7.20 National strategies to support and increase cessation

Australia has had significant successes in reducing the prevalence of and harm from tobacco use and is widely considered a world leader in tobacco control. Far fewer Australians are smoking and being exposed to secondhand smoke as a result of the implementation of comprehensive tobacco control strategies, including making tobacco products expensive, highly regulated, non-advertised, plain packaged, and out of consumers’ sight in retail outlets.¹ However, about 11% of people still smoke, equating to more than 2.2 million Australians who are at increased risk of smoking-related disease and early death.² Smoking is responsible for the deaths of over 24,000 people in Australia every year,³ with people who smoke losing, on average, a decade of life.⁴ Certain groups of Australians experience disproportionate harms from tobacco use, including Aboriginal and Torres Strait Islander peoples, people of lower socioeconomic status, people with mental health disorders, people with substance use disorders, and people experiencing homelessness (see Chapters 8 and 9). Most people who smoke regret ever having started⁵ and many report wanting to and trying to quit.⁶

Encouragingly, Australia has met its first target of national daily smoking prevalence of less than 10% by 2025,^7,8 with 8.8% of Australian adults smoking daily in 2022–23.⁹ Nonetheless, continued and strengthened evidence-based tobacco control efforts are needed to hasten the decline in smoking prevalence,¹⁰ in order to meet the next target of daily smoking prevalence of 5% or less for adults by 2030⁸ and to reduce disparities in progress by hastening reductions in priority populations.¹¹ A number of national strategies provide recommendations for policies and programs to achieve further progress in reducing smoking and its enormous harms, as described below. Links to state and territory tobacco control strategies can be found in Appendix 1.4.  

7.20.1 Australia’s National Tobacco Strategy

The goal of Australia’s National Tobacco Strategy 2022–2030⁷ is to “to improve the health of all Australians by reducing the prevalence of tobacco use and its associated health, social, environmental and economic costs, and the inequalities it causes.” As part of a comprehensive approach to meet this aim, one of its priority areas for future action is to provide greater access to evidence-based cessation services to support people to quit the use of tobacco, e-cigarettes and novel and emerging products. The Australian Government, state and territory governments, non-government organisations, health professional organisations, health services, smoking cessation services, social service organisations, Aboriginal community-controlled organisations, and/or Quit Centre have been charged with responsibility to:

• Conduct an evaluation of smoking cessation services available in Australia, including Quitline services, and monitor innovative approaches to deliver smoking cessation services.
• Commission a national situation analysis of treatment of tobacco dependence as outlined in the WHO FCTC Article 14 implementation guidelines.
• Improve and extend Quitline services, and ensure that there is sufficient capacity to run these services during mass media campaigns.
• Improve referral pathways to Quitline from other programs across the health system, from primary care services and from other services and NGOs which focus on populations with a high prevalence of tobacco use and those most severely affected by tobacco use
• Improve documentation in medical records of smoking status and cessation interventions offered to tobacco users during admission, care and discharge, across the health system.
• Explore the feasibility of including smoking cessation care in the National Safety and Quality Health Service Standards
• Implement IT and accreditation systems to ensure health professionals routinely ask all patients in healthcare facilities about their smoking status and provide smokers with appropriate advice and support to quit.
• Provide policy guidelines and accredited training in smoking cessation (particularly brief interventions) to health professionals, health workers, community and welfare workers and social service organisations, and ensure these are regularly updated to reflect best practice.
• Improve public awareness of services demonstrated to assist with smoking cessation.
• Monitor and continue to update the evidence base for smoking cessation therapies and tobacco and nicotine dependence treatment.
• Review restrictions on and the accessibility of current smoking cessation pharmacotherapies available on the PBS in the context of the latest evidence, best clinical practice, cost-effectiveness and consumer affordability, and enhance the availability of these medications.
• Implement measures to ensure that best practice cessation support and tobacco dependence treatment is offered to every tobacco user in every interaction in the health, mental health and alcohol and drug dependence treatment systems, with routine reporting of brief intervention strategies and cessation service outcomes.
• Develop and disseminate comprehensive national clinical guidelines and supportive policy strategies to embed the treatment of tobacco and nicotine dependence into health services, primary care, and community and social service organisations.
• Strengthen tobacco control workforce capability and capacity to deliver evidence-based services to support people to quit the use of tobacco, e-cigarettes and novel and emerging products.

7.20.2  National Drug Strategy

The National Tobacco Strategy is a sub-strategy of the broader National Drug Strategy 2017-2026,¹² which identifies three priority areas for consideration in implementation: actions, populations and substances. Tobacco is identified as one of the substances to address, and one of its actions includes enhancing access to evidence-informed, effective and affordable treatment services and support. It names the following population groups as priorities for action: Aboriginal and Torres Strait Islander people; people with mental health conditions; young people; older people; people in contact with the criminal justice system; culturally and linguistically diverse populations; and people identifying as lesbian, gay, bisexual, transgender and/or intersex.

Measures of success of the strategy include increasing the average age of uptake of smoking, reducing the prevalence of daily tobacco smoking, and reducing the tobacco-related burden of disease.

