Adult Smoking Tobacco Prevalence in the United States - Essay Example

Tobacco Use on Adults Noel Nunez Walden Policy and Advocacy for Improving Population Health NURS 6050 July 24, Tobacco use is still the leading cause of avoidable deaths among any behavioral risk factor (Kovner & Knickman, 2011). Smoking causes heart attacks, cerebrovascular accident [CVA], cancer, diabetes, and lung diseases such as bronchitis, chronic airway obstruction, and emphysema (Centers for Disease Control and Prevention [CDC], 2012). Despite the federal government’s smoking regulations and the health care industry’s enormous spending on population education about the dangers of tobacco use, smoking occurrence among adults remains to be a challenge. Almost one in four adults in the United States still smokes cigarettes, particularly in the underserved population (Kovner & Knickman, 2011). The success of the programs in Minnesota and Massachusetts can be adapted to help minimize the effect of tobacco use in California. Tobacco Use on Adults Population Affected by Tobacco Use Smoking is the main reason for the development of cardiovascular disease and the leading cause of preventable death and disability in the United States (Vaid et al., 2014). Tobacco use is accountable for more than 480,000 deaths annually in the United States, including a projected 41,000 deaths from secondhand smoke contact (CDC, 2012). Each state in the country has its tobacco cessation programs that aim to promote population health, in the case of Massachusetts and Minnesota; both have been successful in curtailing the prevalence of tobacco use in their community. The purpose of this paper is to identify two present smoking advocacy programs and the characteristics that led to their success. Another purpose of this study is to create a new program for the state of California that utilizes the strengths of the two existing programs that were analyzed. QuitWorks In 2002, the state of Massachusetts created a tobacco cessation program called Quitworks, a smoking referral program that integrates with healthcare organizations, primary care providers, and patients of the state’s smoking cessation quit line. All health plans in Massachusetts collaborate with Quitworks, and in return, Quitworks provides feedback by reporting to each organization and primary care provider. There were an estimated 340 health organizations and primary providers that used Quitworks for eight years after the launching program was launched (Warner, Land, Rodgers, & Keithly, 2012). There are several attributes that led to the success of QuitWorks, including: Engaged partnership with the stakeholders. Consistency in smoking program endorsements to the community. Proactive involvement of QuitWorkswith the hospital’s program in response to the Joint Commissions’ (JCHO) advocacy to curb tobacco use. Provision of Nicotine Replacement Therapy (NRT). In a study by the Tobacco Control, smokers are more likely to quit when they are provided with behavioral and pharmacological assistance (An et al., 2006) Integration of computer software that enables Quitworks to be interfaced with the hospitals’ and primary care provider’s Electronic Medical Record (EMR) for referral purposes via secured email. Minnesota’s Tobacco Prevention and Control The state’s Department of Health Tobacco Prevention and Control (MDH) has been successful in promoting the reduction of tobacco use among its citizens. According to the Minnesota Adult Tobacco Survey (MATS), the state passed legislation that greatly restricts the use of tobacco by the population. These measures include: Enactment of a wide-ranging smoke-free law called the Freedom to Breathe Act, prohibiting smoking in indoor public places, factories and restaurants which resulted in an increase in the number of institutions with a smoke-free policy (MATS, 2010). The state imposes a higher cigarette tax; the consumer has to pay more per pack of cigarettes purchased. As a result, 43.4 percent of current smokers thought about quitting, and 29.4 percent reported that they reduced the amount of tobacco used (MATS, 2007). Provision of free Nicotine Replacement Therapy (NRT) and behavioral counseling for the consumer that requires assistance in abandoning smoking habits. The state targets the intended population through mailing of the NRT (patch or gum) to the callers who have registered in multi-session counseling(An et al., 2006). The MATS data suggested a decline of smoking cases in Minnesota from 1999 to 2010. Statistics showed a decrease from 22.1 percent to 16.1 percent over 11 years of the program. This data suggests a positive societal impact on the state, resulting in less tobacco use by adults, and less exposure to second hand smoke (MATS, 2010). Smoking Advocacy Campaign Although the California does not spend adequate funding on smoking cessation programs similar to the aforementioned states, I would like to propose supplemental regulations in California that are based on the successes of the QuitWorks and MDH programs. State’s Proactive Regulation in Tobacco’s Price and Tax Hike There is a need to learn lessons from the past. Minnesota’s increase in cigarette taxes led the to the decline of smoking cases. According to Matire, Mattick, Doran, & Hall (2011), tobacco price increases have a positive impact on at risk populations that are financially deprived. In another study presented byAddiction, the imposition of a tobacco price hike is related to one’s motivation to quit the habit of smoking (Ross, Blecher, Yan, & Hyland, 2011). Incremental Increase in Tobacco Surcharge if Smoking Continues People should be given free choice in their wellness, meaning, they should be able to decide what is good and bad for their health. However, due to the burden on society – public health care costs and secondhand smoke endangers lives – one who participates in a smoking cessation program with no progress, should be charged with a tobacco surcharge and a cumulative increase in health payment benefits if tobacco use continues. In a study presented by Nicotine & Tobacco Research, the impact of tobacco surcharges in Georgia’s State Health Benefits Plans (GSHP) was