Effective interventions

From National Cancer Control Policy
Tobacco control > Effective interventions

NCPP tobacco control banner.png

Effective interventions

Australia has a strong record of tobacco control and has implemented a number of successful interventions for reducing tobacco use. The success of Australian tobacco control policy is reflected in the declining rates of smoking[1]. Despite this, more than one in six Australian adults smoke daily, accounting for 2.8 million people in 2011-2012[2].

This section of the chapter focuses on interventions for which there is evidence of a positive effect on smoking initiation, quitting and prevalence, and for which there remain opportunities for improving tobacco control in Australia.

Overarching frameworks

Effectively reducing the burden of smoking-related cancer in Australia enquires a coordinated, multi-strategy approach with intervention and funding from all levels and sectors of government, as well as non-government, community and health organisations[3].

A number of policy frameworks exist in Australia to address this, including the Council of Australian Government Agreements for Healthcare[4], Preventive Health[5] and Closing the Gap in Indigenous Health Outcomes[6]. These agreements are designed to facilitate Federal and State and Territory Government cooperation.

The National Tobacco Strategy 2012-2018 is a policy framework designed to provide a platform for government at all levels to work with non-government, community and health organisations[7].

See the Policy context section of this chapter for more on the current policy environment in Australia.

Back to top


Tax increases have been one of the most effective tobacco control strategies in Australia and globally[8][9]. With increases in taxes on tobacco products, the size of the resulting price increase leads to a proportional fall in demand[10].

Tobacco taxation, including federal excise, customs duty and state franchise fees has been a central tobacco control strategy in Australia. In Australia, excise, customs duty and GST make up around 60% of the final price of leading brands of cigarettes[8][11]. The Australian Government has regularly indexed tobacco excise by the Consumer Price Index. However, from 2014 onwards, tobacco excise is to be indexed on the basis of changes in Average Weekly Earnings. In April 2010, a 25% tax increase on tobacco products was introduced. In 2013, the Government announced it would introduce staged 12.5% increases in tobacco excise over four years from 2013-2016, in addition to the increases that will occur under indexation arrangements.The first two 12.5% increases commenced on 1 December 2013 and 1 September 2014, and the remaining 12.5% increases will occur on 1 September 2015 and 1 September 2016, respectively.

Analysis by Federal Treasury found that the 2010 tobacco tax increase in Australia exceeded the set objective of a 6% decrease in tobacco consumption, with a decline of 11% two years after implementation. There was insufficient data to determine whether the increase met the objective of decreasing the number of smokers by 2-3%[12]. The analysis concluded that the excise increase supported other policy, price and taxation measures aimed at reducing the harms of tobacco consumption in Australia[12].

The two main reasons smokers in Australia cited for changing their smoking behaviour in 2010 were because smoking was affecting their health (44.3%) and because it was costing too much money (44.1%). The proportion of people nominating cost as a factor increased significantly from 35.8% in 2007 to 44.1% in 2010 when the tax increase was introduced[1].

The 2010 tax increase saw increased numbers of people attempting to quit, and decreases in the number of cigarettes smoked by regular smokers[13][14]. The effect was strongest in younger smokers and people in the lowest socioeconomic tier[13][14]. Directly following the tax increase (May 2010), one study reported 22% of the study sample quit smoking, compared with 12% at the same time in the previous year and 13% in the previous month[15]. This increased number of people quitting was evident for a short time, however this was not sustained further than three months following the tax increase[15].

Back to top

Mass media campaigns

Mass media campaigns, including social marketing, can have a significant impact on reducing tobacco use[16][17]. Mass media campaigns play a role through education, changing attitudes, prompting quit attempts and decreasing smoking prevalence[16]. They have a direct impact smokers by prompting quit attempts and avoidance of smoking, and also have an indirect effect by de-normalising smoking in society[17].

Television campaigns remain the primary mass media channel for reaching and influencing adult smokers[16]. Developing sustained mass media campaigns, such as repeated cycles of advertising, are the most effective medium for reducing the burden of tobacco-related cancer[18]. There is evidence that while mass media campaigns are effective at increasing quit attempts, the impact does not last beyond a few months of the campaign ending[18]. Adequate campaign intensity is especially important for vulnerable population subgroups[17].

Mass media campaigns are highly cost-effective, as they have high reach into populations[17]. The savings from averted health care costs associated with tobacco control mass media campaigns exceed campaign costs[17].

