Background

Despite declining rates of smoking, tobacco remains the second leading risk factor for disease burden in Australia. Inequalities in smoking prevalence between people with and without disabilities are well documented, but pathways to smoking (initiation, quitting, and relapse) remain poorly understood. We aimed to estimate the prevalence of smoking status and the annual rates of initiation, quitting and relapse among people with and without disabilities in Australia over the past two decades.

Methods

We used data from the Household, Income and Labour Dynamics in Australia Survey from 2002 to 2023. We calculated the prevalence of non-smokers, smokers, and former smokers, and rates of smoking initiation, quitting, and relapse for people with disabilities and without disabilities aged 15–44 years old for each wave, accounting for the complex survey design. Initiation, quitting, and relapse were determined based on changing smoking status between two consecutive years. We standardized estimates by age and sex.

Results

Smoking prevalence decreased from 38.1% in 2002 to 24.7% in 2023 among people with disabilities, and from 27.4% to 13.8% among those without disabilities. Quitting rates increased for both groups but remained consistently lower among people with disabilities: 9.4% to 18.1% among smokers with disabilities vs. 16.1% to 21.5% among smokers without disabilities. Smoking initiation and relapse failed to decline during the study period. The annual rate of initiation remained at approximately 3% among non-smokers and relapse at 15% among former smokers, regardless of disability status.

Conclusion

People with disabilities now have the smoking prevalence that people without disabilities had two decades ago, highlighting a persistent, generation-long gap. Further, our results show that public policies are failing to close the disability gap in smoking cessation and to reduce smoking initiation and relapse for all Australians.