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Health Risk Factors: Tobacco use
Taking up smoking
In 1989-90 the majority (60%) of both current smokers and ex-smokers reported that they began smoking between the ages of 15 and 19 years. A further 17% of current smokers and 15% of ex-smokers started before they were 15 years old. Over the last 50 years women have been taking up smoking at younger ages; 5% of women aged 65 years and over started smoking before they were 15 years old compared to 22% of women aged 18-24 years. There has consequently been an increase over time in the proportion of adolescent girls smoking.
SMOKER STATUS OF PEOPLE AGED 18 YEARS AND OVER
Source: National Health Survey
Although a smaller proportion of adults were smoking in 1989-90 compared to 1977, the cigarette consumption of those who smoked was greater. In 1977, 33% of male smokers smoked more than 20 cigarettes (the most common pack size at that time) a day. By 1989-90 the proportion had risen to 42%. For female smokers the proportional increase in daily cigarette consumption was even greater. Between 1977 and 1989-90 the proportion of female smokers smoking more than 20 cigarettes a day doubled from 14% to 28%.
In 1989-90 daily cigarette consumption for both men and women was greater for 25-64 year olds than for younger and older age groups. The lower consumption level of people in the 18-24 years age group reflects the higher proportion of smokers in this group who have only recently taken up smoking. It is not clear whether the lower daily cigarette consumption of those aged 65 years and over reflects a decline in consumption in old age, a higher proportion of deaths of heavy smokers before 65 years of age or an age cohort with a lower cigarette consumption level throughout their life.
The tar and nicotine content of cigarettes smoked varies according to both a person's age and the length of time they have been smoking. Among persons who had been smoking for less than 5 years, 15% smoked cigarettes with 14mg or more of tar compared to 27% of those who had been smoking for 20 years or more. However, it should be noted that this does not necessarily mean that smokers graduate to higher tar content cigarettes over time. It is likely that the majority of those who have been smoking for 20 years or more have always smoked medium to high tar cigarettes. Lower tar cigarettes have only become more widely available and more popular in recent years hence their prevalence among younger smokers.
The pattern of nicotine content reflects the pattern of tar content because higher tar content cigarettes generally have higher levels of nicotine. Among those who had smoked for less than 5 years, 13% smoked cigarettes with 1.5mg or more of nicotine compared to 21% of those who had been smoking for 20 years or more. A greater proportion of men than women smoked cigarettes with 14mg or more of tar (30% compared to 17%) and with 1.5mg or more of nicotine (23% compared to 14%).
PATTERNS OF TOBACCO USE OF ADULT CIGARETTE SMOKERS, 1989-90
Source: National Health Survey
SMOKERS SMOKING HIGH TAR AND HIGH NICOTINE CIGARETTES(a)
(a) High tar is defined as 14mg or more per cigarette. High nicotine is defined as 1.5mg or more per cigarette.
Source: National Health Survey
The prevalence of smoking differs between occupation groups with 'blue collar' workers generally having a high proportion of smokers. In 1977, the highest prevalence of smoking was recorded for miners and quarrymen (71%) followed by tradesmen, production-process workers and labourers (48%), compared to 29% for professional and technical workers. A similar pattern was evident in 1989-90 although the proportions of both 'blue collar' and 'white collar' workers who smoked had dropped since 1977. In 1989-90 the highest prevalence of smoking was recorded for labourers and related workers, plant and machine operators and drivers (40%) and tradespersons (38%). In contrast, 17% of professionals reported that they currently smoked. A relatively high proportion of the unemployed were smokers (44%).
Smoking is also linked with education; the higher the level of education a person has completed, the less likely that person is to smoke. 16% of people with a bachelor degree or higher were current smokers in 1989-90 compared to 33% of those with a trade/apprenticeship and 30% of those with no post-school qualifications.
Family status is also an important variable in considering smoking behaviour. In 1989-90 half of lone mothers smoked compared to one-quarter of married mothers. The pattern was similar for fathers with 51% of lone fathers smoking compared to 34% of married fathers. Of those people without dependants, 37% of single men were current smokers, as were 26% of married men, 26% of single women and 20% of married women.
FAMILY AND SMOKER STATUS, 1989-90
Source: National Health Survey
Tobacco use and alcohol consumption
There is a relationship between tobacco and alcohol consumption. A high proportion of people who smoke also consume alcohol, 80% of men and 62% of women in 1989-90. Of those who had never smoked, 66% of men and 45% of women consumed alcohol. The proportion of both male and female current smokers rises with increased alcohol consumption. For men, 24% of those who consumed no alcohol were current smokers compared to 60% of those who consumed alcohol at high risk level.
The level of alcohol consumption and the number of cigarettes smoked per day are also related. Among male low risk drinkers, 33% reported smoking more than 20 cigarettes a day, while among high risk drinkers the proportion was 53%. Among women, the proportions were 24% and 47% respectively. For both men and women, those who consumed alcohol at low to medium risk levels had the highest proportions of ex-smokers.
TOBACCO AND ALCOHOL CONSUMPTION, 1989-90
Source: National Health Survey
Reasons for quitting
The decrease in the proportion of smokers is due largely to people quitting smoking. In 1989-90 almost three-quarters of all cigarette smokers reported that they had attempted to give up smoking. There are a number of reasons why people give up smoking, but concern for their health was reported most frequently (45% in 1989-90 compared to 35% in 1977). The reasons given for quitting smoking tend to differ according to the age at which the person quit. Reasons associated with ill-health are more often reported in older age groups.