Mass media campaigns are a particularly effective component of comprehensive tobacco control strategies[19]. Their effectiveness is maximised when coordinated with other tobacco control programs to reinforce the messaging and promote awareness. Mass media campaigns and pictorial health warnings running concurrently may have a complementary effect on increasing awareness of the harms of smoking and motivation to quit[19].

Back to top

Eliminating tobacco advertising, promotion and sponsorship

While many avenues of tobacco advertising, promotion and sponsorship have been restricted, there still remain avenues by which tobacco companies seek to promote their products. The rise of new media and lack of relevant regulations have created an environment in which tobacco control is hampered by the tobacco industry denormalising public health strategies and policies[20]. Eliminating remaining forms of promotion such as internet advertising, price specials, public relations activities, incentive programs and exemptions to point-of-sale display restrictions is an obligation under the World Health Organization Framework Convention on Tobacco Control[21].

The role of tobacco advertising remains important particularly in smoking initiation. A recent meta-analysis demonstrated that non-smoking adolescents who were more aware of tobacco advertising were more likely to experiment with cigarettes and to become smokers[22].

Enforcing plain packaging laws, which commenced in Australia on 1 December 2012, is an important strategy to reduce young people's exposure to tobacco promotion. In an environment where the majority of advertising streams for tobacco products are blocked, product packaging is an important marketing tool for tobacco companies[23][24].

Early indications suggest that plain packaging of tobacco products is associated with lower smoking appeal and higher urgency to quit among adult smokers[25]. Smokers using plain packs are 81% more likely to have thought about quitting at least once a day during the previous week, and to rate quitting as a higher priority compared with those using branded packs[25]. Smokers using plain packs were 66% more likely to think their cigarettes were poorer quality than a year ago and 70% more likely to say they found them less satisfying[25].

See the Quit Victoria and Cancer Council Victoria Plain packaging review of evidence for more information.

Back to top

Smoke-free environments

Polices that create smoke-free environments are effective at reducing tobacco-related illness on a number of levels. Smoke-free environments protect individuals from second-hand smoke exposure[26], denormalise smoking behaviour[27], help prevent smoking experimentation and uptake among youth[27][28][29], and provide an environment that helps promote quit attempts.

The creation of smoke-free environments has had a net benefit to businesses, with no adverse effect on sales in hospitality industry[29].

Flow-on effect of smoke-free policies is an increasing number of smoke free homes, which has an important impact on reducing exposure to second-hand smoke, particularly among children[30][29]. See the section on Links between smoking and cancer for more information.

Commonwealth regulations ban smoking on domestic and Australian-operated international flights. However, the majority of regulation of smoke-free areas is implemented at a state level. Differences in regulations and definitions result in inconsistencies in regulations across Australia. See Table 1 for a brief overview of state regulations.

Table 1. Overview of state level smoke-free environment regulations

State/territory Enclosed public places* Outdoor eating/ drinking areas In cars (children present) Outdoor public venues
ACT Banned Banned (exception for designated areas) Banned
NSW Banned Banned Dependent on local council jurisdiction
NT Banned Banned Banned Banned
Qld Banned Banned (exception for designated areas) Banned Banned in stadiums, children’s playgrounds, patrolled beaches. Additions dependent on local council jurisdiction
SA Banned Banned Banned in children’s playgrounds, public transport stations
Tas Banned Banned Banned Banned in sporting and cultural venues, beaches and children’s playgrounds
Vic Banned Banned Banned in public transport stations. Additions dependent on local council jurisdiction
WA Banned Banned Banned Banned at beaches and children’s playgrounds

* Includes public transport

Back to top

Targeting disadvantaged and high-risk groups

Smoking rates in highly-disadvantaged groups are significantly higher. These communities bear a disproportionate burden of tobacco-related illness. See the Impact section of this chapter for more information.

Tobacco control measures effectively used in the general population may or may not be effective in specific high-risk populations. A recent meta-analysis of cessation support programs in highly disadvantaged groups cited the lack of high-quality evidence in these populations, particularly among the homeless, Indigenous Australians and prisoners[31]. Similarly, a review of mass-media campaigns targeting disadvantaged populations reported a lack of high quality evidence, particularly for highly disadvantaged communities[32]. Evaluation of the effectiveness of population-based tobacco control strategies in these specific populations, and appropriate tailoring where appropriate, is necessary to effectively target tobacco-related disparities.

