NACCHO Aboriginal Health and Tackling Indigenous #Smoking Resources Alert : Download the Review of tobacco use among Aboriginal and Torres Strait Islander peoples

“This research shows reducing tobacco use is achievable with a suite of approaches.

We have been able to look at data up to 2014 where we’re able to estimate around 30,000 Aboriginal and Torres Strait Islander lives have been saved, just due to the decline in smoking rates.

For a long time we just had the general approach in Australia and everybody thought that would be enough, but what we’re seeing now is when Aboriginal and Torres Strait Islander people are leading the charge around these public health issues, then we start to see those benefits.

ANU associate professor Ray Lovett said it’s a big shift compared to the ten years before 2004, when there was no change in smoking rates in the indigenous. Speaking to NITV 

Download the 62 page report  HERE


See report online at HealthinfoNet

Read over 140 Aboriginal Health and Smoking articles published by NACCHO over past 8 years

For the first time, smoking among Indigenous Australians is declining at a faster rate than the general population, according to a new study by the Australian National University.

The review found that between 2004 and 2019, the number of Aboriginal and Torres Strait Islander peoples who smoked cigarettes fell from 50 per cent to 40.2 per cent.

The review found smoking had decreased the most among pregnant women and younger people.

Dr Lovett said the drop was partly a result of more targeted Indigenous-led health campaigns and support services in local Aboriginal and Torres Strait Islander communities.

Aboriginal Quitline Counsellor and Partnerships Officer at Quit Victoria Glen Benton said colonial-era practices involving tobacco still impacted Aboriginal people today.

“We were paid in tobacco, alcohol, sugar, wheat and opium and if you look at those substances, they’re all products that we’ve had issues with as a culture,” he said.

“It’s been something that we’ve had bartered to us for work, so there’s a very confusing and complex history that needs pacing and respect paid to it.”

Mr Benton said telling stories could help drive positive change within Indigenous communities.

He has launched a new podcast called Quit Stories to encourage conversations about the health risks of smoking and benefits of quitting.

“The podcast is an example that people can listen to hear what they might expect if they contact the Aboriginal Quitline because everybody’s got their story,” he said.



NACCHO Aboriginal Health Research Alert : @HealthInfoNet releases Summary of Aboriginal and Torres Strait Islander health status 2019 social and cultural determinants, chronic conditions, health behaviours, environmental health , alcohol and other drugs

The Australian Indigenous HealthInfoNet has released the Summary of Aboriginal and Torres Strait Islander health status 2019

This new plain language publication provides information for a wider (non-academic) audience and incorporates many visual elements.

The Summary is useful for health workers and those studying in the field as a quick source of general information. It provides key information regarding the health status of Aboriginal and Torres Strait Islander people across the following topics:

  • social and cultural determinants
  • chronic conditions
  • health behaviours
  • environmental health
  • alcohol and other drugs.

The Summary is based on HealthInfoNet‘s comprehensive publication Overview of Aboriginal and Torres Strait Islander health status 2019. It presents statistical information from the Overview in a visual format that is quick and easy for users to digest.

The Summary is available online and in hardcopy format. Please contact HealthInfoNet by email if you wish to order a hardcopy of this Summary. Other reviews and plain language summaries are available here.

Here are the key facts

Please note in an earlier version sent out 7.00 am June 15 a computer error dropped off the last word in many sentences : these are new fixed 

Key facts


  • In 2019, the estimated Australian Aboriginal and Torres Strait Islander population was 847,190.
  • In 2019, NSW had the highest number of Aboriginal and Torres Strait Islander people (the estimated population was 281,107 people, 33% of the total Aboriginal and Torres Strait Islander population).
  • In 2019, NT had the highest proportion of Aboriginal and Torres Strait Islander people in its population, with 32% of the NT population identifying as Aboriginal and/or Torres Strait Islanders
  • In 2016, around 37% of Aboriginal and Torres Strait Islander people lived in major cities
  • The Aboriginal and Torres Strait Islander population is much younger than the non-Indigenous population.

Births and pregnancy outcomes

  • In 2018, there were 21,928 births registered in Australia with one or both parents identified as Aboriginal and/or Torres Strait Islander (7% of all births registered).
  • In 2018, the median age for Aboriginal and Torres Strait Islander mothers was 26.0 years.
  • In 2018, total fertility rates were 2,371 births per 1,000 for Aboriginal and Torres Strait Islander women.
  • In 2017, the average birthweight of babies born to Aboriginal and Torres Strait Islander mothers was 3,202 grams
  • The proportion of low birthweight babies born to Aboriginal and Torres Strait Islander mothers between 2007 and 2017 remained steady at around 13%.


  • For 2018, the age-standardised death rate for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT was 1 per 1,000.
  • Between 1998 and 2015, there was a 15% reduction in the death rates for Aboriginal and Torres Strait Islander people in NSW, Qld, WA, SA and the NT.
  • For Aboriginal and Torres Strait Islander people born 2015-2017, life expectancy was estimated to be 6 years for males and 75.6 years for females, around 8-9 years less than the estimates for non-Indigenous males and females.
  • In 2018, the median age at death for Aboriginal and Torres Strait Islander people in NSW, Qld, WA, SA and the NT was 2 years; this was an increase from 55.8 years in 2008.
  • Between 1998 and 2015, the Aboriginal and Torres Strait Islander infant mortality rate has more than halved (from 5 to 6.3 per 1,000).
  • In 2018, the leading causes of death among Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT were ischaemic heart disease (IHD), diabetes, chronic lower respiratory diseases and lung and related cancers.
  • For 2012-2017 the maternal mortality ratio for Aboriginal and Torres Strait Islander women was 27 deaths per 100,000 women who gave birth.
  • For 1998-2015, in NSW, Qld, WA, SA and the NT there was a 32% decline in the death rate from avoidable causes for Aboriginal and Torres Strait Islander people aged 0-74 years


  • In 2017-18, 9% of all hospital separations were for Aboriginal and Torres Strait Islander people.
  • In 2017-18, the age-adjusted separation rate for Aboriginal and Torres Strait Islander people was 2.6 times higher than for non-Indigenous people.
  • In 2017-18, the main cause of hospitalisation for Aboriginal and Torres Strait Islander people was for ‘factors influencing health status and contact with health services’ (mostly for care involving dialysis), responsible for 49% of all Aboriginal and Torres Strait Islander seperations.
  • In 2017-18, the age-standardised rate of overall potentially preventable hospitalisations for Aboriginal and Torres Strait Islander people was 80 per 1,000 (38 per 1,000 for chronic conditions and 13 per 1,000 for vaccine-preventable conditions).

Selected health conditions

Cardiovascular health

  • In 2018-19, around 15% of Aboriginal and Torres Strait Islander people reported having cardiovascular disease (CVD).
  • In 2018-19, nearly one quarter (23%) of Aboriginal and Torres Strait Islander adults were found to have high blood pressure.
  • For 2013-2017, in Qld, WA, SA and the NT combined, there were 1,043 new rheumatic heart disease diagnoses among Aboriginal and Torres Strait Islander people, a crude rate of 50 per 100,000.
  • In 2017-18, there 14,945 hospital separations for CVD among Aboriginal and Torres Strait Islander people, representing 5.4% of all Aboriginal and Torres Strait Islander hospital separations (excluding dialysis).
  • In 2018, ischaemic heart disease (IHD) was the leading specific cause of death of Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT


  • In 2018-19, 1% of Aboriginal and Torres Strait Islander people reported having cancer (males 1.2%, females 1.1%).
  • For 2010-2014, the most common cancers diagnosed among Aboriginal and Torres Strait Islander people living in NSW, Vic, Qld, WA and the NT were lung cancer and breast (females) cancer.
  • Survival rates indicate that of the Aboriginal and Torres Strait Islander people living in NSW, Vic, Qld, WA, and the NT who were diagnosed with cancer between 2007 and 2014, 50% had a chance of surviving five years after diagnosis
  • In 2016-17, there 8,447 hospital separations for neoplasms2 among Aboriginal and Torres Strait Islander people
  • For 2013-2017, the age-standardised mortality rate due to cancer of any type was 238 per 100,000, an increase of 5% when compared with a rate of 227 per 100,000 in 2010-2014.


  • In 2018-19, 8% of Aboriginal people and 7.9% of Torres Strait Islander people reported having diabetes.
  • In 2015-16, there were around 2,300 hospitalisations with a principal diagnosis of type 2 diabetes among Aboriginal and Torres Strait Islander people
  • In 2018, diabetes was the second leading cause of death for Aboriginal and Torres Strait Islander people.
  • The death rate for diabetes decreased by 0% between 2009-2013 and 2014-2018.
  • Some data sources use term ‘neoplasm’ to describe conditions associated with abnormal growth of new tissue, commonly referred to as a Neoplasms can be benign (not cancerous) or malignant (cancerous) [1].

Social and emotional wellbeing

  • In 2018-19, 31% of Aboriginal and 23% of Torres Strait Islander respondents aged 18 years and over reported high or very high levels of psychological distress
  • In 2014-15, 68% of Aboriginal and Torres Strait Islander people aged 15 years and over and 67% of children aged 4-14 years experienced at least one significant stressor in the previous 12 months
  • In 2012-13, 91% of Aboriginal and Torres Strait Islander people reported on feelings of calmness and peacefulness, happiness, fullness of life and energy either some, most, or all of the time.
  • In 2014-15, more than half of Aboriginal and Torres Strait Islander people aged 15 years and over reported an overall life satisfaction rating of at least 8 out of 10.
  • In 2018-19, 25% of Aboriginal and 17% of Torres Strait Islander people, aged two years and over, reported having a mental and/or behavioural conditions
  • In 2018-19, anxiety was the most common mental or behavioural condition reported (17%), followed by depression (13%).
  • In 2017-18, there were 21,940 hospital separations with a principal diagnosis of International Classification of Diseases (ICD) ‘mental and behavioural disorders’ identified as Aboriginal and/or Torres Strait Islander
  • In 2018, 169 (129 males and 40 females) Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA, and the NT died from intentional self-harm (suicide).
  • Between 2009-2013 and 2014-2018, the NT was the only jurisdiction to record a decrease in intentional self-harm (suicide) death rates.

