Smoking rates declining, but still a way to go

One hundred million.
 
That is how many people died tobacco-related deaths throughout the world in the 20th century, according to the World Health Organization (WHO).
 
The number now sits at 5.4 million deaths every year.
 
That makes tobacco, perhaps unsurprisingly, the world’s leading cause of preventable death.
 
Australia’s smoking rates are steadily falling, with the proportion of people who smoked daily in 2015 making up 15.5% of the population, compared to 24.2% in 2011. The current national smoking rate is 14%.
 
When broken down by states, Tasmania’s suburbs rank the highest for smoking rates, followed by New South Wales and South Australia. NSW also boasts the highest rates of non-smoking suburbs.
 
Professor Nicholas Zwar, GP and Chair of the Content Advisory Group for the RACGP’s Supporting smoking cessation: A guide for health professionals, warns that the declining numbers should not make people complacent.
 
‘We shouldn’t think that it’s all over and we can just relax,’ he told newsGP.
 
Annual initiatives such as the WHO's World No Tobacco Day remain an important reminder, according to Professor Zwar.
 
‘Sometimes there’s an assumption to think that tobacco dependency is a problem of the past – people don’t smoke anymore,’ he said. ‘But, in fact, in remains one of our key public health challenges in terms of effects on adverse health outcomes.
 
‘Public policy support from health professionals to help people quit tobacco, increased tobacco prices, public banning of advertising, banning smoking in public places, public health campaigns, have all been very effective [in contributing to smoking cessation rates].’
 
Health professionals, particularly GPs, play a key role in effectively promoting and supporting smoking cessation.
 
‘GPs have a lot of contact with the Australian community and ... a very important role in raising the issue of smoking as probably the single biggest change in behaviour in terms of health, and encouraging people to consider quitting smoking and supporting quitting, should people be willing to try,’ Professor Zwar said.
 
He emphasises that there are certain examples where quitting smoking has particular health benefits, such as during pregnancy or for people who have a smoking-related disease, so GPs can use these opportunities as a springboard for encouraging smoking cessation.
 
Recognising particular populations who require extra support is also an important, though often overlooked, opportunity.
 
‘Although rates of smoking are quite low in the Australian population overall, this can be a little deceptive in that there are still groups in the community who have high rates of smoking and who are getting many adverse health outcomes related to that,’ Professor Zwar said.
 
‘[For example], people with mental health issues tend to have high smoking rates and need particular assistance to quit.
 
‘There can be an assumption that people with mental health issues are not interested in quitting – the evidence shows that they are interested in quitting but it’s a bigger challenge for them, so assistance there is very relevant from health professionals, particularly GPs.
 
‘Aboriginal and Torres Strait Islander people also still have high rates of smoking and a lot of adverse health effects related to smoking. So for this population, support is particularly important.’
 
Updated guidelines
The RACGP’s Supporting smoking cessation: A guide for health professionals is currently under consultation for an update.
 
Professor Zwar said the update will include a number of ways of using existing smoking cessation medicines, as well as information on the somewhat contentious issues of e-cigarettes and the effectiveness and safety of nicotine-replacement therapy as an aid to quitting in pregnancy.
 
‘We’re looking at a number of new developments in the world of smoking cessation,’ Professor Zwar said.
 
‘Probably the most controversial of those is what role e-cigarettes may have in the role of helping people to quit smoking. We’re looking closely at what literature there is on the effectiveness and safety of e-cigarettes, in the context of smoking cessation in particular,’ Professor Zwar said.
 
‘Also, we’re looking at issues to do with new ways of smoking cessation medicines, such as combining varenicline with nicotine replacement, with longer courses of nicotine replacement to see whether that reduces relapse.’
 
Professor Zwar sees the updated guidelines as an important tool for general practice to promote and support smoking cessation, especially given the still relatively high rates of tobacco use.
 
Quoting David Hill, former Chief Advisor of Tobacco, Professor Zwar said that ‘tobacco is like a spring – if you take your hand off, the prevalence will jump back up’.
 
‘World No Tobacco Day is a reminder of that, and it’s also a reminder that although the tobacco pandemic might be decreased in Australia, in some other countries tobacco use is still very prevalent, and in some cases, increasing,’ Professor Zwar said.
 
‘It remains a very major problem and tobacco control around the world still has a fair way to go.’

preventive health smoking cessation tobacco