An Investigation of the Effects of Smoking and International Public Health Campaigns - Essay Example

? An Investigation of the Effects of Smoking and International Public Health Campaigns. The field of respiratory nursing, and healthcare in general entails challenges that extend far beyond the simple as-needed treatment of patients that might present themselves at clinics and hospitals complaining of respiratory distress. There are numerous external threats to public health; and while this premise could be justifiable for a variety of health-issues; the widespread prevalence of legal tobacco, especially in the form of cigars and cigarettes necessitates special concern for anyone invested in respiratory therapy. Specifically, the dangers, consequences, and effects of smoking are the focus of this investigation. During the course of this investigation; several medical databases were utilized for the acquisition of technical articles relevant to respiratory diseases; the dangers of inhalation toxins, the consequences of nicotine in particular; as well as the social and economic realities of smoking, and efforts made by state agencies to curtail the prevalence of smoking. It is worthwhile to investigate these, and other factors, in an attempt to reduce the associated health-hazards; including recent studies that ascribe bladder cancer to the long list of health-consequences associated with tobacco. (Freedman et al. 2011) Initial investigations began in the Journal of the American Medical Association, their central website guides the user to salient articles available for purchase or library access. Specifically, this article will seek to answer whether health consequences of smoking over the past five decades is sufficient cause to trigger a public downturn in the prevalence of smoking. To this end, articles will be sought that describe long-term disease trends, as well as sociological shifts pertaining to public health, anti-smoking campaigns. A very recent study by Pierce and associates is highly relevant to this objective. An investigation was performed encompassing 1965 to 2007 to determine the prevalence of heavy, habitual smoking, in the United States, by age and birth cohorts in this instance; with a focus on the State of California. This, and other studies confirm that The intensity of smoking, not only its prevalence, is associated with future health risks. There were 139,176 total respondents within California and 1,662,353 for the remaining United States. Among individuals excluding Californians born between 1920-1929, the prevalence of moderate/high-intensity smoking, more than ten packs per day, was 40.5% in 1965. This high-level of tobacco consumption declined across successive birth cohorts, and it was noted that for the 1970-1979 birth cohort, the highest rate of moderate/high-intensity smoking was 9.7% in California and 18.3% in the remaining United States. There was a statistically relevant decrease in moderate/high-intensity smoking at older ages in all cohorts studied, but the decline was greater in California. According to this study, there has been considerable decrease in the prevalence of high-levels of tobacco consumption. The decrease is explicable both in terms of diminished onset of new smokers, and increase in prior smokers who succeed in breaking the nicotine addiction. Though more investigation is needed to clarify whether it is an awareness of the health-risks alone, either through personal experience or simple word-of-mouth, or whether public health campaigns should take credit for the decline. The British Medical Journal also proved to be a useful source; as a means to evaluate, on an international scale the effects of smoking, and various campaigns intended to lessen its toll on public health. A study was found in the BMJ database that described 50 years worth of smoking habits among male British doctors. The primary goal being a comparison of the hazards of cigarette smoking in British men who formed their habits at different time periods. In addition to determine the extent of any reduction in risks when cigarette smoking ceases at different ages. Essentially, the high mortalities associated with smoking involved circulatory, cancer-related, and the familiar respiratory diseases known to be caused by smoking. Increases in life-expectancy where charted based on when smoking first occurred as a habit, and the age at which it ceased. Men born between 1900 and 1930 that remained life-long smokers exhibited life-expectancies on average 10 years less than non-smokers. There appears to be a linear correlation between the age at which these men stopped smoking, and their added life-spans. Quitting smoking at age 60 gained 3 years; on average - while quitting at the age of 30 typically resulted in a gain of 10 years; Cessation at other ages between these extremes resulted in gains between these values. The differences in mortality appeared less severe when compared with 19th century data, possibly due to lower life-expectancies in general; while the increase in death-rates was sharper for men born in the 1920's. For early 20th century men, the probability of dying in middle-age went from a two-fold increase in the first decade of the 20th century, to a three-fold, 