Kidney health

  • In 2018-19, 8% of Aboriginal and Torres Strait Islander people (Aboriginal people 1.9%; Torres Strait Islander people 0.4%) reported kidney disease as a long-term health condition.
  • For 2014-2018, after age-adjustment, the notification rate of end-stage renal disease was 3 times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people.
  • In 2017-18, ‘care involving dialysis’ was the most common reason for hospitalisation among Aboriginal and Torres Strait Islander people.
  • In 2018, 310 Aboriginal and Torres Strait Islander people commenced dialysis and 49 were the recipients of new kidneys.
  • For 2013-2017, the age-adjusted death rate from kidney disease was 21 per 100,000 (NT: 47 per 100,000; WA: 38 per 100,000) for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and NT
  • In 2018, the most common causes of death among the 217 Aboriginal and Torres Strait Islander people who were receiving dialysis was CVD (64 deaths) and withdrawal from treatment (51 deaths).

Injury, including family violence

  • In 2012-13, 5% of Aboriginal and Torres Strait Islander people reported having a long-term condition caused by injury.
  • In 2018-19, 16% of Aboriginal and Torres Strait Islander people aged 15 years and over had experienced physical harm or threatened physical harm at least once in the last 12 months.
  • In 2016-17, the rate of Aboriginal and Torres Strait Islander hospitalised injury was higher for males (44 per 1,000) than females (39 per 1,000).
  • In 2017-18, 20% of injury-related hospitalisations among Aboriginal and Torres Strait Islander people were for assault.
  • In 2018, intentional self-harm was the leading specific cause of injury deaths for NSW, Qld, SA, WA, and NT (5.3% of all Aboriginal and Torres Strait Islander deaths).

Respiratory health

  • In 2018-19, 29% of Aboriginal and Torres Strait Islander people reported having a long-term respiratory condition .
  • In 2018-19, 16% of Aboriginal and Torres Strait Islander people reported having asthma.
  • In 2014-15, crude hospitalisation rates were highest for Aboriginal and Torres Strait Islander people presenting with influenza and pneumonia (7.4 per 1,000), followed by COPD (5.3 per 1,000), acute upper respiratory infections (3.8 per 1,000) and asthma (2.9 per 1,000).
  • In 2018, chronic lower respiratory disease was the third highest cause of death overall for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT

Eye health

  • In 2018-19, eye and sight problems were reported by 38% of Aboriginal people and 40% of Torres Strait Islander people.
  • In 2018-19, eye and sight problems were reported by 32% of Aboriginal and Torres Strait Islander males and by 43% of females.
  • In 2018-19, the most common eye conditions reported by Aboriginal and Torres Strait Islanders were hyperopia (long sightedness: 22%), myopia (short sightedness: 16%), other diseases of the eye and adnexa (8.7%), cataract (1.4%), blindness (0.9%) and glaucoma (0.5%).
  • In 2014-15, 13% of Aboriginal and Torres Strait Islander children, aged 4-14 years, were reported to have eye or sight problems.
  • In 2018, 144 cases of trachoma were detected among Aboriginal and Torres Strait Islander children living in at-risk communities in Qld, WA, SA and the NT
  • For 2015-17, 62% of hospitalisations for diseases of the eye (8,274) among Aboriginal and Torres Strait Islander people were for disorders of the lens (5,092) (mainly cataracts).

Ear health and hearing

  • In 2018-19, 14% of Aboriginal and Torres Strait Islander people reported having a long-term ear and/or hearing problem
  • In 2018-19, among Aboriginal and Torres Strait Islander children aged 0-14 years, the prevalence of otitis media (OM) was 6% and of partial or complete deafness was 3.8%.
  • In 2017-18, the age-adjusted hospitalisation rate for ear conditions for Aboriginal and Torres Strait Islander people was 1 per 1,000 population.

Oral health

  • In 2014-15, the proportion of Aboriginal and Torres Strait Islander children aged 4-14 years with reported tooth or gum problems was 34%, a decrease from 39% in 2008.
  • In 2012-2014, 61% of Aboriginal and Torres Strait Islander children aged 5-10 years had experienced tooth decay in their baby teeth, and 36% of Aboriginal and Torres Strait Islander children aged 6-14 years had experienced tooth decay in their permanent teeth.
  • In 2016-17, there were 3,418 potentially preventable hospitalisations for dental conditions for Aboriginal and Torres Strait Islander The age-standardised rate of hospitalisation was 4.6 per 1,000.


  • In 2018-19, 27% of Aboriginal and 24% of Torres Strait Islander people reported having a disability or restrictive long-term health
  • In 2018-19, 2% of Aboriginal and 8.3% of Torres Strait Islander people reported a profound or severe core activity limitation.
  • In 2016, 7% of Aboriginal and Torres Strait Islander people with a profound or severe disability reported a need for assistance.
  • In 2017-18, 9% of disability service users were Aboriginal and Torres Strait Islander people, with most aged under 50 years (82%).
  • In 2017-18, the primary disability groups accessing services were Aboriginal and Torres Strait Islander people with a psychiatric condition (24%), intellectual disability (23%) and physical disability (20%).
  • In 2017-18, 2,524 Aboriginal and Torres Strait Islander National Disability Agreement service users transitioned to the National Disability Insurance Scheme.

Communicable diseases

  • In 2017, there were 7,015 notifications for chlamydia for Aboriginal and Torres Strait Islander people, accounting for 7% of the notifications in Australia
  • During 2013-2017, there was a 9% and 9.8% decline in chlamydia notification rates among males and females (respectively).
  • In 2017, there were 4,119 gonorrhoea notifications for Aboriginal and Torres Strait Islander people, accounting for 15% of the notifications in Australia.
  • In 2017, there were 779 syphilis notifications for Aboriginal and Torres Strait Islander people accounting for 18% of the notifications in Australia.
  • In 2017, Qld (45%) and the NT (35%) accounted for 80% of the syphilis notifications from all jurisdictions.
  • In 2018, there were 34 cases of newly diagnosed human immunodeficiency virus (HIV) infection among Aboriginal and Torres Strait Islander people in Australia .
  • In 2017, there were 1,201 Aboriginal and Torres Strait Islander people diagnosed with hepatitis C (HCV) in Australia
  • In 2017, there were 151 Aboriginal and Torres Strait Islander people diagnosed with hepatitis B (HBV) in Australia
  • For 2013-2017 there was a 37% decline in the HBV notification rates for Aboriginal and Torres Strait Islander people.
  • For 2011-2015, 1,152 (14%) of the 8,316 cases of invasive pneumococcal disease (IPD) were identified as Aboriginal and Torres Strait people .
  • For 2011-2015, there were 26 deaths attributed to IPD with 11 of the 26 deaths (42%) in the 50 years and over age-group.
  • For 2011-2015, 101 (10%) of the 966 notified cases of meningococcal disease were identified as Aboriginal and Torres Strait Islander people
  • For 2006-2015, the incidence rate of meningococcal serogroup B was 8 per 100,000, with the age- specific rate highest in infants less than 12 months of age (33 per 100,000).
  • In 2015, of the 1,255 notifications of TB in Australia, 27 (2.2%) were identified as Aboriginal and seven (0.6%) as Torres Strait Islander people
  • For 2011-2015, there were 16 Aboriginal and Torres Strait Islander people diagnosed with invasive Haemophilus influenzae type b (Hib) in Australia
  • Between 2007-2010 and 2011-2015 notification rates for Hib decreased by around 67%.
  • In 2018-19, the proportion of Aboriginal and Torres Strait Islander people reporting a disease of the skin and subcutaneous tissue was 2% (males 2.4% and females 4.0%).

Aboriginal Health #CoronaVirus and #WorldNoTobaccoDay News Alert No 75 : May 31 #KeepOurMobSafe #OurJobProtectOurMob @NACCHOChair press release : ” There is light at the end of the tunnel, not at the end of a cigarette ” Plus @TISprogramme What is the link between #smoking and #COVID19 ?

“There is no better time to think about how smoking affects your health, your loved ones and your financial position during this COVID-19 pandemic.

Smoking can mean you are more susceptible to developing lung disease. I want to remind everyone that there is light at the end of this COVID-19 tunnel, not at the end of a cigarette.

Chronic diseases such as respiratory diseases (including asthma), heart and circulatory diseases, high blood pressure, diabetes, kidney diseases and some cancers are more common among Aboriginal and Torres Strait Islander people and tend to occur at younger ages, than among other Australians.

I would like to remind everyone especially during these times of COVID-19, stop sharing cigarettes with others or smoking used cigarette butts. Every step counts to ensuring the wellbeing of yourself and those close to you.”

Donnella Mills Chair of NACCHO

The National Aboriginal Community Controlled Health Organisation (NACCHO) is spreading the message to all Australians that ‘There is light at the end of the tunnel, not at the end of a cigarette’ on World No Tobacco Day.

For this year’s World No Tobacco Day, NACCHO’s message is particularly timely during the COVID-19 pandemic.

Read download this full press release HERE

” People who smoke have a higher risk of catching respiratory infections like colds and flu than non-smokers.

They are also more likely to experience complications that lead to more severe illness such as pneumonia.

Because (coronavirus) COVID-19 is primarily a respiratory disease, we expect smokers to be more susceptible.

As COVID-19 is caused by a new virus, we are still learning about its effects on the body, what factors might increase the risk of infection, and who might experience more severe symptoms. Here we summarise what we know from the emerging evidence specifically in relation to smoking as a risk factor

See part 3 below

Download NACCHO COVID-19 Resources HERE

Part 2


“Being more stressed or depressed could be seen as a reason to advise a smoker to quit rather than to put it off.

This is very important in these stressful times, and for Aboriginal and Torres Strait Islander people who experience more stressful events.

Quitting smoking is always a good first step in improving your health and can increase your confidence to take on bigger problems.

Study leader, Menzies’ Professor David Thomas says health staff can emphasise the research evidence of the benefits to stress management, mental health and well-being that come with successfully quitting smoking.

The study was conducted in partnership with the National Aboriginal Community Controlled Health Organisation, its affiliates, 34 Aboriginal Community Controlled Health Services and Torres Shire Council. Download Press Release with access to study

Stress may not be a major long-term obstacle to Aboriginal and Torres Strait Islander people quitting smoking, as previously believed, according to new research released by Menzies School of Health Research (Menzies) today.

The study found that more smokers who reported being stressed at baseline made quit attempts and stayed quit for longer in the next year, contrary to past research that mainly reported smokers’ perceptions that stress caused them to go back to smoking. 

Forming part of the national Talking About The Smokes study led by Menzies in partnership with Aboriginal Community Controlled Health Services, the 759 study participants completed baseline surveys and follow-up surveys a year later.

Many health professionals and smokers believe that smoking relieves stress. But this relief may be merely because smoking a cigarette relieves the recurring symptoms of nicotine withdrawal caused by the time elapsed since their previous cigarette.

