Tobacco use is estimated to be responsible for 22% of Australia’s cancer disease burden in 2015. An Australian study estimated 15,525 cancers (13% of all cancers) diagnosed in 2010 could be attributable to tobacco use, including 8,324 (81%) lung, 1,973 (59%) oral cavity and pharynx, 855 (60%) oesophagus, and 951 (6%) colorectal cancers (see Table 1 below). Of these, 136 lung cancers in non-smokers were attributable to partner smoke.  In 2015, 77.7% of disability-adjusted life years from lung cancer were due to tobacco use in Australia.
Table 1. Population attributable fraction (PAF) for males and females and estimated number of cancers diagnosed in Australia in 2010 attributable to tobacco smoking
|Site||Males||Females||Total number of cancers|
|Kidney & ureter||26||11||633|
Source: Pandeya 2015
Overall health and community impact
Tobacco smoking is the leading preventable cause of both human and economic costs of preventable disease in Australia. An estimated 20,933 deaths in Australia in 2015 were caused by tobacco use. Of these deaths, cancers were responsible for the largest proportion (43%). In 2015-16, the total costs of tobacco use to Australia were estimated at $136.9 billion annually. The largest growth in a single cost item was pharmaceutical expenditure, as new high-cost drugs to treat diseases caused by smoking are listed for subsidy. On current trends, those costs are likely to continue to rise sharply.
The overall economic impact on the community is significant with intangible costs of tobacco use estimated at $117.7 billion in 2015-16.
Impact of tobacco use on lung cancer in Australia
In 2019, there were an estimated 12,817 new cases of lung cancer and 9,034 deaths in Australia.The number of lung cancer deaths in Australia attributable to smoking has been estimated to be 122,384 (77.7%), making lung cancer the second highest cause of death attributable to tobacco use, after chronic obstructive pulmonary disease.
Five-year survival was poor among both females in 2011-2015 (15% and 20.8%, respectively). Lung cancer is the most common cause of cancer death and fifth leading contributor to the burden of disease in Australian males, accounting for 3.6% of total disability-adjusted life years (DALYs) lost due to illness or accident. Among women, lung cancer is the second most common cause of cancer death, after breast cancer.
In 2016, 884,000 deaths worldwide were attributable to second-hand smoke, of which 6.3% occurred among children under the age of ten. The majority of deaths from second-hand smoke have occurred in women (47%), followed by children (28%) and men (26%). It was estimated that 1,714 deaths in Australia and 43,102 years of healthy life lost (DALYS) were attributable to second-hand smoke in 2017.
In Australia, the proportion of dependent children exposed to tobacco smoke inside the home has decreased by 31% since 1995.  In 2019 only 2.8% of adults in households with children smoked inside in the home.
Tobacco use in pregnancy
Tobacco use during pregnancy harms both the mother and the foetus. The National Perinatal Data Collection reported 9.6% of women who gave birth in Australia in 2018 smoked during pregnancy, a decline from 2012 (13%).
In 2017, there were significant variations in the prevalence of smoking during the first 20-weeks of pregnancy among certain sub-populations in Australia:
- Women who lived in the most disadvantaged areas were nearly six times more likely to smoke during pregnancy than women living in least disadvantaged areas (17.8% compared to 2.9%, respectively).
- Those living in very remotes areas were almost five times more likely to smoke in pregnancy than women in major cities (33.7% compared to 7.2%, respectively), and twice as likely as those in remote areas (17.6%).
- Women with Aboriginal or Torres Strait Islander backgrounds were almost four times more likely to smoke during pregnancy than non-Indigenous women (44.3% compared with 11.8%).
- The likelihood of smoking during pregnancy decreased with maternal age. One third (33.7%) of women and girls who became pregnant before the age of 20 smoked during the first half of pregnancy, compared to about 6% of those aged 35 years and older.
In 2015, one-third (32%) of teenage mothers smoked during the first 20-weeks and 25% smoked after 20 weeks of pregnancy, while 21% of mothers aged 20-24 years smoked during the first 20-weeks and 16% smoked after 20 weeks of pregnancy.
Prevalence of tobacco smoking in Australia
The National Drug Strategy Household Survey conducted by Australian Institute of Health and Welfare and the National Health Survey conducted by the Australian Bureau of Statistics both report on the prevalence of smoking in Australia. The National Drug Strategy Household Survey is considered to be the benchmark as it is the leading survey of licit and illicit drug use in Australia.
