Smoking cessation: learning from experience

John Britton (Feb 28, p 703)1Britton J In defence of helping people to stop smoking.Lancet. 2009; 373: 703-705Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar supports the substantial British investment in personalised smoking cessation activities, arguing against Simon Chapman's assertion (p 701)2Chapman S The inverse impact law of smoking cessation.Lancet. 2009; 373: 701-703Summary Full Text Full Text PDF PubMed Scopus (44) Google Scholar that much of this should have been allocated to evidence-based strategies such as mass media campaigns. For many years the British government seemed to put large amounts into cessation programmes as a soft alternative to complete controls on tobacco promotion, protection of non-smokers, and hard-hitting mass media programmes. At last the winds of smoke-free change are blowing through the UK, and few doubt that they will be rewarded by further declines in smoking. Britton, however, wonders whether smoking prevalence in Australia might now be lower, “had the admirable media campaigns run there over past decades been supported by UK-style cessation services”. Western Australia has in recent years had Australia's lowest prevalence of smoking in adults (14·8%)3Australian Institute of Health and Welfare2007 national drug strategy household survey: state and territory supplement. AIHW, Canberra2008Google Scholar and children (6% in 12–17-year-olds),4Coase P Miller J ASSAD smoking report 2005: a research report prepared for the Drug and Alcohol Office WA. TNS Social Research, Perth2007Google Scholar with one major community cessation programme which focuses mainly on training and support activities. There is clearly a role for smoking cessation activity, but there is overwhelming evidence of the effect of well funded media programmes which, with creative advocacy by health organisations, have been the cornerstone of developments in Western Australia.5Wakefield MA Durkin S Spittal MJ et al.Impact of tobacco control policies and mass media campaigns on monthly adult smoking prevalence.Am J Public Health. 2008; 98: 1443-1450Crossref PubMed Scopus (244) Google Scholar Britton might have asked how much better even Western Australia might have done if we had been able to spend as much on public education as the British government frittered away on worthy but low-impact cessation activities. In 36 years of work on tobacco in the UK, Australia, and internationally, I have seen virulent opposition by tobacco companies to tough, well funded media campaigns. I have never seen or heard of any concern from the tobacco industry or its allies about personalised smoking cessation programmes. Philip Morris even runs one itself. I declare that I have no conflicts of interest.