Download full press release

200528 Menzies Media Release – Stress not stopping Aboriginal smokers quitting

Are people who smoke at higher risk of COVID-19 infection?

It is not certain that smokers are more likely to be infected with COVID-19. At the moment the evidence is mixed on whether or not smokers have an increased risk of infection. This may be for several reasons:

  • The evidence we have at the moment is mostly based on hospital admissions, so only really tells us about those people who seek help for their symptoms. Smokers might not recognise mild symptoms, such as increased cough. A large population study in the UK supports this possibility.
  • The study (which is ongoing) uses a smartphone app where people record their health, including any symptoms like coughing, sneezing or fever. Data from 1.5 million users showed smokers were more likely to experience symptoms associated with COVID-19 than non-smokers. At the moment we don’t know if those smokers with symptoms went on to be confirmed cases of COVID-19, but this information may become available as the project continues.
  • Information about smoking in these studies is usually based on self-report. It might be that people are not reporting their smoking status because they want to be seen to be doing the right thing.
  • There is evidence people are quitting because of COVID-19. These people might be classed as former smokers, however if they only quit recently, perhaps they remained at risk of infection.
  • It is possible that because smokers are aware of their increased risk to lung and chest infections, they are being ultra-cautious to avoid catching COVID-19.

What we do know is that the behaviours that smokers engage in put them at greater risk of infection. This includes:

  • frequent hand to mouth action when smoking;
  • sharing cigarettes;
  • collecting and smoking discarded butts;
  • limited physical distancing in designated smoking areas.

 Are people who smoke more likely to have severe complications if they do get COVID-19?

Smokers are likely to be more severely impacted by COVID-19 because smoking:

  • damages your lungs, so they simply don’t work as well;
  • weakens your immune system. This means the body has more trouble fighting the COVID-19 infection;
  • increases the risk of getting a secondary infection such as pneumonia. Lungs naturally produce mucus, but people who smoke have more and thicker mucus that is hard to clean out of the lungs. This mucus clogs the lungs and is prone to becoming infected with bacteria.

The most recent evidence shows that if smokers get COVID-19 and are admitted to hospital then they are more likely to have severe symptoms and die than former or non-smokers. A study published in May 2020 combined hospital data from Asia, Europe and North America. The researchers found that active smokers were almost twice as likely to die than former or never smokers.

What about former smokers, or people who recently quit – are they still at more risk of COVID-19?

We don’t known if people who have quit smoking have a higher risk of getting COVID-19 or are more likely to get severe disease compared to people who have never smoked. What we do know is that:

  • People who have been quit for a while and have normal lung function are less prone to respiratory infection than active smokers, so this is probably true for CVID-19 as well.
  • It is also likely you’ll have a lower risk of severe complications if you become infected than if you were still smoking.

We don’t know how long you need to be smoke free to reduce any potential risk,  but we do know that stopping smoking improves lung health within a few weeks. Risk of lung infections such as bronchitis and pneumonia also decrease in about 4-6 weeks after quitting. This is particularly important as Australia heads into flu season. Being smoke free improves your health and reduces your risk of getting respiratory viruses.  And it improves your ability to fight off any illness.

Is it still safe to start, or continue to use, Nicotine Replacement Therapy (NRT) and other stop smoking medications?

For people who smoke, stop smoking medications or NRT (can help to reduce cravings and manage withdrawal symptoms. Combined with tailored support (for example from Quitline or your local Aboriginal Medical Service), these medications give people the best chance of successfully quitting. There is no evidence or reason to believe that COVID-19 has an impact on the safety and effectiveness of these medications.

  • Anyone already using these medications can be reassured that it is safe to continue.
  • Anyone thinking about starting these medications, should be see a qualified practitioner as usual.

There is also no evidence that stop smoking medications change the risk of contracting the virus. They are also unlikely to increase or reduce symptom severity. You may have read media stories suggesting nicotine could protect against COVID-19. This is not true. This is not a reason for anyone to smoke, smoking carries many risks to our health and wellbeing. It is also not sensible for non-smokers to start using NRT as it will not protect them from COVID-19. Hand hygiene and physical distancing are much more effective ways to stay safe.

How can you tell the difference between nicotine withdrawal symptoms and COVID-19 symptoms?

People who have recently stopped smoking may experience nicotine withdrawal symptoms, including cravings, irritability, and difficulty concentrating. These symptoms are usually temporary and disappear after about 2 to 4 weeks.

Quitters might also experience a cough and sore throat. These withdrawal symptoms may be confused with some of the symptoms of COVID-19. However they are usually temporary and not accompanied by other COVID-19 symptoms, such as fever. Fever is not a symptom of nicotine withdrawal.

Anyone concerned about COVID-19 should visit, call the National COVID-19 Helpline on 1800 020 080, or speak to their doctor or AMS.

What are the risks of e-cigarettes and COVID-19?

As with traditional tobacco products, the evidence around COVID-19 and e-cigarette use (or “vaping”) is still emerging. However the evidence does show a higher number of severe respiratory infections in people who use e-cigarettes, so the risks may well be similar for vapers as they are for smokers. This is because using e-cigarettes has some similar effects to tobacco smoking on your body, including:

  • increased inflammation in the lung;
  • increased coughing and wheezing, probably indicating lung damage;
  • lowered immunity and ability to fight off infection.

Vapers also engage in some of the behaviours that increase risk for smokers (such as frequent hand to mouth action). Vapers should follow good hygiene rules, washing their hands before and after vaping. It is also important not share devices with another person. Vapers should be reminded not to use e-cigarettes near others or in an enclosed space because the aerosol (vapor) produced might carry the virus if the vaper is infected. If someone touches a surface on which aerosol might have settled, they should wash their hands immediately with soap and water.

Is this a good time to quit?

It is always a good time to stop smoking. For some people, concerns about COVID-19 can act as a motivator to quit. Evidence from the UK and the USA supports this:

  • In a UK survey of over 1,000 people, 2% said they had quit because of fears around COVID-19.
  • In addition, a quarter of former smokers in the survey said they were less likely to resume smoking.
  • In the USA survey of smokers, 20% of respondents had made a quit attempt because of COVID19.

Anyone who wants to quit should be encouraged to quit. As described, NRT and other stop smoking medicines are still safe to use.

However it is also important to recognise that for some people this will not be a good time to quit. Additional stress from being in lockdown, or being out of work can be a trigger to smoking. In a UK survey, 4% of former smokers reported that the pandemic had made them more likely to relapse. In a USA survey, 30% of smokers said they were smoking more. For people continuing to smoke, advice around harm reduction for themselves and others is important. Smokers should be reminded to:

  • pay extra attention to the existing hygiene advice: wash your hands thoroughly and frequently, particularly before and after smoking, cough into your elbow, try to avoid touching your face, and maintain a physical distance from others;
  • do not share cigarettes or roll a cigarette for someone else;
  • smoke outside, not in the house, to reduce the impact of second hand smoke.

Smokers should also be reminded to get a flu shot, because they are at increased risk of becoming infected with the influenza virus. As we head into flu season with COVID-19 also around, the risk of catching a respiratory illness is higher than usual.

In summary

Smoking might put you at greater risk for contracting  COVID19, but we don’t know for sure. Emerging evidence suggests smokers are more likely to have severe illness if they are infected. We should encourage smokers to:

  • stay safe by following hygiene and physical distancing rules, not sharing cigarettes or vaping devices;
  • protect others from second and third hand smoke by maintaining a smoke free home;
  • quit if they can.

The dangers of smoking and exposure to second hand smoke have not changed. Stopping smoking has many health benefits beyond a link with COVID-19, and it saves a lot of money. It is always a good time to quit. As we head into flu season, quitting has never been more important – quit for life, not just for COVID-19.

You can find more information about COVID-19 on HealthInfoNet

Australian Government of Health

National COVID-19 Helpline: 1800 020 080

Quitline 13 78 48 -this includes access to Aboriginal Quitline counsellors – Aboriginal and Torres Strait Islander community members who are trained to support our community in quitting.

With thanks to Cancer Council’s Tobacco Issues Committee and Quit Victoria for their contribution to this article.


NACCHO Aboriginal Women’s Health and #Smoking #IDM2020 #Midwives2020 News Alert : Dr @michelle_bovill : What ngidhi yinaaru nhal yayi (this woman told me) about smoking during pregnancy changes the conversation about this national priority.

 ” Let me make it clear right from the start. Aboriginal and Torres Strait Islander women are quitting smoking during pregnancy and care deeply about the health and wellbeing of their babies.

While there has been an acknowledgement that the proportion of Aboriginal and Torres Strait Islander women smoking during pregnancy has declined, reports more frequently measure and monitor smoking rates during pregnancy and compare these to non‐Aboriginal pregnant women.

For example, 43% of Aboriginal and Torres Strait Islander mothers reported smoking during pregnancy compared with 12% of non‐Aboriginal Australians.

I have been privileged to hear Aboriginal and Torres Strait Islander women from Worimi, Awabakal, Biripi, Goomeroi/Kamilaroi/Gamilaraay and Boandik communities share their stories with me about smoking and becoming pregnant.

I acknowledge my responsibility to pass on these stories to inform the conversations about smoking during pregnancy among Aboriginal and Torres Strait Islander women.

What ngidhi yinaaru nhal yayi (this woman told me) about smoking during pregnancy changes the conversation about this national priority.

What is now owed to these women is more action. Action by health professionals to advise Aboriginal and Torres Strait Islander women to quit smoking during pregnancy, and action to find meaningful support strategies to achieve abstinence. “

Selected extracts from

Michelle Bovill as published in MJA Journal

Download the publication HERE


However, two things happen when we measure and monitor in this way. First, this approach assumes that Aboriginal and Torres Strait Islander communities are homogenous.

We are not; we are extremely diverse in cultures, customs and experiences. Second, it creates the impression that smoking during pregnancy is the issue and that Aboriginal and Torres Strait Islander women present a deficit.

This is detrimental because our lived experiences are not the same, nor have they been for generations. Colonisation, dispossession onto missions and reserves, the removal of children, unpaid labour, and refusal of the equal right to education, employment and health care over generations has led to a gap in social and cultural determinants of health.

This gap is founded on racist policies that positioned Aboriginal and Torres Strait Islander people as inferior to other Australians. The gap and deficit mentality follow us today and can be found in countless government reports on Aboriginal and Torres Strait Islander disadvantage.

When we don’t contextualise in terms of colonisation and the resulting social and cultural determinants of health, and fail to privilege Indigenous knowledges, we cannot truthfully address any area of health inequity.

