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Australian Tobacco Smoking Rates by Occupation: Results from Three National Surveys Conducted between 1989 and PDF

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Arch Public Health 2008, 66, Australian Tobacco Smoking Rates by Occupation: Results from Three National Surveys Conducted between 1989 and 2001 by Smith DR 1,2 & Leggat PA 2,1 Abstract Aim The
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Arch Public Health 2008, 66, Australian Tobacco Smoking Rates by Occupation: Results from Three National Surveys Conducted between 1989 and 2001 by Smith DR 1,2 & Leggat PA 2,1 Abstract Aim The aim of this study was to establish historical smoking prevalence rates among the working population of Australia. A clearer understanding of tobacco usage trends by occupation would be helpful to ensure the more effective targeting of tobacco control interventions in the workplace. Methods Smoking data was extracted from the , 1995 and 2001 National Health Surveys, which captured approximately , and Australians (response rates: 92% to 96%). Participants were limited to employed adults aged years, with data stratified by job category and gender during the analysis. Results Slightly less than one-third (31%) of Australian workers were smoking in , a rate which declined to 25% in 1995 and then appeared to rise slightly to around 27% in A consistently higher proportion of males smoked tobacco when compared to females over all three surveys. By job category, tobacco use was most common among Labourers and Related Workers in , Plant and Machine Operators and Drivers in 1995 and Intermediate Production and Transport Workers in The lowest smoking rates were consistently reported among Professionals. Conclusions Overall, our study suggests that there were widespread variations in the smoking rates of working Australians between 1989 and Effective tobacco control strategies will clearly need to target blue collar employees, who continue to shoulder the main burden from tobacco-related disease. Keywords: smoking, occupation, Australia, prevalence, trends 1 University of Newcastle, WorkCover New South Wales Research Centre of Excellence, Ourimbah, Australia 2 James Cook University, Anton Breinl Centre for Public Health and Tropical Medicine, Townsville, Australia Correspondence Professor Derek R. Smith, WorkCover New South Wales Research Centre of Excellence, School of Health Sciences, Faculty of Health, University of Newcastle, Ourimbah New South Wales 2258, Australia. 126 Smith DR, Leggat PA. Introduction Tobacco smoking is a major public health priority, being the worlds second leading cause of death and the fourth most common risk factor for disease (1). Tobacco smoking also represents a significant occupational hazard (2), being associated with greater employee turnover, higher absenteeism rates and medical costs, as well as lower productivity and many other adverse workplace outcomes (3-5). Environmental tobacco smoke harms other people (6), and employers in almost every industry suffer beyond the burden of increased medical care for staff (7, 8). Tobacco use is not evenly distributed in the workplace however, with persistent and widening disparities by occupation, and smoking now becoming increasingly concentrated in certain occupational sub-groups (9, 10). As work sites are known to be an effective location for tobacco control initiatives (11, 12), accurate and up-to-date information on national tobacco smoking rates by job category are essential for the effective distribution and targeting of public health interventions in this regard. Tobacco smoking represents a major public health burden in Australia, being responsible for one of the largest negative impacts on population health, and contributing to more drug-related hospital separations and deaths than illegal drug use and alcohol consumption combined (13). While the absolute proportion of Australians who smoke has declined in recent years, by 2001 it had been noted that in a national population of approximately 19.4 million there were still over three-and-a-half million tobacco users (13). Despite this fact, detailed historical statistics on national smoking rates by occupation are comparatively rare in Australia. The earliest national studies on smoking prevalence rates conducted during the 1940s for example (14), were not truly scientific investigations, and the results were not stratified by occupation. Some workplace tobacco control opportunities may also have been missed in Australia, with many publications on national tobacco usage stratifying their data only by demographic items, or broad (blue collar / white collar) job categories (13-16). There is also a lack of occupational smoking data collected over time using a standard methodology. The purpose of our current study therefore, was to investigate the prevalence of occupational smoking in Australia between 1989 and 2001, with data sourced from three consecutive and nationally-representative surveys of similar methodology. Methods Sample Selection and Methodology This study