Facts about smoking

Tobacco use has many health impacts, including increasing the risk of chronic diseases such as cardiovascular disease, many forms of cancer, and lung diseases. Tobacco use is also a risk factor for complications during pregnancy, and is associated with preterm birth, low birth weight, and perinatal death. Environmental tobacco smoke (second-hand smoke) is also a risk to health. Children are particularly susceptible to problems caused by breathing in second-hand smoke (passive smoking). This includes a greater risk of middle ear infections, more frequent and severe asthma attacks, and increased risk of sudden infant death syndrome (SIDS).

Extent of tobacco use among Aboriginal and Torres Strait Islander people

The latest data about smoking prevalence among Aboriginal and Torres Strait Islander people comes from the 2018-2019 National Aboriginal and Torres Strait Islander Health Survey.

Smoking among young people

The proportion of young people (18-24 years) starting to smoke has decreased which will result in improved health outcomes over time.

Aboriginal and Torres Strait Islander young adults are also starting smoking later.

Visit our Young people page to learn more about school and community-based initiatives to reduce the number of young people taking up smoking and increase the number of young people who quit smoking.


Smoking during pregnancy

There has been a substantial decrease in smoking during pregnancy among Aboriginal and Torres Strait Islander women.

Find out more about pregnancy and smoking on our Mothers and Babies page.


Second-hand smoking among Aboriginal and Torres Strait Islander people

Second-hand smoking is when a person breathes in the smoke from a tobacco product but is not smoking the cigarette (or other tobacco product) themselves. Second-hand smoke releases thousands of chemicals into the environment and is bad for health. While many people smoke outdoors to limit exposure to second-hand smoke, some people live with a friend or family member who smokes inside.

Many Aboriginal and Torres Strait Islander people are making changes to reduce the impact of second-hand smoke on others. These include stopping people from smoking inside, avoiding social situations where people would be smoking, and changing their clothes after smoking.

Read more about second-hand and third-hand smoke and creating smoke-free environments here.



E-cigarettes are battery operated devices that heat a liquid to produce a vapour that can be inhaled. In Australia, it is illegal to sell e-cigarettes that contain nicotine. The limited research suggests that a smaller percentage of Aboriginal and Torres Strait Islander peoples may have tried e-cigarettes than non-Indigenous people.

Read more about e-cigarettes.


Further reading

Bush tobacco

Native tobacco plants (bush tobacco) grows from Queensland right across the central desert to Western Australia. These plants are known by different names including Pituri and Mingkulpa. Traditionally the leaves and stems from the tobacco plant are dried and mixed with burnt ash from specific trees. This mixture is moistened with a little saliva, then moulded into a small package known as a quid. Mixing the leaf with the ash is important, as it help the nicotine enter the body. The quid is then chewed and held in the mouth for long periods of time. It can also be placed behind the ear, which allows the nicotine to be absorbed into the body through the skin. This smokeless use of tobacco is very common across Aboriginal populations in the southern, central and western desert regions of Australia. Yet despite the long tradition of bush tobacco use, our knowledge about its impact on health is limited.

A recent narrative study described how the use of bush tobacco is common-place in remote central Australian Aboriginal communities. Study participants were clear that ‘everyone uses it’, men, women and children. Children were said to start chewing between 5 to 7 years of age. People might hide their bush tobacco use, particularly from non-Indigenous health workers. Participants said they used bush tobacco because it tastes good and keeps you healthy.  The benefits of bush tobacco described by users included:

  • a sense of calm and relaxation
  • improved concentration
  • reduced hunger
  • overcoming thirst
  • bringing sleep (the quid may even be kept in mouth overnight).

It is possible to overdose on bush tobacco and some plants have higher levels of nicotine than others. Signs of toxicity include dizziness, drowsiness and sickness. Not being able to have bush tobacco leads to withdrawal symptoms including cravings, headaches, anxiety and grumpiness.  If supplies run low, bush tobacco might be mixed with cheap commercial tobacco. Or if supplies run out, commercial tobacco might be used in place of the bush tobacco. It is also likely that some people simply prefer commercial tobacco so will regularly mix the two. Despite the recognition that commercial tobacco and bush tobacco have similar properties, users do not consider pituri to be a tobacco plant. This means that using bush tobacco is not believed to lead to the health problems associated with commercial tobacco.

The primary use of bush tobacco is for its nicotine. It is also used in some communities for other purposes including application of a wet mix to skin for treatment of:

  • ringworm
  • insect bites (including ants and spiders)
  • snake or scorpion bites
  • scabies and skin sores.
Bush tobacco has a significant social and cultural role as well, connecting Aboriginal people to each other, their culture, land, and community. Bush tobacco is sometimes bought and sold, but more frequently it is gifted to family or friends as a sign of ‘being loved’.

How harmful is bush tobacco?

It is often suggested that health outcomes for smokeless tobacco users are the same as those for smokers. There is some evidence to support this idea, but this information relates to commercial smokeless tobacco. We are still learning about bush tobacco, so should not assume that the outcomes for bush tobacco will be exactly the same. There are 22 different types of bush tobacco which grow wild across Australia. All are a little bit different in terms of their chemical composition, including how much nicotine they contain. Although the evidence for the health impacts of bush tobacco use are still emerging, what we do know is that:

  • high levels of nicotine make it addictive
  • toxic chemicals are found in the leaves, including some known to cause cancer
  • mixing the ash and the tobacco leaf might produce other harmful compounds
  • maternal use adversely affects pregnancy outcomes, increasing the risk of premature birth and lower birth weight.

Emerging evidence of health effects is perhaps strongest around the use of bush tobacco in pregnancy. A study of pregnant mums showed that women who chewed had higher levels of nicotine than mothers-to-be who smoked, leading to poorer health outcomes.

What is best practice population health promotion for bush tobacco?

Even though smokeless tobacco use occurs across the world and may even be increasing, health promotion campaigns focus on tobacco that is smoked.  However, the evidence we do have suggests that effective health education practices are the same, whether focused on smoked or smokeless tobacco.  It is important to recognise most information about bush tobacco found in the literature comes largely from a European perspective. Recent narrative research has shown that this non-indigenous understanding of bush tobacco use is very different from that of Aboriginal peoples. Bush tobacco is not believed to be the same as commercial tobacco, so users will:

  • deny tobacco use at health assessment
  • not consider Western health information about smoked tobacco is relevant to them.

This means developing different health messages about bush tobacco. Relying on existing health messaging around commercial tobacco is unlikely to be effective as it will not be credible to bush tobacco users. Even where the emerging evidence suggests similar outcomes from bush tobacco use as for commercial tobacco use (e.g. pregnancy), health messages must respect the local knowledge system. Working closely with community to understand local beliefs and the role of bush tobacco will be important for ensuring appropriately tailored messages.

Further reading