42% versus 15% chance of dying in middle age for men born in the 1920's. While smoking mortality rates appear to decline into the latter 20th century; among those that stopped at the age of 60, fewer years where gained, but again there is a three-fold difference in survival rates between smokers ans non-smokers. This study does conclude that rates of death are declining, but earlier instances of intense, habitual smoking negates the survival odds for men born during the 1920's. Prevention, and treatment advances are credited in this study with the declines in mortality that are observed. (Doll et al. 2004) The United States CDC was another resource that has compiled decades of salient data concerning the risks and trends of smoking. From that starting point, numerous relevant articles can be acquired. In terms of prevention of smoking, the CDC has determined that current state budgets are insufficient for controlling tobacco use. Funds have been allocated by the American Federal Government for smoking-related educational programs; but presently only 2% of that budget is being utilized for its intended purpose. But spending a mere 15% of the tobacco-funds made available as a result of tobacco-excise taxes and legal settlements would be sufficient to meet the recommended educational standards of the CDC. (CDC 2007) Tobacco use is among the greatest preventable causes of premature illness and death worldwide. Presently, approximately 5.4 million people die annually due to tobacco-related illnesses. This death?oll is expected to increase upwards of 8 million per year by 2030. An ongoing commitment to systematic surveillance strategies to monitor the putative epidemic is a vital factor necessary for a truly comprehensive tobacco control program. The CDC serves the World Health Organization as a collaboration center for the Global Tobacco surveillance System (GTSS). The priorities of this endeavor are to: 1.) Improve global tobacco surveillance systems towards the monitoring of the international tobacco epidemic. 2.) Increase country and regional capability towards the coordination, development, and implementation of comprehensive tobacco control efforts. 3.) To translate raw data to actionable recommendations for tobacco control. 4.) To advance research contributing to the promotion of effective tobacco control educational programs. Also integral to the CDC's initiative is the 'MPOWER' doctrine. •Monitor tobacco use and prevention policies •Protect people from tobacco smoke •Offer help to quit tobacco use •Warn people about the dangers of tobacco •Enforce bans on tobacco advertising, promotion, and sponsorship •Raise state cigarette taxes on tobacco (CDC, 2010) These principles are the main focus of efforts to stem the 96$ billion dollar cost of smoking-related diseases in the United States annually. Nonetheless, the above reports maintain that more could yet be done, and the internal budgets of the individual American States are not meeting the recommended prevention standards of the CDC. It becomes probable under these conditions that, should decreases in tobacco use be detected; it is dubious whether efforts in the United States are effective. These findings raise doubt about whether there exists sufficient anti-smoking public service messages throughout the entirety of the industrialized world. More analysis is necessary to determine whether knowledge of tobacco health-dangers are disseminating through the global population due simply to passive experience, educational initiatives, or a combination of both. A vital component of any efforts to curtail tobacco use must be the discouragement of new smokers. Youth especially must be informed, not necessarily about the health risks that can accompany long-time tobacco use in old age; but developmental consequences. Educational efforts by the CDC and various other government agencies should not ignore research that describes developmental health-risks to adolescents. Another search through the database of the New England Journal of Medicine revealed that Cigarette smoking is linked with evidence of mild airway obstruction and impeded development of lung function in adolescents. This is one of many dangers that has been known for decades. Smoking can prevent full lung development. Teenagers can normally attain a plateau in lung function between 17 to 18 years in age, but these growth rates are slower by 0.93% in smokers. Adolescent girls may be more vulnerable than boys to the effects of smoking on the growth of lung function. (Gold et al. 1996) The quasi-rational teenage belief in their own indestructibility may be tempered, not by seemingly-remote images of elderly smokers in their death-beds, but rather the threat of limiting their own health and potential. Research Appraisal An extensive study was conducted by Australian authorities under the auspices of the Centre for Behavioural Research in Cancer, by the Cancer Council Victoria, to document the effectiveness of public health anti-smoking campaigns to determine the awareness of associated health risks connected with smoking. This research can serve as a sort of central guiding point for the evaluation of anti-smok health programs. Despite decades of mandated warning labels, connections with