While it has been identified that Aboriginal and Torres Strait Islander women experience multiple barriers to quitting smoking during pregnancy, little work has been conducted to ask Aboriginal and Torres Strait Islander mothers about their experiences of quitting and what they believe could support them to become smoke‐free during pregnancy.

Quit attempts are being made “A lot of people are more wanting to give up smoking but not having the information”

Across New South Wales, Queensland and South Australia, Aboriginal and Torres Strait Islander women often shared a desire to quit smoking and reported making several quit attempts during pregnancy. Aboriginal and Torres Strait Islander people in general are more likely than other Australians to make a quit attempt but are less likely to succeed, which raises the question, “what is happening when Aboriginal and Torres Strait Islander people make a quit attempt?”.

Stories of quit attempts lasting at least 24 hours but often less than a full week were often shared. If we listen to Aboriginal and Torres Strait Islander women, we can hear that motivation to quit is high.

The problem with reduction “I think doctors need to stop telling people to cut down”

Aboriginal and Torres Strait Islander women across communities yarra (say) reduction in cigarette consumption was suggested by health providers.

This tendency to advise reduction in tobacco consumption rather than recommending to women that they quit completely has been previously reported.

 Advising women to cut down cigarette consumption during pregnancy when they are unable to quit smoking is still being promoted across the country in clinical practice guidelines.

 If we only ever report quit rates, yet Aboriginal and Torres Strait Islander women are only being advised to reduce, how will we ever achieve the lower smoking rates of the non‐Aboriginal population?

“I was doing 10 to 15 cigarettes down to 1 to 2 cigarettes a day. I think that is a big, a big reduce”

Aboriginal and Torres Strait Islander women are proud of their success in reducing cigarette consumption. Why shouldn’t they be? Women are successfully following the advice of their health providers.

The only randomised controlled trial conducted with Aboriginal and Torres Strait Islander women during pregnancy reported that 70% of women who were advised to quit smoking by their health provider made a quit attempt.

A recent survey of Aboriginal women who smoke revealed positive attitudes to advice and support from doctors (61%) and midwives (62%). However, health provider support for planned smoking cessation is reported to be weak.

Pregnancy is a life stage during which there are multiple opportunities to offer cessation support to mothers.

Each opportunity should repeat the unambiguous message that the best thing for mothers’ and babies’ health is to quit smoking completely, explain that they are not alone, and offer cessation support.

We therefore hit a dilemma: what cessation support should even be offered? Systematic reviews on Aboriginal tobacco control have concluded that there is limited evidence of effective programs for Aboriginal and Torres Strait Islander people in general as well as during pregnancy.

Community led initiatives are key to successful outcomes

“Everybody looks up to their Elders and stuff, as you know, maybe just a yarn or a get‐together to discuss smoking could help”

Aboriginal women in NSW yarra (speak) of their desire to receive support from their community and Elders. Elders understand community dynamics and the context of women’s lives in a way that (non‐Aboriginal) health providers cannot

. But what would this look like in a health care setting? How can we ensure that consistent messages are offered throughout community to support being smoke‐free?

“I was just thinking that these products, I wouldn’t use them. I’d think about the side effects”

Aboriginal and Torres Strait Islander pregnant women yarra (speak) of their desire to use non‐pharmacological and stress management approaches for smoking cessation. The use of alternative approaches (such as yoga and mindfulness) has been reported in white populations with high socio‐economic status; however, the effectiveness of some of these approaches is as yet uncertain.,

Aboriginal and Torres Strait Islander health does not focus on the individual, but rather the social, emotional and cultural wellbeing of the whole community in which each individual is able to achieve their full potential.

It is therefore important that any support program to address health inequities also focuses on community engagement and empowerment. Aboriginal and Torres Strait Islander women want control and ownership of the quitting process and should be empowered to quit smoking.

If we truly want to support Aboriginal and Torres Strait Islander women to quit smoking during pregnancy, we need to privilege their voices in the process of developing effective and meaningful supports.

I have been privileged to hear Aboriginal and Torres Strait Islander women from Worimi, Awabakal, Biripi, Goomeroi/Kamilaroi/Gamilaraay and Boandik communities share their stories with me about smoking and becoming pregnant.

I acknowledge my responsibility to pass on these stories to inform the conversations about smoking during pregnancy among Aboriginal and Torres Strait Islander women.

What ngidhi yinaaru nhal yayi (this woman told me) about smoking during pregnancy changes the conversation about this national priority.

What is now owed to these women is more action. Action by health professionals to advise Aboriginal and Torres Strait Islander women to quit smoking during pregnancy, and action to find meaningful support strategies to achieve abstinence.

Developing appropriate support strategies for Aboriginal and Torres Strait Islander people should draw on traditional and contemporary knowledges, values and practices.

Over the next 4 years, with the support of a National Health and Medical Research Council Early Career Fellowship and a National Heart Foundation Australian Aboriginal and Torres Strait Islander Award, I will commence this exploratory work in partnership with NSW Aboriginal communities through the Which Way? project.

This project will partner with four communities to explore what Aboriginal and Torres Strait Islander women desire to support smoking cessation and develop an Indigenous led evidence base on smoking cessation.

This work will build on the request for non‐pharmacological support and align with a holistic definition of health and wellbeing. It is my belief that by developing, implementing and evaluating a support strategy that Aboriginal and Torres Strait Islander women desire, our communities can achieve smoking abstinence.

NACCHO Aboriginal Health #AODConnect Resources Alert : Download an app to improve access to #alcohol and other #drugs AOD service information for Aboriginal and Torres Strait Islander communities

The AODconnect app has been developed by the Australian Indigenous HealthInfoNet Alcohol and Other Drugs Knowledge Centre to help alcohol and other drug (AOD) workers, community members and health professionals working in the AOD sector to locate culturally appropriate services.

The app aims to support efforts to reduce harmful substance use among Aboriginal and Torres Strait Islander people.

Read over 200 Aboriginal Health Alcohol and other Drugs articles published by NACCHO over past 8 years 

Aboriginal and Torres Strait Islander people are increasingly using online platforms to share and access information about different health topics.

The ownership and use of mobile phones in rural and remote Aboriginal and Torres Strait Islander communities is widespread and increasing, making apps a viable way to provide people living in these regions with access to health information.

AODconnect provides an Australia-wide directory of over 270 Aboriginal and Torres Strait Islander AOD treatment services.

It delivers a portable way to easily access information about service providers such as contact details and program descriptions, helping to facilitate initial contact and referral.


Once the app has been downloaded, users can search for AOD services even when their internet connection is unstable or not available.

This is especially useful in rural and remote areas of Australia where the Internet coverage is not always extensive or reliable.

The app enables users to search for services by state, territory, region and postcode via either an interactive map of Australia or by alphabetical listing.

Services can be filtered by the type of treatment they provide: counselling and referral, harm reduction and support groups, outreach, mobile patrols and sobering up shelters, residential rehab, withdrawal management and young people.

The services listed on the app are also available through the Alcohol and Other Drugs Knowledge Centre website.

The app is free to download on both iOS and Android devices.

If you would like to have your service added to the app or would like more information about the AODconnect app, please contact the Alcohol and Other Drugs Knowledge Centre email: or Ph: (08) 9370 6336.

Alcohol and other drugs GP education program

NACCHO Aboriginal Health and #Smoking : Download the @RACGP Supporting #smokingcessation Guide : Smoking daily is three times as high in the lowest socioeconomic areas of Australia compared to the highest.

“The likelihood of smoking daily is three times as high in the lowest socioeconomic areas of Australia compared to the highest.

What this means is that smoking-related health problems disproportionately affect those least able to afford the medicines that are essential to helping them quit.

We have made massive inroads, now it’s time for the final, decisive push to reduce daily smoking levels.

These medicines work, we just need to do more to help get them into the hands of people who need them most and removing restrictions on prescribing will do just that.”

RACGP President Dr Harry Nespolon said that the Government should act to assist those who struggle to afford the medicines that are proven to help people quit smoking.

Aboriginal and Torres Strait Islander people

 ” Indigenous Australians are still more than twice as likely as non-Indigenous Australians to be current daily smokers.2 However, there has been a progressive decrease in daily smoking rates for Aboriginal and Torres Strait Islander people, declining from 49% in 2002 to 45% in 2008, and then to 41% in 2012–13.3

People who identify as Aboriginal or Torres Strait Islander qualify for PBS authority listing that provides up to two courses per year of nicotine patches, each of a maximum of 12 weeks. Under this listing, participation in a support and counselling program is recommended but not mandatory. Access t nicotine patches for Aboriginal and Torres Strait Islander people can be facilitated through the Closing the Gap PBS co-payment measure (see page 45).”

Extracts from GUIDE

Download the RACGP Supporting smoking cessation: A guide for health professionals (2nd edition) smoking-cessation

Read over 130 Aboriginal Health and Smoking articles published by NACCHO over past 8 years

Read Aboriginal Health and our partnership with RACGP articles published by NACCHO over past 8 years

The Royal Australian College of General Practitioners (RACGP) has today recommended allowing greater flexibility in prescribing for smoking cessation pharmacotherapy.

The bold proposal, contained in the RACGP’s newly released Supporting smoking cessation: A guide for health professionals (2nd edition) (“the guide”), could prove a game-changer for reducing smoking rates.

Pharmacotherapy options available in Australia include nicotine replacement therapy (NRT, e.g. a transdermal patch or acute forms such as an oral spray, gum, inhaler or lozenge), varenicline (a drug that blocks the pleasure and reward response to smoking) and bupropion hydrochloride (which reduces the urge to smoke and helps with nicotine withdrawal).

Oral forms of NRT subsidised on the Pharmaceutical Benefits Scheme (PBS) are gum and lozenges for use as the sole PBS-subsidised therapy. This means that combination NRT (i.e. using two forms of NRT together such as a patch and gum) is not currently PBS-subsidised.

Under PBS rules, a maximum 12 weeks of PBS-subsidised NRT is available per 12-month period.

Australia has made commendable inroads in tobacco control and smoking rates with daily smoking nearly halved from 24% in 1991 to 12.8% in 2013. However, the job is not complete and there has been a slowing in the rate of decline with little change in prevalence from 2013 to 2016 (12.2%).

The latest National Tobacco Strategy aims to reduce the national adult daily smoking rate to 10% of the population and halve the Aboriginal and Torres Strait Islander adult daily smoking rate.

RACGP President Dr Harry Nespolon said that the Government should act to assist those who struggle to afford the medicines that are proven to help people quit smoking.

“Some people can quit unassisted; however, those who take advantage of behavioural support and vital medicines including combination NRT, varenicline and bupropion will substantially increase their chances of quitting.

