NSW Tobacco Strategy 2012-2021
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NSW Tobacco Strategy
2012–2021NSW MINISTRY OF HEALTH 73 Miller Street NORTH SYDNEY NSW 2060 Tel. (02) 9391 9000 Fax. (02) 9391 9101 TTY. (02) 9391 9900 www.health.nsw.gov.au This work is copyright. It may be reproduced in whole or in part for study or training purposes subject to the inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from the NSW Ministry of Health. © NSW Ministry of Health 2019 SHPN (CPH) 190379 ISBN 978-1-76081-199-0 Further copies of this document can be downloaded from the NSW Health website www.health.nsw.gov.au July 2019
Contents
Foreword...................................................................................................................................2
Executive Summary.................................................................................................................3
Part One
Background and Context for Tobacco Control in NSW....................................................4
Introduction............................................................................................................................................................................................. 4
Policy Context........................................................................................................................................................................................ 4
Part Two
The Approach to Tobacco Control in NSW.........................................................................5
Working in Partnership...................................................................................................................................................................... 5
Key Partners............................................................................................................................................................................................ 6
Guiding Principles................................................................................................................................................................................ 6
Goals, Targets and Priority Areas................................................................................................................................................ 6
Supporting National Strategies to Reduce Tobacco Related Harm.......................................................................... 8
Part Three
Priority Areas............................................................................................................................9
Public Education................................................................................................................................................................................... 9
Cessation Services...............................................................................................................................................................................11
Aboriginal Communities..................................................................................................................................................................13
Groups with High Smoking Prevalence...................................................................................................................................15
Advertising and Promotion............................................................................................................................................................17
Second-hand Smoke.........................................................................................................................................................................19
Young People........................................................................................................................................................................................21
Research, Monitoring, Evaluation & Reporting...................................................................................................................23
References...............................................................................................................................25
NSW Tobacco Strategy 2012-2021 NSW HEALTH PAGE 1Foreword
It is hard to believe that just a few decades ago we New initiatives in this Strategy are focused on
smoked in our workplaces, our homes, in cars, buses, restricting smoking in outdoor areas commonly
trains. In fact everywhere - with ashtrays overflowing frequented by children, young people and families
and long-suffering non-smokers having to put up including:
with second hand smoke.
Playgrounds
n
So it is gratifying to consider how far we have come Public sports grounds and swimming pools
n
in persuading people to give up smoking or not to Public transport stops
n
take it up in the first place. Entrances to public buildings, and, from 2015
n
Commercial outdoor dining areas.
n
Campaigns to get us to quit smoking started slowly
and have increased in incremental steps – introduced The NSW Government will lead an education
by different governments and always with bipartisan campaign to inform the community, businesses and
support. affected agencies about these changes.
So that now, fewer students are taking up smoking And we will continue to monitor and enforce
and fewer adults smoke. restrictions on tobacco advertising and promotion.
But, despite this, smoking remains the leading cause For the benefit of the health of us all, I invite you
of preventable disease and death in NSW – to join with the NSW Government in welcoming
accounting for around 5,200 deaths and 44,000 these initiatives.
hospitalisations a year.
That is why I am pleased to release this Strategy
which places NSW at the front of tobacco control
in Australia.
Jillian Skinner MP
Minister for Health
Minister for Medical Research
PAGE 2 NSW HEALTH NSW Tobacco Strategy 2012-2021Executive Summary
The NSW 2021 Plan sets robust targets on reducing Local Health Districts will also be supported to
smoking in order to decrease chronic disease and ensure that there is no smoking anywhere on NSW
combat rising health costs. Health grounds.
The NSW 2021 Plan states that the NSW The Strategy is comprised of three parts. Part
Government will: One provides the background to tobacco control in
NSW. Part Two sets out a partnership approach to
Reduce smoking rates by 3% by 2015 for non-
n
achieving the objectives, including key principles and
Aboriginal people and by 4% for Aboriginal priority areas. Part Three describes the actions which
people by 2015; and will be taken by the NSW Government and partners
Reduce the rate of smoking by non-Aboriginal
n
in the non-government sector and timeframes under
pregnant women by 0.5% per year and by 2% per each priority area.
year for pregnant Aboriginal women by 2015.
A feature of this Strategy is its focus on some of the
The NSW Tobacco Strategy 2012–2021 sets out the most disadvantaged groups in our society. Many of
actions that the NSW Government will take to these groups have much higher rates of smoking
reduce the harm which tobacco imposes on our than the general population - for Aboriginal people
community and achieve the NSW 2021 Plan targets. it is at least double the rate of the non-Aboriginal
population. To address these particular needs, the
The Strategy will see NSW make a number of public
population-wide approaches that have been
outdoor areas smoke-free in order to protect people
effective and delivered substantial reductions in
from the harmful effects of second-hand tobacco
smoking prevalence in the past will be maintained
smoke.
and complemented with additional targeted
approaches to assist disadvantaged groups to quit
The Strategy includes:
smoking and to reduce the associated
A focus on addressing tobacco smoking in
n disproportionate levels of death and disease.
populations with high smoking rates, particularly
Aboriginal communities, women smoking in
pregnancy, mental health consumers and people
in corrections facilities;
Enhanced programs to help smokers quit; and
n
Measures to protect people from harmful second-
n
hand smoke in outdoor areas.
NSW Tobacco Strategy 2012-2021 NSW HEALTH PAGE 3PART ONE
Background and Context
for Tobacco Control in NSW
Introduction The magnitude of the problems caused by tobacco
continues to present a significant burden for NSW.