debilitating and degenerative diseases, and extensive public health campaigns in most industrialized countries; the laypersons' understanding of smoking related risk factors remains incomplete. In 2006, the Australian Commonwealth Government launched a new campaign of graphic health warning on all manufactured and imported tobacco products in order to increase the salience of the health-related risks. Messages included commercials that included explicit depictions of gangrene and mouth cancer. Campaigns such as this remain relevant even in the 21st century; due to an incomplete comprehension of smoking-related risks amongst the public of most industrialized countries. While most medical professionals would find it easy to believe that the risks of such conditions as emphysema had long since entered the public lexicon. A recent Australian study found that less than half 43% of survey respondents were able to identify emphysema as a disease caused by smoking. And half could not name any additional illnesses. Although the majority could be persuaded under coaching that smoking could cause this and other illnesses. (Brennan, 2007) And yet, these findings indicate that despite these results, the awareness of emphysema in the public consciousness has nonetheless been increasing. An American Survey did find that the majority of respondents were capable of identifying lung cancer and emphysema, less than half could name any others. (Weinstein et al. 2004.) Australian Investigations from 2006, exposed smokers to several analyses designed to increase their awareness of the health consequences of smoking. The Australian Commonwealth Government has mandated the display of graphic health warnings for all tobacco products regardless of origin when intended for retail sale in Australia. There is considerable basis for the belief in many countries that graphic warnings are an effective anti-smoking deterrent, as a means to communicate commensurate health risk information to smokers. The intent being a two-pronged strategy to not only raise health awareness of the risk-factors; but to create a social perception of smoking as undesirable behavior. (Hammond et al. 2003) , (Elliot & Shanahan. 2002) Certainly, all of us have a vague sense of the inherent risk factors of unrestrained tobacco consumption. This incomplete awareness will complicate efforts to elevate the social consciousness of society towards a universal disavowal of tobacco use. The Brennan study specifies the most relevant health-consequences resulting from cigar/cigarette use. These are: Emphysema, Lung Cancer, Heart Disease, oral cancer, gangrene, vascular disease, throat cancer, blindness, potential miscarriage, and the possibility of asthma proclivities due to second-hand smoke. (Brennan, 2007) The Brennan report generated data derived from a series of telephone surveys given to randomly sampled Australian adults in the Victoria province. These annual population surveys are commissioned by the Center for Behavioural Research in Cancer (CBRC) commissions these annual surveys that are conducted by a market research company, interviewing a representative sample of Victorians by telephone each year. The questions, designed by the Behavioural Research Center are asked in an interview from eight- to sixteen-minutes on weekends and weeknights. These survey items targeted smokersperceptions concerning putative health effects of smoking. The relative degrees of comprehension of the illnesses caused by smoking was evaluated using both a spontaneous recall question in addition to a prompted recall question. Initially, Smokers were queried to discover if they believed that there are any illnesses at all that can be attributed to smoking, and then if they agreed or disagreed whether the dangers of smoking have been over-inflated. The spontaneous recall question item then assessed those smokers who expressed belief that there are in fact illnesses caused by smoking, by asking specifically: ?hich illnesses do you think are caused by smoking? Smokers queried in this way then answered by identifying as many, or as few, illnesses as they could think of instantaneously. The percentage of smokers able to identify each of the known illness out of all smokers surveyed was documented in the report. This spontaneous recall item was intended to accentuate the health information that would be most relevant to smokers when assessing the consequences of their smoking behaviour, identified as 'Top of Mind' awareness. In essence, the results of the Brennan report found that, as of 2006, 92% of Australian smokers in the Province surveyed did in fact believe that certain illnesses exist that are directly attributable to smoking. Only 5% of those remaining actively doubted the health risks of smoking. A majority; 78% did not believe that the associated risks were exaggerated; but 19% did believe the risks were over-blown. The rest of the respondents could not commit to an opinion. (Brennan, 2007) The Brennan study does conclude that the 'Top of Mind' awareness of the disease risks has increased. The heightened awareness tended to range between a 5% increase in the case of throat cancer, and a 9% increase in the case of mouth cancer. The greatest awareness increase was for the