Alliances between expert organisations in tobacco control and social services, mental health services, correctional facilities and government are key to assisting disadvantaged groups. These partnerships are important for the development of capacity in community organisations and for the implementation of targeted strategies for specific populations to complement mainstream programs. Current examples include the Cancer Council NSW Tackling Tobacco program which partners community organisations to promote quit attempts and the Break Free Alliance in the US who unite health departments with community organisations and public health advocates.

See the Cancer Council Australia position statement on Tobacco related disparities for more information.

Back to top

Product and supply regulation

Tighter regulation of tobacco products can increase understanding of the health impacts, counter misconceptions of ‘healthier’ options, decrease take-up and increase quit attempts.

The introduction of pictorial warnings in Australia resulted in an increase in people noticing and reading health warnings, considering the health risks, smoking fewer cigarettes, and quitting[30]. The pictorial warnings also stimulated stronger cognitive responses and more reports of reduced tobacco consumption than text-only health warnings in the UK[30].

Monitoring and enforcing compliance with regulations on the supply of tobacco products are key strategies for targetting smoking initiation. In Australia, higher merchant compliance from 1997–2003 predicted lower levels of daily smoking in adolescents[33]. A 20.8% reduction in the odds of smoking among 10th graders during this period was attributed to the improvement in merchant compliance[33].


All government jurisdictions in Australia have endorsed the National Tobacco Strategy 2012-18, which includes a commitment to "consider further regulation of the contents, product disclosure and supply of tobacco products and alternative nicotine delivery systems"[34].

The Commonwealth Department of Health and Ageing is leading two projects to assess the feasibility of improved tobacco product regulation in Australia. One is focused on the scientific, technical and practical feasibility of regulating the disclosure of tobacco product ingredients and emissions data in Australia. Public consultations are currently underway. There is also a literature review and research into the relationship between tobacco product ingredients, palatability and smoking behaviour.

Since September 2010, all cigarettes in Australia have been required to meet a reduced fire propensity standard.

See Cancer Council Australia position statements on Dangers of 'reduced-harm' cigarettes for more information.

Back to top

Cessation services

Close to three in 10 (29%) smokers in Australia tried unsuccessfully to quit smoking in 2010[1]. Almost 40% reduced the amount they smoked in a day[1].

Behavioural interventions such as individual, group and telephone counselling may be effective at improving smoking cessation, as measured at six and twelve months after quitting[35][36]. Pharmacotherapy-based interventions such as nicotine replacement therapy can improve smoking quit rates by 50–70%[37] and a combination of behavioural and pharmacotherapy interventions can increase smoking cessation success even further[38].

Given the effectiveness of cessation services, improving access to such services is an important strategy to reduce the burden of tobacco-related illness. This is particularly important for reducing the tobacco burden in disadvantaged groups. Understanding the barriers to uptake of cessation services among disadvantaged groups is an important step in increasing their access and use. See Targeting disadvantaged and high-risk groups for more information.

Further development of existing services is important for integration of cessation support into routine care, tailoring of services for specific high-risk groups, implementing best-practice and improving awareness and uptake.

See the Cancer Council Australia position statement on Stopping smoking for more information.

Back to top

Research and monitoring

Ongoing research and monitoring of current interventions is important to assess and improve intervention effectiveness, and to enable the dissemination of evidence within the international tobacco control community.