The death toll in Australia from smoking will pass the Smoking is responsible for around 44,000 hospital
one million mark within this decade.1 More than admissions every year and causes the deaths of over
900,000 Australians have already died prematurely 5,200 people in this state each year. 8
because they smoked. Tobacco has been labelled
one of the great killers of the twentieth century, Estimates of the annual social costs of tobacco use
causing unnecessary death, disease and disability on in NSW for 2006/07 are $8.4 billion with tangible
a large scale. 2 costs of $2.9 billion.9 A study by Collins and Lapsley
found that while real tangible costs grew 24 per cent
Tobacco adversely affects almost every organ in the from 1998/99 to 2006/07, real intangible costs fell
body. Evidence about the dangers of tobacco by 14 per cent. Significantly, these results show that
continues to mount. Smoking greatly increases the total real social costs are estimated to have fallen by
risk of many cancers and is a major cause of chronic around four per cent since 1998/99, reflecting the
obstructive pulmonary disease and ischaemic heart decline in smoking-attributable mortality in NSW
disease. 3 It is also clear that exposure to second- over this period.
hand smoke involves adverse health effects including
an increased risk of asthma and sudden infant death Despite these findings, smoking rates remain
syndrome for children.4 unacceptably high, particularly among Aboriginal
people and those from low socioeconomic,
NSW is proud of its successes in tobacco control. disadvantaged and other specific groups. Over the
These include: period 2006-2009, 33.9 per cent of Aboriginal
people aged 16 years and over in NSW were current
Since 1997, there has been a significant decrease
n
smokers (33.5 per cent of Aboriginal males and
in the proportion of adults who were current 34.2 per cent of Aboriginal females).10 In the general
smokers (24.0 per cent to 15.8 per cent in 2010). population, more males are current smokers than
Smoking by secondary school students has
n
females (18.1 per cent compared to 13.5 per cent)
declined by 6 percentage points - falling from and since 2009, there has been an increase in
14.6 per cent in 2002 to 8.6 per cent in 2008. 5 current smoking among males and females aged
Nine out of ten adults now live in smoke-free
n
16-24 years.11
homes.6
Lung cancer rates have now fallen to levels last
n
Policy context
seen in the 1960s mainly due to tobacco control.7
NSW public education campaigns have been
n The NSW Tobacco Strategy 2012–2021 is informed by
used across Australia and internationally in relevant policy frameworks at the international,
countries such as China, the United States and national and state level. This includes the World Health
Canada. Organization's Framework Convention on Tobacco
NSW led the rest of Australia by introducing a
n Control at the international level, the National
comprehensive package of legislative reforms in Partnership Agreement on Preventive Health and the
2008 to protect children from tobacco. The National Partnership Agreement on Closing the Gap
reforms introduced a ban on the display of in Indigenous Health Outcomes at the national level
tobacco, a single point of sale for tobacco and a and the NSW 2021 Plan, the NSW Cancer Plan 2011-
ban on smoking in cars when children under the 2015 and the NSW Tobacco Action Plan 2005-09 at
age of 16 years are present. the state level.
PAGE 4 NSW HEALTH NSW Tobacco Strategy 2012-2021PART TWO
The Approach to Tobacco
Control in NSW
Working in partnership Key partners and stakeholders include the
health care system, social service organisations,
The challenges confronted by all governments non-government organisations, Aboriginal
working in tobacco control are complex and require organisations, relevant industry groups
the formation of partnerships with the community (retailers, media, pharmaceutical etc), unions
and the adoption of a ‘whole of government’ and professional associations.
approach. The NSW Government recognises that
past achievements in tobacco control in NSW have To achieve our targets there is a recognised need to:
resulted from partnerships with strong allies and the
Strengthen long standing partnership
n
ongoing commitment of non-government agencies
relationships;
and local health services to tobacco control.12
Identify and form new partnerships in order to
n
Partnerships were a central feature of the previous expand opportunities for tobacco control
Tobacco Action Plan and remain vital for this interventions within
Strategy. Collaboration between government and a range of community settings;
non-government agencies in NSW will continue to Work with a range of partners to improve the
n
underpin tobacco control approaches in NSW – sustainability and accessibility of quit smoking
delivering benefits in terms of enhanced efficiency services within the community for different
and effectiveness and ensuring successful population groups; and
implementation of the actions in this Strategy. Build the capacity of different organisations and
n
health workers to implement tobacco control
Delivering a comprehensive tobacco control strategy programs.13
requires action in a variety of settings. Key settings
for tobacco control in NSW include workplaces, The figure below demonstrates the approach
schools, media, the built environment, health services to tobacco control in NSW.
(particularly mental health services), the hospitality
industry and prisons.
Figure 1. Approach to tobacco control in NSW
NSW Population
Individuals
Familes
Sectors Communities Settings
Health care system, Community, health
non government system, media,
organisations, Tobacco workplaces, tertiary
Aboriginal Control in NSW education facilities,
organisations, relevant schools, youth
industry groups centres, built
(retailers, media, environment, mental
Governments
pharmaceutical etc), health services,
Australian
unions, professional prisons, hospitality
State/ Territory
associations industry
Local
Adapted from the National Preventative Health Strategy Figure 1.6 Working Together.14
NSW Tobacco Strategy 2012-2021 NSW HEALTH PAGE 5Key partners Reducing inequity – addressing the differences
n
in health status in the community by recognising
Key NSW Government agencies responsible and responding to the special needs of those
for implementing actions under the NSW Tobacco groups whose health is poorest, especially
Strategy 2012–2021 include: Aboriginal people.16
n Working in partnership – recognising that many
NSW Health, including the NSW Ministry of
n
factors that influence health are outside the direct
Health, Local Health Districts, Justice Health and control of the health system and developing
Multicultural Health Communication Service strategic partnerships across government,
Cancer Institute NSW
n
industry, business, unions, the non-government
NSW Department of Education and Communities
n
sector, research institutions, youth groups and
NSW Department of Premier and Cabinet
n
communities as required.17
(Division of Local Government) n Capacity building – focusing on organisational
Corrective Services NSW
n
change, workforce development, resource
Community Services
n
allocation and leadership that incorporates
advocacy and relies on partnerships. By working
Key partners involved in supporting actions
across sectors, there is potential to build
under the Strategy include:
individual skills, strengthen community action and
Cancer Council NSW
n
empower organisations to promote sustainable
National Heart Foundation (NSW Division)
n
health behaviours and support healthy
Aboriginal Health and Medical Research Council
n
environments.18
Action on Smoking and Health
n
n Engaging communities – engaging with people
Australian Respiratory Council
n
where they live, work and play and informing,
NSW Quitline
n
enabling and supporting people to make healthy
Universities and research groups
n
choices. Relevant settings may include home,
Aboriginal community controlled health
n
work, school, youth centres, workplaces and
organisations community.
