Smoking cessation assistance should be free, accessible, and part of routine care

Proactively offering Quitline counselling and nicotine replacement therapy can reduce the prevalence of smoking

The Australian Institute of Health and Welfare has identified tobacco smoking as the leading cause of preventable disease and death in Australia, and 11% of people over 14 years of age reported smoking daily in 2019.1 Public health measures, such as public smoking bans, anti‐smoking media campaigns, and high tobacco taxes, have encouraged people to stop smoking, but most quit attempts are unsuccessful. The most effective approach to smoking cessation is a combination of pharmacological and behavioural support, such as nicotine replacement therapy (NRT) with Quitline telephone counselling.2 Quitlines are an evidence‐based, readily accessible, and cost‐effective public health intervention.3 However, fewer than 2% of Australians who smoke used a Quitline service during 2019.1

The findings of the randomised controlled trial reported in this issue of the MJA by Webb and colleagues highlight the benefits of proactively offering free smoking cessation assistance (mailed NRT and Quitline counselling) at a key point in health care.4 Such offers of support can reach people who might not have considered quitting or were not aware that effective help was available. The authors describe an intervention that is feasible and sustainable, and their findings indicate the benefits of partnerships with support services such as Quitline.

Webb and colleagues describe an intervention that encouraged people to quit smoking in preparation for elective surgery,4 but proactive linking of patients with Quitline counselling and free NRT has great potential for helping a broad variety of patients. Groups with a disproportionate burden of tobacco‐related disease, such as people with serious mental illnesses, could particularly benefit from proactive offers of quit support during encounters with health professionals.

The prevalence of smoking among people with serious mental illness is much higher than for the general population, exceeding 60% for those with schizophrenia.5 Despite people with serious mental illness being as motivated to quit smoking as other smokers, their chances of quitting are lower. They experience many barriers to accessing quit support, including the reluctance of health professionals to treat their smoking and limited treatment options that take their needs into account.2 Consequently, smoking is one of the major modifiable causes of premature death for people with serious mental illnesses.6,7 Proactive quit support as part of routine care would be a promising approach to reducing the health inequality these people experience.

Queensland public mental health services have embedded smoking cessation care into routine practice, improving the recording of smoking status and the delivery of brief cessation interventions.8 Through a partnership with Queensland Quitline, a referral pathway was developed that assists public mental health service clinicians refer patients to the Quitline Intensive Quit Support Program, which provides four support calls and twelve weeks of free NRT for people with serious mental illness. Preliminary (unpublished) results regarding engagement, retention, and quit outcomes have been encouraging.

The Central Queensland Hospital and Health Service, which operates in a regional area where the prevalence of smoking is higher than the national average, developed a health promotion initiative (“10 000 Lives”) to maximise the use of the Quitline Intensive Quit Support Program. Driven by a health promotion officer, the initiative built upon existing smoking cessation support by engaging “quit champions” to improve referrals to Quitline and other cessation programs. The program has been highly successful in increasing the use of Quitline services.9

The Queensland experience8,9 and the findings of Webb and colleagues4 indicate that more people use quit support when it is offered proactively and without cost. Given the immense health benefits of quitting smoking, even modest increases in the likelihood that people will successfully quit can have a profound impact on health and well‐being. The cost of these programs is thus likely to be excellent value for money.

The three examples4,8,9 also highlight the critical role that health care services can play as key contact points for people who smoke. They show how health care services can cooperate with Quitline to support smokers in general, and those who would especially benefit from evidence‐based smoking cessation support in particular. Health care professionals have worked to integrate smoking cessation support into routine care, but more investment is needed. Quit support should be free, accessible, and proactively offered to all people who smoke. Adequate resources that ensure that this support is routinely provided could substantially increase the impact of these interventions and reduce the prevalence of smoking.