Intended for healthcare professionals

Feature Tobacco Control

Tar wars over smoking cessation

BMJ 2011; 343 doi: (Published 08 August 2011) Cite this as: BMJ 2011;343:d5008
  1. Simon Chapman, professor of public health, University of Sydney
  1. simon.chapman{at}

The pharmaceutical industry has a clear commercial interest in eroding public and professional confidence in unassisted smoking cessation, yet easily implemented ideas, such as graphic health warnings, are more effective than nicotine replacement therapy, says Simon Chapman

Tobacco control is the poster child for those now rallying behind international action to control non-communicable disease. In nations that have implemented comprehensive policies and programmes to reduce tobacco use, there have been often continuing and large scale falls in smoking prevalence over the past 20 to 40 years, in the number of cigarettes smoked per day, and—the ultimate test of effectiveness—in the incidence of index diseases like lung cancer.1

The World Health Organization’s Framework Convention on Tobacco Control, with 174 nations having now ratified its legally binding provisions, has inspired thinking about the applicability of the tobacco control model to chronic disease at large.2 This momentum should be profiled and boosted by the September United Nations High-level Meeting on Non-communicable Diseases.

Although preventing uptake among young people has long been a mantra for governments of all political stripes, far more lives will be saved over the next decades by promoting cessation in current smokers.3 There is now extensive consensus on what the so called best buys in tobacco control are when reducing consumption across whole populations is the goal.

All parties—including the perennially protesting tobacco industry (“Of all the concerns . . . taxation alarms us the most”4)—agree that tobacco tax increases are the ace in the pack. Promoting quit attempts in large numbers of smokers is the most important strategy for improving cessation rates throughout a population.5

Australia has seen daily smoking prevalence fall to 15.1%, with tax and well funded mass media awareness campaigns being mainly responsible.6 Youth smoking prevalence is also the lowest …

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