, and the LGBTQI+ population.
There is a consistent inverse dose–response relationship between cigarette smoking and income level (i.e., the lower the income the higher the prevalence of smoking), worldwide and across subgroups.1 Increased risks of smoking-related harm begin before birth, with higher likelihood of pregnant women from low socioeconomic status backgrounds smoking and being exposed to secondhand smoke, and continue through childhood, adolescence, and adulthood.
9.1.1 Smoking prevalence among adults by socioeconomic status
Consistent with findings from international research,1 data from recent Australian surveys2,3 show a clear social gradient in smoking behaviour among adults, with the prevalence of smoking significantly higher in lower socio-economic groups.
Figures 9.1.1 and 9.1.2 set out Australian data from the 2022 National Health Survey published by the Australian Bureau of Statistics.
Figure 9.1.2 shows smoking status by level of social disadvantage. The proportion of ex-smokers is almost identical among people living in the least and most disadvantaged areas; differences in smoking prevalence appear to be largely attributable to fewer socially advantaged people taking up smoking in the first place.2,4
The latest National Drug Strategy Household Survey tells a similar story. In 2022–2023, more than two-thirds of people living in the most advantaged areas or with a university education had never smoked. Table 9.1.1 shows smoking status among those of varying levels of social disadvantage, employment status, and education level.
9.1.2 Reported cigarette consumption
In addition to being more likely to have ever smoked and to currently smoke, those in disadvantaged groups also generally report smoking more heavily.5-7 Table 9.1.2 shows the average number of cigarettes smoked per day among adults who smoke by social characteristics in Australia in 2022–2023.
9.1.3 Duration of smoking
Among people who have quit smoking, those with lower levels of income and education are likely to have smoked for longer periods of time prior to quitting, placing them at greater risk of smoking-related disease. An analysis of data from the 2001 NDSHS found that among ex-smokers, those whose income was less than $300 per week smoked for an average of 35 years, compared with 18 years for those whose income was $800 or more per week.8,9 Table 9.1.3 sets out the average number of years spent smoking prior to quitting for people who reported having quit smoking in the 2022–2023 National Drug Strategy Household Survey.
In the US, there also appear to be marked differences in the duration of smoking between racial and socio-economic groups. One study found that most minority racial groups were likely to smoke for longer periods and individuals living in poverty smoked on a daily basis for 18 years longer than those with a family income about three times above the poverty line.10
Cohort patterns in smoking uptake and quitting are discussed further in Section 9.7.
9.1.4 Smoking during pregnancy
Disadvantage across a woman’s life course increases her risk of smoking during pregnancy.11 Women without a partner, the less educated,12,13 those of lower socio-economic status,12,14 those living in a deprived neighbourhood15,16 and women with a psychiatric disorder17 are more likely to smoke during pregnancy. See Section 7.11.2.1 for a discussion of smoking during pregnancy and social disadvantage, and Section 8.3.7 for a discussion of smoking during pregnancy among Aboriginal and Torres Strait Islander peoples. Disadvantaged women may also be more likely to take up smoking during pregnancy or in the early postpartum period,18 and are less likely to quit and more likely to start smoking in their second pregnancy.19
9.1.5 Smoking behaviours among young people
In 2022–2023, among Australian secondary school students aged 12–15 and 16–17, current (i.e., past week) smoking did not vary significantly with socioeconomic status.20 Figure 9.1.3 shows these proportions by age group.
9.1.6 Exposure to secondhand smoke
People in more disadvantaged groups are more likely to be exposed to secondhand smoke both in their homes and workplaces.21-24
9.1.6.1 Children’s exposure to secondhand smoke
Children from disadvantaged families are more likely to be exposed to secondhand smoke at home. Lower household income, lower parental education level, and living with multiple adult smokers are predictive of children’s exposure to smoking in the home,25-27 which contributes to lifelong health disparities (see Section 9.3). Recent research in England found that smoking prevalence was higher among households with children than those without only among the most disadvantaged social grade, likely exacerbating health inequalities.28
Data from the National Drug Strategy Household Survey show that in 2022–2023, about 23% of households with at least one child under 15 reported having a household member that smokes at least once per day (see Table 9.1.4). Among all households with children, about 3% of these highly disadvantaged children live in a household where someone smokes indoors at least once a day.
