Introduction and Aims: Smoking is a major cause of preventable illness for Indigenous peoples. As most regular smoking is established during adolescence when other substances are often first used, effective tobacco prevention requires an understanding of the patterns of related substance use for Indigenous youth.
Design and Methods: We reviewed smoking among Indigenous students through cross-sectional analyses of the 2017 Australian Secondary Students' Alcohol and Drug survey and compared findings to non-Indigenous participants. We used logistic regression to evaluate differences in prevalence of tobacco, alcohol and cannabis use, and how smoking and other substance use were related.
Results: Past month smoking was strongly associated with alcohol and cannabis use for both Indigenous and non-Indigenous students. The association between tobacco and cannabis use did not differ by Indigenous status, but the tobacco and alcohol use association was weaker for Indigenous students (P = 0.004). However, the prevalence of tobacco [odds ratio (OR) 1.91 (95% confidence interval; CI 1.55, 2.36)], alcohol [OR 1.44 (1.25, 1.66)] and cannabis [OR 1.97 (1.56, 2.48)] use in the past month was significantly higher in Indigenous than non-Indigenous students. Even within the most socially advantaged sub-group, Indigenous students were more likely to smoke than non-Indigenous students [OR 3.37 (2.23, 5.09)].
Discussion and Conclusions: Cannabis and alcohol use are important predictors of smoking for all students. Tobacco policies and community programs must address common determinants of tobacco and other substance use, including resilience and social influence skills as well as broader family and community factors that may be different for Indigenous students.