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Health Risk Factors: Trends in smoking
In the twentieth century, cigarette smoking became widespread.1 The early nineteenth century had seen a craze for cigars; cigarettes were an innovation borrowed from Turkey and adapted to mass production by the end of that century. The supply of cigarettes as rations to troops in the two world wars helped spread smoking, especially among men. For most of the century, smoking was one of the behaviours acceptable for men but less so for women. Nevertheless, by the 1970s, women made up a substantial minority of smokers in some countries, including Australia (40% by 1977).
Increases in lung cancer were noted in the 1920s and 1930s, and by 1950 several major studies had found a link to smoking. Between 1957 and 1964 major health bodies, including governmental agencies, officially recognised a link between smoking and lung cancer. Curbs such as mandatory warnings on cigarette packets and restrictions on advertising followed (in Australia from 1972). In the 1980s, passive smoking became a focus of health concerns. In Australia, this was accompanied by various bans on smoking in workplaces, aircraft and other places.1
Despite the combination of official warnings, price increases, and the activities of the anti- smoking lobby, a national survey in 1985 found that 31% of people thought that tobacco was either ‘not dangerous at all’ or ‘OK if you know how to use it’.2 On the positive side, regular surveys conducted in Victoria since 1983 have found smokers have become more likely to intend to quit, to see a risk in smoking, to name more advantages than disadvantages of quitting, and to expect strong social support for quitting.3
Smoking prevalence 1977-1995
Smoking was less prevalent in 1995 than in 1977. About 24% of the adult population were smokers in 1995, compared to 37% in 1977. The proportion of men aged 18 and over who smoked decreased by 40% over the period, while among women the decrease was 30%. The greatest proportional decline (44%), was among people aged 45 years and over, and the least among young people, aged 18-24 years (24%).
Although the National Health Survey has not collected information on smoking from those under 18 years, an indication of recent teenage smoking patterns can be obtained from other surveys. According to the 1998 National Household Drug Survey, less than half (47%) of those aged 14-19 years had never smoked. One in four were current smokers, comprising 9% who were occasional smokers and 16% who were regular smokers. Similar proportions of males and females were current smokers (24% of males and 26% of females).4
The next national health survey will be conducted in the year 2001, and will provide information on the trend in smoking prevalence since 1995. However, data from recent National Household Drug Surveys indicate little change in the proportion of the population who were smokers between 1995 and 1998 (27% and 26% respectively).4
Changes in smoker status
Decreases in the proportion of the population who smoke can result both from fewer people ever taking up smoking, and from more smokers quitting. The reductions in the prevalence of smoking between 1977 and 1995 resulted mainly from people quitting smoking rather than from fewer people taking it up. The decrease in the proportion of the population who were smokers was accompanied by a small increase in those who said they had never smoked (1.6 percentage points) and a larger increase in those who identified themselves as ex-smokers (12 percentage points).
However, there were different trends for males and females. Among males, the category ‘never smoked’ made almost the same gain in percentage points as did ‘ex-smokers’ (7 percentage points compared to 11 percentage points). In contrast, among females, the proportion who had never smoked decreased by 4 percentage points, while ex-smokers gained 13 points.
Increases in quit ratios
In 1977 about one third of all men and one quarter of all women who had ever smoked had quit (were ex-smokers). By 1995, this had increased to slightly more than half of both men and women who had ever smoked. The greater proportional increases occurred within the broad age range 25-54 years.
People who have never smoked - age and sex pattern
Any changes in the proportion taking up smoking are likely to be seen first and most clearly in the younger age groups, as surveys suggest that, in recent decades at least, most smokers have developed the habit as teenagers or in their early twenties.1 For some time, there were opposite trends for young men and women. Between 1977 and 1989-90 the proportion of males aged 18-24 years who had never smoked increased, while the proportion of females in this age group who had never smoked decreased. However, between 1989-90 and 1995, the trend for females was reversed and the proportion of females of this age who had never smoked increased to 59%, slightly higher than in 1977. Among males of this age, between 1989-90 and 1995 there was a further increase in the proportion who had never smoked, to 58%.
To an extent, the age pattern in 1995 of people who had never smoked indicates the longer-term history of smoking patterns. In older age groups, more than 60% of women had never smoked, but in the younger age groups, the proportions of women who had never smoked were lower. This reflects a long-term trend for women to take up smoking.
PROPORTION WHO HAD NEVER SMOKED, BY SEX, 1995Prevalence by other variables
Source: Unpublished data, 1995 National Health Survey.
