Alcohol and tobacco consumption: What is the role of economic security?

Abstract

Aims: To better understand the longstanding inequalities concerning alcohol and tobacco use, we aimed to quantify the effect of household economic security on alcohol and tobacco consumption and expenditure.

Design: Longitudinal analysis using data from the Household, Income and Labour Dynamics in Australia survey (2001-2018).

Setting: Australia PARTICIPANTS: A nationally representative cohort of 24 134 adults aged 25-64 years (187 378 observations).

Measurements: Tobacco and alcohol use (Yes/No), frequency of use of each per week, household expenditure on each per week, household weekly income (Consumer Price Index [CPI]-adjusted), employment security (based on conditions of employment) and housing affordability (housing costs relative to household income).

Findings: At baseline, one-quarter of the sample used tobacco and 87% used alcohol. Annual increases in household income were associated with the increased use of both tobacco and alcohol for people in households in the lowest 40% of the national income distribution (OR = 1.13, 95% CI = 1.03-1.23 and OR = 1.12, 95% CI = 1.04-1.20, respectively) with no similar income effect observed for higher-income households. In relation to smoking, the odds of a resident's tobacco use increased when their household was unemployed (OR = 1.32, 95% CI = 1.07-1.62). In relation to alcohol, the odds of use decreased when households were insecurely employed or unemployed, or housing costs were unaffordable (OR = 0.87, 95% CI = 0.77-0.98, OR = 0.66, 95% CI = 0.55-0.80 and OR = 0.84, 95% CI = 0.75-0.93, respectively). This was also reflected in the reduced odds of risky drinking (defined in accordance with Australian guidelines) when housing became unaffordable or households became unemployed (OR = 0.90, 95% CI = 0.81-0.99; OR = 0.82, 95% CI = 0.69-0.98, respectively).

Conclusions: In Australia, smoking and drinking appear to exhibit different socio-behavioural characteristics and household unemployment appears to be a strong determinant of smoking.

Keywords: alcohol; employment; housing; longitudinal; security; tobacco.