Australia has made major progress in tobacco control, with population prevalence of smoking falling substantially since the 1960s. Australia has one of the lowest smoking rates among the Organisation for Economic Co-operation and Development (OECD) countries.¹ In 2019, 11% of Australians smoked tobacco daily, down from 12.2% in 2016 and 24% in 1991.² In recent years, smoking rates have also fallen for Aboriginal and Torres Strait Islander peoples, but the prevalence remains unacceptably high (37% in 2018–19).^1,3 Despite the decline in prevalence, smoking remains the behavioural risk factor responsible for the highest levels of preventable disease and premature death.¹

Smoking rates are influenced by socioeconomic status, with higher rates in low socioeconomic status communities. Smoking rates remain high in key population groups, including people with mental illness. Smoking in pregnancy has serious adverse effects for both the mother and developing fetus.

Many people start smoking in during adolescence, with 80% of long-term smokers having started smoking before the age of 20 years.⁴ The prevalence of e-cigarette use is on the rise, even among individuals who have never smoked before. From 2016 to 2019, the percentage of people who had tried e-cigarettes increased from 8.8% to 11.3%.² Although the use of e-cigarettes grew across various age groups, the increase was particularly significant among young adults. Among individuals aged 18–24 years, almost two-thirds (64%) of current smokers and one-fifth (20%) of non-smokers reported experimenting with e-cigarettes. In addition, among those who had tried e-cigarettes, the frequency of use also escalated, with a greater number of people using them at least once a month (rising from 10.3% in 2016 to 17.9% in 2019).² There is increasing evidence that non-smokers who use e-cigarettes are more likely than those avoiding e-cigarettes to start cigarette smoking and become current smokers.⁵

Up to half of all smokers can be expected to die from a smoking-related condition.⁶

The delivery of smoking cessation advice is likely to be one of most effective interventions in reducing mortality.⁸ Some smokers may not be ready to quit, but may still benefit from brief advice about smoking cessation.

Using the Ask Assess Help model as part of shared decision making by considering readiness to quit.

Nicotine dependence can be assessed by asking about the:

• number of minutes between waking and smoking the first cigarette
• number of cigarettes smoked a day
• type of craving or withdrawal symptoms experienced in previous quit attempts.²

There is a high likelihood of nicotine dependence if the person smokes within 30 minutes of waking and smokes more than 10–15 cigarettes a day.

Referrals to Quitline, SMS cessation services and online cessation support are all effective and may complement brief interventions delivered by clinicians.

See RACGP’s Supporting smoking cessation: A guide for health professionals for more information on smoking cessation advice and follow up.

For specific recommendations for Aboriginal and Torres Strait Islander people, please refer to the Smoking section in the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people.

Supporting smoking cessation: A guide for health professionals | RACGP