To increase the proportion of ever smokers who have quit requires a combination of increasing the number of smokers who attempt to quit, increasing the success rates among those who do make attempts and encouraging further attempts even among those who have tried and failed before.
7.9.1 Strengthening of comprehensive tobacco control policy
Expert scientific bodies have concluded that increasing smoking cessation at the population level requires a comprehensive approach to tobacco control.1-4 The implementation of multi-faceted tobacco control programs has led to reductions in smoking prevalence both in Australia5 and internationally.6-8 Comprehensive tobacco control policies can also increase the use of evidence-based cessation support.9 , 10 Maintaining the high proportions of smokers attempting to quit is likely to require:
- reducing the affordability of tobacco products
- evidence-based mass media campaigns at sufficient intensity and duration
- expansion of smokefree public environments
- extension of bans on tobacco advertising and promotion
- inclusion of prominent health warnings on packs and efforts to ensure the warnings remain salient and
- ensuring that smokers receive advice and support to quit in all healthcare settings and other public institutions such as prisons
- making evidence-based cessation support readily available and affordable and promoting its use to smokers
All of these interventions are likely not just to prompt quit attempts among current smokers, but also to prevent relapse among ex-smokers.
7.9.2 Increasing the provision and uptake of smoking cessation treatment
Evidence-based smoking cessation treatments are underutilised. Increasing smokers’ knowledge of and access to such treatments can in turn increase demand for them.11 Many smokers are unaware of the full range of strategies that can help them to quit, and many use non-evidence-based approaches.12 A consumer-centred approach to increasing the use of cessation aids involves understanding and addressing smokers’ needs and concerns and communicating effectively with them about the nature and value of treatments.13 For example, a study in the UK found that presenting information about the effectiveness of the National Health Service (NHS) stop smoking service improved service attendance.14 Addressing smokers’ expectations about the effectiveness and desirability of cessation medications may also increase the likelihood that they will use them.15 A 2012 Cochrane review considered ways in which more smokers might be encouraged to enter smoking cessation programs. It concluded that that increasing contact time with potential participants may be an important strategy, along with tailored and proactive strategies.16 Providing cessation interventions to smokers who don’t feel ready to quit can also be an effective strategy for increasing smoking cessation.17
An integrated, comprehensive systems approach to cessation treatment and policy may help improve population quit rates.18 Australia currently has no national strategy for tobacco dependence treatment, and many opportunities to provide cessation advice and treatment are missed.19 Such a strategy could include:18-23
- expanding cessation treatment coverage and provider reimbursement
- mandating adequate funding for the use and promotion of evidence-based, state-sponsored quitlines
- supporting healthcare system changes to embed tobacco treatment as part of routine care
- increasing smokers’ knowledge of the availability and effectiveness of evidence-based cessation support
- tailoring and targeting cessation support to best meet the needs of priority and disadvantaged populations (see InDepth 9A).
One study from the US that modelled the potential impact of smoking cessation treatment policies on adult quit rates estimated that implementing any policy in isolation could increase quit rates from a baseline rate of 4.3% to between 4.5% and 6%. By implementing policies in combination, the quit rate would increase to 10.9%.20
One way to increase the use of smoking cessation treatment may be to provide greater financial support through healthcare systems to people who want treatment for their tobacco addiction.24 Higher out-of-pocket expense has been associated with a lower probability of a smoker using any smoking cessation medication,25 , 26 and vice versa.27-29 Providing access to subsidised pharmacotherapy can increase usage and increase the proportion of quit attempts that are successful.30 , 31 A 2017 Cochrane review concluded that covering smokers’ costs of cessation treatment increased the proportion of smokers attempting to quit, using smoking cessation treatments, and succeeding in quitting, when compared to providing no financial benefits.32 Providing free cessation medications can also increase treatment adherence, which increases the odds of a successful quit attempt.33 People from low socioeconomic backgrounds have substantially higher smoking rates (see Section 9.1), and may particularly benefit from free or subsided cessation treatments.34-36
7.9.2.1 Availability and cost of nicotine replacement therapy (NRT)
