“We have seen significant declines in smoking among Indigenous Australian adults over the past two decades that will bring major health benefits over time,

But we’re seeing tobacco’s lethal legacy from when smoking prevalence was at its peak.

We need a continued comprehensive approach to tobacco control, and the incorporation of Indigenous leadership, long-term investment and the provision of culturally appropriate materials and activities is critical to further reducing smoking,”

Dr Ray Lovett from the ANU Research School of Population Health.

Please note Dr Lovett will be speaking at the NACCHO Conference 31 Oct -2 Nov

Smoking-related deaths among Indigenous Australians are likely to continue to rise and peak over the next decade despite big reductions in smoking over the past 20 years, a new study led by The Australian National University (ANU) has found.

Cigarette smoking is a leading contributor to the burden of morbidity and mortality among Aboriginal and Torres Strait Islander (hereafter respectfully referred to as Indigenous) Australians1, the total Australian population2, and in developed countries worldwide.3

The health impacts of smoking vary by smoking duration and intensity, but it is well established that smoking causes a range of health conditions.3 Although there have been marked smoking reductions in Australia4,5, the prevalence of smoking among Indigenous adults remains high, estimated at 41.4%, compared with 14.5% in the total Australian adult population.5

Smoking behaviour is influenced by factors including social, cultural and environmental factors, and tobacco control effectiveness.6 Indigenous tobacco use is also tightly tied to Australia’s history of colonisation; for example, tobacco was often used as a form of payment, and was issued as part of rations on mission stations.7

Dramatic decreases in smoking prevalence in the total Australian population suggest that the smoking epidemic is in its final stages.3,6 However, the stage of the tobacco epidemic among the Indigenous Australian population is less clear.

Understanding the stage of the epidemic provides insight into probable trends in smoking-attributable mortality, thereby enabling accurate communication of the likely impacts of smoking4, and informing relevant programs and policies.

This paper provides a perspective on the current stage of the smoking epidemic among Indigenous Australians based on an existing model of smoking epidemic stages3, and describes the expected short- and long-term implications for the wellbeing of the Indigenous population, and for programs and policies.

Stages of the smoking epidemic

Lopez proposed a four-stage model of cigarette consumption and mortality in 1994, characterising features of the smoking epidemic3; the model was updated in 2012.4 The proportion of the adult population that regularly smokes – and variation by characteristics such as age and sex – provides an indication of the extent to which smoking has been adopted.3 Smoking-attributable mortality, which can be crudely approximated by lung cancer deaths, provides insight into the health consequences of smoking at each stage of the epidemic.3,4 Central to the model is the long delay between smoking and its associated cancer mortality; even when the prevalence of smoking begins to decline, smoking-attributed mortality continues to increase, reflecting the smoking behaviours of up to three decades earlier.3,4

In short, Stage 1 of the tobacco epidemic marks the initial population uptake of smoking, with no evidence of smoking-attributable mortality. In Stage 2, the prevalence of smoking increases rapidly to its peak, alongside low but increasing smoking-attributable mortality. By Stage 3, awareness of the health hazards of smoking is common, and conditions are favourable for implementing tobacco control measures; while the prevalence of smoking remains stable or begins to decrease, smoking-attributable mortality rises rapidly. Stage 4 is represented by decreasing smoking prevalence and associated mortality to their lower limits, in a context of widespread awareness of tobacco harms and tobacco control measures

This research paper is published in the Public Health Research & Practice journal 

VIEW HERE

Read over 114 NACCHO Smoking articles published over 5 years

Lead researcher Dr Ray Lovett said the study found the lag between smoking and the onset of smoking-related diseases such as lung cancer means the number of smoking deaths was likely to keep climbing.

“On the positive side, we’ve seen a 43 per cent reduction in cardiovascular disease deaths, mainly from heart attacks, over the past 20 years among Indigenous people, in large part due to people quitting smoking.”

Smoking rates among Indigenous Australians have dropped from more than half the population in 1994 to two in five adults today. This is still two and a half times higher than the rest of the Australian population.

Dr Lovett said the substantial progress in reducing smoking rates, particularly in the past decade, was a clear sign that further reductions and improvements to Indigenous health could be achieved.

Co-researcher Dr Katie Thurber said the team analysed the available national health and death data from the past 20 years to conduct the study.

“The available data do not provide the full picture of smoking and its impacts for the Aboriginal and Torres Strait Islander population, so it’s important to understand these limitations and work towards improving data in the future,” said Dr Thurber from the ANU Research School of Population Health.

“Despite these challenges, we’ve managed to produce the first comprehensive assessment of the tobacco epidemic among Aboriginal and Torres Strait Islander Australians.”

The research paper is published in the Public Health Research & Practice journal and this issue of the journal celebrates 50 years since the 1967 referendum, when Australians voted to amend the Constitution to allow the Commonwealth to create laws for Indigenous people and include them in the Census.