utilized data extracted from the first three National Health Surveys (NHS) conducted by the Australian Bureau of Statistics (ABS). The ABS first began conducting National Health Surveys in 1989 to obtain detailed information on the national health status of Australians, their use of health services and the current state of health-related lifestyle factors (17). Detailed information on a variety of health indicators, including tobacco consumption was originally obtained by conducting the survey every five years (18), although since 2001, the NHS has been conducted every three years (19). The methodology involves a stratified, multistage area sample of both private and non-private dwellings throughout all geographical regions of Australia. For practical reasons, the study is usually limited to a representative sample of approximately one-third of one percent of the entire Australian Australian Tobacco Smoking Rates by Occupation 127 population, resulting in a final group of 20,000 to 50,000 individuals from all job categories. The surveys comprise face-to-face interviews conducted by trained personal interviewers (20-22). Nonetheless, a 100% response rate is never achieved due to participant refusal, being uncontactable on the day of their interview, and other reasons. NHS data is weighted to provide estimates relative to the entire Australian population, based on the data provided by persons who are actually sampled, and the likelihood of those people to have responded. Further details on the sampling methodologies and recruitment strategies for each of the three NHS used in this study are described elsewhere (17-22). Definition of Smoking Definitions for tobacco smoking used during the NHS surveys were based on standard definitions used in Australia at the time each survey was conducted (17-19). Respondents were asked if they currently smoke, whether they smoked regularly or whether they had ever smoked regularly. A current smoker was defined as an adult who smokes manufactured cigarettes, roll-your-own cigarettes, cigars and pipes, but excluding the chewing of tobacco and the smoking of non-tobacco products. The term regular was defined as consuming one or more such items per day. An ex-smoker was defined as someone who previously consumed tobacco in this manner, but does not smoke now. A never smoker was defined as someone who has never regularly smoked tobacco (17-19). Self-reported smoking status and interviewer-administered questionnaires are considered appropriate for epidemiological investigations, with the validity and accuracy of such methodologies being previously demonstrated (23, 24). Occupational Classification The occupational component of the NHS related to the main job held by employed respondents at the time of their interview. Occupations were coded according to the eight major job categories used in the Australian Standard Classification of Occupations (ASCO) First Edition, further details of which are available elsewhere (25). Widespread changes in award restructuring, technological improvements and the introduction of competency-based approaches to career entry and progression in Australia has led to major changes in the Australian labor market during the latter half of last century (26). This situation prompted a revision of the ASCO First Edition classification system beginning in 1992, with the ASCO Second Edition being used for subsequent national health surveys in 1995 and The current ASCO Second Edition uses a similar classification strategy as the International Labour Organization s (ILO) International Standard Classification of Occupations (ISCO-88) (26). An estimate of the total number of workers in each occupational category was also calculated for this study, based on information collected during each survey and the likelihood of each selected sample unit to have responded (17-19). Data Classification by Age All data was restricted to include only those participants aged between 18 and 64 years of age. Eighteen years is the age at which NHS interviewers begin to ask the participants questions about their tobacco smoking habits (17-19). Sixty-four years is the age at which the ABS considers most 128 Smith DR, Leggat PA. Australian workers to be retired. As such, it was anticipated that including younger and older age ranges would have led to a less realistic estimate of tobacco smoking rates among Australians of working-age. In addition, other national smoking surveys conducted in the United States (US) (10) and Australia (27) have also used a similar age range to identify working-age adults. Results FIGURE 1. Tobacco Smoking among Employed Australians Aged Years who Participated in the , 1995 and 2001 National Health Surveys Prevalence Rate Male Female Both The first two National Health Surveys conducted in and 1995 captured approximately and participants and achieved response rates of 96% and 92% and respectively. Budget constraints in later years prevented similarly large surveys from being conducted, and as such, the 2001 NHS contained only participants with a 92% response rate. More detailed information