Alcohol drinking, current daily or occasional smoking by age, Aboriginal persons aged 16 years and over, NSW

•  Alcohol causes more than 1,220 deaths and just under 48,000 hospitalisations in NSW each year.

•  Almost one third of adults (29.9%) reported risk drinking behaviour of drinking two or more standard drinks on any day (40.2% of males and 19.9% of females) in NSW in 2010.

Alcohol as a health risk factor

Long term adverse effects of high consumption of alcohol on health include contribution to cardiovascular disease, some cancers, nutrition-related conditions, risks to unborn babies, cirrhosis of the liver, mental health conditions, tolerance and dependence, long term cognitive impairment, and self- harm (National Health and Medical Research Council 2009).

Some research suggests that at low levels of consumption, alcohol may reduce the risk of some cardiovascular and cerebrovascular disorders, while other research suggests that there may be no protective effect from drinking (National Health and Medical Research Council 2009).

Harm from alcohol-related accident or injury is experienced disproportionately by younger people; over half of all serious alcohol-related road injuries occur among 15–24-year-olds. However, harm from alcohol-related disease is more marked among older people (National Health and Medical Research Council 2009).

Burden of disease due to alcohol in Australia and NSW

In Australia, alcohol is second only to tobacco as a preventable cause of drug-related death and hospitalisation (National Health and Medical Research Council 2009). The burden of disease associated with alcohol in 2003, was over 5 times higher in males (3.8%) than in females (0.7%), with the greatest burden in males occurring in those aged 0-44 years (7.8% of the total disease burden in this age group) (Begg et al. 2007). The total social costs of alcohol consumption in Australia were estimated to be $15.3 billion in 2004-05 with tangible costs (including lost productivity, healthcare costs, road accident-related costs and crime-related costs) of $10.8 billion (Collins DJ et al. 2008).

References

Begg S, Vos T, Barker B. The burden of disease and injury in Australia, 2003. Cat. no. PHE 82 edition. Canberra: AIHW, 2007. Available at http://www.aihw.gov.au/publications/index.cfm/title/10317

Collins DJ, Lapsley HM. The cost of tobacco, alcohol and illicit drug abuse to Australian society in 2004-05. National Drug Strategy Monograph Series no. 64. Canberra: Department of Health and Ageing, 2008. Available at http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/mono64

National Health and Medical Research Council. Australian guidelines to reduce health risks from drinking alcohol. Canberra: NHMRC, 2009. Available at http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/ds10-alcohol.pdf

The NSW Health Drug and Alcohol Plan 2006 - 2010 outlines the NSW Government's commitment to reduce the problems caused by drug and alcohol use. The plan details priority areas that have been identified for future action, including: prevention; brief and early intervention; and treatment and extended care (NSW Department of Health D&A Plan 2007). A statewide Controlled Drinking by Correspondence Program has been established to provide clinical advice and assistance to over 1,300 individuals to reduce excessive drinking (NSW Department of Health D&A Plan 2007). Operation Drinksafe has run in licensed premises in Sydney South West Area Health Service. This community education program, originated in the North Coast Area Health Service, aims to reduce risky and high-risk levels of alcohol consumption (NSW Department of Health D&A Plan 2007).

References

Alcohol Working Group, National Preventative Health Taskforce. Australia: the healthiest country by 2020. Technical Report No 3. Preventing alcohol–related harm in Australia: a window of opportunity. Including addendum for October 2008 to June 2009. Canberra: Commonwealth of Australia, 2009. Available at http://www.health.gov.au/internet/preventativehealth/publishing.nsf/Content/tech-alcohol

Ministerial Council on Drug Safety. National Alcohol Strategy 2006-2011. 2006. Available at http://www.health.gov.au/internet/alcohol/publishing.nsf/Content/nas-06-09

National Preventative Health Strategy. Australia: The Healthiest Country by 2020 – National Preventative Health Strategy – Overview. Canberra: Commonwealth of Australia, 2009. Available at http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/nphs-roadmap/$File/nphs-roadmap.pdf

NSW Department of Health . NSW Health Drug and Alcohol Plan 2006 - 2010. Sydney: NSW Department of Health, 2007. Available at http://www.health.nsw.gov.au/pubs/2007/drug_alcohol_plan.html

NSW Premier's Department. A new direction for NSW. State Plan. Sydney: NSW Premier's Department, 2006. Available at http://www.nsw.gov.au/stateplan/index.aspx?id=8f782cbd-0528-4077-9f40-75af9e4cc3e5

Useful websites include:

Australian Bureau of Statistics at http://www.abs.gov.au

Australian Institute of Health and Welfare at http://www.aihw.gov.au

HealthInsite at http://www.healthinsite.gov.au

•  Smoking causes more than 5,200 deaths and just over 44,000 hospitalisations in NSW per year.

