1989-90 National Health Survey: Lifestyle and Health Australia
CHARACTERISTICS OF SMOKERS
Results of the survey showed that in 1989-90, 28.4 percent of adult Australians were smokers, 23.2 per cent were ex-smokers and 48.4 per cent had never smoked.
These proportions differed by population group, as shown in Table 2.1. A higher proportion of males were smokers (32.1%) than females (24.7%), and smoking was more common among the younger age groups. For example, approximately 36 per cent of both males and females aged 18 to 24 years were smokers compared with 21.4 percent of persons aged 45 years or more. Among people aged 45 years and over 30.4 per cent were ex-smokers.
For both male and female smokers the majority were in younger age groups. Two thirds (67.7%) of male and 70.4 per cent of female smokers were aged 18 to 44 years. This pattern differed for ex-smokers and persons who never smoked. For example, whereas the majority of male ex-smokers were aged 45 years and over (59.7%) most female ex-smokers were in younger age groups (54.7%) (see Table 2.2). The median age of smokers and ex-smokers was lower for females than males (Chart 2.1).
CHART 2.1 SMOKERS STATUS BY MEDIAN AGE BY SEX
Smoker status differed by birthplace, with lower than average proportions of smokers and ex-smokers among Asian, African and American born people, but higher proportions among those born in New Zealand and other Oceania and in the Middle East.
Smoking was more common among unemployed person (43.5%) than the employed (31.2%) and those not in the labour force (27.5%). Although the different age structures of these population groups contributed to the magnitude of these differences, the smoker status pattern was the same for all age groups.
Highest post-school qualifications and smoking were found to be inversely related. Proportionally fewer people with a bachelor degree or higher were smokers (16.4%) than those with trade or apprenticeship qualifications (33.4%) or no post school qualifications (30.2%). The proportion of smokers was highest in low to middle income groups (33.4% of those with an income of $10,000 to $30,000 per year) and lowest among those on high incomes (22.6% of those with an annual income of $50,000 or more.)
Self-assessed health status
Overall the majority of Australians (79.2%) believed they are in good or excellent health and similar proportions were recorded for both males and females, but differed according to smoker status (see Table 2.3). A higher proportion of people (81.9%) who had never smoked believed they are in good or excellent health than smokers (76.6%). The pattern was the same for both males and females.
This pattern was exhibited across all age groups, with more of the never smoked group assessing their health as good or excellent than both smokers and ex-smokers. Conversely more smokers and ex-smokers for both sexes and in every age group reported having poor or fair health than those who had never smoked (Table 2.3)
Number of conditions reported
Table 2.4 shows that the highest percentage of persons with illnesses was recorded for ex-smokers. In total, 82.9 per cent of ex-smokers reported one or more long-term conditions. Among female ex-smokers aged 45 or more, 81.5 per cent recorded having two or more long-term conditions, the highest occurrence of illnesses for any smoker status group. This pattern also varied with age, with the over 44 year age group having a higher percentage of one or more long-term illnesses (91.8 per cent of the never smoked and 89.0 per cent of smokers) than the 18 to 44 age group (63.2 per cent of the never smoked and 64.7 per cent of smokers).
For all characteristics examined (age, sex, country of birth, highest post-school qualifications and personal income) ex-smokers displayed a higher average number of recent and long-term conditions combined (3.9) than both smokers (3.3) and the never smoked group (3.4) (Table 2.5). For both males and females the smoker and never smoked groups had similar average number of conditions, with females having a greater average number of conditions (3.7 for smokers and 3.8 for those who never smoked) than males (2.9 for both smokers and those who have never smoked).