“The science is in – a host of randomised clinical trials tell us that these medicines work. Varenicline or combination NRT almost triples the odds of quitting and bupropion and NRT alone almost double the odds of quitting versus a placebo at six months. The evidence is also clear that combination NRT is most effective.

“However, as things stand we have fixed PBS rules that don’t reflect best-practice medical assistance. As a result, people trying to quit smoking miss out on PBS subsidies that could make a real difference.

“We need to improve flexibility in prescribing to cut costs for patients using pharmacotherapy so that people who could really benefit from these medicines can access them.

“It’s vital to allow for PBS-subsidised combination NRT, which is proven to be the most effective form of NRT.

“We should also allow GPs to prescribe a second round of PBS-subsidised NRT within a 12-month period because it will help reduce relapse in people who have stopped smoking at the end of a standard course of NRT. This is a public health policy no-brainer, pure and simple.”

Dr Nespolon noted that the inflexibility in PBS prescribing was particularly troubling given that smoking rates are inverse to socioeconomic status.

Chair of the Expert Advisory Group behind the guide, Professor Nicholas Zwar, said that health professionals including GPs should also be encouraged to embrace the “brief intervention” approach to smoking cessation.

“One of the most often cited barriers to providing smoking cessation advice is that it can prove time consuming.

“Up until now health professionals have used a ‘5A’s approach’ which involves identifying patients who smoke, assessing nicotine dependence and barriers to quitting, advising patients to quit, offering assistance and arranging a follow up. It is sound practice but it does take time.”

Professor Zwar said that under the three-step model developed by Quit Victoria, advice and help for patients trying to quit smoking could be easier to provide and more frequently offered by a range of health professionals.

“This three-step model offers patients best practice smoking cessation treatment by linking into multi-session behavioural interventions such as Quitline and encouraging the use of pharmacotherapy.

“It can be summarised as ask, advise and help. Ask and record a patient’s smoking status, advise people who smoke to quit and on the most effective methods for doing so and help them by offering to arrange referral, encourage use of behavioural intervention and the use of evidence-based pharmacotherapy.”

The guide update was funded by VicHealth and the Australian Government Department of Health.


NACCHO Aboriginal Health and #Cancer #Smoking : Report from Canada where 400 delegates are meeting at #WICC2019 with theme ‘Respect, Reconciliation and Reciprocity “ discussing cancer and its impact on Indigenous peoples.

“Cancer has been largely overlooked amongst Indigenous populations world-wide and remains the second leading cause of death among Aboriginal and Torres Strait Islander people “

Professor Gail Garvey, who convened the first WICC and is co-chair of WICC 2019 :Pictured above with Professor Tom Calma and Blackfoot Fancy Feather Dancer Kyle Agapi.

“Smoking is the single biggest contributor to early deaths, including cancer deaths, of Aboriginal and Torres Strait Islander people – which is why it is so important that we encourage people not to take up smoking and assist smokers to stop “

Professor Tom Calma AO, National Coordinator, Tackling Indigenous Smoking, and member of the Cancer Australia Aboriginal and Torres Strait Islander Cancer Leadership Group

Read over 80 Aboriginal Health and Cancer articles published by NACCHO in past 7 years

Read over 130 Aboriginal Health and Smoking articles published by NACCHO in past 7 years

Indigenous communities, consumers and health experts from around the world have come together at the opening of the second World Indigenous Cancer Conference (WICC) at the Calgary Telus Convention Centre in Canada.

The conference, which has drawn a large contingent of Australian delegates, follows on from the success of the inaugural WICC held in Brisbane, Australia in 2016.

The WICC 2019 theme is ‘Respect, Reconciliation and Reciprocity,’ with over 400 delegates from across the globe discussing cancer and its impact on Indigenous peoples.

World-wide, Indigenous peoples bear a disproportionately higher cancer burden than non-Indigenous peoples, which makes WICC 2019 so very important.

Hosted by the Canadian Indigenous Research Network Against Cancer (CIRNAC) in partnership with the host sponsor Alberta Health Services, this premier event is supported by the Alberta First Nations Information Governance Centre, Canadian Institutes of Health Research, Canadian Partnership Against Cancer, and the International Agency for Research on Cancer (IARC) which is the specialized cancer agency of the World Health Organization.

 Professor Gail Garvey , Blackfoot Piikani Chief Stan Grier and Professor Tom Calma 

WICC 2019 has drawn expertise of leading cancer researchers, public health practitioners, clinicians, advocacy groups, Indigenous community leaders and consumers.

They are coming together to share knowledge about critical issues across the cancer continuum from prevention and treatment to survivorship and end of life.

Several Aboriginal and Torres Strait Islander delegates with a lived experience of cancer are making an important contribution to the conference.

Des McGrady, an Aboriginal cancer survivor, said “An international meeting is important for the information sharing that we can pass on to community and people working in this space. This will allow us to work in partnership to drive positive change.”

The burden of cancer among Indigenous populations is of major public health importance and forums for collaboration such as this conference will strengthen research and service delivery and help accelerate progress in improving cancer outcomes.

Indigenous leadership, culturally sound service delivery and encouragement of mainstream services to prioritise Indigenous cancer are critical to these efforts and central to WICC 2019.

For more details about the conference, please visit the website:

NACCHO Aboriginal Health #amafdw19 #Prevention #Smoking : At #NPC @AMApresident says the Federal Government must commit adequate resources to its proposed long-term national preventive health strategy :

“ Preventive health measures reduce the rate of chronic ill health and improve the health and wellbeing of all Australians, leading to better and healthier lives.

As a nation, we spend woefully too little on preventive health – around two per cent of the overall health budget.

A properly resourced preventive health strategy, including national public education campaigns on issues such as smoking and obesity, is vital to helping Australians improve their lifestyles and quality of life.

The Australian Government must commit adequate resources to its proposed long-term national preventive health strategy, and work with GPs to help improve the health of all Australians.

AMA President, Dr Tony Bartone, who addressed the National Press Club as part of Family Doctor Week, said the AMA is looking forward to working on the strategy, which Health Minister, Greg Hunt, first announced in a video message to the AMA National Conference in May.

Download full speech HERE

AMA President Press Club Address

” The Northern Territory Government has been judged to have been the worst-performing Australian government on tobacco control measures over the last 12 months, and shamed with the Dirty Ashtray Award for 2019.

This year is the 25th anniversary of the National Tobacco Control Scoreboard – run by the AMA and the Australian Council on Smoking and Health (ACOSH) – and the Northern Territory has managed to collect the dubious Dirty Ashtray Award 13 times.”


Read over 130 Aboriginal Health and Smoking articles published by NACCHO in the last 7 years 

Part 1 AMA President, Dr Tony Bartone Prevention Press Release

“Family doctors – GPs – are best placed to manage preventive health, and can assist their patients in managing issues such as weight, alcohol consumption, physical activity, stress, substance use, and quitting smoking.

“Managing weight is a vital part of preventive health. Carrying excess weight contributes to cancers, high blood pressure, and musculoskeletal disorders like bad backs and neck pain. It also affects general health and wellbeing.

“Too many Australians drink at harmful levels, and this is dangerous to their health. Drinking in moderation, and within the guidelines, is a message all Australians should be aware of, and if you are worried about alcohol consumption, talk to your GP.

“Tobacco kills. There is no way to sugar coat the dangers of smoking. If you smoke, you increase your risk of coronary heart disease and cancer.

“Smoking can cause cancer of the lung, oesophagus, mouth, throat, kidney, bladder, liver, pancreas, stomach, cervix, colon, and rectum.

“If you want to quit smoking, start by seeing your family doctor.”

Dr Bartone will also announced the recipient of the 2019 Dirty Ashtray Award, which is presented to the government – Federal, State, or Territory – that has done the least over the past year to combat smoking.

AMA Family Doctor Week runs from 21 to 27 July 2019.


  • In 2017-18, two-thirds of Australian adults and almost one-quarter of Australian children were overweight or obese.
  • Coronary heart disease is the nation’s leading single cause of death.
  • It is estimated that more than 1.2 million Australians have diabetes. The majority (85 per cent) have type 2 diabetes, which is largely preventable.
  • In 2013, diabetes contributed to 10 per cent of all deaths in Australia.
  • Tobacco is the leading cause of cancer in Australia.
  • In 2014-15, more than 1.6 million Australian males aged 15 years and over smoked, 90 per cent of whom smoked daily.
  • More than 1.2 million Australian females aged 15 years and over smoked, 91 per cent of whom smoked daily.
  • About one in 10 mothers smoked in the first 20 weeks of pregnancy.
  • In 2016, 57 per cent of daily smokers were aged over 40, and 20 per cent of daily smokers lived in remote and very remote areas of Australia.
  • Daily tobacco smoking has been trending downward since 1991, from 24 per cent to 12 per cent in 2016.
  • The proportion of people choosing never to take up smoking has increased to 62 per cent in 2016, from 51 per cent in 2001.
  • In 2016, almost one in three (31 per cent) current smokers aged 14 and over have used e-cigarettes.
  • Of current smokers in secondary school aged 16-17, more than one-quarter (26 per cent) smoked daily.

Sources: Australian Bureau of Statistics’ National Health Survey, Australian Institute of Health and Welfare, Heart Foundation.



To read all the states an Territories scores CLICK HERE

The Northern Territory Government has been judged to have been the worst-performing Australian government on tobacco control measures over the last 12 months, and shamed with the Dirty Ashtray Award for 2019.

This year is the 25th anniversary of the National Tobacco Control Scoreboard – run by the AMA and the Australian Council on Smoking and Health (ACOSH) – and the Northern Territory has managed to collect the dubious Dirty Ashtray Award 13 times.

In contrast, the Queensland Government has achieved a remarkable hat trick by topping the scoring to win the coveted National Tobacco Control Scoreboard Achievement Award for leading the nation in tobacco control measures.

AMA President, Dr Tony Bartone, today released the results of the AMA/Australian Council on Smoking and Health (ACOSH) National Tobacco Control Scoreboard 2019 at the National Press Club in Canberra.

Dr Bartone congratulated Queensland on its strong consistent record in stopping people from smoking, and urged the Northern Territory to build momentum with its efforts on tobacco control, while noting the NT Government had amended and strengthened its tobacco control legislation earlier this year.

“The Queensland Government has continued to protect its community from second-hand smoke in a range of outdoor public areas including public transport, outdoor shopping malls, and sports and recreation facilities,” Dr Bartone said.

“Queensland Health is well ahead of other health services in recording smoking status, delivering brief intervention, and referring patients to evidence-based smoking cessation support such as Quitline.

