Smoking

Introduction

Tobacco smoking is the leading cause of preventable mortality and morbidity in New South Wales. While the relationship between smoking, lung cancer, and cardiovascular disease has long been evidenced, a substantial number of other diseases are now known to be associated with smoking, including: cancers of the stomach, bladder, cervix, uterus, oesophagus, mouth, larynx, pancreas, and kidney; leukemia; chronic obstructive pulmonary disease and pneumonia; respiratory effects in utero and infancy (including sudden infant death syndrome), childhood, adolescence and adulthood; fetal death and stillbirths; problems with fertility; low birthweight; complications in pregnancy; cataract; hip fractures; low bone density; peptic ulcers in persons who are Heliobacter pylori positive; and periodontitis.

Smoking diminishes the overall health of smokers and contributes to widespread organ damage. As smokers need to be aware that smoking carries far greater risks than the most widely known diseases, health care providers should use this new evidence to counsel their patients against smoking. Smokers who quit can lower their risk of a wide range of diseases and improve their health generally. Those who have never smoked can avoid the burden of disease and the years of lost life smoking causes.[1]

Exposure to environmental tobacco smoke (passive smoking) is a significant cause of preventable mortality and morbidity in New South Wales. Passive smoking causes lung, nasal and sinus cancer; stroke and ischemic heart disease in adults; lower respiratory infections (croup, bronchitis, bronchiolitis and pneumonia), onset of asthma and worsening of asthma, respiratory symptoms, reduced lung function, middle-ear disease, and eye and nasal irritation in children; reduced birthweight; and sudden infant death syndrome in infants. There is also a causal association between passive smoking and cervical cancer; decreased pulmonary function and exacerbation of cystic fibrosis in adults; and cardiovascular health and the development of neurodevelopmental and behavioural problems in children. The risk of breast cancer appears to increase with passive smoking during puberty but not with overall lifetime exposure. Most of the evidence of harm caused by passive smoking is based on studies in the home environment; however, passive smoking is harmful wherever it takes place.[2]

In New South Wales there are several pieces of legislation relating to the control of environmental tobacco smoke: the Smoke-free Environment Amendment Act 2004; the Smoke-free Environment Amendment Regulation 2005; and the Smoke-free Environment Amendment (Enclosed Places) Regulation 2006, which provide for 3 incremental phases in the lead up to a total smoking ban in enclosed public areas of licensed premises by July 2007. Also, the Smoke-free Environment Act 2000 and the Smoke-free Environment Regulation 2000 both ban smoking in most other enclosed public places. Further information about legislation relating to environmental tobacco smoke is available from the NSW Department of Health's Tobacco and Health website.[3]

In 2006 the New South Wales Population Health Survey asked respondents: Which of the following best describes your smoking status: I smoke daily, I smoke occasionally, I don't smoke now but I used to, I've tried it a few times but never smoked regularly, I've never smoked? The last time you went to your general practitioner, was your smoking discussed and were you advised to quit smoking? Which of the following best describes your home situation: My home is smoke-free, People occasionally smoke in the house, People frequently smoke in the house? Are people allowed to smoke in your car? If there was a total ban on smoking in hotels and licensed bars would you go there: More often, Less often, and It would make no difference? If there was a total ban on smoking in outdoor dining areas would you go there: More often, Less often, It would make no difference?

Results

Current smoking

Overall, in 2006, 13.9 per cent smoked daily, 3.8 per cent smoked occasionally, 25.3 per cent did not but used to smoke, 10.3 per cent tried smoking a few times but never regularly smoked, and 46.7 per cent never smoked. Therefore, 17.7 per cent of adults were current (daily or occasional) smokers. A significantly higher proportion of males (19.2 per cent) than females (16.2 per cent) were current smokers. Among males, a significantly higher proportion of adults aged 25-34 years (29.4 per cent), and a significantly lower proportion of adults aged 65-74 years (9.4 per cent) and 75 years and over (3.1 per cent), were current smokers, compared with the overall adult male population. Among females, a significantly higher proportion of adults aged 25-34 years (22.3 per cent), and a significantly lower proportion of adults aged 65-74 years (7.6 per cent) and 75 years and over (4.6 per cent), were current smokers, compared with the overall adult female population.