evaluated. The analysis focused on enrollees in smoking cessation programs, a large number of which showed optimistic outcome six years after the initiation of the program. The results showed 45 percent of the cessation program enrollees were certified tobacco free (Liber, Hockenberry, Gaydos, & Lipscomb, 2014). This case study supports the imposition of a tobacco surcharge program to assist in smoking cessation. Methods to Gain Support for the Policy It is imperative that nursing should bring its practice beyond bedside and advocate for health issues that affect the community’s public health and the delivery of quality health through practices that advance legislative issues at the grassroots level (Beu, 2004). Collaboration with health care organizations such as hospitals and nursing organizations in organizing public health events such as health fairs and community outreach programs is essential. Public events attract media attention and an opportunity to access media’s aid in acquiring connections with local or state politician. Establishing relationships with local or state officials is vital to submit a system or policy intervention key determinants of health– in this case, a tobacco control measure to deter tobacco use. Present scientific evidence supports tobacco control by the use of credible professionals such as scientists and medical experts including nurse practitioners or physicians (Hastie & Kothari, 2009). According to Beilenson (2012), nurses and doctors are viewed contrary to regular individuals that come to local or state legislator. Particularly, nurses are highly thought of by legislators. Viability of Advocacy Campaign California has made progress in its effort to reduce the population’s tobacco use. The data presented by The Toll of Tobacco in California showed there is currently an estimated 12.6 percent adult smokers that constitute to about 3,628,900 of its populace and smoking in California is the causeof 33,900 deaths each year. Current trends of tobacco usage in California would behoove California legislators to implement regulations in order to promote a decline in smoking prevalence. California Tobacco Practice The state currently charges 87 cents in taxes on every pack of cigarette sold. The money acquired goes to healthcare programs and the state’s crusade against tobacco use (McGreevy, 2013). In an article by the Los Angeles Times, California State Senator Kevin De Leon said that the healthcare medical spending price tag brought by smokers is valued up to $3.1 billion each year. State Senator De Leon introduced SB 768 that would increase the state’s current 87 cents per pack tax by $ 2.00, but was struck down by the senate appropriation committee (Sherwood, 2013). The passing of the Affordable Care Act (ACA) in 2010 landmarked health insurance reform to end poor practices by health insurance through limiting lifetime benefits and denial of coverage due to pre-existing condition (MacDonald, 2013). According to MacDonald (2013), one goal of the ACA is also to dissuade tobacco use by allowing an insurance company to impose a tobacco tax for individuals who continue to smoke. Currently, California legislators barred the federal health mandate of tobacco surcharges (O’Neill, 2013). Lobbying in Healthcare Arena As our healthcare system transforms, so does the role of the nursing profession. There is an increasing demand for nurses to take a proactive role in persuading healthcare policies, laws, and regulations that oversee larger healthcare organizations(Abood, 2007). The nursing profession is now moving beyond bedside and entering into unfamiliar grounds: the world of politics and policy. Leg One Nurses are well-respected and highly viewed by lawmakers because the nursing profession dictates provisions of quality care without monetary incentives that come along with it. According to Milstead (2013), anybody can lobby, and lobbyist is an individual who is an expert in the field he or she is lobbying. It is crucial for a lobbyist to be well-informed of proposed legislation with evidence-based data to support its outcome to a representative’s staff or to the legislator. Nurse practitioners are effective lobbyists given their pedagogic wide array of evidence-based researches. The proposed smoking laws will be presented to a state legislator; the job of a lobbyist is to make the lawmaker understand what he or she is voting for or against. Leg Two Professional nursing organizations, such as American Nurses Association (ANA) or California Nurses Association (CNA), can help propel the intended smoking laws delivered on the floor of legislation for debate. Having support from any of the aforementioned groups guarantees a number of supporters. There is strength in numbers and having the support of interested groups also influence legislators in considering the passage of the law. Writing a letter to CNA or ANA is necessary for advancing the proposed law for legislation. In order to advance the envisioned smoking law, nursing can establish community education by sponsoring public health forums or rallying healthcare team members in organizing mobile health clinics. Leg Three The role of money in lobbying is significant; unfortunately, this does not sit well with the nursing profession (Milstead, 2013). Collaborating and acquiring financial support from various health care companies like Blue Cross, Blue Shield, and Health Net is essential. These companies would benefit if the tobacco surcharge regulation passed. Working together with anti-smoking lobbying groups, like Americans for Nonsmokers’ Rights (ANR) or National Center for Tobacco Free Kids, is essential in obtaining support for the designed law. Effective communication with these organizations and insurance companies is fundamental to gaining financial aid in the process. The financial assistance is required to maintain political activism and the life of the bill. Nurse lobbyists remain active and visible in the legislative foreground, proactively providing vital information throughout the legislative process (Milstead, 2013). These nurses devote time, will, and vigor accompanied by political abilities needed to play the