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2.03 Environmental tobacco smoke

Why is it important?

Environmental tobacco smoke (also known as second-hand or passive smoking) is a significant cause of morbidity and mortality. The first evidence of harm to children from passive smoking (Colley 1974; Harlap et al. 1974; Leeder et al. 1976) and increased lung cancer risk in adults (Hirayama 1981) emerged over 30 years ago. Global burden of disease analysis attributed 603,000 deaths to second-hand smoke in 2004 (Öberg et al. 2011).

There is strong and consistent evidence that passive smoking increases a non-smoker's risk of lung cancer and ischaemic heart disease. Passive smoking is associated with increased risk of respiratory disease in adults, increases the risk of Sudden Infant Death Syndrome, and exacerbates asthma and ear infections such as otitis media in children (Thomas, DP et al. 2014) (see measure 1.15). Passive smoking during pregnancy is also associated with an increased risk in neural tube defects (Wang, M et al. 2014).

The home is a key setting for exposure to environmental tobacco smoke for pregnant women and young children. Exposure to parents' smoking in childhood is found to have pervasive vascular health effects into adulthood (Gall et al. 2014). Overcrowding in housing (see measure 2.02) increases the risk of such exposure and developing asthma. Smoking in cars is also an important locus for child exposure to second-hand smoke (Agaku et al. 2014).

Smoke-free homes support successful smoking cessation (quit attempts and preventing relapse) along with a reduction in consumption of cigarettes (Thomas, DP et al. 2014) (see measure 2.15). Qualitative research also suggests smoke-free homes are associated with reductions in young people taking up smoking (Thomas, DP et al. 2014).

Evaluation of a family-centred intervention to reduce infant exposure to second-hand smoke in Indigenous families concluded that all household members (not only the mother) should cease smoking from the time of conception (Walker et al. 2014).

Findings

Based on the 2012–13 Health Survey, there were an estimated 130,600 Aboriginal and Torres Strait Islander children aged 0–14 years living in households with a daily smoker, representing 57% of all Aboriginal and Torres Strait Islander children in this age range. In comparison, 26% of non-Indigenous children within the same age range lived in households with a daily smoker.

Of those children living in households with a daily smoker, Aboriginal and Torres Strait Islander children were 2.4 times as likely to live in households with people who smoked at home indoors (28% of Indigenous children living in households with a daily smoker compared with 12% of non-Indigenous children).

Between 2004–05 and 2012–13 there was a significant reduction in the proportion of Aboriginal and Torres Strait Islander children aged 0–14 years living in households with a daily smoker, falling from 68% to 57%. For non-Indigenous children there was also a significant reduction from 35% in 2004–05 to 26% in 2012–13.

In 2012–13, the proportions of Aboriginal and Torres Strait Islander children aged 0–14 years who lived in households with a daily smoker ranged from 50% in major cities to 74% in very remote areas. The proportion of Aboriginal and Torres Strait Islander children aged 0–14 years, who lived in households with a daily smoker who smoked at home indoors, ranged from 25% in major cities to 34% in very remote areas.

The proportion of Aboriginal and Torres Strait Islander children aged 0–14 years living in households with a daily smoker ranged from 47% in the ACT to 75% in the NT. The proportion of Aboriginal and Torres Strait Islander children aged 0–14 years, who lived in households with a daily smoker who smoked at home indoors, ranged from 17% in WA to 37% in the NT.

Strong associations exist between the socioeconomic circumstances of Indigenous households and whether children are exposed to environmental smoke. The 2012–13 Health Survey results indicate that Indigenous children aged 0–14 years living in the lowest income households were 2.7 times as likely to have a smoker who smokes at home indoors compared with those living in the highest income households. There is a similar relationship with housing: 31% of children living in rental households had a smoker who smoked at home indoors compared with those living in homes that are owned or being purchased (17%).

Implications

The Australian Government has a range of policies and programmes in place that complement state and territory activity to reduce the harms from smoking. These policies and programmes include: excise increases on tobacco; education programmes and campaigns; plain packaging of tobacco products; labelling tobacco products with new, larger graphic health warnings; prohibiting tobacco advertising and promotion; and providing support for smokers to quit.

States and territories have taken lead responsibility for smoking restrictions to prevent exposure to second-hand tobacco smoke. Smoking is now banned in almost all indoor public places and increasingly in outdoor spaces, particularly where children are present. Most jurisdictions prohibit smoking in cars when children are present. The NT and Qld have introduced complete smoking bans in their prisons and Victoria, NSW and Tasmania are planning bans in theirs in 2015.