Although some children of low socio-economic status (SES) people who smoke are exposed to tobacco smoke in the home, legislative developments, such as Australia-wide bans on smoking in cars carrying children (see Section 15.7.2.3), and bans on smoking in close proximity to schools and playgrounds, reduce the number of areas where children may be exposed to secondhand smoke. Comprehensive smokefree legislation means that children of non-smoking parents might only very rarely be exposed to tobacco smoke.
International research shows the same associations between deprivation and the likelihood of secondhand smoke exposure among children, with parental smoking habits, household poverty, and lower parental educational levels being common predictors of exposure.25-27,29,30
9.1.6.2 Workplace exposure to secondhand smoke
Since the mid-1980s in Australia, when smoking was banned in the federal public service offices and then, increasingly in big and then smaller companies (see Section 15.4), people in white collar occupations have been more likely to work in places with total bans on smoking. While most workplaces since the late 1980s have restricted smoking, research in the late 1990s found that blue collar workers were three times more likely to work in environments with no restrictions on smoking (21%, compared with 8% of white collar and 7% of professional workers).31
With legislation mandating smokefree policies in hospitality venues and in enclosed workplaces in all Australian jurisdictions, disparities in workplace exposure to secondhand smoke are no doubt much less pronounced in more recent times. Data collected from annual population surveys in Victoria showed for instance, that the proportion of indoor workers reporting total smoking restrictions at their usual area of work increased significantly between 1998 and 2007, from 91% to 95%. The data indicated there was a relatively uniform increase in workplace smoking bans across all socio-economic groups for this period. However, there was still some disparity between smokefree workplaces, with 91% of warehouse, workshop, and factory workers reporting a smokefree workplace compared to the average of 95% of all indoor workplaces.32
Victorian data showed that in 2016, many people were still reporting being exposed to secondhand smoke at work, with the highest levels of exposure among blue collar workers. Those working in upper blue-collar jobs (such as tradespeople and construction workers) were most likely to report having been exposed to secondhand smoke at work, with almost half (45%) reporting exposure, compared with about one-third of those working in upper white (32%) or lower white (33%) collar jobs.33
9.1.6.3 Exposure to secondhand smoke in the home
In the 2022–2023 National Drug Strategy Household Survey, about 5% of people reported that in the past year, a household member had smoked daily inside the home. Looking at education level and socioeconomic status, about 7% of people in the most disadvantaged areas, and about 6% of those who hadn’t finished high school, reported daily smoking inside the home—see Figure 9.1.4.
Recent Victorian data similarly shows that a lower proportion of people in the least disadvantaged socioeconomic areas reported being exposed to secondhand smoke at home compared with those living in the most disadvantaged areas—see Figure 9.1.5. However, looking at this data over time encouragingly showed a significant decrease in secondhand smoke exposure at home among the most disadvantaged Victorians, from 24.5% to 18.3%.34
9.1.6.4 Exposure to secondhand smoke in institutional settings
People spending time in institutions such as correctional facilities, psychiatric hospitals, and drug treatment centres are among the most disadvantaged groups in Australia. Given the much-higher-than-average rates of smoking among residents and clients of such facilities and services, high levels of smoking among staff,35,36 and fears about the impact of restricting smoking on attendance, treatment, and behaviour,37 it is only in recent times that such institutions have begun to introduce comprehensive smokefree policies. For example, all states and territories have introduced or announced intentions to introduce complete smoking bans in prisons, and many inpatient psychiatric settings have implemented smokefree policies. Poor adherence and low levels of support in such settings may, however, limit their effectiveness, resulting in levels of exposure to secondhand smoke among highly disadvantaged clients in such facilities much higher than in the general population.38 See Sections 9A.3.6, 9A.5 and 15.4.4.2 for further discussion of these policies.
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References
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