Smoking cessation rates
The decline in Australia’s smoking prevalence observed since the 1950s
will continue while current rates of smoking cessation and initiation continue. However, if smoking
initiation and cessation rates do not change from those of 2001–2007, the population smoking
prevalence will stabilise at around 10% around the year 2045. Similar results have been reported in a
study modelling the projected smoking prevalence in the USA. That study estimated that if the
1981–1993 cessation rates and smoking initiation rate of 25% continued, the US smoking prevalence
would stabilise at 15–16% by 2050. Hence, our findings have implications for other countries at a
similar stage of the cigarette epidemic, as described by Lopez et al.
The status quo scenario in which smoking initiation rates remain at 2007 levels may be overly
pessimistic. In contrast to the USA, smoking initiation in Australia has declined steadily since the
early 1980s. In 2007, only 8.6% of 14–19 year olds reported that they were current daily or weekly
smokers compared to 12.3% in 2004. This decline in smoking initiation was also seen in the
Australian Secondary Students Alcohol and Drug Surveys which reported a substantial decrease in
smoking prevalence among secondary school students between 2002 and 2005. However, even
if initiation continues to decline, smoking prevalence in the adult population will not drop below
10% until 2029 unless rates of cessation increase. A policy goal of 10% smoking prevalence in the
Downloaded from tobaccocontrol.bmj.com on 1 April 2009
Australian adult population by 2020 requires a doubling of the cessation rate observed between
2001 and 2007. Similar modelling of smoking prevalence in the UK showed that to reach a target
goal of 12% smoking prevalence by 2020 would require a sustained combination of doubling the
cessation rate and halving the initiation rates from the year 2000 onward.
Our model also suggests that it will take nearly 30 years for a doubling of the current decline in
initiation rate to reach the same smoking prevalence achieved by a doubling of the current cessation
rate. Therefore, in addition to lowering rates of initiation, strategies are needed to increase
cessation in current smokers. This situation is also likely to apply to other countries in later stages of
the cigarette epidemic, such as the USA, Canada and UK. Examples of such strategies include:
increased taxation, mass media campaigns, promotion of quitlines, reducing opportunities to smoke
through public smoking bans, and reducing the attractiveness, promotion and availability of
cigarettes. A more controversial option that could be considered is to make
less harmful forms of nicotine and smokeless tobacco products more readily available and taxing
them at a lower rate than smoked tobacco. This option may reduce tobacco smoking and
tobacco-related harm in Australia without eliminating all forms of tobacco use.
Conclusions
Australia’s smoking prevalence will continue to fall while current rates of initiation and cessation are
maintained. But a continuation of current smoking cessation and initiation patterns will still see
around 14% of Australian adults smoking in 2020.
Australian health policy makers are to reduce smoking prevalence to 10% by 2020. Achieving this
ambitious goal will require an intensification of current restrictions on smoked tobacco sales and
increased assistance to smokers who wish to quit.