on the demographic background of participants, the exact number of responding individuals and the overall response rates for each survey is published elsewhere (17-22). Data from our current study suggests that there were approximately 7.6 million, 8.2 million and 8.7 million employed Australians aged between 18 and 64 years in , 1995 and 2001, respectively. Just under one-third (31.2%) reported themselves to be current smokers in , a rate which declined to 25.0% in 1995 and then rose slightly to 26.5% in The trend for ex-smokers varied during the same time period (21.7%, 25.7% and 23.7%), while the prevalence of never smokers rose slightly between each survey (47.1%, 49.3% and 49.8%). A consistently higher proportion of males were current smokers when compared to females over the duration of all three surveys, although a larger Australian Tobacco Smoking Rates by Occupation 129 proportion of females reported themselves to be never smokers. Please refer to Figure 1 for further details. By specific job category, the highest smoking rates were seen among Labourers and Related Workers in (40.3%), Plant and Machine Operators and Drivers in 1995 (35.5%) and Intermediate Production and Transport Workers in 2001 (39.7%). The lowest overall smoking rates by job category were consistently reported among Professionals, where only 17.4%, 13.9% and 16.8% were current smokers in , 1995 and 2001, respectively. By gender, male Professionals were the least likely to smoke across all three surveys (18.3%, 14.3% and 17.4%), although again, their decline in absolute smoking was not consistent, falling in 1995 but then rising in A similar trend was also seen among females, where 16.0% of professionals smoked in , a rate which fell to 13.5% by 1995, but rose again to 16.1% in Please refer to Tables 1, 2 and 3 for further details. TABLE 1. Tobacco Smoking by Occupation among Australians Aged Years who Participated in the National Health Survey Occupational Group (ASCO Code) a Estimated Workforce c 1) Managers and Administrators Male 28.5% 28.9% 42.6% Female 25.9% 16.8% 57.3% Both 27.9% 26.0% 46.1% ) Professionals Male 18.3% 24.1% 57.6% Female 16.0% 18.6% 65.3% Both 17.4% 21.9% 60.8% ) Para-Professionals Male 26.3% 26.8% 46.9% Female 27.4% 23.3% 49.3% Both 26.8% 25.3% 47.9% ) Tradespersons Male 38.0% 23.9% 38.1% Female 35.4% 9.9% 54.7% Both 37.8% 22.4% 39.8% ) Clerks Male 29.8% 24.9% 45.3% Female 27.0% 18.3% 54.7% Both 27.6% 19.8% 52.6% ) Salespersons and Personal Service Workers Male 33.9% 21.3% 44.8% Female 31.3% 17.0% 51.7% Both 32.3% 18.6% 49.1% ) Plant and Machine Operators and Drivers Male 41.6% 25.5% 32.9% Female 30.7% 13.2% 56.1% Both 39.8% 23.4% 36.8% ) Labourers and Related Workers Male 43.4% 22.5% 34.1% Female 35.3% 15.4% 49.3% Both 40.3% 19.8% 39.9% a Australian Standard Classification of Occupations code (ASCO First Edition) (25) b Prevalence in each group (individual rates may not add up to 100% due to rounding) c Calculated from total employment estimates during the Australian National Health Survey (individual figures may not add up to due to rounding) 130 Smith DR, Leggat PA. TABLE 2. Tobacco Smoking by Occupation among Australians Aged Years who Participated in the 1995 National Health Survey Occupational Group (ASCO Code) a Estimated Workforce c 1) Managers and Administrators Male 21.0% 33.1% 45.9% Female 17.5% 25.0% 57.5% Both 20.1% 31.0% 48.9% ) Professionals Male 14.3% 27.8% 57.9% Female 13.5% 22.4% 64.2% Both 13.9% 25.3% 60.7% ) Para-Professionals Male 21.4% 33.7% 44.9% Female 17.9% 28.6% 53.6% Both 19.7% 31.2% 49.1% ) Tradespersons Male 31.2% 26.4% 42.5% Female 26.2% 21.1% 52.6% Both 30.7% 25.8% 43.5% ) Clerks Male 22.8% 26.1% 51.1% Female 22.0% 24.6% 53.4% Both 22.2% 24.9% 52.9% ) Salespersons and Personal Service Workers Male 26.2% 26.1% 47.7% Female 23.7% 20.0% 56.2% Both 24.6% 22.2% 53.2% ) Plant and Machine Operators and Drivers Male 37.2% 31.1% 31.7% Female 25.1% 15.7% 59.3% Both 35.5% 28.9% 35.6% ) Labourers and Related Workers Male 39.7% 23.5% 36.8% Female 29.0% 21.1% 49.9% Both 35.3% 22.5% 42.2% a Australian Standard Classification of Occupations code (ASCO Second Edition) (26) b Prevalence in each group (individual rates may not add up to 100% due to rounding) c Calculated from total employment estimates during the 1995 Australian National Health Survey (individual figures may not add up to due to rounding) TABLE 3. Tobacco Smoking by Occupation among Australians Aged Years who Participated in the 2001 National Health Survey Occupational Group (ASCO Code) a Estimated Workforce c 1) Managers and Administrators Male 20.8% 29.5% 49.6% Female 14.4% 21.2% 64.4% Both 19.2% 27.4% 53.3% ) Professionals Male 17.4% 23.1% 59.5% Female 16.1% 24.4% 59.5% Both 16.8% 23.7% 59.5% ) Associate Professionals Male 23.8% 28.6% 47.5% Female 24.3% 23.7% 52.0% Both 24.0% 26.6% 49.4% ) Tradespersons and Related Workers Male 35.1% 22.3% 42.6% Female 26.7% 20.6% 52.8% Both 34.2% 22.1% 43.7% Australian Tobacco Smoking Rates by Occupation 131 Occupational Group (ASCO Code) a Estimated Workforce c 5) Advanced Clerical and Service Workers Male 19.8% 