Background: Commercial tobacco is the leading cause of preventable death and disease among Aboriginal and Torres Strait Islander peoples. It is responsible for half of all deaths in those aged 45 years and over. Its widespread use reflects the enduring impacts of colonisation. In 2017, we used the four-stage Lopez model to describe the smoking epidemic trajectory for Aboriginal and Torres Strait Islander peoples (stage3: declining prevalence, increasing mortality). We aimed to use contemporary data to update this assessment.

Methods: Published data on Aboriginal and Torres Strait Islander peoples’ smoking prevalence, smoking attributable fraction (SAF), and lung cancer mortality rates were extracted and assessed in line with the Lopez model. Additional indicators were included to extend the model (vaping prevalence, community awareness of tobacco-related harms and support for tobacco control policy, and policy responses).

Results: The tobacco epidemic among Aboriginal and Torres Strait Islander peoples is in stage 3 and may be transitioning to stage 4. There has been a continued decline in the prevalence of current cigarette use (54.4% in 1994 to 34.1% in 2022-23) and a potential stabilisation of smoking-related mortality in those aged ≥45 years (SAF estimates stable between 2009-18 and subsequent decades; 44.8%-55.9%). In addition, the tobacco epidemic among Aboriginal and Torres Strait Islander peoples is characterised by the emergence and rise of e-cigarette use, high societal awareness of harms and support for stricter tobacco control policy, and the implementation of policy and programs to address structural drivers of tobacco use.

Conclusion: Findings reinforce the urgency of Aboriginal and Torres Strait Islander tobacco control, including the abolition of the tobacco industry. The Lopez model provides important insights, but limited utility. An extended model of the tobacco and nicotine epidemic that explicitly centres Indigenous data governance and Indigenous-led approaches is proposed.