According to the National Drug Strategy Household Survey, the proportion of daily smokers (aged 14 or older) has declined from 12.2% in 2016 to 11% in 2019. Males were more likely to smoke than females in 2019 (12.2% compared to 9.9%). The proportion of young adults aged 18-24 who had never smoked has increased significantly (58% in 2001 and 80% in 2019), The proportion of people in their 50s who have never smoked has also increased from 44% in 2001 to 51% in 2019. In 2019 daily smoking rates were at the lowest level since 1991.
Smoking rates vary considerably across states. In 2019, the ACT had the lowest daily smoking prevalence of the states and territories and NT the highest (8.6% and 15.4%, respectively). New South Wales and Victoria have reported statistically significantly reductions in the proportion smoking daily between 2016 and 2019 – decreasing from 12% to 10.1% and 12.3% to 10.6%, respectively.
Aboriginal and Torres Strait Islander people
Aboriginal and Torres Strait Islander people aged 14 and over were 2.5 times more likely to be daily smokers than non-Indigenous people during 2010-19 (27% and 10.8%, respectively).
Tobacco use is responsible for 1 in 5 deaths among Aboriginal and Torres Strait Islander people. Prospective analysis of Aboriginal and Torres Strait Islander adults (≥45 years) found that nearly half of the deaths were attributable to smoking.
Between 2001 and 2019, the proportion of Aboriginal and Torres Strait Islander people who are daily smokers has declined by 12.6%.
Aboriginal and Torres Strait Islander people living in remote areas are more likely to be daily smokers than those living in non-remote areas (49% and 35%, respectively), which has not changed significantly between 2001 and 2018-19.
Data from the 2012-13 National Aboriginal and Torres Strait Islander Health Survey reported that 21.3% of young Aboriginal and Torres Strait Islanders aged 15-17, and 43.8% aged 18-24 were current daily smokers, compared to 4.1% and 17.3% of non-Indigenous young people in the same age groups, respectively. However, more recent analysis of youth uptake among Aboriginal and Torres Strait Islander people aged 15 – 24 years old found a significant decline in smoking prevalence between 2002 and 2014-15.
Nearly 2 in 5 Aboriginal and Torres Strait Islander mothers reported smoking during pregnancy in 2017 – 44.3% compared with 11.8% of non-Indigenous mothers (age-standardised).
Lung cancer and cancers of the lip, mouth and pharynx occur at more than twice the rate in Aboriginal and Torres Strait Islander people compared with non-Indigenous people. The higher rates of lung cancer are likely attributable to tobacco use. Tobacco and alcohol are both risk factors for cancers of the lip, mouth and pharynx, with the risk increasing significantly when the two substances are combined (see Smoking and alcohol). Both smoking and high-risk alcohol consumption (consuming more than 2 standard drinks per day on average) are more prevalent among Aboriginal and Torres Strait Islander people than in the non-Indigenous population.
Children and adolescents
There is evidence that those who start smoking at an earlier age are more likely to become long-term smokers and therefore, at significantly higher risk of tobacco-related cancer. Analyses of national survey data show that in 2017, smoking was extremely rare among 12-year old, however, by 17 years of age, 12% of males and 9% of females were current smokers (i.e. reported having smoked in the past week). The average age of initiation of tobacco use was 16.8 years in 2019, which was significant increase from 15.6 years in 1995 and similar to 2016 (16.4 years). There are fewer secondary students (aged 16 and 17) smoking with rates having decreased from 13% in 2011 to 9% in 2017. 
Among teenagers 14-17 years, in 2019 almost ten percent have tried e-cigarettes. Among young people aged 15-24, nearly two-thirds of current smokers and 1 in 6 non-smokers reported having tried e-cigarettes in 2019.
Other population groups with a high prevalence of tobacco use
While daily smoking rates across Australia have declined substantially over time, there are some population groups, where smoking rates are much higher than the general population. These include:
- People with mental health conditions who were diagnosed or treated in the past year (20.2%).
- Single-parent households with dependent children 25.9%).
- Homeless people (77%), as well as those who are ‘street homeless’ (93%).
- Prisoners (75%).
- People living in remote and very remote areas (19.6%).
- People currently using illicit drugs (36.7%).
Smoking rates are associated with socioeconomic status. In 2019, the proportion of daily smokers in the lowest socioeconomic status tier is greater than that of the highest (19% and 5%, respectively).
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