“The Making Tracks – toward closing the gap in health outcomes for Indigenous Queenslanders by 2033 – Policy and Accountability Framework indicates a commitment to reducing smoking among Indigenous communities.

“Funding continues for the B.Strong Brief Intervention training program to strengthen primary healthcare services for Indigenous smokers by increasing the brief intervention skills of health professionals, access to culturally effective resources, and referral to Quitline.

“A dedicated smoking cessation website – QuitHQ – has been developed for the Queensland community, which includes quit support, information for health professionals, and smoking laws. Promotion of QuitHQ includes on-line messages and billboards.”

Dr Bartone said that the Northern Territory is showing signs of moving ahead with stronger tobacco control programs, but we are yet to see solid action and proper funding.

“The NT Government has  published a new Tobacco Action Plan 2019-2023 stressing the need for  media campaigns, smoke-free spaces, sustaining quit attempts and preventing relapse, and identifying priority populations,” Dr Bartone said.

“But these good intentions are yet to be backed with the necessary funding.”

Dr Bartone said the AMA would like to see the Federal Government take on a greater leadership role to drive stronger nationally coordinated tobacco control to stop people smoking and stop people taking up the killer habit.

“The Federal Government has not run a major, national media campaign against smoking since 2012-13, when plain packaging was introduced,” Dr Bartone said.

“Nor has it implemented any further product regulation or constraints on tobacco marketing in that time.

“We would like to see the National Tobacco Campaign reinstated with additional and sustained funding.

“The $20 million announced during the Federal election health debate is a welcome start, but falls well short of the $40 million a year that is needed for a sustained public education program.

“That is a mere 0.24 per cent of the $17 billion the Government expects to reap from tobacco taxes in 2019-20.

“The Government should also implement a systemic approach to providing support for all smokers to quit when they come into contact with health services.

“These key ingredients should be part of the Minister’s commitment, first announced at the AMA National Conference in May, to develop a National Preventive Health Strategy in consultation with the AMA and other health and medical bodies.

“Smoking remains the leading cause of preventable death and disease in Australia, causing 19,000 premature deaths each year.

“Two-thirds of all current Australian smokers are likely to be killed by their smoking. That is a staggering 1.8 million people.

“While Australia is a world leader in tobacco control, more needs to be done to help people quit smoking, or not take it up in the first place.

“Big Tobacco is attempting to distract attention from evidence-based measures that will reduce smoking, while promoting itself as being concerned about health.

“This is particularly outrageous from an industry whose products kill more than seven million people each year.

“It is crucial that Australia maintains its strong evidence-based policies and avoids being diverted by Big Tobacco’s new distraction strategies, particularly following disturbing evidence from the US and Canada about the epidemic of youth e-cigarette use.

“We must remain vigilant against any attempts to normalise smoking, or make it appealing to young people.

“This includes following the advice of the National Health and Medical Research Council and the Therapeutic Goods Administration in regulating e-cigarettes, and not allowing them to be marketed as quit smoking aids until such time as there is scientific evidence that they are safe and effective.”

The AMA/ACOSH National Tobacco Control Scoreboard is compiled annually to measure performance in combating smoking.

Judges from the Australian Council on Smoking and Health (ACOSH), the Cancer Councils, and the National Heart Foundation allocate points to the State, Territory, and Australian Governments in various categories, including legislation, to track how effective each has been at combating smoking in the previous 12 months.

No jurisdiction received an A or B rating this year or last year.

AMA/ACOSH Award – Judges’ Comments

This year is the Silver Anniversary of the AMA/ACOSH National Tobacco Control Scoreboard. 

Since the introduction of the Award in 1994, daily smoking in Australia has halved from 26.1% in 1993 to 12.8% in 2016.

Importantly, the proportion of 12 to 17-year-old school students who have never smoked in their life has increased significantly from 33% in 1984 to 82% in 2017.

Australia has led the world in its implementation of a comprehensive approach to reduce smoking.

Since the early 1990s, Australia has implemented the following strategies to reduce smoking, many of which have been duplicated in other countries around the globe:

We call on the Australian, State and Territory Governments to implement the following recommendations:

  • allocate adequate funding from tobacco revenue (predicted to be $17 billion in 2019/2020) to ensure strong media campaigns at evidence-based levels;
  • ban all remaining forms of tobacco marketing and promotion and legislate to keep up with innovative tobacco industry strategies;
  • implement tobacco product regulation to decrease the palatability and appeal of tobacco products;
  • implement comprehensive action, including legislation, in line with Article 5.3 of the Framework Convention on Tobacco Control (FCTC) to protect public health policy from direct and indirect tobacco industry interference, and ban tobacco industry political donations;
  • implement positive retail licensing schemes for all jurisdictions;
  • implement best practice support for smoking cessation across all health care settings;
  • ensure consistent funding for programs that will decrease smoking among Aboriginal and Torres Strait Islanders and other groups with a high prevalence of smoking; and
  • ensure further protection for the community from the harms of second-hand smoke.


NACCHO Our Members #Aboriginal Health Deadly Good News Stories : Features #WNTD2019 @TISprogramme Photos from @NACCHOChair #NSW @ahmrc @ReadyMob @Galambila #Redfern ACCHO @awabakalltd #VIC @VACCHO_org #QLD @Apunipima @DeadlyChoices #SA @AHCSA_ #WA @TheAHCWA #NT @CAACongress @Kwhb_OneShield

For World No Tobacco Day 31 May NACCHO celebrates and highlights examples of the great work many of our Aboriginal Community Controlled Health Services throughout Australia are doing in tobacco control.


2.New South Wales



5.Western Australia

6.South Australia


8.Northern Territory


10. Sista Quit

How to submit in 2019 a NACCHO Affiliate  or Members Good News Story ?

Email to Colin Cowell NACCHO Media 

Mobile 0401 331 251 

Wednesday by 4.30 pm for publication Thursday /Friday


On World No Tobacco Day NACCHO participated in the National #CommunityControl Twitter Festival that spotlighted the work of Aboriginal Community Controlled Health Services in tobacco control.

The Festival was sponsored by the Aboriginal Health and Medical Research Council of NSW (AH&MRC) and hosted by Croakey Professional Services.

For full Croakey coverage of the event

Read the first one here

The second one here

And the third here

During the period when Croakey was publishing about the Twitter Festival (13 May-3 June 2019), 299 Twitter accounts sent more than 2,000 tweets using the #CommunityControl hashtag, creating more than 17 million Twitter impressions.

See the Symplur Analytics here, and the Twitter transcript here.

Read all NACCHO Smoking articles HERE 

2.New South Wales



It’s vital that brief tobacco interventions are embedded into routine health care and checks. Our staff love to yarn with community to help them quit. You can read about the #ATRACYarning Tool here: 

We have developed the #ATRAC Yarning Tool which has been incorporated into smoking cessation programs across the country. The tool has assisted many health workers to initiate meaningful smoking cessation discussions with clients.

2.2 Redfern ACCHO

2.3 Ready Mob Coffs Harbour to Port Macquarie

The Tackling Indigenous Smoking program team Ready Mob is a federally funded program based out of Galambila Aboriginal Health Service in Coffs Harbour, covering the Mid North Coast region from Coffs Harbour through to Port Macquarie.

My name is Kristy Pursch and my ancestral ties are to the Butchulla people of Fraser Island in Queensland. I have lived in NSW for the past 20 years and brought my children up in beautiful Gumbaynggirr country for the past 14 years.

Ready Mob is an acronym for Really Evaluate and Decide Yourself, Make Ourselves Better which is all about self determination, we don’t tell our mob what to do we just provide the tools and education so that people can make their own informed decisions.

Our strategy to work in and with our local communities is to use local places and local faces. Our relationships in communities are paramount to our effectiveness as a health promotion program.

There are 8 people in our team and all are Aboriginal people with the majority working within their own ancestral lands. This connection and investment in our own local people is integral at ensuring our approach is both determined by and effective for our local mob.

Second and third hand smoke causes just as much damage to small lungs as smoking resulting in more acute respiratory infections, severe asthma attacks and can cause middle infections.

Encouraging our smokers to ‘take a look around and see, who are you sharing your smoke with?’ A non shame based campaign encouraging introspection and positive decision making especially around the impacts smoking causes to those around you.

As with all our campaigns the call to action is to seek quit support by calling the Quitline or visiting your GP and local Aboriginal Medical Service

2.4 Tharawal ACCHO Dr Tim Senior

And working in #communitycontrol means they know the service is set up for them, and they have friends and relatives employed there and on the board! And we have staff and programs that will help.

So for example, I have access to free nicotine replacement, as well as the medicines on the PBS. And especially important are our health workers and our mums and bubs and social and emotional wellebeing programs. And dentists.

Fundamentally, my goal as a GP in #CommunityControl is to enable people to make decisions about their life, NOT tell people what to do. (We’ve tried that for >200 yrs. It doesn’t work!)

And having a relationship with a patient, means the discussion we have can be very practical.

I’ve never met anyone who doesn’t know that smoking is bad for them. But stress, poverty, boredom, habit, socialising underscored by addiction are all reasons people continue to smoke.

We can offer practical advice for all of these things, in complete confidence, with onward referral as appropriate

FYI, these are the smoking cessation guidelines.

2.5 Awabakal ACCHO

2.6 Yerin ACCHO Gosford 



3.2 Goolum Goolum Aboriginal Co-Operative

World No Tobacco Day @ Goolum. Great day, great feed and celebrating #smokefreemob champions.


4.1 Apunipima ACCHO Cape York

Last week TIS Health Workers Brett and Clara celebrated WNTD in Kowanyama with a morning tea and an educational stall

4.2 Deadly Choices 

5.Western Australia

5.1 AHCWA 

5.2 Join the TIS team now at Wirraka Maya for World no Tobacco Day.

Have your Smoke reading taken, along with Quit Smoking support and information.


6.South Australia


AHCSA Staff came together to raise awareness about World No Tobacco Day today and joined the mob by taking the 2019 Puyu Blasters Pledge.

Are you interested in taking the pledge? Follow the link to find out how..

6.2 Tackling Tobacco Team – Nunkuwarrin Yunti

The Tackling Tobacco Team helped the team and kids of Playford and was given the chance to have a hit of tennis with the Deadly and Legendary Evonne Goolagong-Cawley. The ‘Come and Try’ clinics are for 5 to 15 year old boys and girls, with an emphasis on having fun and being healthy!

6.3 AHCSA Puyu Blaster

Today the Puyu Blaster and the Aboriginal Dental Program visited Berri Primary School to celebrate World No Tobacco Day this week. We look forward to coming back. Thanks for having us!