smoking, emphysema link, at 43%. On the whole, the results suggest that while most smokers possess a rudimentary understanding of the health risks of smoking based on the responses given to the prompted disease-risk questions, nonetheless the majority of smokers do not carry a comprehensive understanding of the specific diseases caused by smoking. The daily decision-making capacity of these tobacco consumers is likely to be influenced by falsehoods. Despite the appearance of the Series A graphic warnings on tobacco products mandated in 2006 and the subsequent media informational campaign, the increase in top-of-mind awareness for smokers is not an end in of itself. There remain serious health consequences of smoking that are not clearly understood by tobacco consumers. The findings indicated that barely more than one-tenth of smokers were able to identify smoking as a causative agent of mouth cancer, gangrene, and throat cancer. In addition, less than 75% of smokers believed when given a prompt, that smoking can cause stroke, miscarriage, gangrene, and blindness. These findings highlight the ongoing relevance of continued efforts to ensure the education of smokers concerning the disease they behavior subjects them to, and it is anticipated that the continuity of the widespread mass-media campaign in Australia will continue to improve the awareness of disease-risks amongst smokers. STRATEGIES FOR IMPROVEMENT There is general agreement and considerable evidence that death rates from smoking have declined considerably over the decades. Those at greatest risk appear to be life-long smokers born in the 1920's; and the odds of survival have improved since then. (Doll et al. 2004) Before us lies the question of whether a passive absorption of the health-risks will inevitably do as much good as active campaigns against smoking? The success of these anti-smoking measures appears to be mixed. The American CDC believes that health campaigns could reach an effectiveness compatible with their long-term health goals with an increase of 13% from current levels within State governments. One must therefore conclude that prevention and cessation methods in the United States are presently inadequate; if the CDC' s own findings are to trusted. Nonetheless, medical advances if nothing else can still help to stem the tide. Certain obvious strategies would be to increase graphic warning concerning tobacco-related diseases, and health-risks; such as CDC slogans that smoking can harm every organ in the body; and indeed, a length variety of cancers has been shown to result. (Brennan, 2007), (Doll et al. 2004), (CDC, 2007), not to mention the developmental retardation in the lungs known from the Gold study. (Gold et al, 1996) But even so, for the entire living memory of a generation of youth in most industrialize countries, there have always been dire warnings on the sides of cigarette labels promising grisly consequences from taking up the habit; and while these efforts achieve a modicum of success, there is still the chance of weariness from repeated warnings. One may become so accustomed to a warning message that it loses its power. And there remains a population, both young and old that fail to heed all these warnings. This is evidenced by the CDC numbers that still place total healthcare costs to treat smoking-related ailments at $96-billion annually. (CDC, 2010) If one has already decided to ignore the warnings on the side of the package; then adding one more line about bladder cancer (Freedman et al. 2011) is unlikely to sway someone already disposed to ignore such messages. Still, encouragement is found in the Australian study by Brennan. Here it does appear that the active campaign in the Victoria region contributed to a measurable increase in disease-consciousness. The two-pronged approach of passively questioning, and then prompting to test the participant's knowledge appears to reinforce the risks in the minds of the public. This is also known as a time-honored teaching technique; not to simply spout facts at those one wishes to educate; but to engage the listener as well as the instructor. While the overwhelming majority possesses some sense that smoking is harmful; incomplete or erroneous knowledge can still serve as a faulty basis that may contribute to unhealthy choices. There will be some determined to put themselves at risk; but plans similar to the Brennan study; that engage and prompt the participant, can raise public awareness to greater levels, and hopefully greater health. REFERENCES Brennan E, Durkin S. Perceptions about the health effects of smoking and passive smoking among Victorian adults, 2003005. CBRC Research Paper Series No. 25. Melbourne, Australia: Centre for Behavioural Research in Cancer, The Cancer Council Victoria, June 2007. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs007. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2007. [accessed 2011 Sept 2]. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs010. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2007. [accessed 2011 Sept 2]. Doll, Richard. Peto, Richard. Boreham, Jillian. 2004. Mortality in relation to smoking: 50 years' observations on male British doctors. 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