Lyn Roberts

Uptake and effectiveness of the Australian telephone Quitline service in the context of a mass media campaign

Objectives: Since June 1997, Australia has run its first nationally coordinated mass media anti-smoking campaign, with all States collaborating to offer a standard Quitline service. An overview of the Australian national Quitline service is presented as well as two studies describing (a) the relationship between television advertising and call volume and type, and (b) the quit rates of callers over time. Design: Data on extent of advertising, as measured by weekly television target audience rating points (TARPs), is compared with weekly call volume and disposition. A randomly selected sample of callers was followed up at 3 weeks, 6 months and 12 months to assess caller appraisal and quit rates. Setting: The Australian Quitline service, in the context of a nationally coordinated, major anti tobacco campaign. Results: In a one year period from June 1997, 3.6% of adult Australian smokers called the Quitline. Weekly call volume was strongly related to TARPs and increased further when an advertisement specifically promoting the Quitline was broadcast. Calls involving requests for counselling, as opposed to brief calls to request quit materials, were more likely with lower TARPs. Of the cohort who were smoking at baseline, 28% reported they had quit smoking at a one year follow up and 5% had been quit for an entire year. Conclusions: In the context of a national mass media campaign, this study illustrates that it is possible to bring together differing State based services to provide an accessible, acceptable, and effective quit smoking service.

Trends in prevalence and acceptance of workplace smoking bans among indoor workers in South Australia.

OBJECTIVE: To compare the reported prevalence and acceptance of bans on smoking in the workplaces of a representative sample of adults in South Australia between 1989 and 1994. DESIGN: Independent cross-sectional representative population surveys. SETTING: South Australian population. PARTICIPANTS: Adults who indicated they were employed mainly indoors, for the years 1989 (875 respondents), 1991 (1472), 1992 (1288) and 1994 (1273). MAIN OUTCOME MEASURES: Percentage reporting total bans on smoking at work; percentage reporting compliance with bans all or nearly all the time; percentage reporting preference for total bans at work. RESULTS: The percentage of indoor workers subject to a total ban on smoking at work increased from 32% in 1989 to 62% in 1994 and preference for a total ban increased during the same period from 26% to 52%. Reported compliance with restrictions and bans was very high. In 1994, 16% of workers still had no restrictions on smoking at work, but only 3% preferred this arrangement. CONCLUSION: The data suggest that smoking bans are now the norm for indoor workers and that further gains in promoting and supporting workplace bans will be made by directing efforts at smaller workplaces, where unrestricted smoking is most prevalent.

Characteristics of heavy smokers

BACKGROUND Heavy smokers (those who smoke greater than or equal to 25 or more cigarettes a day) are a subgroup who place themselves and others at risk for harmful health consequences and also are those least likely to achieve cessation. Despite this, heavy smokers are not well described as a segment of the smoking population. METHODS We used representative population data on 1,048 smokers to examine differences between heavy and lighter smokers (less than or equal to 24 cigarettes per day). RESULTS Heavy smokers constituted 26.7% of all cigarette smokers. Compared with lighter smokers, heavy smokers were significantly more likely to be male, to be age 30 years or older, to smoke their first cigarette of the day within 30 min of waking, to perceive quitting as very difficult, to have little confidence in their ability to quit, to be less likely to report variation in their rate of smoking between work and leisure days, and to be less likely to be employed. CONCLUSIONS Public health strategies which may particularly assist heavy smokers include stronger restrictions on smoking in public places, nicotine replacement therapies, and the use of segmentation research to more carefully target campaign messages to influence quit attempts and confidence.

Prospects for smoking cessation among people with insulin-dependent diabetes

As part of an initiative to develop a smoking cessation resource tailored to the needs of smokers with diabetes, we undertook a survey of 223 people with insulin-dependent diabetes (IDDM) aged 15-40 years, 54 of whom were smokers. Smokers had high levels of awareness that smoking increases the risk of heart and peripheral vascular disease, but were less aware of the risk of microvascular complications. Nearly half of the smokers had other members of the household who were smokers, and 56% indicated they would expect to receive no more than a little encouragement from friends and family members to quit. Concern about weight gain and dietary adherence was a barrier to quitting smoking for approximately one-third of smokers. Seventy percent of smokers recalled advice to quit smoking from a general practitioner, but this most often had involved minimal advice to quit. There is scope for patient education with respect to microvascular complications exacerbated by smoking, and a need to consider the smoking habits of other household members and enlist their active support for smoking cessation.

Promoting reduced smoking rates in the context of workplace smoking bans.

A randomized study was conducted in 41 workplaces to determine the potential of self-help and group-based programs to encourage reduced smoking in workplaces that have implemented smoking bans. The trial had limited success in recruiting smokers, attrition was an important limitation, and the study outcomes were modest. The authors conclude that more research is needed on effective strategies that help smokers minimize smoking at work.

Smoking behaviours and beliefs of older Australians

Abstract: Reviews of the effects of smoking on health have concluded that older smokers can experience considerable health benefits from giving up smoking. In a representative population survey of people aged 15 years and over in South Australia, the percentage of people aged 60 years and over who were smokers was 13.5 per cent (95 per cent confidence interval 10.9 to 16.2 per cent). Compared with smokers aged under 60 years (n=727), older smokers (n=88) were significantly more likely: to be less convinced of the effects of smoking on health; to perceive that they were not personally at risk from their smoking in the future; to believe that smoking had not affected their own health so far; and to believe there was a daily level of cigarette consumption that was safe. Strategies to encourage older people to consider more objectively how smoking impairs daily living, including personal disclosure of smoking‐related damage through lung‐function testing, deserve further research.

Smoking and smoking cessation among men whose partners are pregnant

Smoking among partners of non-smoking pregnant women has been linked to adverse pregnancy outcome, including low birthweight. Paternal smoking also increases the risk of infant respiratory infections and sudden infant death syndrome, irrespective of maternal smoking status. Furthermore, men’s smoking habits are probably one of the strongest influences on the extent to which women are able to quit smoking in pregnancy and maintain cessation after the birth.

Smoking bans in domestic environments in South Australia

In recognition of the adverse consequences of exposure to environmental tobacco smoke, many countries have called for a ban on smoking in all enclosed public places. In South Australia, there has been an unprecedented increase during the 1990s in the percentage of workplaces which have imposed bans on smoking, and legislation has been passed to ban smoking in restaurants from the beginning of 1999. These moves are important from the point of view of protecting the health of adult non-smokers, but they do little to limit exposure of children.