‘Cigarette smoking’ is not a new term for people in the entire world. Most of the people know that it is not good for health but still the smokers continue to smoke, why? People start smoking cigarettes with very numerous individual reasons. Most of the youngsters start smoking cigarettes because they think it looks cool and stylish. Some start smoking because their friends or family members smoke. Cigarette smoking is one of the worst things that people can do to their bodies. It is one of the most leading preventable causes of death in the world. Globally, tobacco use is the second cause of death after hypertension which is currently responsible for killing one in ten adults (WHO, 2010). Smoking cigarette is one of the biggest public health threats the world is facing today. This essay is a research which contains the basic information about the dangers of cigarette smoking. This will be an attempt to analyse the determinants of cigarette smoking. This essay will try to illustrate the factors which are associated with the cigarette smoking cessation in various groups like teenagers, pregnant women and passive smokers. The research will be mainly focused on the policies, interventions and strategies of government and health organisations towards cessation of smoking tobacco on the global, national as well as local level. It will also try to analyse the inequalities in health due to smoking.
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‘the science and the art of preventing disease, prolonging life, and promoting physical health and efficiency through organised community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organisation of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health.’ (p. 5)
In 1986, the health promotion came into full force through the Ottawa Charter for Health Promotion. It has defined health promotion as, ‘the process of enabling people to increase control over, and to improve their health’ (WHO, 1998).
According to World Health Organisation, globally more than one billion people smoke tobacco. Almost 5.4 million people are being killed every year due to tobacco smoking (WHO, 2010). The bad effects of cigarette smoking on health are very severe and in several cases, deadly. Tobacco contains an ingredient called Nicotine which is highly addictive and harmful to the body (WHO, 2009). Cigarette smoke contains around 4000 dangerous chemicals like tar, arsenic, cadmium, benzene, formaldehyde etc. It also contains some poisons like hydrogen cyanide, carbon monoxide, nitrogen oxide and ammonia (Cancer research UK, 2008). These harmful ingredients are very dangerous for health. Lung cancer is a commonest disease caused by cigarette smoking. Nine in ten cases of lung cancers are caused by cigarette smoking. Smoking also increases the risk of other cancers like cancers of mouth, larynx, pharynx, oesophagus, liver, pancreas, stomach, kidney etc (Cancer research UK, 2008).
In UK, each year around 114,000 people die due to cigarette smoking which accounts for a fifth of all deaths occur every year. Almost half of the smokers who smoke regularly and who are the long-term smokers die prematurely. Despite lung cancer is a commonest disease caused by cigarette smoking; it has proved that globally more smokers are died due to cardiovascular disease than by cancer (Petersen & Peto, 2004). The smoking cigarette has been very common in industrialised countries since decades where over 90% of men and 70% of women were estimated for lung cancer and over 22% of all cardiovascular disease (WHO, 2009).
Cigarette smoking is being one of the most causative factors to life expectancy, health inequalities and diseases like respiratory disorders, cancer and cardio vascular disorders. Therefore reducing the prevalence of smoking in people will be a key point to reduce the rate of mortality in the world. The governments of all the countries around the world must act decisively against the epidemic smoking tobacco which is the leading global cause of preventable death. There are various policies and strategies for the prevention of smoking cigarettes. The World Health Organisation celebrates ‘World No Tobacco Day’ each year on 31st May which highlights the health risks associated with tobacco use and advocating for effective policies to reduce tobacco consumption (WHO, 2010). The WHO has entered into the force for prevention of smoking cigarettes with launching Framework Convention of Tobacco Control (FCTC) in 2003 (WHO, 2003). The FCTC has promoted smoke free law for the implementation in all over the world. This law bans smoking in public places like bars, restaurants, sports stadiums, railway stations, cinema halls, etc. But only 9% of countries in the world are following the smoke free rule which prohibits the smoking in enclosed public places like bars and restaurants where 65 countries in the world are not implementing smoke free policies on a national level (WHO, 2009).
