Review of 2021 Census Topics

This submission seeks the inclusion of a topic in the 2021 Census on smoking status, to support planning and delivery of health care services for regions, communities and population groups.

Australia is a global leader in tobacco control policy. As a result of successful efforts over many years in reducing smoking rate, the latest daily smoking prevalence is at 12.2% of people aged 14 and above. 1
Smoking, however, remains a major public health issue with far reaching consequences affecting smokers, their family members and communities they live in. According to the latest Australian Burden of Disease Study (ABDS), the joint effect of health risk factors accounted for 31% of the total burden of disease and injury in Australia in 2011, with tobacco use accounting for the greatest amount of burden (9%). The ABDS also estimated that smoking caused a total of 18,762 deaths in 2011, or more than 1 in every 8 deaths (12.8%). 2
Adverse effects of smoking not only affect smokers but those who share their environment, and they can continue to affect smokers long after they stopped smoking.
Smoking is more prevalent in disadvantaged groups, affecting subpopulations of Australians differently. Aboriginal and Torres Strait Islander peoples show substantially higher smoking rates than the rest of the population, as do members of some other culturally and linguistically diverse communities. Among Aboriginal and Torres Strait Islander people, tobacco smoking rate remains high at 45% (18 years and older) in 2014-15.3 After adjusting for the different age structures of the two populations, Indigenous mothers were 3.6 times as likely to smoke during pregnancy as non-Indigenous mothers. 4. Reducing smoking rate in Indigenous population would significantly contribute to meeting the Closing the Gap targets (particularly the life expectancy target for which we are currently not on track to achieve).









1. Australian Institute of Health and Welfare 2017. National Drug Strategy Household Survey 2016: detailed findings. Drug Statistics series no. 31. Cat. no. PHE 214. Canberra: AIHW.
2. Australian Institute of Health and Welfare, Risk Factors to Health, Web Report, Last updated 07 Aug 2017Assessment criteria
3. Aboriginal and Torres Strait Islander Peoples: Smoking Trends, Australia, 1994 to 2014-15, ABS cat.no. 4737.0
4. Australian Health Ministers’ Advisory Council, 2017, Aboriginal and Torres Strait Islander Health Performance Framework 2017 Report, AHMAC, Canberra.
 

The Australian Government spends a significant amount of funding on tobacco control policies and programs each year, and effectiveness of these would improve further if the 2021 Census was able to provide reliable smoking rates for small geographic areas and small population groups. This would facilitate more targeted messaging and programs to assist Australians with smoking cessation,
Collecting smoking status data along with other Census information such as demographic information, family structure, socioeconomic information and others will help identify target groups who would benefit from anti-smoking messages/campaigns/interventions.

Questions about smoking behaviour can be relatively easily expressed in words as has been done in the New Zealand Census, making this topic suitable for the self-administered questionnaire used in the Census. Australia will be able to draw on this New Zealand experience.

Smoking, quitting smoking, health effects of smoking and so forth are regular topics of conversation among many people and these topics would not be characterised as being controversial.

There may be an issue of some level of under-reporting (especially if a single person in a household administers the Census form), but this issue is not unique to smoking status question.

Exact wording of smoking status questions for inclusion in the next Census will need to be worked through, but it is not likely that this topic will be a lengthy one. Statistics New Zealand would be able to inform ABS about the time requirement for this module
Responses to the smoking status questions will be easily processed as categorical response options can be provided to respondents.

We envisage a continuing need for data on this topic. While a single collection of smoking status alone would provide valuable information to inform health policies and program delivery, collection of smoking status in the subsequent Census(s) will allow identification of geographic areas where smoking rate has decreased and subpopulations whose smoking rate has decreased. The trend data will be very valuable in determining effective ways to further drive down the smoking rate, particularly among those who are in the at-risk groups.

There are a number of sources of smoking prevalence estimates in Australia, including:
• National Drug Strategy Household Survey
• National Health Survey
And also, specific to Indigenous population:
• National Aboriginal and Torres Strait Islander Health Survey
• National Aboriginal and Torres Strait Islander Social Survey
While these are valuable data assets, they cannot be used to reliably estimate smoking rates in small geographic areas, and for small population groups. Lack of reliable point-in-time data at this level, makes it impossible to evaluate trends over time.