The policy implications for addressing the dangers of environmental tobacco smoke are similar to those for tobacco smoking in general (see measure 2.15) and tobacco smoking during pregnancy (see measure 2.21). Exposure to environmental tobacco smoke should be monitored in conjunction with those measures.

The Tackling Indigenous Smoking programme provides a national platform for reducing Aboriginal and Torres Strait Islander smoking rates. This programme includes promoting an understanding of the importance of smoke-free environments and compulsory smoke-free policies for funded organisations. The Tackling Indigenous Smoking programme includes regional teams that work with communities to design and deliver locally tailored health promotion, social marketing and education campaigns and activities addressing smoking.

Australian governments are committed to ensuring that programmes to address high rates of smoking are based on the most up-to-date evidence, and are delivered in a way that is appropriate, effective and efficient. As a result, the Australian Government is undertaking an independent review of the Tackling Indigenous Smoking programme in 2014–15. The review will establish a new evidence base and provide recommendations on the best way to reduce Aboriginal and Torres Strait Islander smoking rates and reduce the high proportion of children who are exposed to second-hand tobacco smoke.

Figure 2.03-1 Children aged 0–14 years living with current daily smoker(s), by Indigenous status and remoteness, 2012–13
children aged 0–14 years living with current daily smoker

Figure 2.03-1 shows the proportion of Aboriginal and Torres Strait Islander children and non-Indigenous Australian children aged 0–14 years who live with at least one current daily smoker in 2012–13. Data is presented separately for major cities; inner regional areas; outer regional areas; remote areas; and very remote areas. In 2012–13, the proportions of Aboriginal and Torres Strait Islander children aged 0–14 years who lived in households with a daily smoker ranged from 50% in major cities to 74% in very remote areas. The proportion of Aboriginal and Torres Strait Islander children aged 0–14 years who lived in households with a daily smoker who smoked at home indoors ranged from 25% in major cities to 34% in very remote areas.

Source: ABS and AIHW analysis of 2012–13 AATSIHS

Figure 2.03-2 Children aged 0–14 years living in households with current daily smoker(s), by remoteness and Indigenous status, 2004–05, 2008/2007–08 and 2012–13
children aged 0–14 years living in households with current daily smoker

Figure 2.03-2 shows the proportion of Aboriginal and Torres Strait Islander children and non-Indigenous Australian children aged 0–14 years who live in households with at least one current daily smoker. Data is presented for non-remote areas and Australia as a whole. Data is presented for 2004–05; 2008/2007–08 and 2012–13. Between 2004–05 and 2012–13 there was a significant reduction in the proportion of Aboriginal and Torres Strait Islander children aged 0–14 years living in households with a daily smoker, falling from 68% to 57%. For non-Indigenous children there was also a significant reduction from 35% in 2004–05 to 26% in 2012–13.

Source: ABS and AIHW analysis of 2004–05 NATSIHS, 2008 NATSISS, 2004–05 NHS, and 2007–08 NHS, 2012–13 AATSIHS

Figure 2.03-3 Children aged 0–14 years living with a current daily smoker who smokes at home indoors, by Indigenous status and remoteness, 2012–13
children living with a daily smoker who smokes at home indoors

Figure 2.03-3 shows the proportion of Aboriginal and Torres Strait Islander children and non-Indigenous Australian children aged 0-14 years who live with at least one current daily smoker who smokes at home indoors in 2012–13. Data is presented separately for major cities; inner regional areas; outer regional areas; remote areas; and very remote areas. Aboriginal and Torres Strait Islander children were three times as likely to live in households with a daily smoker who smoked at home indoors (28% compared with 11% of non-Indigenous children living in households with a daily smoker).

Source: ABS and AIHW analysis of 2012–13 AATSIHS

Table 2.03-1 Children aged 0–14 years living in households with current daily smoker(s), by Indigenous status of children, 2012–13
Aboriginal and Torres Strait Islander children aged 0-14 Non Indigenous children aged 0-14
Daily smoker in household
No 43% 74%
Yes 57% 26%
Whether anydaily smokers smoke at home indoors
No 72% 88%
Yes 28% 12%

*Difference between Indigenous/non-Indigenous children is statistically significant at the p<0.05 level.

Source: ABS and AIHW analysis of 2012–13 AATSIHS