In 1998 the government of England launched the first comprehensive tobacco strategy entitled ‘Smoking Kills’ which was a landmark strategy in global tobacco control. This strategy mainly focused on the preventing hazards of passive smoking, reducing tobacco marketing to teenagers and helping smokers to quit through the local stop smoking services (Department Of Health, 2009). In UK, the government has set up the NHS Centre for Smoking Cessation and Training (NCSCT) in 2009 (Department Of Health, 2009). This programme is funded by the Department of Health and the aim is to develop national standards of training which can help for cessation of smoking. The government of England launched smoke free law in the year 2007. This law prohibits the smokers to smoke in enclosed public places (Smokefree, 2007). The UK government has also raised the tax on sales of cigarettes and banned the advertising of tobacco products (Official Documents gov. UK, 2006). In UK, the health development agency (HDA) has been commissioned by the department of health to develop the evidence base for the reduction of smoking rate (Naidoo, 2004). The government of UK has also set up a comprehensive stop smoking services which provides counselling and support to smokers who want to quit smoking with complementing the use of stop smoking aids Nicotine Replacement Therapy (NRT) and bupropion (Zyban) (Department of health, 2008). The Department Of Health in UK has also published a consultation paper entitled ‘Consultation on the future of tobacco control’ on 31st May 2008. This consultation was the first step towards developing a new national tobacco control strategies. The main objectives of this consultation are to reduce smoking rates and health inequalities caused by smoking, protect children and teenagers from smoking, to support smokers to quit and helping those smokers who cannot quit (Department of health, 2010).
Teenage smoking has became a very serious issue in the world. It is always seen that, smoking is a rite of passage which comes through the teen age. Most of the teenagers just give it a try once in their life; some of them will try just one or two and after that never touch them again. But for some people it leads to a lifetime of regular smoking. Generally at this stage of developing age, the youngsters receive less supervision of their parents and they get attracted towards the risky things like smoking and alcohol. The problem of teen age smoking is getting so worse that however the rate of adult smoking is falling steadily but the teen age smoking rate is increasing day by day (Department Of Health, 1998).
The smoking increases breathing problems in teenage smokers with almost three times more as often as youngsters who do not smoke. The heart rate increases in teen age smokers as compared to the non smokers. The teenage smokers are also more likely to suffer from psychological disorders (WHO, 2010). The UNF project ‘Building alliances and taking action to create a generation of tobacco free children and youth’ provide evidence for the action for teenage smoking related problems in developing countries (WHO, 2010). In the year 2007, the government of England raised the legal age for the purchase of tobacco from 16 years to 18 years (ASH, 2009). This policy helped to reduce the prevalence of smoking in teenagers in England and this will also help to delay smoking uptake in teenagers so that the health risk will be comparatively lesser. In 2009, the act against retailers who sell cigarettes to youngsters under the age 18 was made tighter. To prevent the teenagers to smoke, UK government also published a Health Bill. This includes more controls on the sales of cigarettes from the vending machines which is the easiest way to purchase cigarettes for underage children. This also includes ban on the display of tobacco picture on the point of sale (ASH, 2009).
Smoking is one of the most dangerous habits for a woman during her pregnancy. It can lead to several complications and serious health problems for the newborn baby. Smoking during pregnancy or breast feeding is an important issue which is responsible for the increase in prenatal and infant mortality rate. Smoking during pregnancy mainly causes low birth weight of an infant (Care Quality Commission, 2010). The Nicotine and carbon monoxide are the substances in cigarette which increases the rate of spontaneous abortion. Smoking during pregnancy can cause the risk of cervical and uterine cancer in females. The nicotine patches also does not seem to be effective for pregnant women because it may include faster rate of nicotine metabolism which may cause higher dose of nicotine. The smoking during pregnancy may also decrease the production of breast milk and reduces the levels of some vitamins such as vitamin ‘E’ and vitamin ‘C’. It is also seen that children whose mother was a cigarette smoker, are at a risk of respiratory disorders like Asthma, and skin disease like Eczema (WHO, 2005). The survey shows that, pregnant women from lower socio economic groups smoke nearly twice than the women from higher socio economic groups (Department Of Health, 2009). In UK the NHS provide smoke free pregnancy support DVDs which are free in cost. These DVDs help to quit smoking for pregnant smokers (Smokefree, 2010).
