Smoking inequalities among culturally diverse populations in Australia

Why This Matters

Australia has made major progress in reducing smoking, but national averages do not tell the whole story. In a country as multicultural as Australia, it is important to look beyond overall trends and ask whether all communities are benefiting equally. This study shows that smoking inequalities still exist across culturally diverse populations. Even though smoking has generally declined over time, some groups continue to have worse smoking outcomes than Australian-born Australians. That means progress in tobacco control has not been shared evenly, and some communities may be being left behind.

What Was Done

The study analysed repeated cross-sectional data from 18 waves of the Household, Income and Labour Dynamics in Australia (HILDA) Survey between 2002 and 2019, including Australians aged 15 years and older. Participants were grouped into six population subgroups based on their region of birth, and smoking was classified into ‘never smoking’, ‘current smoking’, and ‘ex-smoking’. To make fairer comparisons across groups with different social and demographic characteristics, the study used a statistical technique called inverse probability of treatment weighting (IPTW). We then compared smoking prevalence and inequalities over time, using Australian-born people as the reference group and examining patterns separately for men and women.

Key Findings

• Inequalities in ‘never smoking’ narrowed over time among men, with the absolute difference between the least favourable group and Australian-born men improving from -16.3% to -11.6%.
• Inequalities in ‘ex-smoking’ also became smaller, improving from -8.11% to 0.36%, suggesting the gap had almost disappeared by the end of the study period. However, the pattern was different for current smokers.
• Among men, the absolute inequality widened from 3.34% to 5.63%, and among women it increased from 0.86% to 2.71%.
• Men from the Middle East and Africa, and women from Europe, the Middle East, and Africa, had some of the poorest smoking outcomes, with increasing rates of individuals who current smoked, and a declining prevalence of those who have never smoked.

What This Means for Policy

The findings suggest that tobacco control policy should not focus only on reducing overall smoking rates but needs to reduce the gap between groups. The paper argues for culturally tailored and equity-focused strategies, rather than one-size-fits-all approaches. It points to the value of proportionate universalism: keeping tobacco control measures universal but providing extra and more targeted support to groups with greater need. The study also suggests that policy should pay closer attention to sex differences and to the social, cultural, and structural factors that shape smoking among immigrant communities, such as settlement stress, language barriers, and unequal access to support.

Citation & Links: Aung, L., Block, K., Maheen, H., Cooray, U. & Singh, A. (2026). Smoking inequalities among culturally diverse populations in Australia: A secondary dataset analysis of the HILDA survey 2002-2019. Tobacco Induced Diseases, 24(June), 100. https://doi.org/10.18332/tid/217085