Jeremy Lasek – PHAA
While the prevalence of smoking has steadily declined (by 75%) in the last 40 years in Australia, it still contributes to around 20,000 deaths a year – that’s 20 times more than the number of deaths on our roads.
Tobacco is also the leading cause of cancer in Australia, contributing to 22% of cancer burden, as well as contributing to 41% of respiratory disease and 12% of cardiovascular diseases.
The December 2021 launch of the government’s long-awaited 10-year National Preventive Health Strategy (NPHS) reinforced a commitment to clear targets for reducing tobacco use.
Australia is already among world leaders in this area, seeing the proportion of adult daily smokers drop by a tenth, from 23.8% in 1995, to 13.8% in 2017-18.
The NPHS puts forward ambitious targets to continue that downward trend: “A national daily smoking prevalence of less than 10% by 2025 and 5% or less for adults (≥18 years) by 2030.”
Perhaps more important is the target from the Aboriginal and Torres Strait Islander Health Plan 2013–2023, to “reduce the smoking rate among Aboriginal and Torres Strait Islander adults to 40% by 2023.”
This has been reinforced in the just released National Aboriginal and Torres Strait Islander Health Plan 2021-2031.
The Plan has a key objective to: “Implement culturally safe and responsive solutions to prevent the uptake of tobacco use. Activity to prevent tobacco use must remain a priority, including reviewing evidence to ensure that population health approaches are targeted appropriately to reach those most at risk.
“There must also be a focus on the cultural determinants and social determinants of tobacco use before it starts in young people, as well as a focus on geographic regions with high levels of smoking prevalence. Activities must also include monitoring and targeting the use of emerging products, such as e-cigarettes and vapes.”
Smoking among those with mental illness
The damage caused by smoking is also the subject of a new study, Monitoring changes in smoking and quitting behaviours among Australians with and without mental illness over 15 years, published in the Australian and New Zealand Journal of Public Health (ANZJPH).
The study analysed data from “Australia’s triennial National Drug Strategy Household Surveys 2004–2019. The prevalence of regular smokers, never smokers, the quit proportion, cigarette consumption, and use of cessation aids were examined for those with and without mental illness.”
The ANZJPH report notes previous research that states:
- A widening gap in average lifespan is occurring between people with and without mental illness, with both genders living more than 10 years less than the general population when affected by mental illness.
- Living with mental illness in Australia is associated with several unfavourable health, social and economic outcomes.
The ANZJPH report also noted that, according to two studies by Tam et al and Lawrence et al, these poor outcomes are reportedly caused by smoking-related illnesses, with research showing that people with mental illness “tend to be heavier smokers and more dependent” compared to the general population.
The survey’s results regarding Australians living with mental illness revealed that, between 2004 and 2019, there was:
- A reduction in regular smokers
- A rise of ‘never smokers’
- A rise of ‘ever smokers’ that were quitting smoking
The study also notes that, “Smokers with mental illness were generally as likely to attempt to quit and more likely to use cessation support; however, they were also more likely to report unsuccessful quit attempts.”
Importantly, it was found that, “Smokers with mental illness who had quit reported lower levels of psychological distress than those still smoking.”
The authors of the ANZJPH report made note that there is currently limited national level data on smoking and quitting behaviours in relation to mental illness. This is even though Australia’s National Tobacco Campaign emphasises focusing on sectors of the population with higher smoking prevalence. They emphasise that current figures are critical for understanding differences in smoking prevalence, and tailoring tobacco control efforts toward these target populations.
The ANZJPH report concludes that, “Since 2004, there have been some encouraging trends in reducing tobacco use among people with mental illness; however, smoking rates remain substantially higher than among those without mental illness.
“The findings highlight the importance of routinely identifying smokers with mental illness and improving access and adherence to best practice smoking cessation treatment.”
Footnote: The ANZJPH report, Monitoring changes in smoking and quitting behaviours among Australians with and without mental illness over 15 years is co-authored by Elizabeth Greenhalgh, Emily Brennan, Catherine Segan, and Michelle Scollo
Image: Mathew MacQuarrie/Unsplash
Regarding ex-smokers, a recent AIHW report – https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/drug-types/tobacco – contains a figure called ‘TOBACCO1: Tobacco status, people aged 14 and over, 1991-2019 (per cent)’ that indicates not much change in the prevalence of all ex-smokers between 1991 and 2019 (basically, always in the 20% to mid 20s% range). There was a few percentage point increase in the mid-90s but since the peak at around 27% in 2004 the prevalence has fallen by a per cent or two and currently sits at around 25%. (I tried to include a screenshot of the graph but either the Reply section doesn’t allow that or I’m simply not skilled enough.)
At the population level, the decrease in daily smokers between 1993 and 2019 seems to be wholly accounted for by the increase in never smokers. Are we wasting our time and resources with quit smoking programs? Should we put all those resources into helping people avoid starting?