What factors are associated with never initiating smoking among Aboriginal and Torres Strait Islander people aged 16-24 years? Evidence from The Next Generation Youth Wellbeing Study

Abstract Introduction Despite reductions in tobacco smoking among Aboriginal and Torres Strait Islander peoples since 2004, particularly among youth, smoking remains elevated in Indigenous communities – highlighting the importance of understanding why some Aboriginal and Torres Strait Islander people never take up smoking. Methods Taking a strength-based approach and using data from 474 Aboriginal and Torres Strait Islander youth aged 16–24-years joining the Next Generation Youth Wellbeing Study (Western and Central Australia, New South Wales), 2018-2020, age-, sex- and family-adjusted prevalence ratios (PR) for never-smoking relative to sociodemographic, health, social and other factors across socioecological levels were estimated through Poisson regression. Results Overall, 45% of participants had never smoked tobacco; 31% reported current daily/weekly/monthly smoking, indicating a normative shift. Among those who ever smoked, mean initiation age was 15. Never-smoking was greater with: younger age [16-17-years (PR=1.9; 95% Confidence Interval=1.5-2.5), 18-20 (1.3;1.0-1.8)]; completing ≥Year 10 (1.8;1.1-3.0); no interaction with (1.9;1.5-2.5) or being charged by police (2.3;1.5-3.3); never being imprisoned (2.5;1.2-4.8); not having friends imprisoned (1.7;1.3-2.2); having non-smoker friends (1.8;1.4-2.2); never vaping (5.7;3.2-10.1) or smoking marijuana (7.9;4.9-12.8), never having tried alcohol (2.4;2.0-3.0); higher physical activity (1.4;1.1-1.7); lower psychological distress (1.3;1.1-1.6), never being diagnosed with depression (1.5;1.1-2.1) or anxiety (1.7;1.2-2.4) and having ‘good-to-excellent’ perceived health (1.5;1.1-2.1), compared with not having these attributes. Conclusion These findings highlight the importance of strengthening family, community, and social environments that protect against smoking initiation and support smoking cessation and call for sustained structural and policy reforms to address systemic drivers of tobacco use.