More than one in five people in New England and the North West are smokers (20.9 per cent), compared to a state low of 7.3 per cent of the population at Sydney’s Northern Beaches. 

Heart Foundation regional health promotion co-ordinator for New England Penny Milson said the reasons people smoke are complex, but an attitude change was urgently needed. 

“The figures in our region are too high,” she said. 

“Smoking is catastrophic for heart health.”

She said smoking damages arteries, infuses the body with carbon monoxide, robs it of crucial oxygen and makes blood stickier and more prone to clotting. 

“Smoking is still normalised in some areas – it is not a normal lifestyle choice, it’s a deadly addiction.”

She welcomed the NSW government’s move to make several outdoor areas smoke-free to protect others from the effects of second-hand smoke, but said local councils could also implement more smoke-free zones. 

Cancer Council community programs co-ordinator for the New England region Paul Hobson said the figures were shocking considering lung cancer, which is “very much linked to tobacco”, makes up 9 per cent of cancer cases but is the top killer, resulting in almost 20 per cent of all cancer deaths.

“One of the biggest issues that we have is the availability of cigarettes for people trying to give them up.”

The Northern Tablelands, for instance, has more tobacco sellers per capita than the state average. 

He said cigarettes should be sold in a similar way to alcohol and that too many convenience locations - such as service stations, pubs and corner stores - tempted people on the tipping point of quitting. 

He said the low price of cigarettes in the region was also a contributing factor, with lower prices aligning with lower socio-economic areas and postcodes with a higher population of children. 

Mr Hobson said this lead to a vicious cycle, where low cigarette prices induced buyers and were more affordable for young people to take up the habit or become addicted. 

Southern Highlands and Shoalhaven topped the state, with 27.8 per cent of the population being smokers. They were followed by Central West with 22.6 per cent and two Sydney districts - Parramata (21.8 per cent) and Outer West and Blue Mountains (22 per cent) - before the New England and North West. 

The figures were collected from the Australian Bureau of Statistics from 2011/12 and analysed by the Heart Foundation. A smoker was classified as someone who smoked daily, weekly, or “other”, but if they had smoked fewer than 100 cigarettes or fewer than 20 pipes or cigars in their life, they were considered to have “never smoked”.