Back to top


  1. 1.0 1.1 1.2 1.3 Australian Institute of Health and Welfare. 2010 National drug strategy household survey report. Canberra: AIHW; 2011 Jul. Report No.: Drug statistics series no. 25. Cat. no. PHE 145. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737421139&libID=10737421138.
  2. Australian Bureau of Statistics. Australia heath survey first results 2011-12. Canberra: ABS; 2012. Report No.: Cat no. 4364.0.55.001. Available from: http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001?OpenDocument.
  3. Reddy KS, Yadav A, Arora M, Nazar GP. Integrating tobacco control into health and development agendas. Tob Control 2012 Mar;21(2):281-6 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22345268.
  4. Council of Australian Governments. National Healthcare Agreement 2012. Sydney: COAG; 2012.
  5. Council of Australian Governments. National partnership agreement on preventive health. Sydney: COAG; 2008 Available from: http://www.federalfinancialrelations.gov.au/content/npa/health/_archive/health_preventive_national_partnership.pdf.
  6. Council of Australian Governments. National partnership agreement on closing the gap in Indigenous health outcomes. Sydney: COAG; 2008.
  7. Intergovernmental Committee on Drugs (IGCD) Standing Committee on Tobacco. National Tobacco Strategy 2012-2018. Canberra: Commonwealth of Australia; 2012.
  8. 8.0 8.1 ITC Project. Tobacco Price and Taxation: ITC Cross-Country Comparison Report. Waterloo, Canada: University of Waterloo; 2012.
  9. WHO Framework Convention on Tobacco Control, Shibuya K, Ciecierski C, Guindon E, Bettcher DW, Evans DB, et al. WHO Framework Convention on Tobacco Control: development of an evidence based global public health treaty. BMJ 2003 Jul 19;327(7407):154-7 Available from: http://www.ncbi.nlm.nih.gov/pubmed/12869461.
  10. International Agency for Research on Cancer. Effectiveness of tax and price policies for tobacco control. Chapter 4. Tax, price and aggregate demand for tobacco products. Lyon, France: IARC; 2011.
  11. Scollo MM, Winstanley MH. Tobacco in Australia: facts and issues. 4th edn. Melbourne: Cancer Council Victoria; 2012 Available from: http://www.tobaccoinaustralia.org.au/.
  12. 12.0 12.1 The Treasury. Post-implementation review: 25 per cent tobacco excise increase. Canberra: Commonwealth of Australia; 2013 Feb Available from: http://ris.finance.gov.au/files/2013/05/03-25-per-cent-Excise-for-Tobacco.pdf.
  13. 13.0 13.1 Hayes L. Smokers' responses to the 2010 increase to tobacco excise: Findings from the 2009 and 2010 Victorian Smoking and Health Surveys. CBRC Topline Research Report. Melbourne: Centre for Behavioural Research in Cancer, The Cancer Council Victoria; 2011.
  14. 14.0 14.1 Scollo M, Zacher M, Warne C, Hayes L, Durkin S, Wakefield M. Impact in Victoria of the April 2010 25% increase in excise on tobacco products in Australia. Short-term effects on prevalence, reported quitting and, reported consumption, real cost, and price-minimising strategies in Victoria. Melbourne: Centre for Behavioural Research in Cancer, The Cancer Council Victoria; 2012.
  15. 15.0 15.1 Dunlop SM, Cotter TF, Perez DA. Impact of the 2010 tobacco tax increase in Australia on short-term smoking cessation: a continuous tracking survey. Med J Aust 2011 Oct 17;195(8):469-72 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22004399.
  16. 16.0 16.1 16.2 Durkin S, Brennan E, Wakefield M. Mass media campaigns to promote smoking cessation among adults: an integrative review. Tob Control 2012 Mar;21(2):127-38 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22345235.
  17. 17.0 17.1 17.2 17.3 17.4 Cancel Council Victoria. Tobacco control and mass media campaigns: evidence brief. Canberra: The Australian National Preventive Health Agency; 2013 Available from: http://anpha.gov.au/internet/anpha/publishing.nsf/Content/94287D19C5A643FFCA257B960003E8F6/$File/LASER%20PRINT_EV%20BRIEF_MASS%20MEDIA_v2_screen%20res.pdf.
  18. 18.0 18.1 Wakefield MA, Spittal MJ, Yong HH, Durkin SJ, Borland R. Effects of mass media campaign exposure intensity and durability on quit attempts in a population-based cohort study. Health Educ Res 2011 Dec;26(6):988-97 Available from: http://www.ncbi.nlm.nih.gov/pubmed/21730252.
  19. 19.0 19.1 Brennan E, Durkin SJ, Cotter T, Harper T, Wakefield MA. Mass media campaigns designed to support new pictorial health warnings on cigarette packets: evidence of a complementary relationship. Tob Control 2011 Nov;20(6):412-8 Available from: http://www.ncbi.nlm.nih.gov/pubmed/21474501.
