For women and health professionals

Dr Robin Bell MBBS, PhD, MPH, FAFPHM, Cert Health Econ.

Cigarette smoking is still the most important avoidable cause of death and disability in developed countries like Australia, although the increasing prevalence of obesity may mean that, within the not too distant future, the contribution of obesity to death and disability may well rival that of smoking¹. However, obesity aside, smoking remains a very important public health issue. Half of all smokers will die of a disease caused by smoking. The most common health problems associated with smoking are diseases of the cardiovascular and respiratory systems. However smoking damages nearly every organ in the human body².

For almost all smokers, stopping smoking is the single most important step that they can take to improve their future health. Health professionals have enormous potential to help people stop smoking. Interventions by health professionals have been shown to be effective (see below). Young smokers stand to gain the most benefit from quitting, however there are health benefits to quitting at any stage of life.

Why is quitting so hard?

Smoking involves an addiction to a drug called nicotine. Smoking a cigarette delivers the first shot of nicotine from the lung to the brain within seconds. After reaching high levels during the smoking of a cigarette, blood nicotine levels drop to low levels within about two hours. If smokers are not able to smoke, they report feeling irritable, depressed and have a very strong desire to smoke.

Each smoker establishes his or her own preferred daily dose of nicotine so that if the smoker tries to reduce the number of cigarettes smoked daily, they smoke each cigarette more completely which tends to negate the expected benefit from reducing the number of cigarettes per day.

Nicotine addiction is not the only factor determining whether a smoker quits or continues to smoke. The social context of the smoker, such as whether family members smoke, is also important³.

What helps people to quit?

People should not be discouraged by previous failed quit attempts. Most quitters do not succeed on the first attempt.

Simple advice by a health professional has been shown to result in quitting for 1 in 40 smokers⁴. This evidence is a compelling reason for opportunistic advice by health professionals about quitting. However health professionals are reluctant to raise the issue of smoking because they are not confident that advice makes a difference (even though there is evidence that it does), they are not confident they have the skills to counsel smokers and they think that there is insufficient time⁵.

People who are motivated enough to attend a counsellor will quit in 1 out of 13 cases⁶.

About one in five smokers who use NRT and have intensive support will quit long-term⁷.

Who benefits from a smoker quitting?

Obviously the person with the most to gain from quitting is the active smoker. There are also benefits to non-smokers previously passively exposed to cigarette smoke. This may be especially important for children. It has been estimated that passive smoking is responsible for 19% of expenditure on childhood respiratory illness⁸. Despite this alarming statistic, for parents, stopping in the interests of their own health should be a good enough reason to quit.

Smoking during pregnancy is a special situation where smoking by the mother directly causes harm to the fetus, increasing the risk of growth retardation, preterm delivery and perinatal death. Smoking interventions for pregnant women reduce the risks of growth retardation and pre-term birth⁹.

What should you do?

If you are a smoker, talk to your doctor about how you feel about smoking and strategies you would like to explore to quit. If you are a health professional, learn about the evidence and local services available to support smokers who want to quit and use every reasonable opportunity to counsel smokers about quitting, and support those who have started the journey to becoming a non-smoker.

References:

Content updated November 22, 2004