7.20.3 National Preventive Health Strategy

The goal of the National Preventive Health Strategy 2021–2030⁸ is to improve the health and wellbeing of all Australians at all stages of life through prevention. One of its focus areas is reducing tobacco use and nicotine addiction, with the targets of achieving a daily smoking prevalence of less than 10% by 2025 and 5% or less for adults by 2030, and reducing the daily smoking rate among Aboriginal and Torres Strait Islander people (≥15 years) to 27% or less by 2030. It describes a number of policy goals to be achieved by the year 2030:

• Ongoing development, implementation and funding of mass media campaigns and other communication tools have been implemented to: motivate people who use tobacco to quit and recent quitters to continue smoking abstinence; discourage uptake of tobacco use; and reshape social norms about the tobacco industry and tobacco use
• Protection of public policy, including tobacco control policies, from tobacco industry interference
• Increased provision and access to evidence-based cessation services and support to help people who use tobacco and other novel and emerging products, including e-cigarettes, to quit
• Ongoing reduction of affordability of tobacco products including harmonisation of excise and custom duty on roll your own products compared with factory made cigarettes
• Elimination of exceptions to smoke-free workplaces, public places and other settings
• Reduced tobacco use among populations at a higher risk of harm from tobacco use, and populations with a high prevalence of tobacco use
• Elimination of remaining tobacco-related advertising, promotion and sponsorship
• Stronger regulation of the contents and product disclosures pertaining to tobacco products
• The supply, availability and accessibility of tobacco products is reduced through stronger regulation
• Reduced tobacco use among Aboriginal and Torres Strait Islander people, including during pregnancy, through expansion of efforts and community partnerships
• Stronger regulation, monitoring and enforcement for novel and emerging products including e-cigarettes is implemented
• Reduced tobacco use among disadvantaged communities and other vulnerable population groups through expansion of efforts and community partnerships
• Reduced tobacco use among regional and remote Australians through targeted support

7.20.4 Framework Convention on Tobacco Control

The World Health Organization (WHO) has stated that a crucial part of reversing the tobacco epidemic is increasing smokers’ access to effective and comprehensive cessation treatments. Article 14 of the WHO Framework Convention on Tobacco Control (FCTC) states that governments shall take effective measures to promote cessation of tobacco use and adequate treatment for tobacco dependence.¹³ Australia is a full Party to the FCTC, and is therefore required to perform, in good faith, the full range of obligations set out in this treaty. Progress in tobacco control in Australia is now intimately connected with FCTC processes.

In November 2010, the fourth Conference of the Parties (COP4) to the WHO FCTC adopted guidelines for the implementation of Article 14 (tobacco cessation and treatment) of the convention. Article 14 asks Parties to develop national guidelines and effective measures to encourage and assist tobacco cessation.¹⁴

This involves:

• designing and implementing effective programs aimed at promoting tobacco in such locations as educational institutions, healthcare facilities, workplaces and sporting environments
• including diagnosis and treatment of tobacco dependence and cessation counselling services in national health and education programs, plans and strategies with the participation of health workers, community workers and social workers as appropriate
• establishing in healthcare facilities and rehabilitation centres programs for diagnosing, counselling, preventing and treating tobacco dependence
• facilitating accessibility and affordability for treatment of tobacco dependence including pharmaceutical products.

For more information on the FCTC, see Chapter 19.

7.20.5 World Health Organization Guidelines and Resources

A major report by the World Health Organization outlines the substantial health and economic benefits of investing in cessation. Specifically, it recommends investing in 3 population-level approaches (brief advice in primary care, national free quit lines and mobile phone interventions) and 3 pharmacologic interventions (nicotine replacement therapy (NRT), Bupropion, and Varenicline), and makes the case that investing in these interventions could help millions of people quit smoking, save millions of lives, and offer a significant return on investment for governments. The report estimates that an additional US$1.68 invested in all 6 cessation interventions (per capita per year from 2021 to 2030) would result in 152 million people who smoke being helped to quit and 2.7 million lives being saved by the year 2030. By the time the cohort of people who quit reaches age 65, 16 million lives would be saved and each dollar invested would have yielded US$7.50 in gains.¹⁵

A clinical treatment guideline for tobacco dependence has also been developed by the World Health Organization in recognition of the fact that such guidelines are basic infrastructure for promoting tobacco cessation and providing effective treatment (WHO FCTC Article 14), but that many Member States have not developed them.¹⁶ The guideline provides recommendations on the use of digital, pharmacological, and system-level interventions and policies to enhance the adoption and implementation of tobacco cessation interventions. System-level recommendations include:

• all healthcare facilities include tobacco use status and use of tobacco cessation interventions in their medical records (including electronic health records), to facilitate provider interaction with tobacco-using patients and increase adoption and maintenance of evidence-based treatment interventions.
• training of all health-care providers on delivery of evidence-based cessation interventions, with ongoing prompting and feedback, in their routine medical practices at all levels of health-care settings.
• evidence-based tobacco cessation interventions be provided at no or reduced cost to all tobacco users interested in quitting. No cost is strongly preferred over reduced cost.

Related reading

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References

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14. Framework Convention on Tobacco Control (FCTC). Article 14 Guidelines.  2010. Available from: http://www.who.int/fctc/Guidelines.pdf

15. World Health Organization. It’s time to invest in cessation: the global investment case for tobacco cessation. Methodology and results summary. Geneva: WHO, 2021. Available from: https://www.who.int/publications/i/item/9789240039285

16. World Health Organization. WHO clinical treatment guideline for tobacco cessation in adults. Geneva: WHO, 2024. Available from: https://www.who.int/publications/i/item/9789240096431