Smoking cigarettes or vaping can impact health and wellbeing and increase the risk of cancer.

It also puts other people at higher risk of lung disease and cancer when they breathe in the smoke. This is called ‘second-hand smoke’.

Children exposed to smoke from cigarettes are at higher risk of:

• respiratory infections
• middle ear infections
• sudden infant death syndrome (SIDS). 

There is no safe level of smoking or second-hand smoke.

Quitting smoking has immediate benefits, including improved health and fitness and saving money. 

Quitting smoking can be hard, but every step takes your client closer to quitting smoking for good and improving their health.

They’ll see short-term health benefits like:

• oxygen levels in the blood improving 
• exercise becoming much easier and lung function improving
• less coughing and easier breathing.

Longer term benefits of quitting include: 

• a reduced risk of heart disease
• less risk of cancers including lung, mouth, bladder and kidney cancers 
• lowered risk of stroke.

Smoking is also expensive. Use the iCanQuit calculator with your client to see how much they could save if they quit smoking.

Small steps can help your client’s quit journey. Encourage them to:

• try cutting down the amount they smoke
• make their home and car smoke free
• cut out smoking in certain situations.

Cutting down to quit is not as effective as stopping straight away. If your client plans to cut down, it helps to have a quit date they are working towards.  

It's important to remember that the person who smokes has to be the one who decides to quit.

People who feel supported in their quit journey are more likely to quit for good.

If you’re working with a client who’s trying to quit smoking: 

• be respectful, positive and non-judgemental 
• encourage and support your client 
• offer distractions—things that will help take their mind off smoking 
• create a supportive environment by making where you meet smoke-free
• celebrate successes 
• suggest they seek information and support, like setting up a quit plan on iCanQuit or talking to experts on Quitline by calling 13 78 48. 

Don't: 

• lecture or nag them 
• question their ability to quit—even if they have a slip-up, stay positive, encourage them to learn from the experience and try again
• take their grumpiness personally—people trying to quit experience withdrawals and it won't last forever.

Smoking during pregnancy harms both the mother and her baby.

Quitting before or during pregnancy is the best way to protect the baby and the mother from adverse health outcomes. 

Pregnancy provides an opportunity for health workers to help people who smoke to quit, as they’re more likely to be motivated to protect the baby’s health. 

Risks of smoking during pregnancy 

Women who smoke have a greater risk of: 

• having a miscarriage
• having a low-weight baby who is more vulnerable to infection and health problems later in life (a small baby does not make labour easier) 
• having a premature baby 
• having a baby with a weaker immune system. 

Passive smoking (breathing in second-hand smoke) also creates a risk for the baby. Encourage partners and others in the household to quit smoking. 

Supporting pregnant women to quit smoking  

Women who smoke while pregnant might feel shame, so it can be hard for some women to admit that they smoke. 

Behavioural counselling, such as through Quitline, is the best strategy for pregnant women to quit smoking.

Nicotine replacement therapy (NRT) can be offered if other quit attempts have been unsuccessful. Using NRT in pregnancy is less harmful than smoking. 

Women who do quit during pregnancy may need support to stay smoke-free after the birth. Staying smoke-free protects the baby’s health. 

Everyone’s quit smoking journey is different.

The most effective strategies use nicotine replacements or medications combined with professional advice and support.

Or your client might choose to:

• cut down to quit
• quit cold turkey.

Find what works for your client from the many different quit methods and strategies.

Nicotine replacement therapy 

NRT works by releasing a lower dose of nicotine compared to smoking. The body absorbs nicotine slowly. 

This helps to:

• minimise or avoid withdrawal symptoms
• reduce craving intensity and frequency.

People trying to quit smoking may have a slip-up or relapse if they have withdrawals and cravings. 

NRT can greatly reduce the risk of returning to smoking in this crucial early stage.

It comes in patches, gum, lozenges, mouth sprays and inhalers. It’s more effective to use a combination of these than a single type.

Your client can buy them from the pharmacy over the counter, or:

• seek a prescription for them from the doctor to get the products at a cheaper cost
• find them for free at some Aboriginal Medical Services or Aboriginal Community Controlled Health Services.

Quit smoking medications

A doctor can prescribe non-nicotine medication.

In Australia, there are quit smoking medications that can be prescribed including Varenicline and Bupropion.

Your client should talk to their doctor about whether these medications can help them.

Professional support and advice

When compared to no assistance, these professional support services greatly increase a person’s chance of quitting:

• Multiple calls with the NSW Quitline: 25% to 50% increase.
• Individual counselling to help quit smoking: 40% increase.
• Quit smoking advice from a doctor: 66% increase.
• Attending a quit smoking group: 98% increase.

Combining professional support with NRT or a prescribed quit smoking medication can result in a 70% to 100% increased chance of quitting. 

