Technical Paper 2:
Tobacco Control in Australia: making smoking history
3.6.1 Social inclusion
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Adolescents with weak bonds to parents, school and other community institutions are at increased risk of engaging in deviant behaviour.[439-441] Students who start to fail at school are much more likely to ‘act out’ and to engage in high-risk behaviours, including smoking.[441-445]
New evidence since 2004
A study of the social determinants of smoking showed that, adjusted for age and gender, Indigenous people who had been removed from their natural family are half as likely to be a non-smoker. Likelihood of being a non-smoker reduces with lower household income and education, and nine other indicators of social disadvantage.
While dozens of social problems can be associated with high rates of smoking, it is evident that many of these problems stem from and could be mitigated by the prevention of educational failure in children.
In Australia, children who predict that they will complete Year 12 are much less likely to have ever tried smoking (or cannabis, inhalants, amphetamines or hallucinogens).
Young people who do well at school are more likely to understand information about health risks, and are more likely to feel connected to school and to feel hopeful about their future. If they succeed in further education and get a good job, they are much less likely to end up in stressful personal circumstances, or be part of social groups where many people smoke.
As Graham et al. have demonstrated:
“Education eliminates the effect of childhood circumstances on these dimensions of smoking status, suggesting that childhood conditions exert their influence through education. Education in turn determines adult socioeconomic position, with poor adult circumstances adding further to the risk of smoking in adulthood and reducing the odds of quitting.” pii8
Findings of American research on the association between social cohesion and lower smoking rates, and the relationship between social cohesion and self-reported health status, suggest that improvements in social capital could help to reduce smoking uptake. European research suggests that policies to reduce the ugliness and disorder of the most disadvantaged neighbourhoods, and to provide opportunities for young people to participate in activities that build a sense of community, may reduce risk-taking behaviour, including smoking.[450, 451]
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Progress in Australia
The Cancer Council of NSW and the Council of Social Services of New South Wales have jointly released a Tobacco Control and Social Equity Strategy to build the capacity of social service agencies to contribute to tobacco control efforts and better integrate tobacco control into economic and welfare responses to social disadvantage.
Ideas for consideration
Government efforts to ensure universal access to child and maternal health services and early-childhood education, a well-resourced public school system that can attract and retain skilled teachers, and use of evidence-based programs to screen for and address early problems with literacy and numeracy are all likely to reduce uptake of high-risk behaviours such as smoking.
Initiatives that improve parenting, prevent family breakdown and promote resilience in children should help not only to prevent educational failure but also the development of mental health and other personal and social problems, all of which are highly correlated with smoking uptake.[453, 454]
Initiatives to encourage training in trades and business skills for young people who are not interested in white-collar jobs may also be useful in interrupting smoking trajectories among young men currently at high risk of unemployment. Continuation of education for young women who have babies before they complete school could also be helpful.
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