Since February 2011, Australian smokers have been able to access a 12-week supply of subsidised nicotine replacement therapy under the Pharmaceutical Benefits Scheme (PBS) as long as they have a medical prescription.37 In line with best-practice cessation support, a condition for the subsidy is that the smoker participates in cessation counselling. Although this requirement may reduce use of cessation medications,38 ‘real-world’ studies have highlighted the importance of combining pharmacotherapies with behavioural support, to increase their odds of successful cessation. Smokers who use NRT with no behavioural support appear no more likely to successfully quit than those who do so unassisted.39-41
Subsidy of NRT was associated with a substantial increase in use in Australia, particularly among concessional patients—see Sections 7.16 and 9.9. UK research found that while making pharmacotherapies for cessation reimbursable did not increase the proportion of smokers who tried to quit, the policy increased the proportion of quit attempts that were aided by medication.42 There is evidence from the US that adding free NRT to a smoking cessation program may increase numbers in the program and short-term quit rates, but not sustained abstinence.43 Research in Canada examining the effectiveness of mass distribution of nicotine patches found that odds of cessation at six months were significantly greater among groups receiving nicotine patches compared to those who did not,44 though research in the US found that providing free nicotine patches by mail to a proactively recruited sample of smokers did not lead to increases in tobacco cessation five years later.45
7.9.2.2 Subsidy of other prescribed quit-smoking medicines
As with distribution of low-cost NRT, making prescribed pharmacotherapies more affordable for smokers appears to increase their use. Evidence from the UK shows that making prescription smoking cessation medicines reimbursable leads to greater use.42 Similarly, Australian research has found that reported use of prescription medication to quit smoking rose sharply with the addition of varenicline to the PBS in 200846 —see Section 7.16.
7.9.3 Increasing the number and success of quit attempts
Success rates among those attempting to quit are relatively low. A longitudinal study of smokers from Canada, the US, the UK, and Australia (the ITC-4 study) found that among those who reported at least one quit attempt within the past year, about half lasted a week or less on their most recent attempt, and only about one-fifth successfully abstained for more than a month.47 Most smokers attempt to quit on their own even when effective support is available (see Section 7.6.3). Building smokers’ knowledge about and skills in quitting may play an important role in increasing successful cessation. Smokers are often unaware of and underestimate the benefits of available cessation assistance.48-50 While the large number of smokers who have quit unassisted has undoubtedly played a major role in the reduction in smoking prevalence,51 evidence-based cessation support can increase the likelihood of a quit attempt being successful.52
To increase successful cessation at a population level it is important to understand which cessation methods are most often used by smokers, and which are most helpful.53 In 2019, among Australian adult smokers who had tried to quit in the previous year, going cold turkey was the most popular approach (35%), followed by NRT (23%), asking their doctor for help (14%), e-cigarettes (12%), cessation medications (10%), a mobile phone app (9%), and contacting the Quitline (3%).54 Earlier Australian research found that going cold turkey, NRT, and gradual cigarette reduction before quitting are strategies commonly used by smokers and are perceived as being very helpful, while receiving advice from health professionals, although common, is perceived as less helpful. Although the number of prescriptions filled is very high (see Section 7.16), surveys suggest that prescribed medication has low use but high perceived helpfulness.53
A key consideration among public health experts is whether it is more beneficial to focus on increasing success rates among smokers who have quit (i.e., preventing relapse) or whether it would be more useful to try and increase the number of smokers who make quit attempts. There is some evidence that shifting the focus from the quality of smokers’ quit attempts to the quantity of those attempts produces greater overall benefits.55 Data from California indicated that smokers on average tried 12 to 14 times before quitting for good: 12 if they used cessation aids, and 14 if they did not.56 More recent research suggests that some smokers may make 30 or more attempts to quit before being successful.57 While the use of best-practice cessation support (i.e., pharmacotherapy combined with behavioural counselling) can increase the odds of a quit attempt being successful,52 given most people who smoke will need to make multiple attempts, an important part of increasing the proportion of ever-smokers who have quit appears to be encouraging smokers to try again if they relapse.56 , 58 Even after an unsuccessful attempt, smokers remain motivated to quit.59
For a discussion of the effectiveness of quitting strategies used by smokers, see Section 7.6. Sections 7.14–7.16 discuss the effectiveness of behavioural interventions and pharmacotherapies.
