Patterns of smoking by age and ethnicity: an analysis of New Zealand Health Survey data between 2020 and 2022

The Aotearoa New Zealand Government has a Smokefree Aotearoa Goal to reduce daily smoking prevalence to under 5% for all population groups by 2025. This goal is unlikely to be met. Daily smoking prevalence declined from 16.4% in 2011/2012 to 6.8% in 2024/2025,² and substantial inequities persist. Daily smoking prevalences were 15.0% for Māori and 10.3% for Pacific peoples in 2024/2025.²

There have been many important developments in the policy environment in Aotearoa New Zealand over the past decade.³ Following the repeal of key tobacco control measures included in the previous action plan, in 2024 the Government launched a Getting to Smokefree 2025 action plan,¹ building on existing measures such as cessation support and health promotion campaigns. The plan stated smoking rates have “fallen dramatically for younger age groups” and “smoking uptake among young people is low”.¹ This was supported by data from the New Zealand Health Survey (NZHS), which showed reductions in daily smoking prevalence to 4.4% among 18–24-year-olds in 2024/2025. ² It has also been suggested that the low smoking prevalence among young people meant interventions such as a smokefree generation were no longer required.⁴ However, smoking prevalence by ethnicity among young people (or other age groups) is not reported on the NZHS Data Explorer online.²

This study aimed to identify how smoking prevalence varies by ethnicity and age in Aotearoa New Zealand. At the time of analysis, the latest available adult NZHS datasets were 2020/2021 and 2021/2022 with a combined sample size of 14,143 participants. Participants under the age of 18 were excluded (n=359). Participants who refused to answer or answered “don’t know” regarding smoking status were also excluded (n=18), leaving 13,766 participants. We did not analyse smoking prevalence among under-18-year-olds as the sample size was small and precision of prevalence estimates low.

The analysis is part of a wider study registered on Open Science (see: https://osf.io/avdkn) with University of Otago ethical approval (HD23/102).

Data were analysed in R 4.5 (R Core Team, 2025, R Foundation for Statistical Computing) and presented as n-values and prevalence estimates with 95% confidence intervals (CIs), with prevalence and CIs accounting for the survey design of the NZHS.⁵ Absolute differences are reported within age strata comparing estimates for Māori, Pacific and non-Māori/non-Pacific/non-Asian. No further adjustments were made.

Smoking status was defined as reporting having smoked a “total of more than 100 cigarettes in your whole life” and smoking at least once a day (daily smoking) or at least once a month (monthly smoking). Prevalence estimates are reported by total response ethnicity classification, with a residual category of non-Māori/non-Pacific/non-Asian.⁶

Daily smoking prevalence for ages 18–24 was 8.4% overall (95% CI 6.2–11.3) (Figure 1). Daily smoking prevalence for 18–24-year-olds was considerably higher for Māori at 18.7% (95% CI 13.2–25.7) than non-Māori/non-Pacific/non-Asian at 5.0% (95% CI 3.2–7.7), representing an absolute difference of 13.7% (95% CI 7.2–20.2). Prevalence for Pacific peoples aged 18–24 was 16.0% (95% CI 6.4–34.7; absolute difference compared with non-Māori/non-Pacific/non-Asian 11.0, 95% CI −2.8–24.8). Daily smoking was also substantially higher for Māori and Pacific peoples compared with non-Māori/non-Pacific/non-Asian peoples in both 25–44 and 45+ age groups (Figure 1).

View Figure 1.

Similar patterns were observed for current smoking (Figure 1), with a prevalence for people aged 18–24 of 11.4% (95% CI 8.9–14.4). Current smoking prevalence in this age group was again considerably higher for Māori (21.5%, 95% CI 15.8–28.6) compared with non-Māori/non-Pacific/non-Asian (7.6%, 95% CI 5.5–10.6), with an absolute difference of 13.9% (95% CI 7.1–20.6%). Current smoking prevalence for Pacific peoples aged 18-24 was 20.1% (95% CI 9.7–37.0); absolute difference compared with non-Māori/non-Pacific/non-Asian 12.5 (95% CI −1.2–26.1). Current smoking in both the 25–44-years and 45-years-and-over age groups was higher for Māori and Pacific peoples compared with non-Māori/non-Pacific/non-Asian.

In summary, daily and current smoking prevalences among young Māori were around three times as high as the prevalences among the non-Māori/non-Pacific/non-Asian population of young people, with absolute differences over 13%. Differences in smoking prevalence by ethnicity most likely represent the outcome of multiple contextual factors such as experiences of structural disadvantage and racism, rather than being due to ethnicity itself.⁷

A key strength of this study is the use of NZHS data as a large and nationally representative population survey.² The 2020/2021 and 2021/2022 datasets were combined due to small numbers of participants, in part due to fieldwork disruptions from the COVID-19 pandemic.⁸ The three age groups were selected to assess smoking patterns at different stages of life, with people aged 45 and over more likely to have formerly smoked and less likely to vape compared with the 18–24-year-old age group.² The relationship between vaping and smoking prevalence is beyond the scope of this analysis; however, we are undertaking analyses of NZHS data to investigate it (see: https://osf.io/avdkn).

In 2024/2025 daily smoking prevalence among 18–24-year-olds was 4.4%.² The full NZHS datasets from 2022/2023 to 2024/2025 were not available to external researchers at the time of this report so we do not know smoking prevalence among Māori and Pacific young people in 2024/2025. However, the evidence of substantial inequities we have reported in the 2020/2021 and 2021/2022 surveys, alongside evidence of persisting inequities in smoking prevalence by ethnicity among all adults,^2,9 suggests that daily smoking prevalence for Māori and Pacific young people is likely to be above 5% and that substantial initiation of smoking in these groups is continuing.

However, other sources suggest inequities in smoking prevalence by ethnicity are also present among people under the age of 18. Data from the 2024 ASH Year 10 Snapshot Survey of 14–15-year-olds show that while the daily smoking prevalence was 1.2% overall for this year group, it was highest among Māori students (2.9%), followed by Pacific (1.7%), European/Pākehā (0.7%) and Asian students (0.4%).¹⁰

These findings demonstrate the importance of having access to data by both age and ethnicity when assessing progress, as population averages can hide stark differences between groups. We strongly recommend adding the facility to present key measures like smoking prevalence stratified by both age and ethnicity to the online NZHS Data Explorer,² as long as Indigenous data sovereignty principles are observed. In 2010, Māori leaders called for a goal to eliminate smoking to address persisting inequities.¹¹ The NZHS data suggest inequities have not been addressed and substantial numbers of Māori young people continue to start smoking. It is highly unlikely that the Smokefree Aotearoa 2025 goal has been achieved for young Māori. This highlights the continued need for the implementation of robust interventions to equitably protect young people from starting to smoke.

View Appendix.