Smoking questions on the Australian death notification form: adopting international best practice?

Australia's achievement in tobacco control has been remarkable, but relies on indirect estimates of tobacco-attributed mortality, and on using relative risks from Western countries to calculate tobacco's impact. To accelerate the decline in smoking, more precise measures of tobacco's relative importance among different population subgroups are required. We propose that more direct and accurate measures of tobacco-attributed mortality are needed, which could be achieved by adding a small set of voluntary questions about the smoking status of the deceased to a revised death notification form. Ideally, this form should also record the smoking status of the next-of-kin or family informant, as this would help establish a living control group. Such information will provide data on tobacco-attributed deaths with incomparable precision, allowing accurate monitoring of the current state of the smoking epidemic, and its evolution over time. This is particularly pertinent for sections of the population in which tobacco control measures have been less successful. A number of practical concerns have been raised, but we do not believe these are insurmountable.