7.9.3.1 Intensity of intervention
An important consideration in implementing cessation interventions is their structure or level of intensity, including the duration of each contact/session, total amount of contact time, and number of person-to-person sessions. Cessation rates tend to increase with extended contacts and with the number of treatment formats (different types of counselling and educational interventions).1 , 60 Low intensity interventions typically offered in Australia include brief advice from a doctor or other health professional. Examples of high intensity interventions include multi-session behavioural counselling such as that provided by Quitline, a face-to-face counsellor or health professional, or group therapy. The effectiveness of all levels of behavioural interventions is improved by concurrent use of cessation medications.61 , 62
Smokers who undergo more intense interventions generally have a greater likelihood of achieving successful cessation.61 Lower SES smokers in particular are often more addicted and may therefore be more likely to need more intensive support to quit successfully.63 However, higher intensity interventions are usually more costly (to the individual, government or other funders) and less likely to be available or attractive to all smokers. There are also interventions (such as motivational interviewing) that appear to be more effective when they are less intense.64 The relative costs and benefits of each intervention is therefore an important consideration to individuals and policy makers.
7.9.4 National policy to promote and support cessation
The draft National Tobacco Strategy 2022–3065 outlines a comprehensive approach to tobacco control in Australia that included several priority areas and actions specifically for prompting or assisting people to quit:
- develop, implement and fund mass media campaigns and other communication tools to motivate people who use tobacco to quit
- continue to reduce the affordability of tobacco products
- continue and expand efforts and partnerships to reduce tobacco use among Aboriginal and Torres Strait Islander people
- strengthen efforts to prevent and reduce tobacco use among populations at a higher risk of harm from tobacco use and populations with a high prevalence of tobacco use
- further regulate the contents and product disclosures pertaining to tobacco products
- strengthen regulation to reduce the supply, availability and accessibility of tobacco products
- provide greater access to evidence-based cessation services to support people who use tobacco to quit
Australia’s National Preventative Health Strategy 2021–2030 also named these strategies as key action areas for state and federal tobacco control policies.66
See Section 7.20 for a discussion of national policy and progress in encouraging and supporting cessation in Australia, and Section 8.13 for a discussion of policies for advancing tobacco control programs among Aboriginal and Torres Strait Islander peoples.
Relevant news and research
For recent news items and research on this topic, click here. ( Last updated January 2024)
References
1. US Department of Health and Human Services. Reducing tobacco use: a report of the Surgeon General. Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/2000/complete_report/index.htm
2. World Health Organization. Policy recommendations for smoking cessation and treatment of tobacco dependence--advancing tobacco control in the 21st century. 2004 March.Geneva: World Health Organization, 2004. Available from: http://www.wpro.who.int/NR/rdonlyres/8D25E4D3-BB81-479E-8DF5-7BAF674DB104/0/PolicyRecommendations.pdf
3. National Cancer Institute. Monograph 12: Population based smoking cessation: proceedings of a conference on what works to influence cessation in the general population. US Department of Health and Human Services, National Institutes of Health, National Cancer Institute,, 2000. . Bethesda, MD:. Year. Available from: https://cancercontrol.cancer.gov/sites/default/files/2020-08/m12_complete.pdf.
4. World Health Organization. MPOWER: A policy package to reverse the tobacco epidemic. Geneva 2008. Available from: https://apps.who.int/iris/bitstream/handle/10665/43888/9789241596633_eng.pdf
5. Wakefield MA, Coomber K, Durkin SJ, Scollo M, Bayly M, et al. Time series analysis of the impact of tobacco control policies on smoking prevalence among Australian adults, 2001-2011. Bulletin of the World Health Organization, 2014; 92(6):413–22. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24940015
6. Beard EV, West R, Jarvis M, Michie S, and Brown J. 'S'-shaped curve: modelling trends in smoking prevalence, uptake and cessation in Great Britain from 1973 to 2016. Thorax, 2019; 74(9):875–81. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31391317
7. Dahne J, Nahhas GJ, Wahlquist AE, Cummings KM, and Carpenter MJ. State tobacco excise taxation, comprehensive smoke-free air laws, and tobacco control appropriations as predictors of smoking cessation success in the United States. Journal of Public Health Management and Practice, 2020; 26(5):E1–E4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32732730