There was no significant variation between the proportion of adults in rural areas and urban areas who were current smokers; however, a higher proportion of adults in the Greater Western Health Area (22.7 per cent), and a lower proportion of adults in the Northern Sydney & Central Coast Health Area (14.2 per cent), were current smokers.

The proportion of adults who were current smokers increased with socioeconomic disadvantage. A higher proportion of adults in the most disadvantaged quintile (24.3 per cent), and a lower proportion of adults in the 2 least disadvantaged quintiles (12.9 per cent and 14.9 per cent), were current smokers, compared with the overall adult population.

There was a significant decrease in the prevalence of current smoking between 1997 (24.0 per cent) and 2005 (17.7 per cent). The significant decrease was in both males (27.1 per cent to 19.2 per cent) and females (21.1 per cent to 16.2 per cent).

Daily smoking

Overall, in 2006, 13.9 per cent of adults smoked daily. There was no significant variation between males and females who smoked daily. A significantly higher proportion of adults aged 25-34 years (18.0 per cent) and 35-44 years (18.4 per cent), and a significantly lower proportion of adults aged 55-64 years (11.5 per cent) and 65-74 years (7.0 per cent) and 75 years and over (3.1 per cent), smoked daily, compared with the overall adult population.

A significantly higher proportion of adults in rural areas (15.8 per cent) than urban areas (13.1 per cent) smoked daily. A higher proportion of adults in the Greater Western Health Area (19.5 per cent), and a lower proportion of adults in the Northern Sydney & Central Coast Health Area (10.3 per cent), smoked daily.

The proportion of adults who smoked daily increased with socioeconomic disadvantage. A higher proportion of adults in the most disadvantaged quintile (18.3 per cent), and a lower proportion of adults in the 2 least disadvantaged quintiles (8.8 per cent and 11.4 per cent), smoked daily, compared with the overall adult population.

There was a significant decrease in the prevalence of daily smoking between 2002 (16.4 per cent) and 2006 (13.9 per cent). This decrease was significant in males (18.5 per cent to 15.0 per cent).

Advice to quit smoking

Overall, in 2006, 48.4 per cent of adults who smoked were advised to quit smoking the last time they visited their general practitioner. There was no significant variation between males and females who were advised to quit smoking. A significantly lower proportion of adults aged 16-24 years (30.4 per cent), and a significantly higher proportion of adults aged 45-54 years (61.6 per cent) and 65-74 years (63.2 per cent), were advised to quit smoking, compared with the overall adult population.

There was no significant variation between adults in rural areas and urban areas, or by level of socioeconomic disadvantage; however, a higher proportion of adults in the South Eastern Sydney & Illawarra Health Area (59.5 per cent) were advised to quit smoking, compared with the overall adult population. There was no significant variation in the proportion of adults who were advised to quit smoking between 2005 and 2006.

Smoking in the home

Overall, in 2006, 87.7 per cent of adults lived in smoke-free homes. The proportion of adults living in a smoke-free home was significantly lower among those aged 16-24 years (82.5 per cent), and significantly higher among those aged 65-74 years (92.2 per cent) and 75 years and over (93.1 per cent), compared with the overall adult population.

There was no significant variation in the proportion of adults in rural areas and urban areas living in smoke-free homes; however, a higher proportion of adults in the Northern Sydney & Central Coast Health Area (92.4 per cent), and a lower proportion of adults in the Sydney South West (84.7 per cent) and Greater Western (82.4 per cent) Health Areas, lived in smoke-free homes, compared with the overall adult population.

The proportion of adults living in smoke-free homes increased as socioeconomic disadvantage decreased. Compared to the overall population, the least disadvantaged quintile (93.8 per cent) had a higher proportion of adults living in smoke-free homes, and the most disadvantaged quintile (81.7 per cent) had a lower proportion of adults living in smoke-free homes.