  20. Freeman B. New media and tobacco control. Tob Control 2012 Mar;21(2):139-44 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22345236.
  21. World Health Organization. WHO Framework Convention on Tobacco Control. Geneva, Switzerland: WHO; 2003.
  22. Lovato C, Watts A, Stead LF. Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours. Cochrane Database Syst Rev 2011 Oct 5;(10):CD003439 Available from: http://www.ncbi.nlm.nih.gov/pubmed/21975739.
  23. Freeman B, Chapman S, Rimmer M. The case for the plain packaging of tobacco products. Addiction 2008 Apr;103(4):580-90 Available from: http://www.ncbi.nlm.nih.gov/pubmed/18339104.
  24. Wakefield M, Morley C, Horan JK, Cummings KM. The cigarette pack as image: new evidence from tobacco industry documents. Tob Control 2002 Mar;11 Suppl 1:I73-80 Available from: http://www.ncbi.nlm.nih.gov/pubmed/11893817.
  25. 25.0 25.1 25.2 Wakefield MA, Hayes L, Durkin S, Borland R. Introduction effects of the Australian plain packaging policy on adult smokers: a cross-sectional study. BMJ Open 2013;3:e003175.
  26. Pickett MS, Schober SE, Brody DJ, Curtin LR, Giovino GA. Smoke-free laws and secondhand smoke exposure in US non-smoking adults, 1999-2002. Tob Control 2006 Aug;15(4):302-7 Available from: http://www.ncbi.nlm.nih.gov/pubmed/16885579.
  27. 27.0 27.1 Smart RG, Stoduto G. Interventions by students in friends' alcohol, tobacco, and drug use. J Drug Educ 1997;27(3):213-22 Available from: http://www.ncbi.nlm.nih.gov/pubmed/9366127.
  28. Wakefield MA, Chaloupka FJ, Kaufman NJ, Orleans CT, Barker DC, Ruel EE. Effect of restrictions on smoking at home, at school, and in public places on teenage smoking: cross sectional study. BMJ 2000 Aug 5;321(7257):333-7 Available from: http://www.ncbi.nlm.nih.gov/pubmed/10926588.
  29. 29.0 29.1 29.2 IARC Working Group on the Evaluation of the Effectiveness of Smoke-free Policies. Evaluating the effectiveness of smoke-free policies. IARC Handbooks of Cancer Prevention, Tobacco Control. Lyon, France: IARC; 2009.
  30. 30.0 30.1 30.2 Borland R, Wilson N, Fong GT, Hammond D, Cummings KM, Yong HH, et al. Impact of graphic and text warnings on cigarette packs: findings from four countries over five years. Tob Control 2009 Oct;18(5):358-64 Available from: http://www.ncbi.nlm.nih.gov/pubmed/19561362.
  31. Bryant J, Bonevski B, Paul C, McElduff P, Attia J. A systematic review and meta-analysis of the effectiveness of behavioural smoking cessation interventions in selected disadvantaged groups. Addiction 2011 Sep;106(9):1568-85 Available from: http://www.ncbi.nlm.nih.gov/pubmed/21489007.
  32. Guillaumier A, Bonevski B, Paul C. Anti-tobacco mass media and socially disadvantaged groups: a systematic and methodological review. Drug Alcohol Rev 2012 Jul;31(5):698-708 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22571783.
  33. 33.0 33.1 DiFranza JR, Savageau JA, Fletcher KE. Enforcement of underage sales laws as a predictor of daily smoking among adolescents: a national study. BMC Public Health 2009 Apr 17;9:107 Available from: http://www.ncbi.nlm.nih.gov/pubmed/19374735.
  34. Intergovernmental Committee on Drugs. National Tobacco Strategy 2012–2018. Canberra: Commonwealth of Australia; 2012.
  35. Tzelepis F, Paul CL, Walsh RA, McElduff P, Knight J. Proactive telephone counseling for smoking cessation: meta-analyses by recruitment channel and methodological quality. J Natl Cancer Inst 2011 Jun 22;103(12):922-41 Available from: http://www.ncbi.nlm.nih.gov/pubmed/21666098.
  36. Mottillo S, Filion KB, Bélisle P, Joseph L, Gervais A, O'Loughlin J, et al. Behavioural interventions for smoking cessation: a meta-analysis of randomized controlled trials. Eur Heart J 2009 Mar;30(6):718-30 Available from: http://www.ncbi.nlm.nih.gov/pubmed/19109354.
  37. Stead LF, Perera R, Bullen C, Mant D, Hartmann-Boyce J, Cahill K, et al. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2012 Nov 14;11:CD000146 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23152200.
  38. Stead LF, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database Syst Rev 2012 Oct 17;10:CD008286 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23076944.

Overview   Impact   Link   Policy context   Effective interventions   Policy priorities   Position statements