Ex-smokers aged 65 years and over had the highest average number of conditions (5.2) of all age groups. Overall the younger age groups reported a lower average number of conditions for all smoker status groups than the older groups. Of the younger age groups, smokers had a higher average number of conditions (2.8 for the 18 to 24 age group and 3.0 for those aged 25 to 44 years) than those that have never smoked (2.6 for 18 to 24 years and 2.9 for 25 to 44 years). However, among those aged 45 years and over, those who had never smoked had a slightly higher prevalence of conditions than the smokers (Table 2.5). Further a higher proportion of smokers 45 years and over reported no illness (24.9%) than ex-smokers (15.9%) and those who never smoked (17.9%). This pattern is similar for males and females (Table 2.6).
Types of conditions reported
There were some differences in the prevalence of certain medical conditions according to smoker status, and as might be expected these differences were most evident in the older age groups.
Chart 2.2 shows that the prevalence of bronchitis and emphysema, which have historically been linked with smoking, is higher among smokers aged 45 years and over (7.8%) than among those who have never smoked (3.4%), but similar for ex-smokers (7.6%). Males in all age and smoker status groups, except for ex-smokers 45 years and over, reported a lower prevalence of bronchitis than females. Overall, a higher prevalence of this condition was reported among smokers (5.3%) and ex-smokers (5.1%) than persons who had never smoked (2.5%) (Table 2.6)
Chart 2.2 also shows differences to the prevalence of heart disease between smoker status groups. For persons aged 45 years and over, the proportion of ex-smokers who reported heart disease (11.4%) was almost double that for smokers (6.0%) and those who have never smoked (6.7%) (see also Table 2.6). This pattern was the same for both males and females, but the prevalence of heart disease was lower among females (9.4%) than males (12.3%) in the ex-smoker group aged 45 years and over.
CHART 2.2 PERSONS AGED 45 YEARS AND OVER: SMOKER STATUS BY
SELECTED CONDITION(S). AUSTRALIA, 1989-90
The high proportion of ex-smokers who reported heart disease may be due to smokers developing the disease and then giving up smoking as a result. Table 2.7 shows that the main reason for quitting smoking most often reported by ex-smokers of cigarettes over the age of 44 was that it is harmful to their health. Further, the number of ex-smokers of cigarettes with heart disease who reported health reasons as the main reason for quitting smoking (94,900 persons) was over four times the number who reported any other reason for quitting (for example, 20,800 reported they quit smoking because they lost interest).
However, not all related conditions were positively correlated with smoking. For example, lower proportions of smokers aged 45 years or more of both sexes reported obesity and high cholesterol as recent and long-term conditions than ex-smokers or those who never smoked (Tables 2.6 and 2.10).
Proportionally fewer smokers aged 45 years and over reported hypertension (18.3%) than those who have never smoked (29.0%) and ex-smokers (27.0%) (Chart 2.2). This is true of both males and females, although the prevalence of hypertension was higher among females than males in all smoker status groups. This finding may be associated with body mass. Some 38.9 per cent of smokers aged 45 years and over were classified overweight or obese based on self-reported height and weight, compared with 49.5 per cent of ex-smokers and 44.1 percent of those who had never smoked (Table 2.8).
Duration of smoking
Results of the survey indicated that the prevalence of recent and long-term conditions is also associated with the length of time a person has smoked.
For persons aged 45 and over, the proportion of ex-smokers with illness was higher than for current smokers. Some 94.3 per cent of ex-smokers in this age group who smoked for more than 20 years reported one or more long-term illnesses, while 89.2 per cent of current smokers o f the same duration reported long-term illnesses. More smokers and ex-smokers reported having two or more illnesses (recent or long-term) than persons who had never smoked. Unexpectedly a higher percentage of ex-smokers, who had smoked for less than 10 years, than current smokers had one or more recent illnesses (85.8%) compared with 78.2%) (Table 2.9)
The prevalence of bronchitis and emphysema among those aged 45 years and over increases markedly as duration of smoking increases. Of current smokers in this age group who have smoked for less than 20 years 5.2 percent reported bronchitis and emphysema, compared with 7.9 per cent among those who have smoked for 20 years or more and 3.4 percent for those who have never smoked (Table 2.6). Among ex-smokers who smoked for 20 years or more, the prevalence of bronchitis and emphysema was greater still (9.6%) (Table 2.10).