8. Feliu A, Filippidis FT, Joossens L, Fong GT, Vardavas CI, et al. Impact of tobacco control policies on smoking prevalence and quit ratios in 27 European Union countries from 2006 to 2014. Tobacco Control, 2019; 28(1):101–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29472445
9. Dahne J, Wahlquist AE, Garrett-Mayer E, Heckman BW, Cummings KM, et al. State tobacco policies as predictors of evidence-based cessation method usage: Results from a large, nationally representative dataset. Nicotine and Tobacco Research, 2017. Available from: https://pubmed.ncbi.nlm.nih.gov/29059345/
10. Thrul J, Riehm KE, Cohen JE, Alexander GC, Vernick JS, et al. Tobacco control policies and smoking cessation treatment utilization: A moderated mediation analysis. PLoS ONE, 2021; 16(8):e0241512. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34460821
11. Husten CG. A Call for ACTTION: Increasing access to tobacco-use treatment in our nation. American Journal of Preventive Medicine, 2010; 38(3 Suppl):S414–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20176316
12. Marques-Vidal P, Melich-Cerveira J, Paccaud F, Waeber G, Vollenweider P, et al. High expectation in non-evidence-based smoking cessation interventions among smokers--the CoLaus study. Preventive Medicine, 2011; 52(3-4):258–61. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21334370
13. Shiffman S. Smoking-cessation treatment utilization: The need for a consumer perspective. American Journal of Preventive Medicine, 2010; 38(3 Suppl):S382–4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20176311
14. Matcham F, McNally L, and Vogt F. A pilot randomized controlled trial to increase smoking cessation by maintaining National Health Service Stop Smoking Service attendance. Br J Health Psychol, 2014; 19(4):795–809. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24289715
15. Vogt F, Hall S, and Marteau TM. Understanding why smokers do not want to use nicotine dependence medications to stop smoking: Qualitative and quantitative studies Nicotine and Tobacco Research, 2008; 10(8):1405–13. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18686189
16. Marcano Belisario JS, Bruggeling MN, Gunn LH, Brusamento S, and Car J. Interventions for recruiting smokers into cessation programmes. The Cochrane Library, 2012. Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009187.pub2/abstract
17. Ali A, Kaplan CM, Derefinko KJ, and Klesges RC. Smoking cessation for smokers not ready to quit: Meta-analysis and cost-effectiveness analysis. American Journal of Preventive Medicine, 2018; 55(2):253–62. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29903568
18. Abrams DB, Graham AL, Levy DT, Mabry PL, and Orleans CT. Boosting population quits through evidence-based cessation treatment and policy. American Journal of Preventive Medicine, 2010; 38(3 Suppl):S351–63. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20176308
19. White S, McCaffrey N, and Scollo M. Tobacco dependence treatment in Australia – an untapped opportunity for reducing the smoking burden. Public Health Research & Practice, 2020. Available from: https://www.phrp.com.au/issues/september-2020-volume-30-issue-3/tobacco-dependence-treatment-an-untapped-opportunity/
20. Levy DT, Graham AL, Mabry PL, Abrams DB, and Orleans CT. Modeling the impact of smoking-cessation treatment policies on quit rates. American Journal of Preventive Medicine, 2010; 38(3 Suppl):S364–72. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20176309
21. Kaslow AA, Romano PS, Schwarz E, Shaikh U, and Tong EK. Building and scaling-up California quits: Supporting health systems change for tobacco treatment. American Journal of Preventive Medicine, 2018; 55(6 Suppl 2):S214–S21. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30454676
22. Plever S and Gartner CE. Smoking cessation assistance should be free, accessible, and part of routine care. Medical Journal of Australia, 2022; 216(7):345–6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35318657
23. VanFrank B and Presley-Cantrell L. A comprehensive approach to increase adult tobacco cessation. JAMA, 2021; 325(3):232–3. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33464294
24. Hughes JR. How confident should we be that smoking cessation treatments work? Addiction, 2009; 104(10):1637–40. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19681807
25. Tauras JA and Chaloupka F. The demand for nicotine replacement therapies. NBER Working Paper no. 8332, 2001. Available from: https://www.nber.org/system/files/working_papers/w8332/w8332.pdf
26. Zeng F, Chen CI, Mastey V, Zou KH, Harnett J, et al. Utilization management for smoking cessation pharmacotherapy: varenicline rejected claims analysis. American Journal of Managed Care, 2010; 16(9):667–74. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20873954
27. Heydari G. Is cost of medication for quit smoking important for smokers, experience of using Champix in Iranian smoking cessation program 2016. Int J Prev Med, 2017; 8:63. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28966752