25.9% 54.4% Female 20.7% 26.0% 53.3% Both 20.6% 26.0% 53.5% ) Intermediate Clerical, Sales and Service Workers Male 27.6% 26.0% 46.4% Female 25.6% 21.8% 52.6% Both 26.1% 23.0% 50.9% ) Intermediate Production and Transport Workers Male 40.8% 25.6% 33.6% Female 33.6% 13.2% 53.2% Both 39.7% 23.8% 36.5% ) Elementary Clerical, Sales and Service Workers Male 29.2% 15.4% 55.3% Female 24.5% 19.7% 55.7% Both 26.3% 18.1% 55.6% ) Labourers and Related Workers Male 45.1% 25.0% 29.8% Female 30.0% 23.2% 46.8% Both 39.1% 24.3% 36.6% a Australian Standard Classification of Occupations code (ASCO Second Edition) (26) b Prevalence in each group (individual rates may not add up to 100% due to rounding) c Calculated from total employment estimates during the 2001 Australian National Health Survey (individual figures may not add up to due to rounding) Discussion Our current study presents one of the first analyses of Australian occupational smoking data sourced from three consecutive and nationally-representative surveys of similar methodology. Much can be learned about tobacco usage in the workforce by examining the results of national health surveys in this regard. The first prevalence data on smoking in the Australian population appears to have been a relatively basic study conducted in 1945, when around three-quarters of males and one-quarter of females were reported to be smokers (14). The first large-scale epidemiological investigation of national tobacco smoking habits in Australia was conducted in 1974 (28), although only a broad stratification of job categories had been performed by the authors. Even so, some differences were elucidated in the smoking prevalence rates of upper white collar workers when compared to lower blue collar workers. The first detailed investigation of Australia s national smoking rates by job category was conducted by the ABS in 1977 (29). In the ABS study, males and females working in the professional and technical fields were found to have the lowest overall smoking rates, as opposed to male miners or quarrymen, and females in the service, sport and recreation industries; where the highest rates were seen. Our current study found similar differences in smoking rates by occupation, with the highest prevalence reported among Labourers and Related Workers, Plant and Machine Operators and Drivers and Intermediate Production and Transport Workers, all of whom could be classified as blue collar employees. Similarly, the lowest overall smoking rates by job category were consistently found among those survey participants who were working as Professionals. Aside from the 1977 ABS study previously mentioned, some other authors have also reported historical differences in 132 Smith DR, Leggat PA. smoking rates by occupation. In the United States for example, Sterling and Weinkam (30) found that the higher smoking rates were among those employed in lower prestige paying jobs. A higher intensity of smoking among blue-collar workers was also reported in another early study from the US (31). Similar to our current investigation, a longitudinal analysis of US national smoking data by Lee et al (32) concluded that while the overall rates of smoking among US workers were probably declining by the late 20 th century, a large proportion of blue-collar workers continued to smoke. Various Australian researchers have looked at historical tobacco smoking trends, although most had used considerably broader occupational categories than our current study. White et al (15) for example, reported that between 1980 and 2001 there was a continual decline in tobacco smoking across the entire Australian population, with much of it experienced among the blue collar workforce. The slight rise in certain occupational smoking rates that we documented between 1995 and 2001 was therefore somewhat of an unexpected finding. On one hand, as the magnitude of this rise was relatively small (only a few percent), it may reflect a statistical artifact due to differences in survey methodologies, particularly the large difference in sample sizes between 1995 when people were sampled, and 2001, where the total sample was roughly halved (26 900). On the other hand, ASCO job classifications changed between the 1995 and 2001 NHS, which may have further affected the distribution of current smokers in different occupational subcategories. Skill level and skill specialization formed the basis of job classification in the ASCO First Edition, meaning that when it was introduced, ASCO was considerably different from most other occupational classifications then being used by national and international agencies (26). Widespread changes in industry, technological advances, restructuring and a greater focus on competency-based approaches to career entry and career development brought about major changes in the Australian labor market following introduction of the ASCO First Edition. For these reasons, a review of the ASCO First Edition was commenced in 1992, culminating in publication of the ASCO Second Edition by the ABS in The c
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