The proportion of people giving up smoking because they felt it was unclean or offensive also increased, from 2% in 1977 to 9% in 1989-90, suggesting that the promotion of negative images of smoking is having an effect on smokers. However, the proportion of smokers quitting due to the expense has declined. In 1977, 11% of ex-smokers said they had quit because of the expense but this dropped to 10% in 1989-90.
Health risks associated with smoking include cancers, respiratory diseases such as bronchitis and emphysema, and circulatory diseases including thrombosis and heart disease. In 1989-90 a greater proportion of smokers (11%) and ex-smokers (10%) aged 65 years and over had bronchitis and emphysema as a long-term condition than people of the same age who had never smoked (3%).
In 1977 there were 4,326 deaths from lung cancer representing 4% of all deaths. In 1989-90 there were 6,053 deaths from lung cancer (5% of all deaths). This increase was largely due to an increase in the death rate from lung cancer among women. In 1977 there were 11 per 100,000 female deaths from lung cancer compared to 19 per 100,000 in 1990. In comparison, the rates remained similar for men (50 per 100,000 in 1977 and 52 per 100,000 in 1990).
The ABS has not conducted any surveys to measure adolescent smoking. However, the Anti-Cancer Council of Victoria has conducted a series of three surveys to measure adolescent tobacco and alcohol use1,2,3.
In 1987, 25% of boys and 29% of girls aged 17 years old were current smokers. In 1990 this had decreased marginally to 24% and 28% respectively. While girls are more likely than boys to be smoking by 17 years, at 12 years of age the reverse is true. In 1990, 6% of boys aged 12 years were current smokers compared to 5% of girls of the same age. These patterns were similar to those recorded in 1984.
ADOLESCENT TOBACCO CONSUMPTION, 1990
Source: Anti-Cancer Council of Victoria
Consumption patterns of adolescents
Adolescent girls are more likely to smoke than adolescent boys. However, boys tend to consume more when they do smoke. In 1990, the average number of cigarettes smoked a week by boys aged 12 years was 9. By 17 years of age this had risen to 43. For girls, the average number of cigarettes smoked a week rose from 8 at age 12 years to 30 at age 17 years. Consumption patterns have remained steady over time with no significant difference in the average number of cigarettes smoked a week between 1984 and 1990.
Adolescent tobacco consumption is largely a social activity and as such peak consumption occurs at social gatherings on weekends. Almost a quarter of current smokers smoked only at the weekend. For boys, weekday cigarette consumption was about 4 a day rising to a peak of 7 a day on Saturdays. A similar pattern occurred among girls with weekday consumption of about 3 a day rising to a weekend peak of 6 a day on Saturdays.
There is a relationship between the average number of cigarettes smoked a week and packet size. Those buying a large pack size smoked more a week than those buying smaller packs. In 1990, boys who bought packs of 25 smoked an average of 33 cigarettes a week. For girls who bought the same pack size the average was 22. However, for boys and girls buying packs of 40, the average numbers of cigarettes smoked a week were 41 and 42 respectively. In the 1987 survey it was found that packs of 15 were more popular among smokers aged 12-15 years than among smokers aged 16-17 years, probably due to their lower price per packet. Between 1988 and 1990, this pack size was banned in all States. Packs of 40 were introduced between 1988 and 1990, and these have been marketed as budget packs with a lower price per cigarette. In 1990, 17% of 12-15 year olds and 9% of 16-17 year olds reported buying this larger pack size. However, packs of 25 have remained the most popular among both age groups.
Availability of cigarettes to adolescents
54% of boys and 52% of girls who smoked reported that they had bought their last cigarette themselves. However, purchasing cigarettes was strongly age related. 25% of boys and 21% of girls aged 12 years bought their own cigarettes compared to 64% of boys and 66% of girls aged 17 years. The most frequently reported source of cigarettes for adolescents was 'a friend'.
Effects of parents smoking
There is an association between adolescent smoking and the smoking status of parents. In 1985, 13% of children who reported their parents to be smokers were themselves current smokers, compared to 8% of children who reported their parents to be non-smokers. In families where only one parent smoked, girls were more likely to be smokers if the parent who smoked was the mother. However, the sex of the parent who smoked had little effect on the smoking status of boys4.
Tobacco use and alcohol among adolescents
As with adults, there is an association between smoking and alcohol consumption among adolescents. Of all boys aged 12-17 years who were current drinkers in 1990, 38% also smoked. Of those boys who were not current drinkers, 8% smoked. For girls there was a similar pattern. Of all girls aged 12-17 years who were current drinkers in 1990, 45% also smoked. Of all girls who were not current drinkers, 10% smoked.
1 Hill, D.J. et. al. (1987) Tobacco and alcohol use among Australian secondary schoolchildren. Med J Aust; Vol.146.
2 Hill, D.J. et. al.(1990) Tobacco and alcohol use among Australian secondary schoolchildren in 1987. Med J Aust; Vol. 152.
3 Hill, D.J. et. al.(1993) Tobacco and alcohol use among Australian secondary school students in 1990. Med J Aust; Vol. 158.
4 Gliksman, M.D. et. al.(1989) Cigarette smoking in Australian schoolchildren. Med J Aust; Vol 150.