28. Kostova D, Xu X, Babb S, McMenamin SB, and King BA. Does state Medicaid coverage of smoking cessation treatments affect quitting? Health Services Research, 2018; 53(6):4725–46. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29806177
29. van den Brand FA, Nagelhout GE, Hummel K, Willemsen MC, McNeill A, et al. Does free or lower cost smoking cessation medication stimulate quitting? Findings from the International Tobacco Control (ITC) Netherlands and UK Surveys. Tobacco Control, 2019; 28(Suppl 1):s61–s7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29618494
30. Minue-Lorenzo C, Olano-Espinosa E, Del Cura-Gonzalez I, Vizcaino-Sanchez JM, Camarelles-Guillem F, et al. Subsidized pharmacological treatment for smoking cessation by the Spanish public health system: A randomized, pragmatic, clinical trial by clusters. Tob Induc Dis, 2019; 17:64. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31582953
31. Wang SK, Kao CW, Chuang HW, Tseng YK, Chen WC, et al. Government's subsidisation policy and utilisation of smoking cessation treatments: a population-based cross-sectional study in Taiwan. BMJ Open, 2021; 11(1):e040424. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33441354
32. van den Brand FA, Nagelhout GE, Reda AA, Winkens B, Evers S, et al. Healthcare financing systems for increasing the use of tobacco dependence treatment. Cochrane Database of Systematic Reviews, 2017; 9:CD004305. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28898403
33. Aksel O, Kucuktepe N, Yaslica Z, and Basak O. Providing free access to smoking cessation medications: Does it have an impact on the treatment adherence and success of smoking cessation? Turk Thorac J, 2021; 22(3):224–30. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35110232
34. Bailey SR, Hoopes MJ, Marino M, Heintzman J, O'Malley JP, et al. Effect of gaining insurance coverage on smoking cessation in community health centers: A cohort study. Journal of General Internal Medicine, 2016; 31(10):1198–205. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27329121
35. Brantley EJ, Greene J, Bruen BK, Steinmetz EP, and Ku LC. Policies affecting Medicaid beneficiaries' smoking cessation behaviors. Nicotine and Tobacco Research, 2019; 21(2):197–204. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29522120
36. DiGiulio A, Jump Z, Babb S, Schecter A, Williams KS, et al. State Medicaid coverage for tobacco cessation treatments and barriers to accessing treatments - United States, 2008-2018. MMWR; Morbidity and Mortality Weekly Report, 2020; 69(6):155–60. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32053583
37. Department of Health, The extension of the listing of nicotine patches on the Pharmaceutical Benefits Scheme from 1 February 2011. Australian Government; 2013. Available from: http://www.pbs.gov.au/info/publication/factsheets/shared/Extension_of_the_listing_of_nicotine_patches.
38. Ku L, Brantley E, Bysshe T, Steinmetz E, and Bruen BK. How Medicaid and other public policies affect use of tobacco cessation therapy, United States, 2010-2014. Preventing Chronic Disease, 2016; 13:E150. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27788063
39. Kotz D, Brown J, and West R. 'Real-world' effectiveness of smoking cessation treatments: a population study. Addiction, 2014; 109(3):491–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24372901
40. Kotz D, Brown J, and West R. Prospective cohort study of the effectiveness of smoking cessation treatments used in the "real world". Mayo Clinic Proceedings, 2014; 89(10):1360–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25282429
41. Jackson SE, Kock L, Kotz D, and Brown J. Real-world effectiveness of smoking cessation aids: A population survey in England with 12-month follow-up, 2015-2020. Addictive Behaviors, 2022; 135:107442. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35908322
42. West R, DiMarino ME, Gitchell J, and McNeill A. Impact of UK policy initiatives on use of medicines to aid smoking cessation. Tobacco Control, 2005; 14(3):166–71. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15923466
43. Alberg AJ, Stashefsky Margalit R, Burke A, Rasch KA, Stewart N, et al. The influence of offering free transdermal nicotine patches on quit rates in a local health department's smoking cessation program. Addictive Behaviors, 2004; 29(9):1763–78. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15530720
44. Kushnir V, Sproule BA, Zawertailo L, Selby P, Tyndale RF, et al. Impact of self-reported lifetime depression or anxiety on effectiveness of mass distribution of nicotine patches. Tobacco Control, 2016; 26(5):526–33. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27543563
45. Cunningham JA, Kushnir V, Selby P, Zawertailo L, Tyndale RF, et al. Five-year follow-up of a randomized clinical trial testing mailed nicotine patches to promote tobacco cessation. JAMA Intern Med, 2020; 180(5):792–3. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32150239