There has been a significant increase in the proportion of adults living in smoke-free homes between 1997 (69.7 per cent) and 2006 (87.7 per cent). This increase was significant in both males (69.4 per cent to 87.1 per cent) and females (70.0 per cent to 88.2 per cent).

Smoking in cars

Overall, in 2006, 87.7 per cent of adults had smoke-free cars. A significantly higher proportion of adults aged 65-74 years (92.6 per cent) and 75 years and over (92.1 per cent) had smoke-free cars.

There was no significant variation in the proportion of adults in rural areas and urban areas with smoke-free cars; however, a higher proportion of adults in the Northern Sydney & Central Coast Health Area (90.3 per cent), and a lower proportion of adults in the Greater Western Health Area (84.3 per cent), had smoke-free cars, compared with the overall adult population.

The proportion of smoke-free cars decreased as socioeconomic disadvantage increased. Compared to the overall adult population, the most disadvantaged quintile (84.4 per cent) had a lower proportion of adults with smoke-free cars.

There has been a significant increase in the proportion of smoke-free cars, from 81.2 per cent in 2003 to 87.7 per cent in 2006. This increase was significant in both males (77.9 per cent to 85.3 per cent) and females (84.6 per cent to 90.0 per cent).

Smoking in hotels and licensed premises

Overall, in 2006, 35.0 per cent of adults would be more likely to frequent hotels and licensed premises if there was a total ban on smoking. A significantly higher proportion of females (36.7 per cent) than males (33.3 per cent) would be more likely to frequent hotels and licensed premises if there was a total ban on smoking. Among males, a significantly lower proportion of adults aged 75 years and over (22.3 per cent) would be more likely to frequent hotels and licensed premises if there was a total ban on smoking, compared with the overall adult male population. Among females, a significantly lower proportion of adults aged 75 years and over (21.3 per cent) would be more likely to frequent hotels and licensed premises if there was a total ban on smoking, compared with the overall adult female population.

A significantly lower proportion of adults in rural areas (31.6 per cent) than urban areas (36.5 per cent) would be more likely to frequent hotels and licensed premises if there was a total ban on smoking, compared with the overall adult population. A higher proportion of adults in the Northern Sydney & Central Coast Health Area (39.7 per cent), and a lower proportion of adults in the Greater Western Health Area (28.8 per cent) 39.7 per cent), would be more likely to frequent hotels and licensed premises if there was a total ban on smoking, compared with the overall adult population.

A higher proportion of adults in the 2 least disadvantaged quintiles (40.8 per cent and 39.4 per cent), and a lower proportion of adults in the third most disadvantaged quintile (31.6 per cent) and most disadvantaged quintile (28.4 per cent), would be more likely to frequent hotels and licensed premises if there was a total ban on smoking, compared with the overall adult population.

The proportion of adults who would be more likely to frequent hotels and licensed premises if there was a total ban on smoking has increased significantly from 24.2 per cent in 2003 to 35.5 per cent in 2006. The significant increase was observed in both males (23.1 per cent to 33.3 per cent) and females (25.5 per cent to 36.7 per cent).

Overall, in 2006, 6.6 per cent of adults would be less likely to frequent hotels and licensed premises if there was a total ban on smoking. A significantly lower proportion of females (5.6 per cent) than males (7.5 per cent) would be less likely to frequent hotels and licensed premises if there was a total ban on smoking. Among males, a significantly lower proportion of adults aged 55-64 years (4.5 per cent) and 65-74 years (4.0 per cent) and 75 years and over (2.7 per cent), and a significantly higher proportion of adults aged 25-34 years (13.1 per cent), would be less likely to frequent hotels and licensed premises if there was a total ban on smoking, compared with the overall adult male population. Among females, a significantly lower proportion of adults aged 65-74 years (2.5 per cent) and 75 years and over (2.3 per cent) would be less likely to frequent hotels and licensed premises if there was a total ban on smoking, compared with the overall adult female population.