Aboriginal communities
n
n Ensuring effective implementation – providing
Aboriginal peak organisations
n
a strong infrastructure that supports individuals
Culturally and linguistically diverse communities
n
and communities in making and sustaining
Mental health organisations
n
healthy choices and measures progress in
GP divisions
n
achieving targets.
Medicare Locals
n
Australian Government
n
Goals, Targets and Priority Areas
Local councils
n
Local Government and Shires Associations
n
Our Goal
of NSW
Tertiary education providers
n To improve the health of the people of NSW and to
Catholic and independent schools
n eliminate or reduce their exposure to tobacco in all
Consumer and media organisations
n its forms.
Our Objectives
Guiding Principles
Reduce the number of people using tobacco
n
The following six principles underpin Prevent the uptake of smoking especially
n
the implementation of this Strategy: by children and young people
Prevent exposure to second-hand smoke
n
n A population approach - focusing on improving and the harm it causes
the overall health status of the community, Reduce smoking among Aboriginal people
n
delivering sustained, effective and comprehensive and other disadvantaged populations
programs that promote and support healthy Decrease tobacco related death and disease
n
living for all.15
PAGE 6 NSW HEALTH NSW Tobacco Strategy 2012-2021Our Targets Our Priority Areas
The NSW 2021 plan includes the following targets The achievement of these targets will require renewed
in regard to reducing smoking rates: efforts in implementing our program of anti-tobacco
public education campaigns, enhanced attention
n Reduce smoking rates by 3 per cent by 2015 to cessation support, a strong commitment to
for non-Aboriginal people and by 4 per cent monitoring and enforcing regulatory reforms and
by 2015 for Aboriginal people; and action to prohibit smoking in commercial outdoor
eating areas to further protect the community from
n Reduce the rate of smoking by pregnant the health consequences of second-hand smoke.
Aboriginal women by 2 per cent per year and
reduce the rate of smoking by pregnant non- A greater focus is needed on smoking in Aboriginal
Aboriginal women by 0.5 per cent per year. communities, smokers from culturally and linguistically
diverse (CALD) communities, low socioeconomic
NSW is also committed to the targets set in the and other disadvantaged groups. To achieve the
National Partnership Agreement on Preventative objectives of this Strategy, eight priority areas based
Health (NPAPH) to reduce daily smoking among on best practice approaches to tobacco control
adult Australians aged 18+ to 10 per cent or lower by will be addressed:
2020. The Agreement sets interim targets for States
and Territories of a 2 percentage point reduction n Public Education
from the 2007 baseline by 2011 and a 3.5 percentage
Continue and build on public education
point reduction from this baseline by 2013.
campaigns to motivate smokers to quit.
n Cessation Services
The NSW target to reduce smoking rates by
3 per cent by 2015 for non-Aboriginal people and Continue to provide evidence based cessation
by 4 per cent by 2015 for Aboriginal people is services to support smokers to quit.
measured by the NSW Health Survey Program n Aboriginal Communities
and includes daily and occasional smoking by
people 16 years of age and older. Work in partnership with Aboriginal communities
and peak bodies to reduce smoking and exposure
The NPAPH target is based on the National Drug to second-hand smoke among Aboriginal people.
Strategy Household Survey administered by the
n Groups with High Smoking Prevalence
AIHW and includes only daily smoking by people
18 years of age and older. The NSW specific Strengthen efforts to reduce smoking among
targets based on the 2007 baseline figure of 17.2% people in low socioeconomic and other groups
is to achieve 15.2% by 2011 and 13.7% by 2013. with high smoking prevalence such as some
culturally and linguistically diverse groups.
Under the NSW Tobacco Strategy 2012–2021, n Tobacco Advertising and Promotion
NSW will also: Regulate the advertising and promotion of
tobacco products and restrict the availability and
n Reduce the proportion of students who have
supply of tobacco, especially to children.
ever smoked tobacco by 1 per cent per year
to 2017; and n Second-hand Smoke
Strengthen efforts to reduce exposure to second-
n Increase the proportion of adults living in smoke-
hand smoke in workplaces, public places and
free households by 0.5 per cent per year to 2017.
other settings.
n Young People
Strengthen efforts to prevent the uptake
of smoking by young people.
n Research, Monitoring, Evaluation & Reporting
Strengthen research, monitoring, evaluation
and reporting of programs for tobacco control.
NSW Tobacco Strategy 2012-2021 NSW HEALTH PAGE 7The NSW Ministry of Health will take the lead in The Australian Government also indicated its
coordinating and monitoring the implementation of intention to consider removing the duty-free
the Strategy across government. A mid-term review allowance on tobacco products for international
of progress towards the targets and implementation travellers entering Australia. The Australian
of actions will be undertaken in 2014. The NSW Government will also continue to participate in
Ministry of Health will report on population level international negotiations for a protocol to eliminate
indicators of smoking prevalence. Other key the illicit trade in tobacco products under the WHO
indicators from the Strategy will be reported on Framework Convention on Tobacco Control.
a regular basis by other lead agencies.
The NSW Ministry of Health supported these
measures through the NSW submission to the
Supporting national strategies National Preventative Health Taskforce Discussion
to reduce tobacco related harm Paper Australia: the Healthiest Country by 2020. In
addition, NSW prepared a joint submission on behalf
The Australian Government has a range of specific of the Northern Territory, Western Australia, South
tobacco regulatory responsibilities. These include the Australia, Tasmania, New South Wales and the
regulation of tobacco products through trade Australian Capital Territory Health Ministers for the
practices legislation, the prohibition of sponsorship Australian Government Henry Review – Australia’s
and advertising of tobacco products, the regulation future tax system. This submission highlighted the
of tobacco packaging (including cigarette contents important role that taxation plays in tobacco control
and graphic health warnings on cigarette packs) and and recommended that the Australian Government
regulating taxes on tobacco products. increase the price of tobacco through taxation and
that it abolish duty-free sales of tobacco products.
