Abstract
INTRODUCTION: Australia's limited social housing has created geographically concentrated locales of poverty with high smoking rates. The impact of social housing on smoking initiation among adolescent residents is unknown, despite adolescence being a critical period for smoking prevention. We examine the relationship between social housing residency and smoking initiation among adolescents to quantify the likelihood of smoking uptake among social housing residents compared to a similar cohort in other tenures, accounting for socioeconomic factors and household exposure to smoking. METHODS: We analyzed data on 15- to 18-year-old adolescents (n = 3132) from the Household, Income and Labour Dynamics in Australia survey (2001-2019). We applied inverse probability treatment weights to maximize exchangeability between social housing tenants and their counterparts in other tenures. We quantified the risk of smoking 5 years after exposure measurement among those in social housing on both an absolute and relative scale. Baseline covariates included household income, age at study entry, sex, family type, smoking at baseline, highest household education, and household exposure to smoking. RESULTS: Adolescent residents in social housing had a 17% greater risk of smoking 5 years after baseline measurement than their counterparts in all other tenures (Average Treatment Effect (ATE): 0.165, 95% confidence interval [CI] = 0.02 to 0.31). On the relative scale, those in social housing had 1.80 times (95% CI = 0.95 to 2.66) higher risk of being a smoker than those in other tenures. CONCLUSIONS: Adolescents residing in social housing have a higher risk of becoming smokers as young adults than their counterparts in other tenures, irrespective of smoking exposure in their own homes. IMPLICATIONS: This study investigates the impact of social housing on smoking initiation among adolescents, revealing that those residing in social housing have a higher risk of becoming smokers in young adulthood, independent of smoking exposure at home. The research highlights the contribution of social housing to ongoing disparities in smoking rates in Australia and emphasizes the need to further understand and review social housing provision from the perspective of its consequences on health. Moreover, the results advocate for comprehensive policies that extend beyond individualized harm reduction strategies to promote social inclusion and address health inequalities associated with smoking in adolescents.