Who are the Puyu Blasters?

We all are!

Puyu Blasters is a community based approach to addressing the issue of smoking within our communities.

The Puyu Blasters Team is hosted by the Aboriginal Health Council of South Australia and it’s Tackling Indigenous Smoking (TIS) Program.

The AHCSA TIS Program has been funded to support regional approaches to reducing the gap in prevalence of smoking among Aboriginal and Torres Strait Islander People compared to that among non-Indigenous, through;

  • Reducing uptake of smoking
  • Increasing smoking cessation and
  • Reduced exposure to environmental tobacco smoke

7.Tasmania ( TBC )

8.Northern Territory

8.1  Congress Alice Springs

Our Health Promotions team would like to thank everyone who came down to Araluen Park on Saturday to participate in the World No Tobacco Day Colour Smash Fun Run/Walk.

To View all Facebook Photos 

We had a massive turn out and all had a lot of fun!

#filltheskywithcolournotsmoke #smokefreethewaytobe

8.2 Katherine West Health Board

The Quitskills Team would like to acknowledge the traditional people of the Katherine region for welcoming the Quitskills educators onto their country to deliver smoking cessation training.

We would also like to acknowledge the hard work of the team from Katherine West Health Board whose aim is to provide a holistic clinical, preventative and public health service to clients in the Katherine West Region of the Northern Territory of Australia.

We wish you the greatest success in achieving your aim.

Smoke breath 🤢
Keep your breath fresh by staying smoke free!

Yarn with your local Health Centre about how to quit smoking
What’s Your Smoke Free Story?

8.3 Danila Dilba ACCHO

On May 31 Danila Dilba Community Services and Northern Territory Government AOD teams set up information stalls around Darwin and Palmerston for World No Tobacco Day. Thank you to everyone who popped in for a yarn! If you are ready to start your quit journey or thinking about quitting smoking, contact your local Danila Dilba Clinic and book an appointment with a GP, Aboriginal Health Practitioner or Tobacco support team.

Make every day World No Tobacco Day! #Notobacco #WorldNoTobaccoDay#KickinTobacco #LiveLongLiveStrong


10. Sista Quit

Our new centre in Coffs Harbour will support excellence in we are seeking three full-time researchers (as many as possible to be Indigenous) and offering Indigenous PhD scholarship – get in touch

See details here on NACCHO Communique 

Aboriginal Health and Smoking #WNTD2019 31 May News Alerts #CommunityControl #YourHealthYourFuture: Over 7 years 130 Plus articles Including 20 myths about smoking that will not die

“Smoking kills. Smoking robs people, including young people, of their health.

Governments must do more to help people to stop smoking, or to not take up the deadly habit in the first place.

Strong government actions, including making packaging unappealing, keeping tobacco products out of view, and keeping tobacco prices high, have helped to encourage people to quit, or young people not to start.

The Minister for Indigenous Health, Ken Wyatt, is to be commended for continuing funding of $183.7 million over four years for the Tackling Indigenous Smoking program.

Releasing the AMA/ACOSH National Tobacco Control Scoreboard on World No Tobacco Day, AMA President, Dr Tony Bartone

NACCHO and Croakey followers are invited to join Aboriginal Community Controlled Health Services in New South Wales in a Twitter Festival focused on tobacco control initiatives and successes across Australia.

NACCHO will be posting 8.45 to 9.00 AM Follow NACCHO

Follow the discussions on Twitter and contribute your views by using the hashtags #CommunityControl and #YourHealthYourFuture.

Please encourage your networks and organisations to support the event by following the discussion and retweeting as much as possible.

See full program 8.00 to 1.00 Pm HERE

Our special thanks to Tom Calma who has been our NO 1 promoter of our alerts 

Read or subscribe to NACCHO Daily Aboriginal Health News Alerts

“Across forty years I’ve come to recognise many factoid-driven myths about smoking that just won’t die. If I asked for a dollar each time I had to refute these statements, I’d have accumulated a small fortune.

Their persistence owes much to their being a vehicle for those who utter them to express unvoiced but clear sub-texts that reflect deeply held beliefs about women, the disadvantaged, mental illness, government health campaigns and the “natural”.

Let’s drive a stake through the heart of ten of the most common myths.”

Simon Chapman  Emeritus Professor in Public Health, University of Sydney

Originally published in The Conversation 

1. Women and girls smoke more than men and boys

Women have never smoked more than men. Occasionally, a survey will show one age band where it’s the other way around, but from the earliest mass uptake of smoking in the first decades of last century, men streaked out way ahead of women.

In 1945 in Australia, 72% of men and 26% of women smoked. By 1976, men had fallen to 43% and women had risen to 33%.

As a result, men’s tobacco-caused death rates have always been much higher than those of women. Women’s lung cancer rates, for example, seem unlikely to reach even half the peak rates that we saw among men in the 1970s.

Currently in Australia, 15% of men and 12% of women smoke daily.

But what about all the “young girls” you can see smoking, I’m always being told. In 2014, 13% of 17-year-old male high school students and 11% of females smoked. In two younger age bands, girls smoked more (by a single percentage point).

Those who keep on insisting girls smoke more are probably just letting their sexist outrage show about noticing girls’ smoking than their ignorance about the data.

2. Quit campaigns don’t work on low socioeconomic smokers

In Australia, 11% of those in the highest quintile of economic advantage smoke, compared with 27.6% in the lowest quintile. More than double.

So does this mean that our quit campaigns “don’t work” on the least well-off?

Smoking prevalence data reflect two things: the proportion of people who ever smoked, and the proportion who quit.

If we look at the most disadvantaged group, we find that a far higher proportion take up smoking than in their more well-to-do counterparts. Only 39.5% have never smoked compared with 50.4% of the most advantaged – see table 9.2.6).

When it comes to quitting, 46% of the most disadvantaged have quit compared to 66% of the least disadvantaged (see table 9.2.9).

There is a higher percentage of the disadvantaged who smoke mainly because more take it up, not because disadvantaged smokers can’t or won’t quit. With 27.6% of the most disadvantaged smoking today, the good news is that nearly three-quarters don’t. Smoking and disadvantage are hardly inseparable.

3. Scare campaigns ‘don’t work’

Countless studies have asked ex-smokers why they stopped and current smokers about why they are trying to stop. I have never seen such a study when there was not daylight between the first reason cited (worry about health consequences) and the second most nominated reason (usually cost).

For example, this national US study covering 13 years showed “concern for your own current or future health” was nominated by 91.6% of ex-smokers as the main reason they quit, compared with 58.7% naming expense and 55.7% being concerned about the impact of their smoking on others.

If information and warnings about the dire consequences of smoking “don’t work”, then from where do all these ex-smokers ever get these top-of-mind concerns? They don’t pop into their heads by magic. They encounter them via anti-smoking campaigns, pack warnings, news stories about research and personal experiences with dying family and friends. The scare campaigns work.

4. Roll-your-own tobacco is more ‘natural’ than factory made

People who smoke rollies often look you in the eye and tell you that factory made cigarettes are full of chemical additives, while roll-your-own tobacco is “natural” – it’s just tobacco. The reasoning here that we are supposed to understand is that it’s these chemicals that are the problem, while the tobacco, being “natural”, is somehow OK.

This myth was first turned very unceremoniously on its head when New Zealand authorities ordered the tobacco companies to provide them with data on the total weight of additives in factory made cigarettes, roll-your-own and pipe tobacco.

For example, data from 1991 supplied by WD & HO Wills showed that in 879,219kg of cigarettes, there was 1,803kg of additives (0.2%). While in 366,036kg of roll-your-own tobacco, there was 82,456kg of additives (22.5%)!

Roll-your-own tobacco is pickled in flavouring and humectant chemicals, the latter being used to keep the tobacco from drying out when smokers expose the tobacco to the air 20 or more times a day when they remove tobacco to roll up a cigarette.

5. Nearly all people with schizophrenia smoke

It’s true that people with mental health problems are much more likely to smoke than those without diagnosed mental health conditions. A meta-analysis of 42 studies on tobacco smoking by those with schizophrenia found an average 62% smoking prevalence (range 14%-88%). But guess which study in these 42 gets cited and quoted far more than any of the others?

If you said the one reporting 88% smoking prevalence you’d be correct. This small 1986 US study of just 277 outpatients with schizophrenia has today been cited a remarkable 1,135 times. With colleagues, I investigated this flagrant example of citation bias (where startling but atypical results stand out in literature searches and get high citations – “wow! This one’s got a high number, let’s quote that one!”).

By googling “How many schizophrenics smoke”, we showed how this percolates into the community via media reports where figures are rounded up in statements such as, “As many as 90% of schizophrenic patients smoke.”

Endlessly repeating that “90%” of those with schizophrenia smoke does these people a real disservice. We would not tolerate such inaccuracy about any other group.

6. Everyone knows the risks of smoking

Knowledge about the risks of smoking can exist at four levels:

  • Level 1: having heard that smoking increases health risks.
  • Level 2: being aware that specific diseases are caused by smoking.
  • Level 3: accurately appreciating the meaning, severity, and probabilities of developing tobacco related diseases.

Level 4: personally accepting that the risks inherent in levels 1–3 apply to one’s own risk of contracting such diseases.

Level 1 knowledge is very high, but as you move up the levels, knowledge and understanding greatly diminish. Very few people, for example, are likely to know that two in three long term smokers will die of a smoking caused disease, nor the average number of years that smokers lose off normal life expectancy.

7. You can reduce the health risks of smoking by just cutting down

It’s true that if you smoke five cigarettes a day rather than 20, your lifetime risk of early death is less (although check the risks for one to four cigarettes a day here).

But trying to “reverse engineer” the risk by just cutting down rather than quitting has been shown in at least four large cohort studies such as this one to confer no harm reduction.

If you want to reduce risk, quitting altogether should be your goal.

8. Air pollution is the real cause of lung cancer

Air pollution is unequivocally a major health risk. By “pollution”, those who make this argument don’t mean natural particulate matter such as pollen and soil dusts, they mean nasty industrial and vehicle pollution.

The most polluted areas of Australia are cities where pollution from industry and motor vehicle emissions are most concentrated. Remote regions of the country are the least polluted, so if we wanted to consider the relative contributions of air pollution and smoking to smoking-caused diseases, an obvious question to ask would be “does the incidence of lung cancer differ between heavily polluted cities and very unpolluted remote areas?”

Yes it does. Lung cancer incidence is highest in Australia in (wait for this …) in the least polluted very remote regions of the country, where smoking prevalence happens also to be highest.