While the focus of this Strategy is on what NSW will
do, it is recognised that there are a number of
reforms outside the control of the NSW Government
that would further reduce the harm caused by
tobacco. Of critical importance is increasing the
price of tobacco, plain packaging of tobacco
products, eliminating the remaining forms of tobacco
advertising and enhancing national
anti-tobacco public education campaigns.
In April 2010, the Australian Government announced
a range of national tobacco control strategies in a
bid to reduce smoking rates. Strategies included: an
increase in tobacco excise of 25 per cent, enacting
legislation to require cigarettes to be sold in plain
packaging, amending legislation to bring restrictions
on tobacco advertising and sales on the internet into
line with restrictions on other media and at physical
points of sale and additional funding for anti-
smoking campaigns targeting disadvantaged
populations. To further assist quitting by low-income
people, the Australian Government announced in
December 2010 that concession card holders will be
able to access nicotine patches under the
Pharmaceutical Benefits Scheme (PBS) from
February 2011, meaning the products are free of
charge to concession card holders. Since December
2008, Nicotine Replacement Therapy (NRT) has
been available to Aboriginal and Torres Strait
Islanders through the PBS.
PAGE 8 NSW HEALTH NSW Tobacco Strategy 2012-2021PART THREE
Priority Areas
Public Education
Continue public education campaigns The actions under this priority area will build on the
to motivate smokers to quit effective anti-tobacco public education campaign
approaches that have been implemented over past
There is strong evidence that public education
years. Adult-targeted campaigns will continue to
campaigns are one of the most effective population
highlight the health consequences of smoking as the
strategies to reduce tobacco consumption. Public
key motivator for smoking cessation. By providing
education campaigns help to personalise the health
fresh insights and delivering messages that are
risks of smoking and increase people’s sense of
personally relevant to smokers, campaigns will aim to
urgency about quitting.19
limit self-exempting beliefs and focus on delivering a
The Cancer Institute NSW has lead responsibility for strong message to quit, and stay quit.
the design, delivery and evaluation of anti-tobacco
The development, implementation and evaluation of
public education campaigns in NSW. Since 2004,
new campaigns to highlight the danger of tobacco
over 40 anti-tobacco campaigns have been
use to people from culturally and linguistically diverse
implemented using a variety of styles of
backgrounds, people with mental illness, prisoners
advertisements, from graphic to emotive executions,
and Aboriginal communities will also form a key part
to maximise personal relevance and believability
of the Strategy. These groups within the community
among smokers to motivate quitting. Examples of
have a higher rate of tobacco use and have shown
these high performing campaigns include What’s
a smaller decrease in tobacco use in response to
Worse, Sponge and Everybody Knows.
previous Government anti-smoking messages.
Public Education
Continue public education campaigns to motivate smokers to quit
Actions Responsibility Timeframe – Year Measurement
1 2 3 4 5
Build on, develop, implement Cancer Institute NSW n n n n n Recognition of campaign
and evaluate a range of Justice Health activity
anti-tobacco mass media Corrective Services
campaigns which: NSW Quitline calls & website traffic
a) Utilise a variety of styles and NGOs
communication channels to
maximise personal relevance
and believability among
smokers to motivate quit
attempts;
b) Have sufficient frequency,
reach and intensity to have
an impact at the population
level; and
c) Utilise a range of mediums
to ensure maximum
relevance, reach and impact
on CALD groups, low
socioeconomic smokers
and smokers from other
disadvantaged groups,
including the custodial
population.
NSW Tobacco Strategy 2012-2021 NSW HEALTH PAGE 9Public Education
Continue public education campaigns to motivate smokers to quit
Actions Responsibility Timeframe – Year Measurement
1 2 3 4 5
Develop public education Cancer Institute NSW n n n n n Recognition of campaign
campaigns for Aboriginal Aboriginal peak activity
people that smoke: bodies
a) Using existing effective Aboriginal Quitline calls & website traffic
mainstream campaigns communities
complemented by Culturally relevant
Aboriginal specific representation of Aboriginal
campaign elements; and people and smoking
b) Public education campaign environments /situations in
messages developed and mainstream and Aboriginal
refined for Aboriginal specific tobacco public
people. education campaigns
Develop innovative approaches Cancer Institute NSW n n n n n Response to online advertising
to online advertising and social and social media strategies
media strategies as part of
tobacco campaign strategies
to encourage, support and
promote quitting.
Develop partnerships with Cancer Institute NSW n n n n n Organisations undertaking
key organisations in NSW NSW Health campaign related support
(including NGOs, Aboriginal activities
peak organisations and primary
care services) to extend the
reach of campaigns.
Develop partnerships with Cancer Institute NSW n n n n n National and inter-state
other states, territories, the MOH partnerships established
Australian Government and
internationally to maximise the National campaigns effectively
impact and cost effectiveness implemented in NSW
of campaign development and
placement.
Conduct education campaigns Cancer Institute NSW n n n n n Value adding activities
to ensure the community is NGOs identified
aware of the risks associated NSW Health
with exposure Community awareness of
to second-hand smoke, second-hand smoke related
particularly for children. harm
Key:
MOH – NSW Ministry of Health
MHCS – NSW Multicultural Health Communication Service
NGOs – Non-government organisations
PAGE 10 NSW HEALTH NSW Tobacco Strategy 2012-2021Cessation Services
Continue to provide evidence Actions for this priority area focus on enhancing
based cessation services to support the high quality and effectiveness of the Quitline
smokers to quit telephone and online services and on better
integrating referral pathways to and from the Quitline
Complementing anti-tobacco public education
with the health system, primary care services and
campaign strategies are cessation support services
relevant non-government organisations.
to help smokers to quit. These cessation services
include a range of programs such as the NSW There is also a need to increase smokers' awareness
Quitline, online services, specialised cessation and understanding of pharmacotherapies, particularly
services, brief interventions provided by health for highly dependent smokers. Evidence suggests
professionals and workplace programs. that there are considerable benefits in enhancing
brief interventions by GPs and other health
There is now increasing recognition in Australia of the
professionals.
need to increase the proportion of smokers who
access the Quitline and for additional strategies to
increase smokers’ confidence in their ability to quit.