There was no significant variation between rural areas and urban areas or among health areas.

A lower proportion of adults in the least disadvantaged quintile (4.6 per cent), and a higher proportion of adults in the most disadvantaged quintile (9.4 per cent), would be less likely to frequent hotels and licensed premises if there was a total ban on smoking, compared with the overall adult population.

The proportion of adults who would be less likely to frequent hotels and licensed premises if there was a total ban on smoking has decreased significantly from 9.8 per cent in 2003 to 6.6 per cent in 2006. This decrease was significant in both males (10.5 per cent to 7.5 per cent) and females (8.9 per cent to 5.6 per cent).

Smoking in outdoor dining areas

Overall, in 2006, 38.2 per cent of adults would be more likely to frequent outdoor dining areas if there was a total ban on smoking. A significantly higher proportion of females (40.4 per cent) than males (36.0 per cent) would be more likely to frequent outdoor dining areas if there was a total ban on smoking. Among males, there was no significant variation by age group. Among females, a significantly lower proportion of adults aged 75 years and over (29.7 per cent) would be more likely to frequent outdoor dining areas if there was a total ban on smoking, compared with the overall adult female population.

A significantly lower proportion of adults in rural areas (35.9 per cent) than urban areas (39.2 per cent) would be more likely to frequent outdoor dining areas if there was a total ban on smoking, compared with the overall adult population. A lower proportion of adults in the Greater Western Health Area (32.1 per cent) would be more likely to frequent outdoor dining areas if there was a total ban on smoking, compared with the overall adult population.

A higher proportion of adults in the least disadvantaged quintile (44.2 per cent), and a lower proportion of adults in the most disadvantaged quintile (31.7 per cent), would be more likely to frequent outdoor dining areas if there was a total ban on smoking, compared with the overall adult population.

Overall, in 2006, 6.3 per cent of adults would be less likely to frequent outdoor dining areas if there was a total ban on smoking. There was no variation between males and females. A significantly lower proportion of adults aged 65-74 years (3.0 per cent) and 75 years and over (2.1 per cent) would be less likely to frequent outdoor dining areas if there was a total ban on smoking, compared with the overall adult population.

A significantly lower proportion of adults in rural areas (5.2 per cent) than urban areas (6.9 per cent) would be less likely to frequent outdoor dining areas if there was a total ban on smoking, compared with the overall adult population. A higher proportion of adults in the Sydney South West Health Area (9.0 per cent) would be less likely to frequent outdoor dining areas if there was a total ban on smoking, compared with the overall adult population.

A higher proportion of adults in the most disadvantaged quintile (9.0 per cent) would be less likely to frequent outdoor dining areas if there was a total ban on smoking, compared with the overall adult population.

References

United States Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon-General. Atlanta: United States Department of Health and Human Services, Centers for Disease Control and Prevention, Office on Smoking and Health, 2004. Available online at www.cdc.gov/tobacco/sgr/sgr_2004/index.htm (accessed 9 May 2007).
Commonwealth Department of Health and Ageing and the National Drug Strategy. Environmental Tobacco Smoke in Australia. Canberra: Commonwealth Department of Health and Ageing, 2002. Available online at www.health.gov.au/internet/wcms/publishing.nsf/Content/health-pubhlth-publicat-document-env_ets-cnt.htm/$file/env_ets.pdf (accessed 9 May 2007).
Centre for Chronic Disease Prevention and Health Advancement, Tobacco and Health Branch Website. The Law and Policy. Sydney: NSW Department of Health, 2007. Available online at www.health.nsw.gov.au/public-health/health-promotion/tobacco/legislation/index.html (accessed 9 May 2007).

Graphs

Source:	New South Wales Population Health Survey 2006 (HOIST). Centre for Epidemiology and Research, NSW Department of Health.
Print version:	Although this page can be printed directly from your web browser, a higher quality version is available as a PDF file that can be printed or viewed on screen.
Produced by:	Centre for Epidemiology and Research, Population Health Division, NSW Department of Health.
Last updated on:	1 July 2007