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Tobacco smoking – enough of the puff

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It is no surprise that the smoking of tobacco has decreased significantly from a generation ago, amid targeted and widespread programs to deter its use. Indeed, in Australia we seem to view our stringent tobacco legislation and divestment movements as huge wins for public health. However, what may come as a surprise is that our smoking rates are still roughly one in seven people, and it continues to cause more deaths than alcohol and illicit drugs combined.

As a young person, I’m astounded when I see friends and other young people lighting up. On the one hand, it’s probably good that myself and others have such a cultural distaste for this deadly habit, but on the other it’s tragic to see people beginning something that they will inevitably struggle with for years.

Like many medical students, I’ve spent time in respiratory medicine and seen patients dying of cancer, infection and chronic obstructive pulmonary disease, where people describe their existence as “slowly drowning”. There is simply no safe level of tobacco consumption. It shocks me that this harsh reality, not just the threat of cancer, causes more than 15,000 Australian deaths per year and yet young people continue to pretend they’re invincible.

Interestingly, in the US and UK, smoking rates are now dropping to comparable or even lower levels than in Australia, where our plain packaging and advertising laws are very strong. On a pure price disincentive, we still have some of the most expensive cigs in the world, yet perhaps we are starting to see diminishing returns on smoking rates. Clearly, more needs to be done.

Earlier in the year, AMA President Dr Michael Gannon gave out the “Dirty Ashtray Award” to the State most behind on their smoking crackdown. The Northern Territory, 11-time recipient of that award, has a rate of smoking of more than one in five, with comparatively lax laws regarding smoking in pubs, clubs and even schools. We cannot sit by while children and young people are indoctrinated into a culture where smoking is tacitly accepted.

Some advocates for smoking reduction have looked at the possibility of e-cigarettes as a tool for cessation or alternative. We must be wary of these products, none of which have yet proved to be useful as cessation tools, and may in their use and marketing make smoking more socially acceptable.

Many universities have some form of a tobacco-free policy available on their websites. However, many of these are not enforced or incomplete, meaning that smoking and particularly passive smoking continue. As medical students, we call for more stringent tobacco-free policies to reduce prevalence and change attitudes.

While universities are a great target, we need also to ensure that smoking-related disease does not become a disease of the poor. There is a significant gap in smoking rates between the highest and lowest economic quintiles (8.0 per cent and 21.4 per cent respectively). Although this gap is slowly closing, we need to pursue methods of education and intervention that promote equity and work for the people most at risk.

At the patient level, it’s important for doctors to remain vigilant, to work with smokers to quit. We acknowledge this is not easy, it is often a long and relapsing process, but ultimately it cannot just be ignored. Thankfully in medical school we are taught some of the tools of motivational interviewing, but we can’t afford complacency.

Complacency cannot be afforded at the Government level, too. The Council of Australian Governments several years ago made the target of 10 per cent daily smokers by 2018, a rate we may just fall short of. Continued efforts, including banning in public places, availability of support to quit programs and widespread public education need to continue. This is not a fight we can say we’ve won just yet.

Twitter: robmtom
Email: rob.thomas@amsa.org.au