Smokers were not distributed evenly in the population in 1995. In addition to differences in prevalence by age and sex, there were differences by other demographic variables such as marital status, living arrangements, birthplace and Indigenous status. Prevalence also differed according to variables indicative of socio-economic status such as labour force status, occupation and education. This is generally consistent with the previous surveys (1977 and 1989-90).
Some differences are to be expected, given the different age and sex profiles of many of these groups. For example, very few widowed people smoke - not surprising given the older age ranges and the greater proportion of females in this group. Likewise, the high rate among trades persons is consistent with the predominance of men in that occupational group. However, after age and sex standardisation of data (a technique which shows what the prevalence in a particular group would be if the group had the same sex and age make-up as the total population) there is still considerable variation in smoking prevalence.
Labour force status, education, occupation
Among adults of working age (18-64 years) 40% of unemployed people were current smokers (after age and sex standardisation of data). This compared to 24% of those not in the labour force and 33% of employed persons.
Among all adults, the highest rates of smoking were recorded among people with no post-school qualifications (29%). The prevalence of smoking was lower among people with post-school qualifications, with higher qualifications associated with lower smoking rates.
Smoking was more prevalent among people in ‘blue collar’ occupations. Labourers and related workers had the highest rate (34%) followed by plant and machine operators and drivers (31%) and trades persons (28%). Sales and personal service workers (24%) and clerks (22%) fell in the middle range. About 19% of para-professionals and 20% of managers and administrators smoked, while the lowest prevalence was recorded for professionals (14%).
Household type and marital status
Of people in different types of household, lone parents with dependant children and people living alone were the most likely to smoke (almost a third of each group were smokers). Couples with dependant children (22%), and couple-only households (20%) had lower proportions of smokers.
Smoking was most common among people who were separated from their spouses (41%) or divorced (37%). Those who were in a de facto relationship (32%), had never been married (29%) or were widowed (29%) also had relatively high prevalence rates. Married people (20%) were the least likely to smoke.
Indigenous status, birthplace
Smoking was more prevalent among Indigenous Australians (47%) than among the total population (24%).
People born in Australia and Southern Europe had smoking rates which were very close to that of the total population. The prevalence among those from Western Europe (26%), New Zealand and Oceania (26%) and the United Kingdom and Ireland (27%), was slightly higher. The highest prevalence was among those born in the Middle East (30%). Smoking was less common than in the total population among those from the former USSR (20%), Africa (18%) and regions in Asia (from 6% to 13%).
Among some birthplace groups, smoking was relatively uncommon among women, and this lowers the overall rate of smoking. For example, crude smoking rates were 27% for men born in South-East Asia but 5% for women born there. Of men born in North-East Asia, 11% were smokers, compared to 3% of women born there. Among those born in Southern Europe, Africa and the Middle East men were about twice as likely to smoke as women.
CIGARETTE CONSUMPTION PER CAPITA(a), AUSTRALIA
Source: NTC Publications Ltd, World Tobacco Trends 1996.
Cigarette consumption trends - Australia and elsewhere
According to information compiled by a market research company, Australia’s per capita consumption of cigarettes decreased over the 1980s and early 1990s, despite annual fluctuations. In 1994, consumption was 2,146 cigarettes a year (per person aged 15 years and over), a decrease of about a third from 3,161 in 1977.5
In 1994, Australia ranked 17th out of 77 countries in per capita (persons aged 15 years and over) tobacco consumption. The countries with the highest per capita consumption were Poland, Greece and Japan. Those with the lowest included some of the poorest countries: Tanzania, India and Zaire. Australia’s per capita consumption was higher than that of Canada, the United Kingdom and New Zealand but lower than consumption in the United States. A few Western European countries had higher tobacco consumption than Australia but most, like France (1,954) and Italy (1,837) had slightly lower per capita consumption.
1 Winstanley, M., Woodward, S. and Walker, N. 1995, Tobacco in Australia: Facts and Issues (second edition), Victorian Smoking and Health Program, Carlton.
2 Department of Community Services and Health 1990, Tobacco in Australia; a summary of related statistics, AGPS, Canberra.
3 Victorian Smoking and Health Program 2000, Quit Evaluation Studies vol. 7, chapter 5
<URL: http://quit.org.QE7.QE7Info > (Accessed 25 May 2000).
4 Australian Institute of Health and Welfare 1999, 1998 National Drug Strategy Household Survey: First results, AIHW Cat. no. PHE 15 (Drug Statistics Series), AIHW, Canberra.
5 NTC Publications Ltd 1996, World Tobacco Trends 1996, NTC Publications, Henley-on-Thames.