Hazards of Smoking Confirmed by Australian Study

THUNDER BAY – Smoking kills. That simply but harsh reality has been confirmed by a large Australian study of more than 200,000 people. The study has provided independent confirmation that up to two in every three smokers will die from their habit if they continue to smoke.

The research, published today in the international journal BMC Medicine, is the first evidence from a broad cross-section of the population to show the smoking-related death toll is as high as two thirds.

“We knew smoking was bad but we now have direct independent evidence that confirms the disturbing findings that have been emerging internationally, said lead author Professor Emily Banks, Scientific Director of the Sax Institute’s 45 and Up Study and a researcher at the Australian National University.

“Even with the very low rates of smoking that we have in Australia we found that smokers have around three-fold the risk of premature death of those who have never smoked. We also found smokers will die an estimated 10 years earlier than non-smokers.”

Until relatively recently it was thought that about half of smokers would die of a smoking-related illness, but newer studies in UK women, British doctors and Amercian Cancer Society volunteers have put the figure much higher, at up to 67%.

“We have been able to show exactly the same result in a very large population-wide sample,” Professor Banks said.

The research is the result of a four-year analysis of health outcomes from more than 200,000 men and women participating in the Sax Institute’s 45 and Up Study ? the largest longitudinal study of healthy ageing in the Southern Hemisphere.

Australia has one of the lowest smoking rates in the world – at 13% of the population ? and is an international leader on plain cigarette packaging. “But our findings are an important reminder that the war on tobacco is not yet won, and tobacco control efforts must go on,” Professor Banks said.

The research was supported by the National Heart Foundation of Australia in collaboration with major 45 and Up Study partner Cancer Council NSW and was conducted by a national and international team. It also found that compared with non-smokers, smoking just 10 cigarettes a day doubles the risk of dying and smoking a pack a day increases the risk four- to five-fold.

The NSW Heart Foundation’s CEO, Kerry Doyle, said the Australian Government was on the right path in driving down smoking rates through initiatives like tax increases and plain packaging.

“Higher tobacco prices have been shown to be the most effective intervention available to governments to reduce demand for tobacco. With smoking being a major cause of cardiovascular disease, including heart attack, stroke and peripheral vascular disease the more deterrents people have between them and smoking, the better,” Ms Doyle said.

Scott Walsberger, Tobacco Control Manager at Cancer Council NSW, said the research results highlighted an important message for smokers: “It’s never too late to quit ? no matter what your age, or how much you smoke.”

Butting Out?

In Thunder Bay the Regional Health Sciences Centre offers help.

“Are you thinking about quitting? Is it something you’d like to try?” That’s how Veronica Proper, Inpatient Tobacco Cessation Research Nurse, starts conversations with inpatients at Thunder Bay Regional Health Sciences Centre (TBRHSC). “If I say ‘try’ it’s less intimidating.”

Since May 2013 Proper has been approaching patients who indicate upon admission that they have smoked within the past 30 days and offers them a smoking cessation program. If patients are interested, Proper works with them to develop a personalized quit plan.

And if patients say no? “I still talk to them and let them know that the offer is always on the table. Sometimes, after a few days, a patient will think about ‘What do I have to do to not have to be in here?’ and they ask their nurse to give me a call to come to see them.”

Beyond its obvious benefits to inpatients, the program is also a research study led by Dr. Patricia Smith, through a partnership between TBRHSC, the Ministry of Health and Long-Term Care, and the Northern Ontario School of Medicine. “The success rate among hospitalized patients is much higher than the general public” says Smith. “So it’s a good time to give it a try. One reason for high success is that many people quit or cut down at least temporarily during hospitalization and go through the worst withdrawal period, first 2 to 3 days, without noticing it. So, with Veronica’s help, when people go home they can focus on the gains they made in hospital with cutting down or quitting rather than starting cold.”

Illness also motivates. “Many of the people who have signed up for the program had not been seriously thinking about quitting before they were hospitalized,” says Proper. “Then the reality of the situation hits home and many realize that they could at least take control of this part of their health.”

Only about 3% of people who try to quit smoking on their own are able to remain smoke-free. Compare that to the program at TBRHSC where 35% of patients who sign up with Veronica are still smoke-free one year after hospital discharge. “These are among the highest quit rates ever reported and show that the program is working,” says Proper.

One of the main reasons for the program’s success is that it takes into account every aspect of an individuals’ smoking behaviour.

“This program meets people where they’re at,” says Proper. “Even if you use medication to help you quit, quitting involves figuring out what you can do instead of smoking in all of the situations that usually trigger you to smoke.”

The approach is friendly, flexible, patient-centred, and supportive. After hospital discharge, Proper follows up by telephone with a regular schedule of calls. “Quite a few people have told me it made a big difference to be able to talk to someone outside their family. Others tell me that they were able to hang in there and not smoke because they knew that I would be calling.”

Proper loves her job. “Quitting smoking is the best thing you can do for your health,” she says. “And I get to support people through the process. Even making the decision that you want to quit is a big deal. There is a lot about our health that we can’t control but we can control what we do moving forward.”

If you are an inpatient interested in quitting smoking, you may ask to see the Inpatient Tobacco Cessation Research Nurse. Or, for help anytime, call the Smokers’ Helpline at 1-877-513-5333.