As shown in Chart 2.3 there were also differences between current smokers and ex-smokers in the prevalence of other conditions. Those persons aged 45 years and over who stopped smoking, and who had smoked for 20 years or more, had a higher prevalence of hypertension, heart disease, asthma, high cholesterol and neoplasms than those who were still smoking and had done so for 20 years or more. Smokers who had smoked for less than 20 years had the lowest prevalence of the conditions examined when compared with long-term smokers (who had smoked for 20 years or more) and ex-smokers, except for nerves, tension, nervousness, emotional problems, bronchitis, emphysema and neoplasms. Similar results are found when smokers and non-smokers are compared. That is smokers aged 45 years and over have a lower prevalence of neoplasms, high cholesterol, hypertension and heart disease than both ex-smokers and those who had never smoked in the same age group. (Table 2.6).
CHART 2.3 SMOKERS AND EX-SMOKERS AGED 45 YEARS AND OVER: DURATION OF
SMOKING BE SELECTED CONDITIONS EXPERIENCED(a). AUSTRALIA 1989-90
As well as the effects of smoking for the smoker him/herself, attention has been drawn by researchers to the possible effects of smoking on the health of non-smokers through passive smoking. A particular aspect identified is the effects of passive smoking on the health of infants and children.
The 1989-90 National Health Survey did not directly address the issue of passive smoking and its possible effect on health. However, data from the survey are available describing the health of children in household in which there are one or more adult smokers (Table 2.11). Survey results show only slight differences between children living in households with or without smokers in the likelihood of children experiencing recent and/or long-term conditions. In households with smokers there was a slightly higher prevalence of disorders of refraction and accommodation, influenza, bronchitis, emphysema and asthma among children.
Of Australians aged 18 years and over, just over half were, or had been smokers. The majority of Australians believed themselves to be in good or excellent health regardless of smoker status, but a higher proportion of those who had never smoked rated their health as good or excellent than did smokers.
The data on reported conditions both supports and contradicts this view. While smokers experienced higher rates of bronchitis and emphysema, they also had the lowest rates of hypertension compared with ex-smokers and the never smoked group, and proportionally fewer smokers reported experiencing any illness conditions. Although age is a factor in this finding, the pattern was similar across age groups. In contrast ex-smokers had the highest rate of heart disease of all three smoker status groups.
An important factor when comparing reported conditions across smoker status groups was the duration of smoking. Smokers and ex-smokers who had smoked for 20 years or more faired far worse in terms of bronchitis and emphysema, as did smokers for heart disease, than those who had never smoked.
TABLE 2.1. PERSONS AGED 18 YEARS AND OVER: SMOKER STATUS BY SELECTED CHARACTERISTICS
(000) / Per cent
|Age group (years) —|
|18 — 24|
|25 — 45|
|45 — 64|
|65 and over|
|Country of birth —|
|New Zealand &|
|United Kingdom &|
|Other Europe and U.S.S.R.|
|Northern, South & |
and the Caribbean
|Africa (incl. North Africa)|
|Total overseas born|
|Highest post school|
|Still at school or never went to School|
|Bachelor degree or higher|
|No Post-school qualification|
|Labour Force status (a) —|
|Not Applicable (b)|
|Unemployed (looking for work)|
|Not in Labour Force|
|Gross personal annual|
|$0 — 9,999|
|$10,000 — 19,999|
|$20,000 — 29,999|
|$30,000 — 39,999|
|$40,000 — 49,999|
|$50,000 — or more|
(a) Persons 18 to 64 years only. (b) Persons aged 65 years and over. (c) Persons 18 years and over who reported a source of income. (d) Persons 18 years and over still as school and persons who did not report a source of income.
TABLE 2.4. PERSONS AGED 18 YEARS AND OVER: SMOKER STATUS BY NUMBER OF
RECENT AND LONG-TERM CONDITIONS BY AGE BY SEX