46. Cooper J, Borland R, and Yong HH. Australian smokers increasingly use help to quit, but number of attempts remains stable: findings from the International Tobacco Control Study 2002-09. Australian and New Zealand Journal of Public Health, 2011; 35(4):368–76. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21806733
47. Partos TR, Borland R, Yong HH, Hyland A, and Cummings KM. The quitting rollercoaster: how recent quitting history affects future cessation outcomes (data from the International Tobacco Control 4-country cohort study). Nicotine and Tobacco Research, 2013; 15(9):1578–87. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23493370
48. Hammond D, McDonald P, Fong G, and Borland R. Do smokers know how to quit? Knowledge and perceived effectiveness of cessation assistance as predictors of cessation behaviour. Addiction, 2004; 99(8):1042–8. Available from: https://pubmed.ncbi.nlm.nih.gov/15265101/
49. Knox B, Mitchell S, Hernly E, Rose A, Sheridan H, et al. Barriers to utilizing medicaid smoking cessation benefits. Kans J Med, 2017; 10(4):1–11. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29472979
50. Kwah KL, Fulton EA, and Brown KE. Accessing National Health Service Stop Smoking Services in the UK: a COM-B analysis of barriers and facilitators perceived by smokers, ex-smokers and stop smoking advisors. Public Health, 2019; 171:123–30. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31128557
51. Smith AL and Chapman S. Quitting smoking unassisted: the 50-year research neglect of a major public health phenomenon. JAMA, 2014; 311(2):137–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24399549
52. US Department of Health and Human Services. Smoking Cessation. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, 2020. Available from: https://www.hhs.gov/sites/default/files/2020-cessation-sgr-full-report.pdf
53. Hung WT, Dunlop SM, Perez D, and Cotter T. Use and perceived helpfulness of smoking cessation methods: results from a population survey of recent quitters. BMC Public Health, 2011; 11(1):592. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21791111
54. Australian Institute of Health and Welfare. National Drug Strategy Household Survey, 2019. ADA Dataverse, 2021. Available from: http://dx.doi.org/10.26193/WRHDUL.
55. Zhu S-H, Differential cessation rates across populations: what explains it and how to reduce it. Smokefree Oceania. Tobacco Control Conference. From vision to reality. September, Handbook 4-7 Auckland, New Zealand 2007.
56. Zhu S-H, Melcer T, Sun J, Rosbrook B, and Pierce J. Smoking cessation with and without assistance: a population-based analysis. American Journal of Preventive Medicine, 2000; 18(4):305–11. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10788733
57. Chaiton M, Diemert L, Cohen JE, Bondy SJ, Selby P, et al. Estimating the number of quit attempts it takes to quit smoking successfully in a longitudinal cohort of smokers. BMJ Open, 2016; 6(6):e011045. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27288378
58. Chapman S. Accelerating smoking cessation and prevention in whole communities, in Public Health Advocacy and Tobacco Control: Making Smoking History. Blackwell Publishing; 2007. Available from: https://catalogue.nla.gov.au/Record/4935337.
59. Petty-Saphon N and Kavanagh P. Towards a Tobacco Free Ireland-scaling up and strengthening quit smoking behaviour at population level. Irish Journal of Medical Science, 2020; 189(1):3–10. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31414327
60. Piasecki TM. Relapse to smoking. Clinical Psychology Review, 2006; 26(2):196–215. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16352382
61. Siu AL and Force USPST. Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 2015; 163(8):622–34. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26389730
62. Stead LF, Koilpillai P, Fanshawe TR, and Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database of Systematic Reviews, 2016; 3:CD008286. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27009521
63. Cummings KM, Fong GT, and Borland R. Environmental influences on tobacco use: evidence from societal and community influences on tobacco use and dependence. Annu Rev Clin Psychol, 2009; 5:433–58. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19327036
64. Lindson-Hawley N, Thompson TP, and Begh R. Motivational interviewing for smoking cessation. Cochrane Database of Systematic Reviews, 2015; 3(3):CD006936. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25726920
65. Consultation Draft National Tobacco Strategy 2022-2030 Canberra: Commonwealth of Australia, 2022. Available from: https://consultations.health.gov.au/atodb/national-tobacco-strategy-2022-2030/supporting_documents/Draft%20NTS%2020222030%20for%20consultaion%20hub.pdf
66. Australian Government Department of Health. National Preventive Health Strategy 2021–2030. Canberra: Commonwealth of Australia, 2021. Available from: https://www.health.gov.au/resources/publications/national-preventive-health-strategy-2021-2030