It is easy to advice stop smoking to people, who smoke, but what about those people who does not smoke directly but smoke indirectly by passive smoking? Every person has a right to be protected from harm from passive smoke and enjoy the smoke free fresh air. A survey shows that globally about one third of adults are regularly exposed to passive smoking and about 600000 people are being killed each year by passive smoking (WHO, 2009). The WHO’s Framework Convention on Tobacco Control (FCTC) played an important role in reducing smoking rate as well as passive smoking by promoting smoke free law worldwide. This law does not allow smokers to smoke in public places like restaurants and bars where the exposure to passive smoke is always very high. Despite this all, only few countries in the world are following this smoke free law. Passive smoking causes certain diseases like lung cancer, ischemic heart disease, asthma attacks, childhood respiratory disease and irritation of eyes, nose and throat (Nuffield Council on Bioethics, 2007).
The smoking rate is always high in some disadvantaged groups such as vulnerable, minorities and prisoners. In UK, the groups like prisoners smoke at very high rate with 70% and more. The smoke free legislation also describes that prison wardens and other non smoking prisoners are at a risk of very high level of passive smoking (Department Of Health, 2009). In UK, it has been identified that smoking is a main causative factor for the inequalities in death rate between poor and rich people. In UK, a death rate caused due to smoking is two to three times more in poor people than in the rich people. The rate of smoking is comparatively higher in poor people against rich people. The cost of cigarette also differs between rich and poor people, a poor person spend more amount of his income on smoking as compared to a rich person. In 2003, the poorer 10% of households spent 2.43% of his income per week for the smoking where the rich 10% of households spent 0.52% of his income for smoking cigarettes per week (ASH, 2005).
The smoking rate varies significantly between some ethnic groups and also between men and women within those particular groups. The Black and other minority ethnic groups have higher smoking rates than the general population in UK. The statistics shows high prevalence of smoking rates among Bangladeshi men with 40%, Irish men at 30%, Black Caribbean men with 35% and Pakistani men at 29% where in women, around 5% of Bangladeshis smoke, compared with 25% of Irish women. The causes for this ethnic diversity in smokers are heavily linked to gender, age, religion and tradition. For example, in Pakistan and Bangladesh smoking for men is associated with socialising, sharing and male identity where the prevalence of smoking rate is very low in women of these countries because it seems to be associated with stigma and shame (Department Of Health, 2009).
The UK government has set ambitious Public Service Agreement (PSA) to reduce health inequalities which targets to reduce the gap in health inequalities between rich and poorest communities. The main target of PSA is the group of routine and manual smokers in which the prevalence of smoking is much higher and this will ultimately reduce the health inequalities including infant mortality rate. The routine and manual smokers occupation for men include HGV drivers, storage handling, sales and retails, van drivers and labours where the occupation for women include sales, retails, carers, cleaners, educational assistants, and kitchen and catering assistance. The NHS, PCTs and some local authorities play as a supportive role by helping PSA (Department of health, 2009).
