Tobacco in Australia Facts & Issues A comprehensive online resource tobaccoinaustralia.org.au Book excerpt List of chapters available at tobaccoinaustralia.org.au Introduction Chapter 1 Trends in the prevalence of smoking Chapter 2 Trends in tobacco consumption Chapter 3 The health effects of active smoking Chapter 4 The health effects of secondhand smoke Chapter 5 Factors influencing the uptake and prevention of smoking Chapter 6 Addiction Chapter 7 Smoking cessation Chapter 8 Tobacco use among Aboriginal peoples and Torres Strait Islanders Chapter 9 Smoking and social disadvantage Chapter 10 The tobacco industry in Australian society Chapter 11 Tobacco advertising and promotion Chapter 12 The construction and labelling of Australian cigarettes Chapter 13 The pricing and taxation of tobacco products in Australia Chapter 14 Social marketing and public education campaigns Chapter 15 Smokefree environments Chapter 16 Tobacco litigation in Australia Chapter 17 The economics of tobacco control Chapter 18 The WHO Framework Convention on Tobacco Control Appendix 1 Useful weblinks to tobacco resources Tobacco in Australia: Facts and Issues. Fourth Edition A comprehensive review of the major issues in smoking and health in Australia, compiled by Cancer Council Victoria. First edition published by ASH (Australia) Limited, Surry Hills, NSW, 1989 Second edition published by the Victorian Smoking and Health Program, Carlton South, Victoria (Quit Victoria), 1995 Third edition published by Cancer Council Victoria 2008 in electronic format only. ISBN number: 978-0-947283-76-6 Suggested citation: Scollo, MM and Winstanley, MH. Tobacco in Australia: Facts and issues. 4th edn. Melbourne: Cancer Council Victoria; 2012. Available from www.TobaccoInAustralia.org.au OR <Author(s) of relevant chapter section>, <Name of chapter section> in Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. 4th edn. Melbourne: Cancer Council Victoria; 2012. <Last updated on (date of latest update of relevant chapter section)> Available from < url of relevant chapter or section> Tobacco in Australia: Facts and Issues; 4th Edition updates earlier editions of the book published in 1995, 1989 and 2008. This edition is greatly expanded, comprising chapters written and reviewed by authors with expertise in each subject area. Tobacco in Australia: Facts and Issues is available online, free of charge. A hard copy version of this publication has not been produced. This work has been produced with the objective of bringing about a reduction in death and disease caused by tobacco use. Much of it has been derived from other published sources and these should be quoted where appropriate. The text may be freely reproduced and figures and graphs (except where reproduced from other sources) may be used, giving appropriate acknowledgement to Cancer Council Victoria. Editors and authors of this work have tried to ensure that the text is free from errors or inconsistencies. However in a resource of this size it is probable that some irregularities remain. Please notify Cancer Council Victoria if you become aware of matters in the text that require correction. Editorial views expressed in Tobacco in Australia: Facts and Issues. Fourth Edition are those of the authors. The update of this publication was funded by the Australian Government Department of Health and Ageing. Cancer Council Victoria 1 Rathdowne Street Carlton VIC 3053 Project manager: Michelle Scollo Senior Policy Adviser, with assistance from Merryn Pearce, Policy and Projects Officer, Quit Victoria. Editorial advice and editing: Rosemary Moore Website design: Creative Services, Cancer Council Victoria Design and production: Jean Anselmi Communications Proofreading: Caz Garvey Tobacco in Australia Facts & Issues A comprehensive online resource tobaccoinaustralia.org.au Chapter 9 Smoking and social disadvantage Chapter 9: Smoking and social disadvantage i Chapter 9 Smoking and social disadvantage By Michelle Scollo, Table of contents VicHealth Centre for Tobacco Control with 9.0 Introduction ........................................................................................... 1 input from Dr Mohammad 9.0.1 What is social disadvantage? ....................................................... 1 9.0.2 What is health inequality? ........................................................... 2 Siahpush, formerly Centre 9.0.2.1 Tobacco-related disparities ........................................... 3 for Behavioural Research 9.0.2.2 Inequality as deficit, gap or gradient ............................... 3 in Cancer, Cancer Council 9.0.2.3 Absolute and relative changes in inequality...................... 4 Victoria, now Professor, 9.0.2.4 Apparent change versus statistically significant Department of Health change ....................................................................... 