Alternative quit methods

You may have heard about other alternative methods to quit, such as acupuncture, hypnotherapy, herbs or laser therapy. 

There is no convincing evidence that these are effective ways to quit.

Quitting can be hard, and slip-ups happen. Think of a slip-up as a learning experience.

It takes practice and persistence. When your client feels they’ve failed, it's important to try again. 

Quitline counsellors are skilled at helping people learn from previous experience. Clients can ask to speak to an Aboriginal counsellor.

Find out more about managing a slip-up.

You can help build on the substantial progress already made in tackling Indigenous smoking. 

Daily smoking rates among Aboriginal adults decreased by 8.9 percentage points from 2002 to 2022.

One best-practice model to follow is Ask, Advise, Help (AAH).

• Ask each client in a sensitive, non-judgemental way if they smoke or vape when it’s a good time and place to have the conversation.
• Advise your clients who smoke to quit in a clear way without confrontation, focusing on the benefits of quitting and the best ways to do so.
• Help your client and refer them to a quit smoking strategy and the Quitline (13 78 48)—a confidential service with professional counsellors.

When you apply all three steps of the AAH model, it increases the number of your clients who make a quit attempt and go on to quit for good.

If you run 715 health checks with clients, remember to ask about their smoking status. See the RACGP site for 715 Health Check templates that cover smoking status.

Training for health workers

Doing some training can prepare you for yarning about quitting smoking.

HETI modules for NSW Health staff: 

• Smoking cessation: a guide for all staff 
• Yarning about quitting 
• Smoking in Pregnancy (part A and B)

Cancer Council NSW has training for community organisations under their Tackling Tobacco Program.

For training in health services, contact the NSW statewide Smoking Cessation Training Coordinator.

Direct clients to Quitline

You're not expected to be an expert in quitting smoking. 

Quitline is there to provide expert advice. 

An evaluation of Quitline shows that people who engage with the service report that: 

• they feel comfortable talking with counsellors 
• counsellors are seen as genuine, understanding and supportive 
• counsellors are trustworthy and provide good advice.

Developed for young people who want support to quit vaping. Pave will offer daily opportunities to learn and grow as the user is guided on the best ways to give up vaping.

E-cigarettes are battery-operated devices also known as vapes, mods, tanks or stigs.

They work by heating a solution, which the user breaths in—this is what people call ‘vaping’.

In NSW, a prescription is needed for adults to legally buy and use vaping products containing nicotine.

Vaping can be harmful, particularly for young people and people who don’t smoke.

That’s because the liquid in e-cigarettes contains chemicals such as formaldehyde, heavy metals and solvents, which cause adverse health outcomes.

The liquid often also contains nicotine, even when the label states ‘nicotine free’, and users can develop a nicotine addiction from it.

There’s strong evidence that non-smokers who use e-cigarettes are three-times more likely to go on to smoke cigarettes than those who don’t.

Vaping is too new to know the long-term effects on health. But we do know e-cigarettes cause:

• addiction
• intentional and unintentional poisoning
• burns and injuries
• lung injury
• increased uptake of smoking.

If your client hasn’t been able to quit smoking using other strategies, they should talk to their doctor about whether e-cigarettes might be useful.

Until more information is known about the long term effects of vaping, NSW Health recommends that people try other strategies (see the ‘Quit smoking strategies' section above) to help them quit smoking, such as using NRT along with professional support such as Quitline. 

If your client’s considering vaping, help them to understand that:

• the medical sector doesn’t know the long-term health effects
• you need a prescription to use e-cigarettes with nicotine 
• e-cigarettes are supposed to be used for a short time
• they should avoid smoking while also using e-cigarettes.

If you run 715 health checks with clients, remember to ask about their vaping status. See the RACGP site for 715 Health Check templates that cover vaping status.

You can also bust these myths about vaping:

It’s just ‘water vapour’:

• Vaping products produce an aerosol made up of chemicals and particles.
• Chemicals can lodge in your lungs and can harm your body.

It’s just flavouring:

• The flavours of e-cigarettes are made from multiple chemicals that are not safe to inhale and can damage your airways.
• The long-term effects of vaping chemicals are unknown.

Vaping is safe:

• E-cigarettes contain harmful chemicals, which can cause short and long-term health effects, such as vomiting, shortness of breath and lung damage.
• E-cigarettes haven’t been around long enough to know all the health risks, but experts think it is likely they will cause mouth and lung cancers.

The brand I buy is labelled nicotine-free:

• Most e-cigarettes on the market in Australia contain nicotine, even those that claim that they don’t.

These websites have more information about e-cigarettes:

• Tackling Indigenous Smoking: Facts about vaping (e-cigarettes)
• Department of Health: About e-cigarettes
• Lung Foundation Australia: E-cigarettes and vaping
• Quitline: E-cigarettes and teens: what you need to know