Cessation Services
Continue to provide evidence based cessation services to support smokers to quit
Actions Responsibility Timeframe – Year Measurement
1 2 3 4 5
Continue to implement and promote Cancer Institute n n n n Website traffic and number
the iCanQuit website to provide NSW of registered users
greater opportunities for interaction NSW Quitline
and support smokers to quit.
Build on and promote Multilingual Cancer Institute n n n n n Calls to the Multilingual
Quitline services and enhance NSW Quitline
coordination between this service MHCS
and tobacco control programs NSW Health
delivered by health services.
Comply with the National Quitline Cancer Institute n Achievement against National
Minimum Standards and contribute NSW Quitline Minimum Standards
to any national reviews of the NSW Quitline
standards. MOH
Enhance recruitment to and Cancer Institute n Evaluation of the Quitline
effectiveness of the Quitline to NSW conducted
ensure it is an effective and high NSW Quitline
quality service accessed by an MOH Proportion of smokers that
increasing proportion of smokers. utilise the Quitline
Develop and implement strategies Cancer Institute n n n n n Quitline referrals from other
to improve the integration of the NSW agencies
Quitline with other programs NSW Quitline
across the health system, primary NSW Health
care services and relevant non- NGOs
government agencies with a priority MHCS
focus on CALD communities, low Justice Health
socioeconomic and disadvantaged
groups, including the custodial
population.
Provide training in best practice NSW Quitline n n Number of workshops
smoking cessation (particularly brief NSW Health conducted and staff trained
interventions) to a range of health Universities
professionals and health workers NGOs Changes in health
including mental health staff, nurses, professionals and other
allied health, dentists, medical staff, workers confidence
Aboriginal Health Workers, drug and to implement brief
alcohol workers and other relevant interventions with clients
groups including non-health sector
professionals who work with
disadvantaged populations.
NSW Tobacco Strategy 2012-2021 NSW HEALTH PAGE 11Cessation Services
Continue to provide evidence based cessation services to support smokers to quit
Actions Responsibility Timeframe – Year Measurement
1 2 3 4 5
Develop strategies to promote Cancer Institute n n n n n Calls to Quitline by pregnant
cessation services to pregnant NSW women and their families
women and the families of pregnant NSW Quitline
women. NSW Health Quit attempts by pregnant
GP Divisions women and their families
% of women who
smoke during pregnancy
Develop, implement and review NSW Health n n n Let’s take a moment, Brief
NSW Ministry of Health policies NGOs intervention for smoking
and systems to ensure patients and cessation – a guide for health
clients of health services: professionals implemented
a) Receive appropriate and and regularly updated
consistent management of
nicotine dependency; Managing Nicotine Dependent
b) Are routinely asked about Health Clients guide
their smoking status and are implemented and regularly
supported to quit while being updated
treated and post discharge;
c) Have their smoking status and Health services reporting on
treatment routinely recorded to the proportion of patients
enable consistent protocols for whose smoking status is
smoking cessation treatment; assessed and
and the proportion of patients
d) Are reported on in terms of identified as smokers offered
smoking status and the provision NRT and supported to quit
of smoking cessation care and
outcomes.
Under the Healthy Workers Initiative, NSW Health n n n n Quitline referrals from the
promote the Get Healthy Information NGOs Get Healthy Information
& Coaching Service® to workplaces Workplaces & Coaching Service®
and refer callers wishing to quit
smoking to the Quitline.
Key:
MOH – NSW Ministry of Health
MHCS – NSW Multicultural Health Communication Service
NGOs – Non-government organisations
PAGE 12 NSW HEALTH NSW Tobacco Strategy 2012-2021Aboriginal Communities
Work in partnership with Aboriginal While these results are encouraging, there is much
communities and peak bodies to reduce more that needs to be done, as Aboriginal people
smoking and exposure to second-hand remain twice as likely as non-Aboriginal people to be
smoke among Aboriginal people current daily smokers.
The level of poor health and disadvantage experienced The drivers of the high rate of smoking among
by Aboriginal people is significant. Aboriginal people Aboriginal people are complex and include both
experience greater levels of chronic disease and historical and contemporary processes. Evidence
injury and have shorter life expectancies than the suggests that smoking is highly normalised in
non-Aboriginal population. The burden of disease Aboriginal communities and that strong social
and injury study for the Aboriginal and Torres Strait factors drive early initiation and can act as barriers
Islander population of Australia which was published to smoking cessation among Aboriginal people. 22 23
in 2007, shows that the Aboriginal health gap
accounted for 59 per cent of the total burden of The involvement of Aboriginal community-controlled
disease for Aboriginal people in Australia in 2003. health organisations in providing leadership, policy
Tobacco was the largest risk factor and was development, program implementation and the
responsible for 17 per cent of the health gap and 12 evaluation of tobacco control strategies in
per cent of the total burden of disease. 20 partnership with governments, health services and
non-government organisations will be critical
The 2006-2009 Report on Adult Aboriginal Health if we are to achieve further reductions in the
from the NSW Population Health Survey found that prevalence of smoking among Aboriginal people.
since 2002-2005 there has been a significant decrease
in the proportion of Aboriginal adults who were
current smokers (41.3 per cent to 33.9 per cent). 21
Aboriginal Communities
Work in partnership with Aboriginal communities and peak bodies to reduce smoking and exposure
to second-hand smoke among Aboriginal people
Actions Responsibility Timeframe – Year Measurement
1 2 3 4 5
Provide training to Aboriginal NSW Health n Knowledge, skills, attitude and
Health Workers and other Cancer Institute NSW awareness of Aboriginal Health
relevant health workers to Universities Workers and other relevant
improve skills in the provision AHMRC workers
of smoking cessation advice NGOs
and in developing community- Proportion of clients
based tobacco control who smoke identified
programs.
