Contemporary Issues in Nursing Practice

Contemporary Issues in Nursing Practice: Smoking

A big research body indicates that very few individuals in the United States start smoking cigarette or become regular smokers after their teenager years. Provided the introduction of smoking epidemiology, a great deal of programmatic attention and policy have been aimed at youth smoking prevention (Jacobson et al., 2001). Tobacco use amid United States teenagers rose during the 1990s, until waning moderately few years back in spite of the strong smoking policy focus. Short reviews of the evaluation and policy literature concerning strategies directed towards youth smoking prevention are presented. The summaries are founded mainly on further reviews that were lately published (Lantz et al., 2000; Jacobson et al., 2001).

Throughout the last three decades, several school-based tobacco prevention strategies have been placed into practice, mainly at the elementary and middle school level. Most of these programs have appeared to be founded on one of three major approaches. First, an information shortfall or coherent model where the program offers information concerning the negative social consequences and health risks of tobacco exploit in an effort to deal with knowledge deficits, most frequently in a way deliberated to aggravate fear, disgust or concern. Second is a sentimental education replica whereby the program tries to influence attitudes, intentions, norms, and beliefs connected to the use of tobacco with an aim on enhancing values clarification and self-esteem. The third is the social influence resistance replica (Bruvold, 1993). This third model stresses that, besides personal factors such as attitudes and knowledge, the social setting is a vital factor in tobacco usage. Imperative features of the social environment comprise peer attitudes and behavior, and particular aspects of ecological, cultural, and familial contexts. Consequently, intercessions based on this tactic focus on implementing skills required to oppose negative influences, together with decision-making and communication skills, training, assertiveness and identification of peer influences and industry advertising tactics. The consequences of a number of meta-analyses and individual evaluations strongly recommend that learning programs under the social influence resistance replica are the most efficient of the three strategies (Bruvold, 1993; Botvin, 2000; Jacobson et al., 2001). These forms of programs can have a meek but momentous impact on smoking initiation and the level of use.

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A latest yet contentious response to youth tobacco usage is the implementation of local and state laws that put charges against youth for the use, purchase, or possession of tobacco products. A number of tobacco control activists have protested this advance as an effort to shift responsibility and attention away from sellers who sell the products to children. Nevertheless, this shift gained noteworthy force throughout the 1990s. As Giovino and Wakefield (2000) reported, the figure of states having legislation limiting possession of tobacco products amid minors increased from six in 1988 to thirty two in 2001. The penalties connected with these laws differ broadly, including reception of a ticket, appearance in court, a fine, loss of driving rights, suspension from school, referral to a smoking cessation program, and other court-ordered reactions.

Smoking in Malaysia was initially addressed in legislation involving a general caution message on each Malaysia cigarette wrapping in 1976. Cigarette smoking bans in community places was implemented in the 1980. Selling cigarettes to individuals under the age of 18 has become forbidden since 1994. The advertisement and promotion of tobacco was banned in 2003; ever since January 1995, screening cigarette wrapping in advertisements had been prohibited, and print media promotion had been limited to only one page.

Malaysia is ranked in position 71 based on the per capita cigarette use, with an average of 650 cigarettes smoked yearly per adult.

Tobacco has an unenthusiastic effect on nearly all organs of the human body. According to the Malaysia Department of Health and Human Services, use of tobacco is the leading avoidable cause of death in the Malaysia, which results in about 443,000 deaths every year. Globally, recent studies show that tobacco is accountable for around 6 million deaths every year.

The long-term consequences of smoking are wide. There are many diseases associated to smoking. It can cause the mouth and throat cancer and lung cancer, and might augment the risk for kidney cancer, stomach cancer, cervical cancer, pancreatic cancer, and bladder cancer. Around a third of all cancers are connected to tobacco use and 90 percent cases of lung cancer are associated to smoking. Smoking causes chronic disruptive pulmonary diseases (COPD) such as emphysema and chronic bronchitis among others, which are harsh lung damage. Smoking narrows blood vessels and lessens blood circulation, grudging the body of oxygen system and escalating the danger for heart disease. The studies have shown that non-smokers who are depicted to second-hand smoke are 25 percent more probable to have heart disease. It also doubles the danger for stroke and raises the threat for developing cataracts.

Smoking causes extra health threats for women. It raises the danger for rheumatoid arthritis and contributes to loss of bone compactness, raising the probability of spine and hip breakages in postmenopausal women. Smoking during pregnancy increases the health risks of the unborn baby. After birth, the peril for SIDS (sudden infant death syndrome) doubles for infants exposed to second-hand smoke. Women of child-bearing age bracket who smoke have greater risks for impediments during pregnancy and higher rates of infertility.

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Children and teenagers are especially susceptible to the hazards of smoking. Since their bodies are not completely mature, smoking hampers normal lung growth in those who start smoking as children or teenagers. Young individuals who smoke could become more captivated to cigarettes and face bigger risk for growing lung cancer compared to those who begin smoking later in life. Each day, roughly 5000 children below 18 years try to smoke cigarette for the first instance and 2000 become habitual smokers.

Smoking is strictly banned in hospitals and clinics, toilets and public lifts, airports, public transport, air-conditioned restaurants, educational institutions, government premises, Internet cafes, petrol stations, shopping complexes, and personal office spaces with shared air-conditioning; nevertheless, enforcement is a concern (Zarihah & Zain, 2007).

Smoking is, in general, forbidden on public transportation, apart from in air-conditioned places of ships and trains where food is served. It is forbidden in particular workplaces and public places listed in the regulation including in places of work with a central air-conditioning system; education, health, cultural and government facilities, and enclosed stadiums. It is also banned on places with a service counter in financial institutions, banks, National Energy Company, post offices, and National Telecom Company. Smoking is allowable in discotheques, pubs, casinos, nightclubs, in designated smoking places, in air-conditioned eating areas and in non air-conditioned communal transport terminals.

