The data shows that 16 per cent of adults still smoke in the region, which is slightly higher than the NSW average.

Laura Twyman, a Cancer Council NSW senior officer, said tobacco-control campaigns in the mass media had been proven to increase the number of smokers quitting.

Ms Twyman said NSW was “falling behind in its investment” in this area.

“The last NSW Tobacco Strategy expired in 2017,” she said.

In the next strategy, the Cancer Council wants targets set for “continued declines in smoking, given the absence of declines in recent years”.

Further, it wants increased investment in anti-tobacco mass media campaigns.

It also wants the removal of tobacco vending machines and a requirement for retailers who sell tobacco to have a license.

Additionally, it wants a “commitment to making pubs and clubs truly smoke-free”.

The number of adult smokers has fallen in the Hunter-New England region by about 8 per cent in the past 15 years.

However, smoking rates have flatlined in NSW – as well as the Hunter – over the past four years.

A Hunter New England Local Health District spokesperson said the NSW government had spent $225 million on “alcohol and other drug services in 2018/2019”.

It was planning to spend a further $13.5 in the 2018-19 state budget for tobacco control, which included funding for the Cancer Institute NSW’s Quitline and iCanQuit services.

“Since 2015, the Cancer Institute NSW has invested more than $22 million on public awareness and education campaigns for smoking cessation,” the spokesperson said.

Health data shows that 21 per cent of male adults and 11 per cent of female adults smoke in the Hunter-New England area.

University of Newcastle Professor Billie Bonevski said smoking rates had “always been much higher among men”.

“That’s historical and has existed since cigarettes became popular in the 1950s and ‘60s,” said Professor Bonevski, of the university’s School of Medicine and Public Health.

Feminism and equal rights led to a rise in the number of females smoking for a while. But overall, men have always smoked more. This was mostly attributed to cultural reasons.

“Back in those days, it was unacceptable for ‘good girls’ to smoke,” she said.

“The tobacco industry did try to change those perceptions by targeting women with their marketing of cigarettes as liberating, feminist, glamorous and slimming.

“Fortunately, women never quite caught up with men.”

Ms Twyman said smoking rates were higher among the unemployed, those with severe mental illness and the homeless.

Such people often faced multiple barriers to being able to quit smoking successfully and “may benefit from additional support”.

Professor Bonevski said regional, rural and remote areas generally have higher smoking rates than metropolitan areas.

“The further remote you go, the higher the smoking rate is,” she said.

“The lower the socio-demographics – like income, education, employment – the higher the smoking rate.”

Professor Bonevski said National Tobacco Campaign initiatives had significantly reduced smoking rates over the past 30 years.

“People who are still smoking are finding it hard to quit. They are mostly from population groups who experience socio-demographic disadvantage and comorbidities.”

These factors made it hard for such smokers to quit and quit for good.

Asked if she thought smoking would ever be banned in public, Professor Bonevski said: “Smoking is banned in many public places like bars, clubs, restaurants, some sporting venues and parks, airports and airplanes, workplaces, hospitals, schools and universities”.

“There’s not many places left where you can smoke,” she said.

Research showed that the most effective way to quit smoking was to use “a combination of behavioural counselling and stop-smoking medicines”.

“The behavioural counselling addresses motivation to quit, triggers to smoking, distraction techniques, cognitive behaviour therapy and relapse prevention.

“The stop-smoking medicine acts on the physical addiction to nicotine and provides relief from withdrawal symptoms and cravings.”

These medicines include over-the-counter options like nicotine replacement therapy, including patches and gum, along with prescription medicines like Champix.

Ms Twyman said Australia was an “international leader in tobacco control”.

“Our smoking rates are some of the lowest in the world,” she said.

“However, there are a number of reasons why people continue to smoke.

“Tobacco contains nicotine, a highly addictive substance. Nicotine withdrawal symptoms including cravings, irritability, insomnia and in some cases low mood can make quitting challenging for some.

“Additionally, many people who smoke have friends and family who also smoke. It’s harder to quit when everybody around you continues to smoke.”

The Cancer Council NSW said tobacco smoking was the biggest risk factor for preventable cancer.

About one in eight cancer cases and one in five cancer deaths were caused by smoking, it said.

For counselling support smokers, can talk to their GP or directly link to free public services like the Quitline or online services like iCanQuit in NSW.