Develop and implement NSW Health n n % of Aboriginal Health Workers
strategies to tackle the high AHMRC who smoke
levels of smoking by Aboriginal
Health Workers. Attitude and awareness of
Aboriginal Health Workers to
smoking
Deliver best practice smoking NSW Health n n n n n Aboriginal clients routinely
cessation brief interventions Cancer Institute NSW asked about their smoking
as part of routine service AHMRC status, brief interventions
delivery to Aboriginal clients. Universities implemented and cessation
NGOs support provided as required
Develop and implement Cancer Institute NSW n n n n n Strategies implemented
strategies to enable the NSW AHMRC
Quitline to better meet the NSW Quitline
needs of Aboriginal people
who smoke.
Develop and implement NSW Health n n n n n % of Aboriginal people
policies and projects in AHMRC in custody who smoke
collaboration with peak Justice Health
Aboriginal organisations, Corrective Services
Corrective Services NSW and
Justice Health to decrease
smoking by Aboriginal people
in custody.
NSW Tobacco Strategy 2012-2021 NSW HEALTH PAGE 13Aboriginal Communities
Work in partnership with Aboriginal communities and peak bodies to reduce smoking and exposure
to second-hand smoke among Aboriginal people
Actions Responsibility Timeframe – Year Measurement
1 2 3 4 5
Encourage and support NSW Health n n n n % of Aboriginal women
pregnant Aboriginal women to AMIHS who smoke during pregnancy
quit by providing best practice AHMRC
cessation interventions. % of pregnant Aboriginal
women who live in smoke-free
homes
Number of quit attempts
and intention to quit
Establish a high level NSW MOH n n n n n Advisory Group established
Aboriginal Tobacco Advisory AHMRC and key strategic approaches
Group to advise on tobacco Cancer Institute NSW identified and agreed
control efforts for Aboriginal
people in NSW.
Review existing evidence NSW Health n n n n n Review completed
and current projects being MOH
implemented to reduce AHMRC Effective models identified
Aboriginal smoking in NSW and Cancer Institute NSW and integrated into strategic
identify effective models that approach and planning of
can be built upon in the future. the NSW Aboriginal Tobacco
Partnership Group
Strengthen partnerships NSW Health n n n n n Number and range of
and collaboration between AHMRC organisations and partners
key organisations in NSW to Cancer Institute NSW delivering programs
develop and deliver sustained NGOs
and coordinated Aboriginal
tobacco control programs
especially between AMS and
health services.
In partnership with peak NSW Health n n n n n Knowledge, attitude and
Aboriginal organisations, NGOs, AHMRC awareness of tobacco among
health services and other Cancer Institute NSW Aboriginal organisations
relevant groups: NGOs
a) Build the capacity of Tobacco control programs
Aboriginal organisations developed, implemented
and staff to develop and and evaluated by Aboriginal
implement tobacco control organisations
programs; and
b) Support Aboriginal Number of smoke-free
organisations to move organisations (change from
towards smoke-free baseline measure)
workplaces and events.
Support national tobacco MOH n n n n n Nationally funded programs
control efforts to reduce AHMRC to reduce Aboriginal smoking
Aboriginal smoking and Cancer Institute NSW implemented in NSW
ensure coordination with NSW NGOs coordinated with NSW activity
programs. Universities
Build tobacco control capacity NSW Health n n n n n Knowledge, skills, attitude and
within Aboriginal Community AHMRC awareness of Aboriginal Health
Controlled Health Services. Workers and other relevant
workers
Increase awareness and use NSW Health n n Uptake of NRT through PBS in
among Aboriginal people AHMRC NSW
that smoke of NRT products Universities
available through the PBS. Cancer Institute NSW
Key:
MOH – NSW Ministry of Health
MHCS – NSW Multicultural Health Communication Service
NGOs – Non-government organisations
AHMRC - Aboriginal Health and Medical Research Council
PAGE 14 NSW HEALTH NSW Tobacco Strategy 2012-2021Groups with High
Smoking Prevalence
Strengthen efforts to discourage smoking n People in drug treatment have smoking rates
among people in low socioeconomic ranging from 74-100 per cent. 27
and other groups with high smoking
prevalence such as some culturally and Within the actions under this priority area, targeted
linguistically diverse groups populations include people from low socioeconomic
groups, people with mental illness, people with drug
Over the past 40 years, smoking prevalence has and alcohol dependency, people in correctional
declined significantly in the general population. facilities and other population groups with high
However, the decline has been less evident amongst smoking prevalence such as some culturally and
the most disadvantaged. Smoking rates are high linguistically diverse groups. Specific strategies for
among people from low socioeconomic groups, Aboriginal people are covered under the Aboriginal
Aboriginal people, those who are unemployed, Communities priority area.
homeless or imprisoned and those with a mental
illness or drug or alcohol dependency. For example: Working in these settings is complex and poses many
challenges for tobacco control. A range of
n Smoking rates among people in NSW correctional approaches will be implemented over the life of this
facilities are around 76 per cent24 and the plan in partnership with correctional facilities, mental
prevalence is higher among inmates of psychiatric health and social service organisations to build the
wards. 25 capacity of these services to contribute to tobacco
control efforts and discourage smoking among
n People who self-reported mental or behaviour
disadvantaged communities.