4 Promotion, Social and 9.0.3 Data available on tobacco-related disparities in Australia ................. 4 Behavioral Health, College of 9.1 Socio-economic position and disparities in tobacco exposure Public Health, University of .................................................................................................. 8 and use Nebraska Medical Center 9.1.1 Disparities in smoking during pregnancy ...................................... 8 9.1.2 Disparities in exposure of children to secondhand smoke ................ 8 Updated by Merryn Pearce, 9.1.3 Disparities in smoking behaviours among young people .................. 9 9.1.4 Disparities in smoking prevalence among adults .......................... 10 Policy Unit, Quit Victoria 9.1.5 Disparities in reported cigarette consumption .............................. 11 9.1.6 Disparities in duration of smoking ............................................. 11 9.1.7 Disparities in exposure to secondhand smoke .............................. 12 9.1.7.1 Disparities in workplace exposure ................................ 12 9.1.7.2 Disparities in domestic exposure ................................. 12 9.1.7.3 Exposure in institutional settings ................................. 13 9.2 Socio-economic disparities in tobacco exposure and use: are the gaps widening? ......................................................................................16 9.2.1 Changes in the prevalence of smoking among adults in various socio-economic groups .................................................. 16 9.2.1.1 Changes in prevalence among those with varying levels of formal education ................................ 17 Date of last update: 20 November 2012 Tobacco in Australia: ii Facts and Issues 9.2.1.2 Changes in prevalence in blue versus white collar groups ............................................................. 18 9.2.1.3 Changes in smoking prevalence by area-level measures of SES ........................................................ 19 9.2.2 Differential uptake or differential cessation? ................................ 21 9.2.3 Changes in consumption of cigarettes ......................................... 25 9.2.4 Changes in the prevalence of smoking among students in schools in areas of varying levels of disadvantage .......................... 26 9.2.5 Changes in childhood exposure to smoking in the household............................................................................... 27 9.2.6 International comparisons ........................................................ 27 9.3 Contribution of smoking to health inequality ............................................30 9.3.1 Socio-economic position, reported health status and smoking ................................................................................. 30 9.3.2 Socio-economic position and illnesses known to be caused by smoking ............................................................................. 30 9.3.3 Socio-economic disparities in death rates from diseases known to be caused by smoking................................................. 31 9.3.4 Socio-economic disparities in health-adjusted life expectancy ............................................................................. 32 9.3.5 Quantifying the contribution of smoking to socio-economic differentials in health status ................................ 33 9.3.6 Are tobacco-related differentials in health status widening? ........... 34 9.4 The relationship between tobacco smoking and financial stress ...................38 9.4.1 Spending on tobacco as a cause of financial stress ......................... 38 9.4.2 Financial stress and its influence on smoking abstinence ............... 39 9.4.3 Smoking cessation and the reduction of financial stress ................. 39 9.5 Smoking and intergenerational poverty ....................................................41 9.5.1 Spending on tobacco products and its impact on financial security and wealth accumulation .............................................. 41 9.5.2 The long-term effects of smoking during pregnancy ..................... 42 9.5.3 Exposure to environmental tobacco smoke and school absence ...... 42 9.5.4 Parental example and smoking uptake: the cycle continues ............ 43 9.6 Smoking, ill-health, financial stress and smoking-related poverty among highly disadvantaged groups ........................................................46 9.6.1 People living in regional and remote areas of Australia .................. 46 9.6.2 People born overseas ................................................................ 47 9.6.3 Lone parents, especially lone mothers ........................................