The smoking cigarettes also affects economically with increasing cost to smokers and the health care services. It is a costly habit for the smokers in more ways than one. It can be a burden on the household budget. One survey found that if both from a couple smoke, they could be spending as much as 15% of their income on tobacco (NHS HealthScotland, 2010). On an average, the smokers spend £676 a year on their tobacco smoking habit. An average 20-a-day smoker can expect to shell out £2,500 a year in total (BBC News, 2006). In UK, Smoking is estimated to cost the NHS £1.7 billion per year but still a full estimate of the total costs of smoking in UK has not been calculated. It has, however, been estimated that banning smoke free in enclosed public places would result the annual saving of £3.9 billion to the UK economy. Reducing childhood exposure to smoke and smoking during pregnancy would also result in the further savings to the government (Nuffield Council on Bioethics, 2007).
Smoking cigarette is a right of every individual so nobody can ban smoking completely but can only reduce the prevalence by spreading awareness to the people about the ill effects of it. Smoking prevalence can be decreased if the general people follow the government strategies and policies. The government should also keep an eye on the implementations of the strategies. The work should be carried out with representative samples of the target audience to implement appropriate messages and activities. The activities of the programme should reach the intended target population. The resistance to smoking messages should be given from the advertisements and the media. Glamorisation of smoking in films and mass media can affect the youth attitudes towards smoking cigarettes and may increase the initiation of smoking impulsively. Therefore the government should investigate which component of intervention like multimedia or mass media prevention campaign are more effective to increase smoking prevalence and should act on decisively to prevent increase in prevalence of smoking. The attractive packing of the cigarettes may also cause for increase in smoking prevalence therefore the government should take action on this and should make compulsory for cigarette companies to produce a standard plain packing. Cigarette packs which contain only ten cigarettes are cheaper as compared to twenty cigarettes pack. This may increase the attraction for youngsters because generally young people are particularly price sensitive. So the government should ban those packets which are less in quantity and price. But it may also affect adversely as some smokers who are trying to quit and prefer buying small packets of cigarettes. This may encourage those people to smoke more. So in this case government can implement this ban on a trial basis and take further decisions.
The government should allocate licence to retailers to sell the cigarettes and restrict them to sell cigarettes without proper licence and should take action against them. There should be greater financial penalties for retailers who sell cigarettes to teenagers who are underage of 18years. The government should also think about the law which prohibits teenagers to smoke. According to the law, there is a penalty for selling cigarettes to minors but there is no penalty for minors who smoke. There should be a fine or penalty to minors who smoke. This may restrict the minors to smoke. The cigarette packets should be kept out of the sight in the shops so that it may reduce the attraction for smokers. Reducing the tobacco outlets can also reduce the prevalence of smoking. The government have already banned the sale of cigarettes to minors from vending machines but if people can get the nicotine patches from vending machines then it would be beneficial for the smokers who want to quit. It is very necessary to act strongly for the teenage smokers because they will become tomorrow’s parents who will smoke and will continue the cycle of smoking related consequences and premature deaths.
This research overall concludes that smoking cigarette is very harmful to the health and has became a huge threat to the public health. All smokers should reduce the smoking for their own benefits and for the people around them. This research overall demonstrate an association between the prevalence of smoking among different groups such as teenagers, pregnant women, global, national and local policies and interventions. This study suggests that the government of each country in the world should act decisively for the cessation of smoking among targeted groups such as different ethnicities who comparatively smoke more. Every country should follow the FCTC’s smoke free laws so that smoking rate can be under control. The teenagers and pregnant women should be given more importance in planning the strategies against smoking cigarettes. This could help in moderate and short-term delay in smoking onset.
The price of cigarettes should be increased more to reduce the smoking prevalence. This would narrow the difference between socioeconomic groups in smoking and the related inequalities in health. The smokers who are trying to quit should be encouraged by government and help them to quit it. The passive smoking should be controlled by implementing smoke free law everywhere wherever it is possible. Because it increases more threat as there is more consumption of cigarette smoke and ultimately the more death rates. Finally the important suggestion would be, every individual should try not to smoke and try to help quitting the other who smoke. If each and everyone will take care of their own health then there would be no need of different strategies and laws. So ‘be a responsible person and avoid smoking’ would be a key solution for the smoking cessation in the world.
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