Social and community service organisations are non-government, not-for-profit organisations that provide welfare services, such as accommodation assistance, emergency relief, and financial and relationship counselling, to people who are socially disadvantaged. Given the much higher prevalence of smoking among people who are socially disadvantaged (see Section 1.7), and the contribution of tobacco use to health disparities (see Chapter 9), social and community service organisations are increasingly recognising their role as important settings for implementing cessation interventions.1-3 Such interventions are also cost-effective.4 An Australian trial that examined the effectiveness of behavioural counselling with the option of NRT delivered to highly disadvantaged people who smoke through a community social service by trained case workers found that while it did not increase abstinence rates, it increased quit attempts and reduced consumption.5 The complex needs of highly disadvantaged people who smoke may necessitate tailored and targeted interventions—see InDepth 9A.
Staff training and organisational policies that require routine cessation support can help ensure that cessation care is provided to all clients of community service organisations.6 A review of factors that could facilitate the provision of cessation interventions by professionals working in social and community service identified knowledge, self-efficacy, positive relationships with clients, and organisational support.7 Another review of the role of community health workers in cessation programs also highlighted the importance of a positive and consistent relationship between the person who smokes and the health worker in promoting abstinence.8
Twenty years ago, Cancer Council NSW introduced the ‘Tackling Tobacco’ program, which aims to reduce tobacco-related inequality by embedding cessation support within community service organisations for priority populations using an organisational change model. An evaluation of the model supported its feasibility, acceptability and effectiveness; since 2006, 252 community service organisations have implemented the Tackling Tobacco program, and 21,648 clients were provided with support to quit in NSW. Since 2021, 3001 clients had their smoking status assessed and of these clients, 661 accessed nicotine replacement therapy (NRT), 214 received Quitline referrals, 295 received referrals to a clinician, 1432 received behavioural strategies and written support information, 196 reported quitting smoking and 648 reported smoking less.9 A recent trial in NSW also supported the effectiveness of the Tackling Tobacco program in increasing delivery and uptake of NRT among people with severe mental illness receiving support through community managed mental health organisations.10 See Section 9A.3 for a detailed discussion of smoking among people with mental illness.
Although people who are disadvantaged can face complex barriers to quitting, social and community service organisations have the potential to increase service users’ knowledge and use of cessation aids, and to provide direct and tailored support to disadvantaged Australian smokers.1 A study in NSW found that more than half of the service users reported wanting help from staff to quit, with access to free NRT, cash and non-cash rewards, and support and encouragement from staff cited as the most preferred types of help.11 The implementation of evidence-based interventions, such as the 5As, brief motivational interviewing, and use of NRT, appears to be acceptable and feasible within social and community service organisations.12 Staff education, training, and support may further promote the integration of smoking cessation support into usual care.13
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References
1. Bryant J, Bonevski B, Paul C, O'Brien J, and Oakes W. Developing cessation interventions for the social and community service setting: a qualitative study of barriers to quitting among disadvantaged Australian smokers. BMC Public Health, 2011; 11:493. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21699730
2. Bryant J, Bonevski B, Paul C, O'Brien J, and Oakes W. Delivering smoking cessation support to disadvantaged groups: a qualitative study of the potential of community welfare organizations. Health Education Research, 2010; 25(6):979-90. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20884732
3. Parnell A, Box E, Chapman L, Bonevski B, Anwar-McHenry J, et al. Receptiveness to smoking cessation training among community service organisation staff. Health Promotion Journal of Australia, 2020; 31(3):418-22. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31278872
4. Reisinger SA, Kamel S, Seiber E, Klein EG, Paskett ED, et al. Cost-Effectiveness of Community-Based Tobacco Dependence Treatment Interventions: Initial Findings of a Systematic Review. Preventing Chronic Disease, 2019; 16:E161. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31831106
5. Bonevski B, Twyman L, Paul C, D'Este C, West R, et al. Smoking cessation intervention delivered by social service organisations for a diverse population of Australian disadvantaged smokers: A pragmatic randomised controlled trial. Preventive Medicine, 2018; 112:38-44. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29626552
6. Parnell A, Box E, Biagioni N, Bonevski B, Anwar-McHenry J, et al. Factors influencing the willingness of community service organisation staff to provide smoking cessation support: a qualitative study. Australian and New Zealand Journal of Public Health, 2020; 44(2):116-20. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32050298
7. Visser JEM, Nur FA, Rozema AD, Kunst AE, and Kuipers MAG. Facilitators and barriers to smoking cessation support among professionals in social and community service settings: a systematic review and thematic synthesis. Health Education Research, 2025; 40(5). Available from: https://www.ncbi.nlm.nih.gov/pubmed/40796334
8. Woodruff D, Sawyer S, and Taggart T. The Role of Community Health Workers in Tobacco Cessation: A Scoping Review. American Journal of Health Promotion, 2026:8901171261433812. Available from: https://www.ncbi.nlm.nih.gov/pubmed/41808606
9. Twyman L, Vourliotis T, Walsberger S, Skelton E, Guillaumier A, et al. Cancer Council's Tackling Tobacco program: an Australian initative building partnerships for public health research impact. Public Health Res Pract, 2026; 36(2). Available from: https://www.ncbi.nlm.nih.gov/pubmed/42112943
10. Twyman L, Walsberger S, Baker AL, Ahmadi S, Oldmeadow C, et al. Outcomes of an organisational change program aimed at increasing smoking cessation support within Australian community managed mental health organisations: A cluster randomised controlled trial. Addiction, 2025; 120(5):937-50. Available from: https://www.ncbi.nlm.nih.gov/pubmed/39987579
11. Bryant J, Bonevski B, and Paul C. A survey of smoking prevalence and interest in quitting among social and community service organisation clients in Australia: a unique opportunity for reaching the disadvantaged. BMC Public Health, 2011; 11(1):827. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22026718
12. Bryant J, Bonevski B, Paul C, Hull P, and O'Brien J. Implementing a smoking cessation program in social and community service organisations: a feasibility and acceptability trial. Drug and Alcohol Review, 2012; 31(5):678-84. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22146050
13. Bonevski B, O'Brien J, Frost S, Yiow L, Oakes W, et al. Novel setting for addressing tobacco-related disparities: a survey of community welfare organization smoking policies, practices and attitudes. Health Education Research, 2013; 28(1):46-57. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22798564