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Select the rows below to view more detail on a method
Estimates of the numbers and rates of deaths and hospitalisations attributable to the use of tobacco, alcohol, to high body mass and other risk factors used age and sex-specific aetiologic fractions developed by the School of Population Health, University of Queensland and the Australian Institute of Health and Welfare and published in 2007 (Begg et al. 2007).
The contribution of 14 health risks to the total burden of disease was assessed by the School of Population Health, using methods developed by the WHO Comparative Risk Assessment project (Ezzati et al. 2004). Earlier work by English and colleagues (English et al. 1995) was also used with reference to risks from the use of drugs and alcohol by the researchers from the School of Population Health. The main elements of the methodology are the prevalence of exposure to a health risk in a population and information on the risk of disease, injury or death from this exposure, which is derived from meta-analysis of published scientific literature. Calculations result in estimates of the proportions of cases of specific diseases and injuries that could be attributed to each risk factor.
For this report, electronic files of the aetiologic fractions developed by Begg and colleagues were obtained directly from the School of Population Health, University of Queensland by the Centre for Epidemiology and Research. The disease and injury groupings used in these files were defined using coding developed for the Burden of disease study (BOD), but a mapping to ICD-10-AM codes was also provided.
There are two steps in applying the aetiologic fractions to a death or hospitalisation dataset:
(a) ill-defined categories (e.g. ICD-10-AM: heart failure, unspecified diabetes mellitus and injuries with unspecified intent) are redistributed into specific BOD categories based on other information in the record and/or on a pro rata basis;
(b) the aetiologic fractions are applied to categorised records.
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
English DR, Holman CDJ, Milne MG. The quantification of drug caused morbidity and mortality in Australia. Canberra: Commonwealth Department of Human Services and Health, 1995.
Ezzati M, Lopez AD, Rodgers A, Murray CJL (eds). Comparative quantification of health risks: Global and regional burden of disease attributable to selected major risk factors. Geneva: World Health Organization, 2004. Available at http://www.who.int/healthinfo/global_burden_disease/cra/en/
Select the rows below to view more detail on a code
The disease and injury groupings used in the analysis of aetiologic fractions were defined using coding developed for the Burden of disease study (BOD) with a mapping to ICD-10-AM codes (Begg et al. 2007). These resources were provided by the School of Population Health, University of Queensland directly to the Centre for Epidemiology and Research.
Refer to the Methods tab for more information on aetiologic fractions methodology.
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
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Related Indicators
• 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