problems have smoking rates of 32 per cent
compared to 20 per cent of those who do not
report these problems with rates significantly
higher among people admitted to a mental health
hospital. 26
Groups with High Smoking Prevalence
Strengthen efforts to discourage smoking among people in low socioeconomic and other groups
with high smoking prevalence
Actions Responsibility Timeframe – Year Measurement
1 2 3 4 5
Build on existing advocacy for MOH n n n n n Monitor real price of tobacco
staged tobacco tax increases Cancer Institute increases over time
to encourage smokers from low NSW
socioeconomic groups to quit. NGOs
Implement measures NSW Health n n n n n Assistance measures for
to promote cessation Cancer Institute disadvantaged smokers
assistance for smokers from NSW
CALD communities, low NGOs
socioeconomic and other MHCS
disadvantaged groups. NSW Quitline
Further strengthen NSW Health Assistance measures for
partnerships with social service Cancer Institute disadvantaged smokers
and mental health organisations NSW
to build the capacity of these NGOs Knowledge and attitudes
groups to contribute to tobacco Social service of staff in relation to tobacco
control efforts. organisations
Tobacco control goals reflected
in relevant service plans and
policies
Review and fully implement the NSW Health n n n n n Progress reports on
NSW Health Smoke-Free Cancer Council NSW implementing the Smoke-Free
Health Health Care
Care Policy in mental health Policy & Guidelines for Smoke
and drug and alcohol facilities. Free Mental Health Services
NSW Tobacco Strategy 2012-2021 NSW HEALTH PAGE 15Groups with High Smoking Prevalence
Strengthen efforts to discourage smoking among people in low socioeconomic and other groups
with high smoking prevalence
Actions Responsibility Timeframe – Year Measurement
1 2 3 4 5
Increase referrals by GPs and NSW Health n n n n n Referrals to Quitline and
other health professionals in Cancer Institute the iCanQuit website from
disadvantaged areas to Quitline NSW NSW Health and GPs
and the iCanQuit website. NSW Quitline
GP Networks
Provide information to GPs and NSW Health n n n n n Information disseminated
other health professionals Cancer Institute
to highlight that people NSW Knowledge and attitudes of
with common mental health NGOs health professionals regarding
problems can succeed in GP Networks smoking and mental illness
quitting and benefit from
greater control of withdrawal
symptoms.
Develop, implement and Justice Health n n n n n Policies developed and
evaluate a range of appropriate Corrective Services implemented
strategies to reduce smoking NSW
prevalence and exposure to MOH Exposure of staff and inmates
second-hand smoke amongst to second-hand smoke
custodial populations and
workforce specific to the Smoking rates among prisoners
correctional environment.
Quit attempts &
pharmacotherapy use
Develop and implement Justice Health n n n n n Plan developed and
the Collaborative Tobacco Corrective Services implemented
Initiatives NSW
Plan through the Corrective
Services NSW and Justice
Health Tobacco Working
Group to guide tobacco control
activities in the NSW custodial
setting.
Increase awareness and use MOH n n Uptake of NRT through PBS in
among low income groups that Cancer Institute NSW
smoke NSW
of NRT products available
through the PBS.
Key:
MOH – NSW Ministry of Health
MHCS – NSW Multicultural Health Communication Service
NGOs – Non-government organisations
PAGE 16 NSW HEALTH NSW Tobacco Strategy 2012-2021Advertising and Promotion
Eliminate the advertising and brought into effect significant reforms in NSW
promotion of tobacco products and to restrict the availability and supply of tobacco,
restrict the availability and supply especially to children and young people. More
of tobacco, especially to children can be done to further reduce the advertising and
promotion of tobacco products.
Tobacco advertising portrays tobacco smoking as a
regular and socially acceptable activity. Tobacco The Australian Government has significant
advertising can also undermine the warnings about responsibilities in this area, including the regulation
the adverse health effects caused by smoking. of tobacco products through trade practices
legislation, the prohibition of sponsorship and
Research suggests that displays of tobacco can
advertising of tobacco products and the regulation
influence children’s perceptions about the availability
of tobacco packaging, including cigarette contents
and accessibility of cigarettes in their community. 28
and graphic health warnings on cigarette packs.
In addition, tobacco displays have been found to
NSW will build on the Australian Government
make it harder for intending quitters to quit
commitment to bring restrictions on tobacco
smoking. 29
advertising and sales on the internet into line with
Tobacco sponsorship, advertising and point of sale restrictions on other media and at physical points of
promotions have been restricted and progressively sale by strengthening state legislation to expressly
phased out over time. The commencement of the prohibit the sale of tobacco on the internet.
Public Health (Tobacco) Act 2008 on 1 July 2009
Advertising and Promotion
Eliminate the advertising and promotion of tobacco products and restrict the availability and supply of
tobacco, especially to children
Actions Responsibility Timeframe – Year Measurement
1 2 3 4 5
Monitor and enforce the NSW Health n n n n n Compliance with legislation
requirements of the Public
Health (Tobacco) Act 2008. Warning notices/ prosecutions
Survey data on source of supply
of cigarettes for children and
whether they have been asked
for proof of age
Review data collection and NSW Health n n Review completed and
reporting systems for the recommendations implemented
Public Health (Tobacco) Act
2008 and implement key
recommendations.
Continue to implement the NSW Health n n n n n Scheme implemented
retailer notification scheme and
review its effectiveness. Number of retailers registered
Conduct retailer education NSW Health n n n n n Knowledge of retailers
campaigns (including those MHCS about tobacco legislation
specifically tailored for CALD
groups) to raise tobacco retailer Compliance with legislation
awareness of their obligations
under the law and increase Retailer education available
compliance with legislation. in other languages
Publicise successful NSW Health n n n n n Prosecutions publicised in the
prosecutions to enhance media
community and retailer
awareness.
NSW Tobacco Strategy 2012-2021 NSW HEALTH PAGE 17Advertising and Promotion
Eliminate the advertising and promotion of tobacco products and restrict the availability and supply of
tobacco, especially to children
Actions Responsibility Timeframe – Year Measurement
1 2 3 4 5
Conduct regular training to NSW Health n n n n n Regular training and skills
ensure Authorised Inspectors update sessions conducted for
are appropriately skilled Authorised Inspectors
and supported to monitor
compliance with legislation and
assist with prosecutions.
