Smoking prevalence trends in Indigenous Australians, 1994-2004: a typical rather than an exceptional epidemic

BACKGROUND: In Australia, national smoking prevalence has successfully fallen below 20%, but remains about 50% amongst Indigenous Australians. Australian Indigenous tobacco control is framed by the idea that nothing has worked and a sense of either despondency or the difficulty of the challenge. METHODS: This paper examines the trends in smoking prevalence of Australian Indigenous men and women aged 18 and over in three large national cross-sectional surveys in 1994, 2002 and 2004. RESULTS: From 1994 to 2004, Indigenous smoking prevalence fell by 5.5% and 3.5% in non-remote and remote men, and by 1.9% in non-remote women. In contrast, Indigenous smoking prevalence rose by 5.7% in remote women from 1994 to 2002, before falling by 0.8% between 2002 and 2004. Male and female Indigenous smoking prevalences in non-remote Australia fell in parallel with those in the total Australian population. The different Indigenous smoking prevalence trends in remote and non-remote Australia can be plausibly explained by the typical characteristics of national tobacco epidemic curves, with remote Indigenous Australia just at an earlier point in the epidemic. CONCLUSION: Reducing Indigenous smoking need not be considered exceptionally difficult. Inequities in the distribution of smoking related-deaths and illness may be reduced by increasing the exposure and access of Indigenous Australians, and other disadvantaged groups with high smoking prevalence, to proven tobacco control strategies.