•  In 2010, just under 16%  of adults in NSW smoked (daily or occasionally), 18% of males and 13.5% of females.

•  Rates of current (daily or occasional) smoking were highest amongst those aged 25-34 years. The oldest age group reported the lowest rates.

Smoking as a health risk factor

Tobacco smoking is the leading preventable cause of illness and premature death, particularly from cardiovascular disease; cancers of the lung, larynx, and mouth; and chronic obstructive pulmonary disease. It is a major risk factor for coronary heart disease, stroke, peripheral vascular disease, cancer and a variety of other diseases and conditions . Smoking also contributes to the risk of sudden infant death syndrome (SIDS) and low birthweight (U.S. Department of Health and Human Services 2004). Tobacco smoking contributes more drug-related hospitalisations and deaths than alcohol and illicit drug use combined (AIHW Cat. no. AUS 122 2010) and is estimated to kill approximately half (Peto et al. 2004) to two-thirds (Doll et al. 2004 ) of all its long-term users.

The currently reviewed evidence on the mechanisms by which smoking causes disease indicates that there is no risk-free level of exposure to tobacco smoke, which causes adverse health outcomes, particularly cancer and cardiovascular and pulmonary diseases, through mechanisms that include DNA damage, inflammation, and oxidative stress (U.S. Department of Health and Human Services 2010).

Exposure to environmental tobacco smoke (ETS), particularly indoors, carries well documented health risks.

Burden of disease due to smoking and prevalence in Australia

Tobacco smoking was responsible for 7.8% of the total burden of disease in Australia in 2003 (Begg et al. 2007). In 2004-05, the total social costs of tobacco use in Australia were estimated to be $31.5 billion with tangible costs of $12.0 billion (Collins DJ et al. 2008).

In 2007, around 2.9 million Australians aged 14 years and over smoked daily. Males were more likely to be daily smokers (18.0%) than females (15.2%) (AHIW Cat No. PHE 98 2008).

References

Australian Institute of Health and Welfare. Australia’s health 2010. Australia’s health series no. 12. Cat. no. AUS 122. Canberra: AIHW, 2010. Available at http://www.aihw.gov.au/publication-detail/?id=6442468376

Australian Institute of Health and Welfare. 2007 National Drug Strategy Household Survey: first results. Drug Statistics Series No 20. Cat No. PHE 98. Canberra: AHIW, 2008. Available at http://www.aihw.gov.au/publications/phe/ndshs07-fr/ndshs07-fr-no-questionnaire.pdf

Begg S, Vos T, Barker B. The burden of disease and injury in Australia, 2003. Cat. no. PHE 82 edition. Canberra: AIHW, 2007. Available at http://www.aihw.gov.au/publications/index.cfm/title/10317

Collins DJ, Lapsley HM. The cost of tobacco, alcohol and illicit drug abuse to Australian society in 2004-05. National Drug Strategy Monograph Series no. 64. Canberra: Department of Health and Ageing, 2008. Available at http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/mono64

Doll R, Peto R, Boreham J and Sutherland I. "Mortality in relation to their smoking: 50 years' observations on male British doctors ". British Medical Journal 2004. Vol328 1519-28.

