Review of 2021 Census Topics

CAPHIA proposes adding one or more questions about smoking prevalence to the 2021 Australian Census. These questions would be similar to the questions suggested by Thomas and Scollo (2018) and the questions asked about smoking in the New Zealand Census in 2013.

These questions would be phrased:
‘Do you smoke regularly (that is, once or more a day)?'
Yes/No
If the answer is ‘No’ then the respondent is asked:
'Have you ever been a regular smoker (that is, once or more a day)?'
Yes/No

If only one question can be asked for the sake of space, then we recommend:

‘Do you currently smoke regularly, that is at least once a day?’
Yes/No

Reference:
Thomas, T.P. and Scollo, M. (2018). Should a smoking question be added to the Australian 2021 Census? Australian and New Zealand Journal of Public Health 42(3): 225-226

Tobacco smoking is the leading preventable cause of death in Australia.

The Australian Institute of Health and Welfare estimated that in 2011, tobacco use contributed to over 13% of all deaths in Australia. Tobacco use has been found to be responsible for more than 9% of the overall burden of disease, especially contributing to cardiovascular diseases, cancers and respiratory illnesses.

More detailed and comprehensive data about tobacco smoking is required for research into the most effective policies to prevent smoking and encourage existing smokers to quit. Data is also required in order to implement smoking cessation policies in the most effective manner.

Reference:
Australian Institute of Health and Welfare (2018). Australia’s Health 2018. https://www.aihw.gov.au/getmedia/3fd37284-905a-4ee4-bdbe-2b27ee25a941/aihw-aus-221-chapter-4-5.pdf.aspx

While smoking has decreased over the last decades in the Australian population as a whole, specific population and geographic groups are significantly more likely to experience added burden of disease from smoking.

In particular, Aboriginal and Torres Strait Islander Australians are more than twice as likely to smoke as non-Indigenous Australians. According to the Australian Bureau of Statistics, 45% of Aboriginal and Torres Strait Islander people aged 18 years and over were smokers in 2014-15, compared to 16% of non-Indigenous people 18 years and over.

In order to put together more effective and targeted smoking prevention and cessation campaigns, researchers and policymakers require more detailed information about smoking, especially about small geographic areas and small population groups which are unable to receive this level of coverage in surveys. The need for this data to be collected in the Census is made more urgent by the fact that many preventative health campaigns are held on the state and local levels, and so require more detailed data to formulate effective policy than would be necessary for a national campaign.

References:
Australian Bureau of Statistics (2017). Aboriginal and Torres Strait Islander Peoples: Smoking Trends, Australia, 1994 to 2014-15. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4737.0~1994%20to%202014-15~Main%20Features~Smoking%20Prevalence~10

Thomas, T.P. and Scollo, M. (2018). Should a smoking question be added to the Australian 2021 Census? Australian and New Zealand Journal of Public Health 42(3): 225-226

CAPHIA’s proposed questions will be able to be quickly and easily collected on the Census household form. The questions have only two possible answers (‘yes’ or ‘no’), meaning that there will be minimal ambiguity in responses.

This is also a topic well understood by Australians. Anti-smoking campaigns have been broadcast and published in Australia for decades, meaning that there is a high level of awareness of why the issue of smoking is of public importance.

The proposed smoking questions are unlikely to be considered intrusive, and similar questions have been asked without incident or offence in the National Health Survey and the New Zealand Census in the past.

The most recent non-response rate for similar questions in the New Zealand Census (2013) was low, at 6.7% . This indicates that the vast majority of people are willing and able to answer questions about smoking.

Reference:
Statistics New Zealand (2013). http://archive.stats.govt.nz/Census/2013-census/info-about-2013-census-data/information-by-variable/cigarette-smoking-behaviour.aspx#nonresponse

As the proposed questions have only two possible responses (‘yes’ and ‘no’) it is anticipated that these will not present difficulties in coding or interpreting the data collected.

As the questions are short, and respondents will be able to read and answer the questions quickly, it will not add significantly to respondent burden or the cost of the Census.

Smoking prevalence is likely to continue to be an issue of interest to policymakers in the future. The bulk of the Australian burden of disease has moved from the communicable diseases of the past, to chronic, non-communicable diseases such as Type 2 diabetes. Smokers have a higher likelihood of developing many of these non-communicable diseases, as well as having a worse prognosis, than do non-smokers. Smoking is also a risk factor for health conditions developed in the future, so rates of smoking today are likely to affect the rates of chronic disease decades in the future.

Furthermore, as Australia continues to integrate into the global economy, it needs to prepare itself for trends occurring overseas. Smoking prevalence is increasing in many low- and middle-income countries with whom Australia has strong connections. The growth in cigarette smoking is particularly a concern in China, where an average smoker currently consumes 50% more cigarettes than they did in 1980. China is Australia’s largest trading partner and the third largest country of origin of overseas-born Australians . This provides a substantial reason why smoking prevention and cessation programs are likely to continue to be necessary in decades to come.

References:
Tobacco Atlas 2015. https://web.archive.org/web/20151222131456/http://www.tobaccoatlas.org/topic/cigarette-use-globally/
Australian Bureau of Statistics. Migration, Australia 2015-16. http://www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/3412.0Main%20Features32015-16?opendocument&tabname=Summary&prodno=3412.0&issue=2015-16&num=&view=

While information about smoking prevalence is collected in the National Health Survey (NHS), there is a trend of survey response rates decreasing over time, both in Australia and overseas. This means that it is unwise to rely on the NHS as the major source of information for this issue.

Another reason that survey data alone is inadequate is that it does not allow for data integration in the way that census data does. Census data can be linked to mortality records, which provides much more accurate estimates of smoking prevalence and mortality in smaller subgroups, such as Aboriginal and Torres Strait Islander Australians, small ethnic and cultural groups, LGBTI Australians, the severely socioeconomically disadvantaged and people experiencing homelessness.