Monitor and review the Public MOH n n n n n Regular reviews conducted and
Health (Tobacco) Act 2008 to key findings implemented as
ensure its effective operation appropriate.
and identify whether further
amendments are required.
Develop a protocol for MOH n n Protocol developed
compliance with Article 5.3 of
the World Health Organization
Framework Convention on
Tobacco Control (FCTC)
regarding transparent
communication with the
tobacco industry.
Contribute to initiatives to MOH n n Issues relating to
determine the optimal design Cancer Institute Commonwealth legislation put
of plain packaged cigarettes NSW forward in appropriate forums,
to reduce their appeal and NGOs considered and implemented as
increase the impact of health appropriate
warnings.
Review compliance data MOH n n n n n Data monitored regularly
relating to tobacco vending
machines to determine whether
tobacco vending machines
represent a risk of sales
to minors.
Examine options to phase MOH n n Options examined and
out tobacco sales on NSW recommendation made
Government premises.
Amend the Public Health MOH n Legislation amended
(Tobacco) Act 2008 to
expressly prohibit the sale of
tobacco on the internet.
Key:
MOH – NSW Ministry of Health
MHCS – NSW Multicultural Health Communication Service
NGOs – Non-government organisations
PAGE 18 NSW HEALTH NSW Tobacco Strategy 2012-2021Second-hand Smoke
Reduce exposure to second-hand Smoke-free environments are effective in reducing
smoke in workplaces, public places non smokers’ exposure to second-hand smoke and it
and other settings is argued that they contribute to the denormalisation
of tobacco smoking. Smoke-free environments are
It is well established that there is no safe level of
also beneficial for smokers by supporting their
exposure to second-hand smoke and that it causes
efforts to quit and reducing the consumption of
a range of serious health problems including
cigarettes as smoke-free environments provide fewer
coronary heart disease and lung cancer in
opportunities to smoke.
non-smoking adults. 30 Children are particularly
susceptible to health damage caused by second- Local councils in NSW have been progressively
hand smoke due to their immature immune systems introducing smoke-free policies in outdoor areas
and their smaller airways. Children can suffer a range such as children's playgrounds, swimming pools
of health problems including increased risk of asthma and beaches. The NSW Government will amend the
and sudden infant death syndrome from exposure Smoke-Free Environment Act to protect the
to second-hand smoke. 31 community from harmful second-hand tobacco
smoke in a number of outdoor settings, including:
at public sports grounds, within 4 metres of the
entrance to a public building and in commercial
outdoor dining areas.
Second-hand Smoke
Reduce exposure to second-hand smoke in workplaces, public places and other settings
Actions Responsibility Timeframe – Year Measurement
1 2 3 4 5
Amend the Smoke-free MOH n n n n n
Environment Act 2000 to
prohibit smoking in the
following areas:
a) In public playgrounds within
10m of children’s play
equipment;
b) In open areas of public
swimming pools;
c) In major sporting facilities
and at public sports
grounds;
d) At public transport stops
and stations;
e) Within 4m of the entrance
to a public building; and
f) In commercial outdoor
dining areas.
Continue to monitor and NSW Health n n n n n Number of complaints
enforce the Smoke-free
Environment Act 2000. Number of inspections
and % premises complying
with the legislation
Prosecutions and warning
notices issued
Conduct a targeted NSW Health n n n n n Education activities conducted
communications strategy MHCS
(including for CALD groups) to Level of awareness of the Act
ensure licensed premises and and its provisions across the
other employers are aware of hospitality industry
their obligations under the Act.
Continue to monitor and MOH n n n n n Number of infringement
enforce the ban on smoking in NSW Police notices issued by NSW Police
cars when children under the
age of 16 years are present.
Build the capacity of Authorised NSW Health n n n n n Regular training and skill
Inspectors to enforce smoke- update sessions conducted
free legislation.
NSW Tobacco Strategy 2012-2021 NSW HEALTH PAGE 19Second-hand Smoke
Reduce exposure to second-hand smoke in workplaces, public places and other settings
Actions Responsibility Timeframe – Year Measurement
1 2 3 4 5
Review and fully implement the NSW Health n n Review conducted and policy
Smoke-Free Health Care Policy NGOs revised as appropriate
for NSW Health.
Number of NSW facilities which
achieve totally smoke-free
health
care status
Increase awareness of NSW Health n n n n n % population reporting their
parents, particularly those AHMRC home and car is smoke-free
from CALD communities, low NGOs (especially CALD, low SES and
socioeconomic groups and MHCS Aboriginal populations)
Aboriginal people,
of the health risks to children of
second-hand smoke and ban on
smoking in cars with children.
Under the Healthy Workers MOH n n Guidelines developed and
Initiative, develop and implemented
implement guidelines and other
resources for workplaces and
other settings wishing to go
smoke-free.
Conduct research on impacts of MOH n n Research conducted and
second-hand smoke to health. recommendations made
Support the implementation MOH n n n n n % of strata schemes which
of smoke-free multi-unit NGOs introduce smoke-free
residential dwellings by strata requirements
organisations through the
promotion of guidelines.
Advocate at a national level MOH n Discussions held with the
for a national approach on the Australian Government and
issue of removing smoking ban other states
exemptions for casino private and territories
gaming areas.
Develop and implement options NSW Health n n Options paper finalised and
for reducing smoking on NSW action taken to progress
Health facilities. recommendations
Promote smoke-free policies NSW Health n n n n n Number of tertiary facilities
in youth centres and tertiary and youth centres introducing
education facilities, including smoke-free policies
TAFE, universities and private
colleges. % of young people exposed to
second hand smoke in tertiary
facilities and youth centres
Introduce a strengthened MOH n n Powers granted to Local Health
enforcement regime for the Districts
Smoke-Free Health Care Policy
through penalty notices. Policy Directive issued on
use of penalty notices
Key:
MOH – NSW Ministry of Health
MHCS – NSW Multicultural Health Communication Service
NGOs – Non-government organisations
PAGE 20 NSW HEALTH NSW Tobacco Strategy 2012-2021You can also read