Peto R, Lopez AD, Boreham J, Thun M, Heath JC. Mortality from smoking in developed countries 1950-2000. Oxford: Oxford University Press, 2004. Available at http://rum.ctsu.ox.ac.uk/~tobacco

U.S. Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Atlanta, GA: 2010. Available at http://www.surgeongeneral.gov/library/tobaccosmoke/index.html

U.S. Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centres for Diseases Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004. Available at http://www.cdc.gov/tobacco/data_statistics/sgr/2004/index.htm

Plain packaging

Australia has one of the most comprehensive tobacco control policies and programs in the world and a new National Tobacco Strategy is expected to be developed in 2011. The National Preventative Health Strategy recommends a range of actions aimed at reducing chronic disease burden associated with three lifestyle risk factors: obesity, tobacco and excessive alcohol consumption. The Strategy recommends ending all remaining forms of advertising and promotion of tobacco products, including eliminating promotion of tobacco products through the design of a package, by amending the Tobacco Advertising Prohibition Act 1992 and the Trade Practices CPIS (Tobacco) Regulations 2004 to reduce tobacco consumption and prevalence of smoking within Australian communities.  Public consultation on a draft Tobacco Plain Packaging Bill 2010 is underway.

Social marketing and other measures

Other proposed national strategies focus on revenue measures that would reduce the affordability of tobacco products, legislative reforms to address current deficiencies in tobacco regulation, funding for social marketing campaigns, Indigenous tobacco control, other initiatives to reduce social disparities in smoking such as subsidising nicotine replacement therapy for highly disadvantaged people, and health system interventions (Tobacco Working Group 2009).

Smoke-free Environment Act

The Smoke-free Environments Act 2000 protects the community from second-hand smoke by prohibiting smoking in all enclosed public places in NSW (with the exception of the private gaming areas in Star City Casino).

Public Health (Tobacco) Act

The Public Health (Tobacco) Act 2008 strengthen restricts the sale, advertising and display of tobacco products, non-tobacco smoking products and smoking accessories in NSW.  Key provisions of the Act include the introduction of a tobacco retailer notification scheme, restricting tobacco sales to a single point of sale in any retail outlet, a ban on smoking in cars with children present, the removal of tobacco products removed from shopper loyalty programs and the introduction of a total display ban for retailers (with the exception of approved specialist tobacconists).

Targeting young people

Recent amendments to the Public Health Act 1991 further strengthen measures already in place to prevent young people from taking up smoking. These include banning the sale of sweet, fruit or confectionery flavoured tobacco products that may encourage young people to smoke, and banning the sale of tobacco products from mobile or temporary premises at events targeted at young people, such as music festivals. The NSW Government introduced a number of reforms to further reduce children and young people's exposure and access to tobacco in amendments to the Public Health (Tobacco) Act 2008.

Support for smoking cessation  

Smoking cessation, or quitting, has immediate and important health benefits for individuals of all ages. Ex-smokers have improved life expectancy and reduced risk of smoking-related disease, compared to continuing smokers (Fiore et al. 2000). Dependence on tobacco-delivered nicotine can be characterised as a chronic relapsing disorder. Without assistance, around 95% of quitters will fail on any single attempt and most people make several attempts before they are successful. At least 70% of Australian smokers are believed to be dependent on tobacco-delivered nicotine (Ministerial Council on Drug Strategy 2005).

The Quitline

The correct use of nicotine replacement therapies, such as gum, lozenge, patch, sublingual tablet or inhaler, doubles the chance of successfully quitting smoking (Stead et al. 2008). The Quitline (13 7848) provides expert smoking cessation advice and quitting smokers can enrol in the free callback service, where an advisor will provide ongoing support throughout the quit attempt. The Quitline is accessible for the cost of a local call throughout NSW. A fax referral system is in place for all health services in NSW to refer clients who want to quit smoking to the NSW Quitline.

NSW Health has published a guide to brief intervention for health professionals, titled 'Let's take a moment'. The document outlines clear and practical advice in the provision of smoking cessation interventions for health professionals, based on evidence for best practice (NSW Department of Health Let's take a moment 2005).

