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Clinical guidelines

Supporting smoking cessationA guide for health professionals

Introduction

Australia has made major progress in tobacco control with population prevalence of smoking falling substantially since the 1960s. In recent years smoking rates have continued to fall, including in the Aboriginal and Torres Strait Islander population for the first time – where rates have been unacceptably high.1,2,3 However, despite the decline in prevalence, smoking remains the behavioural risk factor responsible for the highest levels of preventable disease and premature death.4 The task of further reducing the number of Australians who are using tobacco requires a collaborative effort between government, health authorities, health professionals and the community at large.

The former chief adviser to the Australian Government on tobacco control, Professor David Hill, has likened tobacco control efforts to keeping a spring compressed – take the pressure off and rates of tobacco use, and the harm that follows, will rebound. Tobacco control involves preventing uptake and supporting cessation. Health professionals play a key role in both, but have a particular responsibility to assist all smokers to stop.5,6 Reducing parental smoking rates is the intervention with the clearest effect on youth smoking uptake.

Two publications, Smoking cessation guidelines for Australian general practice (2004)7 and Smoking cessation pharmacotherapy: an update for health professionals (2009),8 provided a framework for assisting quitting, and informed health professionals of developments in the understanding of nicotine addiction and the pharmacotherapies available to assist smoking cessation. These publications were based on a literature review undertaken for the National Tobacco Strategy,9 experience with cessation programs in Australia – in particular the Smokescreen Program10 – and international experience with smoking cessation guidelines in other countries.11–14

Since these publications, there have been important developments in both the science and practice of cessation support. These include advances in our understanding of the neurobiology of nicotine addiction, further research on the use of varenicline and substantial changes in the approved use of nicotine replacement therapy (NRT). Another important development for smoking cessation in Australia has been the listing of nicotine patches on the Pharmaceutical Benefits Scheme (PBS), initially for Aboriginal and Torres Strait Islander people in 2008, and for the general community since February 2011. In recognition of the emerging evidence and the need to keep this guide current, updates were done in June 2012 and 2014.

Supporting smoking cessation: a guide for health professionals aims to be a practical, succinct and evidence-based resource that can be used by a wide range of health professionals working in a variety of contexts. As with the previous publications, it is based on research evidence and is informed by guidelines from other countries with similar population profiles. It seeks to link smoking cessation advice by health professionals to the materials and support services provided through the telephone quitlines operating in each state and territory. It also seeks to build on the momentum for cessation gained by public health interventions such as tax increases, restrictions on smoking in public places, changes to tobacco display and packaging and the social marketing of smoking cessation.

     
  1. Australian Institute of Health and Welfare. 2010  National Drug Strategy Household Survey report. Drug statistics series no. 25. Cat. no. PHE 145. Canberra: AIHW, 2011. Available at http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737421314 [accessed 12 August 2011].
  2. Australian Institute of Health and Welfare. Substance use among Aboriginal and Torres Strait Islander people. Cat. no. IHW 40. Canberra: AIHW, 2011. Available at www.aihw.gov.au/publication-detail/?id=10737418268 [accessed 19 August 2011].
  3. Australian Bureau of Statistics. Australian Aboriginal and Torres Strait Islander Health Survey: first results, Australia, 2012−13.  Cat. no. 4727.0.55.001. Canberra: ABS, 2013.
  4. Australian Institute of Health and Welfare. Australia’s health 2008. Cat. no. AUS 99. Canberra: AIHW, 2008.
  5. Mullins R, Livingston P, Borland R. A strategy for involving general practitioners in smoking control. Aust N Z J Public Health 1999;23:249–51.
  6. Richmond RL. The physician can make a difference with smokers: evidence based clinical approaches. Int J Tub Lung Dis 1999;3:100–12.
  7. Zwar N, Richmond R, Borland R, Stillman S, Cunningham M, Litt J. Smoking cessation guidelines for Australian general practice: practice handbook. Canberra: Australian Government Department of Health and Ageing, 2004.
  8. Zwar N, Richmond R, Borland R, et al. Smoking cessation pharmacotherapy: an update for health professionals (updated 2009). Melbourne: The Royal Australian College of General Practitioners, 2009.
  9. Miller M, Wood L. Effectiveness of smoking cessation interventions: review of evidence and implications for best practice in Australian health care settings. Aust NZ J Public Health 2003;27(3):300–9.
  10. Mendelsohn CP, Richmond RL. Smokescreen for the 1990s. A new approach to smoking cessation. Aust Fam Physician 1994;23:841–8.
  11. Fiore MC, Jaén CR, Baker TB, Bailey WC, et al. for the Guideline Panel. Treating tobacco use and dependence: 2008 update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service, May 2008. Available at http://www.ncbi.nlm.nih.gov/books/NBK63952/  [accessed 20 March 2011].
  12. Ministry of Health. New Zealand Smoking Cessation Guidelines. Wellington: Ministry of Health, 2007. [accessed 23 March 2011]. Available at http://www.health.govt.nz/publication/new-zealand-guidelines-helping-people-stop-smoking
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