Quit Facts
Medical Journal of Australia

June 20, 2005

Fast Facts: Smoking cessation. Robert West and Saul Shiffman. Oxford: Health
Press, 2004 (78 pp, $35.20). ISBN 1 903734 42 8.

This is, quite simply, a terrific little book. Written by two highly
respected figures in the field, it is a fount of evidence-based wisdom. It
should be on the bookshelves of every health professional who counsels
smoking cessation, or who wants to be well informed. The writing style is
very approachable and the synthesis of the material is, for the most part,
masterful. It provides a great summary of the main health effects and
benefits of quitting. There are figures here that should motivate smokers to
think about quitting: half of all long-term smokers who die lose 16 years of
life on average; put another way, all smokers lose an average of 8 years of
life. In addition, disability sets in 12 years earlier than for non-smokers.
I compute this to be, on average, 4 more years of disability-affected life.

West and Shiffman also clearly and concisely set out the best path to
cessation — behavioural help augmented with pharmacotherapy — with useful
hints for helping smokers quit. There is a good explanation of why it is
worth health professionals persisting with encouraging cessation, even
though, on any one piece of advice, very few clients will eventually quit.
The authors also wisely counsel against too much pushing, suggesting annual
review (unless a smoker opts to follow up).

There were only three things in the book with which I had any serious
disagreement. Firstly, I think the authors over estimate the benefits of
bans on smoking as a means of encouraging smokers to quit. Secondly, they
suggest that the greater incidence of smoking among low socioeconomic groups
in many Western societies is due to a deficit of skills. I think it is due
partly to less access to compelling information and, for some, the competing
priorities of lives out of control or lacking in essential rewards. Finally,
they assert that virtually all slip-ups end in relapse. While most do,
relapse is far from inevitable, and the danger in assuming relapse will
occur is that this may become a self-fulfilling prophecy. However, these
quibbles, important as they are, do not distract overly from the utility of
the book. Every health worker should have some capacity to help smokers
quit, even if only in knowing useful referral sources. This book is a
fantastic resource.

Ron Borland
Nigel Gray Distinguished Fellow in Cancer Prevention,
The Cancer Council Victoria, VIC