Many thanks to Dr Melissa Stoneham for the latest instalment from JournalWatch.
Dr Melissa Stoneham writes:
In 1976, 43 per cent of Australian males and 33 per cent of women smoked. This was three years after the decision to phase out direct cigarette advertising on radio and television. By 1995, most forms of tobacco sponsorship were phased out, with exemptions granted to international events that perceived they could not exist without it. By 1998, 27 per cent of Australian males and 25 per cent of women smoked. Indoor smoking bans commenced in 2007, smoking in cars was banned from 2008 and local councils were moving to make alfresco areas smoke-free from 2009. The ABS report current smoking rates to be 20 per cent for males and 16 per cent for females.
Clearly tobacco interventions are working to reduce the prevalence of smoking in Australia. Yet we continue to strive for lower smoking rates, with the most recent suggestion being that Australian smokers carry a ”smartcard licence” to purchase cigarettes to enable health authorities to track their behaviour and better target quit messages to them.
In an article published in the Medical Journal of Australia, University of Sydney Law School’s Professor Roger Magnusson and Chief Executive of the Cancer Institute NSW Professor David Currow said a licence scheme could make it harder for children and adolescents to buy cigarettes. It is estimated that between 5-9 per cent of adolescents smoke in Australia, and research has indicated that after the age of 25 years, people tend not to take up smoking. The authors argue that the smart-card “licence” may help reduce unlawful tobacco sales to children – thereby reducing the uptake of smoking and helping adult smokers quit.
This article builds on work conducted by Professor Simon Chapman who in 2012, proposed a scheme where smokers sit a pre-licence test on the risks of smoking, and where limits be placed on how many cigarettes they are able to purchase. The authors of this MJA article suggest a simpler system that has two main objectives being to reduce unacceptably high rates of unlawful tobacco sales to children and adolescents, and to make intelligent use of information about smokers.
Their proposed system would ultimately help adult smokers quit by using smart cards to monitor smokers’ purchases and enable health authorities to detect patterns and variations in smokers’ behaviour. This would then allow the development of more sophisticated individualised communications to assist smokers to quit. The professors suggest the smart cards would enable rigorous evaluation of smoking cessation programs, resulting in focused, cost effective and evidence-based strategies.
Magnusson and Currow suggest the smart cards be a mandatory requirement for adult smokers and include details of age and other identity-verifying information. The system would require retailers to be licensed to sell tobacco and necessitate them to reconcile all stock purchased from wholesalers against a digital record of retail sales to licensed smokers. This would create a database of smokers and their cigarette purchases, while also creating an incentive for retailers to comply with laws that prohibit tobacco sales to children.
The authors go on to identify and discuss four key objections to the smokers’ licence idea including that tobacco is a legal product, a resultant loss to government revenue, whether the licensing scheme would be digestible by the Australian community and the exacerbation of the stigmatisation of smokers.
Finally, the authors suggest that to avoid undermining the integrity of a point-of sale licence verification scheme, Australia should follow the United States, which has substantially curtailed internet and mail-order sales by making tobacco products non-mailable matter through the US Postal Service, with limited exceptions. It is proposed that if mail-order and internet tobacco sales are permitted in Australia, they be limited to adults in remote areas who present their smokers licence on collection. This is a valid recommendation as the 2010 National Drug Strategy Household Survey identified that teenagers tend to purchase their cigarettes from either online stores or retailers.
Smoking is recognised as the largest single preventable cause of death and disease in Australia. To combat this, we remain a leader in tobacco control, with recent examples being the implementation of the Tobacco Plain Packaging Act 2011 and the extension of the Tobacco Advertising Prohibition Act 1992 (Cwlth) to ban tobacco advertising on the internet or using telecommunications devices. Yet these strategies primarily address demand. Maybe it is time to proactively address the issue of supply of cigarettes. This new strategy of a smart card, combined with licensing of retailers may be just the intervention to reduce the astounding figure of 2.8 million Australian smokers.
About JournalWatch
The Public Health Advocacy Institute WA (PHAIWA) JournalWatch service reviews 10 key public health journals on a monthly basis, providing a précis of articles that highlight key public health and advocacy related findings, with an emphasis on findings that can be readily translated into policy or practice.
The Journals reviewed include:
Australian & New Zealand Journal of Public Health (ANZJPH)
Journal of Public Health Policy (JPHP)
Health Promotion Journal of Australia (HPJA)
Medical Journal of Australia (MJA)
The Lancet
Journal for Water Sanitation and Hygiene Development