game of policy making (Abood, 2007). Anticipated Interference In any healthcare reform, there will be expected obstacles to prevent the law from passing. The impediment to changes in the law comes from special interest groups as they abuse our political system (Fuchs, 2007). To surmount these problems coming from special interest groups, nurse lobbyists should provide evidence-based data that support the outcome by promulgation of the proposed law, and not talking points. It is crucial to develop a convincing case by presenting clear and concise scholarly data that is up to date and statistics or numbers that confirm the probable outcome if the law passed (Milstead, 2013). The intended law must have specific goals that are achievable. For example, increasing cigarette tax in Minnesota showed success eight years after its initiation (MATS, 2007) and the study provided by GHSP demonstrated the effectiveness of tobacco surcharges six years after its inception from 2006 to 2011 (Liber et al., 2014). Ethical Dilemmas Before the law passed, an intense debate happened between two opposing side, one for the bill and the other against it. With the aforesaid proposed tobacco regulation, some constituents will question its effect to the society. Public fears of a possible rise in unemployment being tied to business sectors condemnation of increase in cigarette tax by limiting its number of employees. However, in a study by American Journal of Public Health, the report shows that there is no relationship between unemployment rate and cigarette tax hike (Golden, Ribisl, & Perreira, 2014). Multiple research studies show that tobacco tax hikes lead to a decline in smoking pervasiveness and considerable improvement of population health (Chaloupka, Yurekli, & Fong, 2012). Another fear is that cigarette tax hikes hurt low-income individual or family. In a study by Southern Economic Journal, financially deprived people with an income below the median cuts their cigarette consumption by four times than that of people with above the median income (Farrelly, Bray, Pechacek, & Woollery, 2001). If low-income tobacco users were not responsive to cigarette tax hikes, the study presented by Farrelly et al., (2001), would be invalid. Therefore, a price increase in cigarette tax helps the impoverished group of the society by limiting their tobacco usage (Gruber & Koeszegi, 2004). An additional concern is that tobacco surcharges promote healthcare disparities in society. The enforced penalties will lead to an increase in the uninsured individuals, particularly, the smokers due to rising insurance premiums. Nonetheless, tobacco users under the ACA can prevent health insurance penalties by registering in a tobacco cessation program or acquisition of health benefits through a state adopted protection standard that sets lower limits on tobacco surcharges. According to MacDonald (2013), seven states –including California –have banned any insurance price manipulation based on tobacco use. Tobacco Surcharge Under the ACA Under the ACA, smokers are given the opportunity to change bad health practices and rewarded for healthy behaviors. The implementation of ACA’s part XVIII does not penalize tobacco users, but provides reasonable opportunity for smokers to avert tobacco surcharge during health insurance enrollment (Department of Labor [DOL], 2014). This provision of the ACA avoids smoking penalties for smokers when they enlist for smoking cessation programs. There is a window of opportunity for a tobacco user. One provision is that they should enroll in smoking cessation classes on the initial health benefit recruitment. Furthermore, the participant would be eligible for reimbursement of tobacco fines on the same year of enrollment when he or she decides to seek help by going through tobacco cessation educational programs offered. If a client starts to smoke after the insurance purchase, she or he will be accountable to tobacco surcharges during renewal of the health plan. Conversely, if a client stops smoking after acquisition of health coverage, the insurance company is not required to lower the premium until the renewal date. In the event that an enrollee provides false information about tobacco use, the insurance company has the right re-examine and apply the applicable changes to the individual’s insurance premium (DOL, 2014). Ethical Challenges for Tobacco User According to Mokhad, Marks, Stroup, & Gerberding (2004), the four leading behavioral risk factors –namely tobacco use, alcohol abuse, inactive lifestyle, and unhealthy diet –chronicles for more than 900,000 deaths in the year 2000. Our state, federal, and private organizations spend billions of dollars to curtail smoking and promote public health by creating measures that initiates in changing the target group’s behavior. However, some members of the community question its motives. One reason for such motives links to special interest group, like insurance company’s support for higher insurance premiums for smokers. Healthcare reforms should promote the advancement of public health, and nursing –as a leading advocate for health –should continue to support individual responsibility and collective action. The progress made by the federal government, states, and private organizations for tobacco measures are attributed to denormalization, in which all institutions implement similar cigarette control methods to change modifiable risk behavior (Courtwright, 2013). According to Courtwright (2013), contradictory to the positive outcome of such identical methods of persuading the public to discontinue such ill health practices, others believed that denormalization is synonymous to stigmatization, which some sectors of the public consider unethical. As nursing faces such ethical dilemmas, it is imperative that nursing practice remains committed through effective communication with the public in addressing issues like stigmatization that connotes a negative perception. References Abood, S. (2007). 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Integrating tobacco cessation quitlines into health care: Massachusetts, 2002-2011. Preventing Chronic Disease, 9 E133-E133. Read More