What explains the smoking prevalence disparity between Indigenous and non-Indigenous Australians?

Abstract

Persistent disparities in smoking prevalence between Indigenous and non-Indigenous Australians have been widely attributed to systemic discrimination and the enduring impacts of colonisation. However, limited empirical evidence exists on the extent to which these structural and social determinants contribute to the observed gap. This study investigates the drivers of smoking prevalence disparities using nationally representative longitudinal data from Australia (2002–2022). Employing regression analysis and a modified two-fold decomposition approach, we quantify the contributions of various explanatory factors. Our analysis identifies financial distress and alcohol consumption as primary contributors to the explained component of the disparity, with age and educational attainment also playing significant roles. These findings reflect broader socioeconomic inequalities that disproportionately affect Indigenous communities. Notably, a substantial portion of the disparity remains unexplained, suggesting the influence of unobserved factors such as systemic discrimination, cultural norms, colonisation, peer effects, and intergenerational trauma. Despite targeted tobacco control efforts, smoking rates remain markedly higher among Indigenous Australians, particularly in remote regions. Our study underscores the need for comprehensive, culturally responsive strategies to address both structural determinants and unobserved influences to reduce smoking prevalence disparities and achieve health and wellbeing equity for Indigenous Australians.