There is an absolute ban on tobacco promotion, advertising, and sponsorship in Malaysia. Nevertheless, due to the lack of explanation of tobacco promotion in the law, a number of tobacco promotions, such as retailer inducement programs, might not be included under the ban. The sponsorship of tobacco is forbidden if a support or sponsorship is publicized, however, the law does not forbid financial support if that support is not made public to prop up a tobacco product.

The Regulations necessitate that one of six certified health cautions, with a depiction and accompanying wording, appear on every carton and packet of cigarettes. The graphic and text warning must cover 40 percent of the facade of the cigarette package and 60 percent of the backside of the cigarette package. The warning text is in Malay on the frontage pane and English on the backside pane.  For carton, the warning must cover 40 percent of the top pane written in Malay and 60 percent of the base pane written in English. Qualitative emissions and constituent messages are necessary but metaphorical displays of production yields are not positively banned. The policies do not necessitate health warnings regarding tobacco products apart from cigarettes. Misleading conditions and descriptors signifying that one product is less harmful than others are forbidden; nevertheless, colors and other connected indicia are not prohibited (Tobacco Control Laws, n.p., 2005).

It is foreseen that tobacco will not be the main public health issue in Malaysia by the year 2020, where reducing national predominance of tobacco usage is halved and the diseases attributed with tobacco will continuously decline.

The efficiency of a smoking ban depends on the intensity of enforcement, breadth of legislation, degree of previous legislation in place, and public support. The studies assessing a new, comprehensive, and local smoking ban accounted the strongest consequences on smoking prevalence (Hahn, et. al 2010). Studies carried out at the national level, in which tobacco control actions have been continuing tended to find less theatrical changes in smoking prevalence.  Two studies appraised the results of venue-specific smoking prohibition among employees most affected by the laws (Bitler, Carpenter & Zavodny 2011). The studies established a reduced smoking prevalence amid bartenders after banning smoking in bars, but there is no change in other employees (Bitler, Carpenter & Zavodny, 2010). Another research carried out regarding state smoking bans by type of restrictions and the number reported results categorized by age group (Sloan & Trogdon, 2004). State smoking bans were irrelevant, but this is perhaps due to the small figure of changes in the state smoking bans throughout the time of their analysis.

Studies reveal that there is no sufficient proof to approximate the direct effect of advertisement bans or limitations on smoking commencement, prevalence, or cessation in the general populace. The youth studies propose that advertising and promotion bans may play a role in decreasing smoking; nevertheless, methodological confines restrict deductions that can be drawn.

Tobacco health warning tags are a means for conveying messages regarding health risks as of smoking and resources for acquiring help to quit. These warning messages can be realized with modest cost to governments, compared with mass media promotion (Hammond, et. al 2007). Despite the partial direct proof, indirect facts describes the result of warning labels on salience, cognitive processing, and knowledge and the relationship between these intermediary results and quit intents, quit efforts, or cessation behavior (Institute of Medicine, 2007).

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References

Botvin GJ. Preventing drug abuse in schools: Social and competence enhancement approaches targeting individual-level etiologic factors. Addictive Behaviors. 2000;25 (6):887–897

Bruvold WH. A meta-analysis of adolescent smoking prevention programs. American Journal of Public Health.1993;83 (6):872–880.

  1. Hammond, G. T. Fong, R. Borland, K. M. Cummings, A. McNeill, and P. Driezen, “Text and graphic warnings on cigarette packages: findings from the international tobacco control four country study,”American Journal of Preventive Medicine, vol. 32, no. 3, pp. 202–209, 2007.
  2. J. Hahn, M. K. Rayens, S. L. Ridner, K. M. Butler, M. Zhang, and R. R. Staten, “Smoke-free laws and smoking and drinking among college students,”Journal of Community Health, vol. 35, no. 5, pp. 503–511, 2010.
  3. A. Sloan and J. G. Trogdon, “The impact of the master settlement agreement on cigarette consumption,”Journal of Policy Analysis and Management, vol. 23, no. 4, pp. 843–855, 2004

Institute of Medicine, Ending the Tobacco Problem: A Blueprint for the Nation, The National Academies Press, Washington, DC, USA, 2007.

Jacobson PD, Lantz PM, Warner KE, Wasserman J, Pollack H. A., Ahlstrom AK., 2001. Combating teen smoking: Research and policy strategies. Ann Arbor, MI: University of Michigan Press.

Lantz PM, Jacobson PD, Warner KE, Wasserman J, Pollack HA, Berson J, Ahlstrom A. Investing in youth tobacco control: A review of smoking prevention and control strategies. Tobacco Control. 2000 March;9:47–63. [PMC free article] [PubMed]

  1. P. Bitler, C. S. Carpenter, and M. Zavodny, “Effects of venue-specific state clean indoor air laws on smoking-related outcomes,”Health Economics, vol. 19, no. 12, pp. 1425–1440, 2010.

National Cancer Institute, The Role of the Media in Promoting and Reducing Tobacco Use, Tobacco Control Monograph No. 19, U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, Bethesda, Md, USA, 2008.

Tobacco Control Laws, n.p.,(September 16, 2005). Explore Tobacco Control Legislation and Litigation From Around the World: Country Details For Malaysia. http://www.tobaccocontrollaws.org/legislation/country/malaysia/summary

Zarihah, Z. (2007). Malysian Smoking Cessation Program & Smoke-Free Air Laws. http://www.maptb.org.my/files/iuatld2007/Malaysian%20Smoking%20Cessation%20Programme%20&%20Smoke-Free%20Air%20Laws.pdf

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