References

Fiore MC, Baily WC, Cohen SJ, Dorfman SF, Goldstein MG. Treating tobacco use and dependence. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, U.S. Surgeon General, 2000. Available at http://www.surgeongeneral.gov/tobacco/treating_tobacco_use.pdf

Ministerial Council on Drug Strategy. National Tobacco Strategy 2004-2009. Canberra: Department of Health and Ageing, 2005. Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/phd-pub-tobacco-tobccstrat2-cnt.htm

NSW Department of Health . Let's take a moment. Quit smoking brief intervention - a guide for all health professionals. Sydney: NSW Department of Health, 2005. Available at http://www.health.nsw.gov.au/pubs/2005/lets_take_a_moment.pdf

Stead LF, Perera R, Bullen C, Mant D, Lancaster T. Nicotine replacement therapy for smoking cessation. Second edition. Cochrane Database of Systematic Reviews, 2008. Available at http://www.ncbi.nlm.nih.gov/pubmed/18253970

Tobacco Working Group. Australia: the healthiest country by 2020. Technical Report No 2. Tobacco control in Australia: making smoking history. Including addendum for October 2008 to June 2009. Canberra: National Preventative Health Taskforce, Commonwealth of Australia, 2009.

Useful websites include:

Australian Bureau of Statistics at http://www.abs.gov.au

Australian Institute of Health and Welfare at http://www.aihw.gov.au

HealthInsite at http://www.healthinsite.gov.au

• Unhealthy behaviours contribute significantly to the burden of death and ill-health in NSW. For example:

smoking causes more than  5,200 deaths and just over 44,000 hospitalisations per year

alcohol causes more than 1,220 deaths and just under 448,000 hospitalisations each year.

• Unhealthy behaviours affect people of all ages.

• Among adults in 2010:

18% of men and 13.5% of women are current smokers

60% of men and 48% of women are overweight or obese

while only:

60% of men and 51% of women are adequately physically active

53% of men and 60% of women eat adequate quantities of fruit

7% of men and 12% of women eat adequate quantities of vegetables.

• Of secondary school students aged 12-17 years in 2008:

7% of boys and 8% of girls smoked in the previous week

21% of boys and 20% of girls consumed alcohol in the previous week

26% of boys and 15% of girls were overweight or obese

13% of boys and 12% of girls have used cannabis at least once

and only:

33% of boys and 17%of girls wear a hat in the sun

34% of boys and 53% of girls usually use sunscreen.

• Encouragingly, though:

smoking rates have declined among both men and women since 1977

in 2008, for both sexes, the number of ex-smokers was greater than the number of current smokers

there has been a slight increase in the proportion of adults undertaking adequate physical activity over the last five years

the death rate from heroin overdose has declined steeply since 1999.

Health risk factors and burden of disease

Good health enhances the quality of human life and benefits the community. The opportunity to participate in and contribute to society is maximised in a healthy population. Organisational, economic, and environmental factors have major influences on the health of individuals.

Health-related behaviours also contribute significantly to cardiovascular and respiratory diseases, cancer, and other conditions that account for much of the burden of morbidity and mortality in later life. Some factors have positive effects, and others have negative effects on health. Diets with a high daily intake of fruit and vegetables, or being vaccinated against disease, are factors that protect us against ill health. Risk factors, such as smoking, or being physically inactive increase our risk of ill health (AIHW Cat. no. AUS 122 2010).

Risk factors contribute to almost one-third of Australia’s total burden of death, disease and disability. Tobacco smoking was estimated to contribute the greatest burden (7.8% of the total health burden), followed by high blood pressure (7.6%) and overweight or obesity (7.5%) (AIHW Cat. no. AUS 122 2010). Physical inactivity was responsible for 6.6% of the total burden of disease and injury and low fruit and vegetable consumption for 2.1% (Begg et al. 2007).

These risk factors are major contributors to the development of chronic conditions (such as cancers and cardiovascular diseases), which are the main contributors to the total burden of disease and injury in Australia (AIHW Cat. no. AUS 122 2010).

References

Australian Institute of Health and Welfare. Australia’s health 2010. Australia’s health series no. 12. Cat. no. AUS 122. Canberra: AIHW, 2010. Available at http://www.aihw.gov.au/publication-detail/?id=6442468376

Begg S, Vos T, Barker B. The burden of disease and injury in Australia, 2003. Cat. no. PHE 82 edition. Canberra: AIHW, 2007. Available at http://www.aihw.gov.au/publications/index.cfm/title/10317

Useful websites include:

Australian Bureau of Statistics at http://www.abs.gov.au

Australian Institute of Health and Welfare at http://www.aihw.gov.au

HealthInsite at http://www.healthinsite.gov.au