Smoking is recognised as the single most
preventable cause of death in Australia. Each year there are over 19,000 tobacco related
deaths. This represents 15% of all deaths and 72% of drug related deaths (English, Holman
et al, 1995). The 1993 National Household Survey estimated that approximately 29% of
Australian males and 21% of females smoke on a regular basis (ABS Household Survey, 1993).
In 1989/90, 40.2% of males and 28.2% of females aged 18+ smoked in the Central Sydney Area
Health Service (Rissel, Winchester, Ward et al, 1995) compared with national averages of
31.4% for males and 25% for females (National Health Survey, 1989/90).Australian Bureau
of Statistics (ABS) figures show smoking in Australia has dropped by a quarter since the
late 1970's. The ABS National Health Survey 1989-90 showed that 28% of adult Australians
were smokers compared with 37% in the same survey in 1977. This represents a drop of 24%
in a 13 year period. However, this decrease is due primarily to people giving up smoking
rather than changes in the uptake of smoking (Commonwealth Department of Human Services
and Health, 1994).
Recent evidence suggests that 37.7% of women in the 20-24 year age group are smokers,
compared to 36% of males in the same age group. These gender differences are more
accentuated among younger people. A 1992 Survey of NSW secondary school students revealed
that 17% of males and 22% of females aged 12-16 were current smokers. This compares with
13% and 17% respectively in 1983 (Cooney, Dobbinson et al, 1993).
Approximately 70,000 Australian teenagers start smoking every year. The main
developmental period of uptake of current smoking among school children is between the
ages of 12 and 16 (Hill, White, Williams et al, 1990).
The prevalence of smoking among some NESB groups, blue collar workers and Aboriginals
and Torres Strait Islanders has also been shown to be higher than that of the general
population. According to national data 54% of Aboriginal males and 46% of Aboriginal
females smoke (Australian Bureau of Statistics, 1995) and the population of smokers is
highest in the 25-44 age group (61%) (Australian Bureau of Statistics, 1995). When smoking
by ethnicity is examined, a high proportion of males born in Vietnam (53%), Greece (44%)
and Italy (32.5%) smoke (Rissel and Russell, 1993; Wilson, et al 1993; Gleeson, 1995), and
a high proportion of both Arabic-speaking males and females smoke (both over 50%) (Jukic,
Pino and Flaherty, 1996).
There is no identified safe level of tobacco consumption. The link between smoking and
diseases such as lung cancer, stroke, heart disease and emphysema has been well
established (Holman, Armstrong, et al, 1988). In Central Sydney, lung cancer accounts for
substantially more deaths from cancer than any other type (see Figure 1).
The evidence suggests that virtually every smoker who smokes regularly for an
appreciable part of their life suffers lung damage and that 25-40% of smokers die
prematurely due to their smoking (Winstanley, Woodward and Walker, 1995). The risk of
premature death in active smokers is associated both with years of use and amount smoked.
The cost of tobacco use to the community is great not only in terms of mortality but
also morbidity. An Australian study estimated that in 1992, patients with tobacco caused
disease experienced nearly 100,000 hospital episodes resulting in over 800,000 hospital
bed days. Ill health and disease due to tobacco use was responsible for around 56% of all
drug-caused hospital episodes, and around 51% of drug caused hospital bed days. Tobacco
use was responsible for 3.4% of total hospital episodes and 4.9% of hospital bed days in
1992 (English, et al 1995).
The economic cost of tobacco-related health problems in Australia in 1992 was at least
$12.7 billion (Collins and Lapsley, 1995). On a proportional basis this indicates that the
estimated cost to NSW would be over $5 billion. Australian data collected over an eighteen
month period between 1990 and 1992 showed that smokers recorded an average of 27% more
absenteeism than non smokers (South Australian Smoking and Health Project, 1992).
