Technical Paper 2:
Tobacco Control in Australia: making smoking history
Goals of tobacco control: To reduce the human, social and financial costs of smoking
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Smoking and mortality and morbidity
- Recent studies confirm the importance of smoking alone or in combination with other risk factors as a major contributor to premature death and disease and reduced quality of life.
- Both smoking and adiposity are independent predictors of mortality, but the combination of current or recent smoking with a BMI > or = 35 or a large waist circumference is related to an especially high mortality risk.
- A large prospective cohort study in the US has found that around 55% of premature deaths in middle-aged women can be attributed to the combination of smoking, being overweight, lack of physical activity and a low diet quality. Relative risks for five compared with zero lifestyle risk factors for mortality in middle-aged women were 3.26 (95% confidence interval 2.45 to 4.34) for cancer mortality, 8.17 (4.96 to 13.47) for cardiovascular mortality, and 4.31 (3.51 to 5.31) for all cause mortality. Adherence to lifestyle guidelines is associated with markedly lower mortality in middle-aged women.
- A Finnish study has found that men who had never smoked lived an average of 10 years longer than heavy smokers. The study, published in the Archives of Internal Medicine, found non-smokers also had the best scores on all health-related quality-of-life measures, especially for physical functioning.
provides an overview of research published since 1 October 2008, highlighting the health effects of smoking that are not as well known as those described in consumer product information currently required to be printed on the packaging of tobacco products sold in Australia.
The 2008 edition of America’s Health Rankings: A Call to Action for Individuals & Their Communities revealed that the health of Americans has failed to improve for the fourth consecutive year. Key factors contributing to these results included unprecedented levels of obesity, an increasing number of uninsured people, and the persistence of risky health behaviours, particularly tobacco use. The longest running report of its kind, America’s Health Rankings evaluates a historical and comprehensive set of health, environmental and socio-economic data to determine national health benchmarks, and an annual ranking of the healthiest and least healthy states. During the 1990s, health improved at an average rate of 1.5% per year, but improvements against national health measurements have remained flat for the last four years. Smoking, obesity and the uninsured are the nation’s three most critical challenges. Source: Business Wire, 2008-12-03.
Smoking and inequality
A UK study assessing the impact of tobacco smoking on the survival of men and women in different social positions found that among both women and men, those who had never smoked had much better survival rates than smokers in all social positions. Smoking itself was a greater source of health inequality than social position and nullified women’s survival advantage over men. This suggests the scope for reducing health inequalities related to social position in this and similar populations is limited unless many smokers in lower social positions stop smoking.
A US study has found that living with adult smokers is an independent risk factor for adult and child food insecurity, associated with an approximate doubling of its rate and tripling of the rate of severe food insecurity.
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A Queensland study has confirmed that smoking remains an important cause of poor health among newborn babies, and that smoking is a major contributor to the poorer health outcomes for Indigenous babies. The adjusted outcomes for babies born to Indigenous non-smokers were similar to those for non-Indigenous non-smokers (preterm, 7.1% v 6.1%; full-term low birthweight, 1.6% v 1.1%). The adjusted percentages for smokers were high regardless of Indigenous status (preterm, Indigenous v non-Indigenous, 8.3% v 7.8%; full-term low birthweight, Indigenous v non-Indigenous, 5.3% v 3.7%). The percentage of Indigenous mothers who smoked (54%) was almost triple that for non-Indigenous mothers (risk ratio, 2.90; 95% CI, 2.81-2.99).
A study of medical costs among health plan members in Minnesota, in the United States, found that physical inactivity and smoking were significant predictors of higher medical costs  This suggests that investment by health funds in preventative activities would appear to be warranted.
Contrary to claims of those who say that because non-smokers live longer they incur more lifetime healthcare costs, a study from Hong Kong finds that those who have never smoked do not use more acute hospital services in the last years of life.
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