9. Smokers should not try to quit without professional help or drugs

If you ask 100 ex-smokers how they quit, between two-thirds and three-quarters will tell you they quit unaided: on their final successful quit attempt, they did not use nicotine replacement therapy, prescribed drugs, or go to some dedicated smoking cessation clinic or experience the laying on of hands from some alternative medicine therapist. They quit unaided.

So if you ask the question: “What method is used by most successful quitters when they quit?” The answer is cold turkey.

Fine print on this English National Health Service poster states a bald-faced lie by saying that “There are some people who can go cold turkey and stop. But there aren’t many of them.” In the years before nicotine-replacement threapy and other drugs were available, many millions – including heavy smokers – quit smoking without any assistance. That’s a message that the pharmaceutical industry was rather not megaphoned

10. Many smokers live into very old age: so it can’t be that harmful

In just the way that five out of six participants in a round of deadly Russian roulette might proclaim that putting a loaded gun to their head and pulling the trigger caused no harm, those who use this argument are just ignorant of risks and probability.

Many probably buy lottery tickets with the same deep knowing that they have a good chance of winning.

11. Today’s smokers are all hard core, addicted smokers who can’t or won’t give up

This claim is the essence of what is known as the “hardening hypothesis”: the idea that decades of effort to motivate smokers to quit has seen all the low-hanging fruit fall from the tree, leaving only deeply addicted, heavy smokers today.

The key index of addicted smoking is the number of cigarettes smoked per day. This creates a small problem for the hardening hypothesis: in nations and states where smoking has reduced most, the average number of cigarettes smoked daily by continuing smokers has gone down, not up. This is exactly the opposite of what the hardening hypothesis would predict if remaining smokers were mostly hard core.

12. Smoking is pleasurable

Repeated studies have found that around 90% of smokers regret having started, and some 40% make an attempt to quit each year. There’s no other product with even a fraction of such customer disloyalty.

But I’m always amused at some die-hard smokers’ efforts explain that they smoke for pleasure and so efforts to persuade them to stop are essentially just anti-hedonistic tirades. Many studies have documented that the “pleasure” of smoking centres around the relief smokers get when they have not smoked for a while. The next nicotine hit takes away the discomfort and craving they have been experiencing.

This argument is a bit like saying that being beaten up every day is something you want to continue with, because hey, it feels so good when the beating stops for a while.

13. Light and mild cigarettes deliver far less tar and nicotine to the smoker than standard varieties

Several nations have outlawed cigarette descriptors such as “light” and “mild” because of evidence that such products do not deliver lower amounts of tar and nicotine to smokers, and so are deceptive.

The allegedly lower yields from cigarettes labelled this way resulted from a massive consumer fraud.

Cigarette manufacturers obtained these low readings by laboratory smoking machine protocols which took a standardized number of puffs, at a standardized puff velocity. The smoke inhaled by the machine was then collected in glass “lungs” behind the machine and the tar and nicotine weighed to give the readings per cigarette.

But the companies didn’t tell smokers two things. So-called light or mild cigarettes had tiny, near-invisible pin-prick perforations just on the filter (see picture). These holes are not covered by the “lips” or “fingers” of the laboratory smoking machine, allowing extra air to be inhaled and thus diluting the dose of tar and nicotine being collected.

But when smokers use these products, two things happen. Their lips and fingers partially occlude the tiny ventilation holes, thus allowing more smoke to be inhaled. Smokers unconsciously “titrate” their smoking to obtain the dose of nicotine that their brain’s addiction centres demand: they can take more puffs, inhale more deeply, leave shorter butt lengths or smoke more cigarettes.

Today, where use of these descriptors has been stopped, the consumer deception continues with the companies using pack colours to loudly hint to smokers about which varieties are “safer”.

Magnification and location of filter ventilation holes. Author collection

14. Filters on cigarettes remove most of the nasty stuff from cigarettes

We’ve all seen the brown stain in a discarded cigarette butt. But what few have seen is how much of that same muck enters the lungs and how much stays there.

This utterly compelling video demonstration shows how ineffective filters are in removing this deadly sludge. A smoker demonstrates holding the smoke in his mouth and then exhales it through a tissue paper, leaving a tell-tale brown stain. He then inhales a drag deep into his lungs, and exhales it into a tissue. The residue is still there, but in a much reduced amount. So where has the remainder gone? It’s still in the lungs!

15. Governments don’t want smoking to fall because they are addicted to tobacco tax and don’t want to kill a goose that lays golden eggs

This is perhaps the silliest and most fiscally illiterate argument we hear about smoking. If governments really want to maximise smoking and tax receipts, they are doing a shockingly bad job of it. Smoking in Australia has fallen almost continuously since the early 1960s. In five of the 11 years to 2011, the Australian government received less tobacco tax receipts than it did the year before (see Table 13.6.6).

Plainly, as smoking continues to decline, diminishing tax returns will occur, although this will be cushioned by the rising population which will include some smokers.

In the meantime, tobacco tax is a win-win for governments and the community. It reduces smoking like nothing else, and it provides substantial transfer of funds from smokers to government for public expenditure.

Those of us who don’t smoke do not squirrel away what we would have otherwise spent on smoking in a jam jar under the bed. We spend it on other goods and services, benefiting the economy too.

16. Most smokers die from smoking caused diseases late in life, and we’ve all got to die from something

Smoking increases the risk of many different diseases, and collectively these take about ten years off normal life expectancy from those who get them.

Smoking is by far the greatest risk factor for lung cancer. In Australia, the average age of death for people with lung cancer is 71.4 (see Table 4.2), while life expectancy is currently 80.1 for men and 84.3 for women.

This means that, on average, men diagnosed with lung cancer lose 8.7 years and women 12.9 years (mean 10.8 years). Of course, some lose many more (Beatle George Harrison died at just 58, Nat King Cole at 45).

If a 20-a-day smoker starts at 17 and dies at 71, 54 years of smoking would see 394,470 cigarettes smoked. At ten puffs per cigarette, that’s some 3.94 million point-blank lung bastings.

It takes about six minutes to smoke a cigarette. So at 20 a day, smokers smoke for two hours each day. Across 54 years, that’s a cumulative 1,644 days of smoking (4.5 years of continual smoking if you put it all together).

So by losing ten years off life expectancy, each cigarette smoked takes about 2.2 times the time it takes to smoke it off the life expectancy that might otherwise have been enjoyed.

17. Smokers cost the health system far less than the government receives from tobacco tax

In June 2015, a senior staff member of Australian libertarian Senator David Leyonhjelm, Helen Dale tweeted:

In Australia, a now old report looking at 2004/05 data estimated the gross health care costs attributable to smoking “before adjustment for savings due to premature death” were $A1.836 billion. In that financial year, the government received $A7,816.35 billion in customs and excise duty and GST on tobacco.

Someone who thought that the fiscal ledger was all that mattered in good government might conclude from this that smokers easily pay their way and perhaps we should even encourage smoking as a citizen’s patriotic duty.

With smokers being considerate enough to die early, these noble citizens lay down their lives early and thus contribute “savings due to premature death” like failing to draw a state pension or needing aged care services late in life. Philip Morris notoriously gave this advice to the new Czech government in 1999.

Other assessments, though, might well point to the values inherent in such assessments. History’s worst regimes have often seen economically non-productive people as human detritus deserving death. Primo Levi’s unforgettable witnessing of this mentality in Auschwitz comes to mind.

18. Big Tobacco is starting to invade low-income nations, now that smoking is on the wane in the wealthiest nations

Sorry, but US and British manufacturers have been aggressively marketing cigarettes in places such as China since the early years of last century. These collectable posters show many featuring Chinese women.

The large populations, the often lax tobacco-control policies and the higher corruption indexes of many low- and middle-income nations makes many of these nirvanas for Big Tobacco.

There are fewer more nauseating experiences than reading the corporate social responsibility reports of tobacco transnationals and then seeing how they operate in smokers’ paradises such as Indonesia. This documentary says it all.

19. Millions of cigarette butts on the world’s beaches leach lots of toxic chemicals into oceans

Cigarette butts are the most discarded items in all litter. Every year uncounted millions if not billions are washed down gutters in storm water and find their way into rivers, harbours and oceans. Cigarette filters and butts contain toxic residue and experiments have shown that placing laboratory fish in containers for 48 hours with leachate extracted from used cigarette butts, 50% of the fish die. From this, we sometimes hear people exclaim that cigarette butts are not just unsightly, but they “poison the oceans”.

But a confined laboratory container does not remotely mirror real life exposures in oceans or rivers. There are some 1,338,000,000 cubic kilometers of water in the world oceans, so the contribution of cigarette butts to the toxification of all this could only excite a homeopath.

If we want to reduce tobacco litter, we need not wander into such dubious justifications. The best way by far is to keep reducing smoking. Industry attempts at portraying themselves as corporately responsible by running dinky little clean-up campaigns or distributing personal butt disposal canisters avoids their efforts to keep as many smoking as possible.

20. Tobacco companies care deeply about their best customers dying early

Naturally, all businesses would rather their customers lived as long as possible so that the cash registers can keep ringing out long and loud. Tobacco companies wish their products didn’t kill so many, but worship the god nicotine for its iron grip on so many.

Visit any tobacco transnational’s website and you will find lots of earnest and caring talk about the companies’ dedication to doing all they can to reduce the terrible harm caused by their products. All the major companies have now invested heavily in electronic cigarettes, so isn’t this a sign that they taking harm reduction seriously?

It might be if the same companies were showing any sign of taking their feet off the turbo-drive accelerator of opposing effective tobacco control policies. But they are doing nothing of the sort. All continue to aggressively attack and delay any policy like tax hikes, graphic health warnings, plain packaging and advertising bans wherever in the world these are planned for introduction.

For all their unctuous hand-wringing about their mission to reduce harm, they are all utterly determined to keep as many smoking as possible. Big Tobacco’s business plan is not smoking or ecigarettes. It’s smoking and ecigarettes. Smoke when you are able to, vape when you can’t. It’s called dual use and some 70% of vapers are doing just that. The tragedy now playing out in some nations is that too many gormless tobacco control experts are blind to this big picture.

NACCHO and RACGP Podcast

Do you smoke?’ A simple preventive activity for clinicians to engage with every patient.

With over 30 years’ experience in Indigenous health, Professor David Thomas from the Menzies School of Health Research discusses updates to the smoking topic from Chapter 1: Lifestyle, in the third edition

Listen to Episode one:

Smoking & Smoking Cessation with Prof David Thomas on The National Guide Podcast