Introduction
Tobacco use is one of the key causes of health complications. According to Jones, Waters, Ota, and McGhee (2010), smoking of cigarettes is the most avoidable cause of death in the U.S., which leads to approximately 400,000 fatalities annually. Globally, tobacco use leads to the demise of more than 4 million people yearly, and this rate is expected to increase by 3 million mortalities by the year 2030 (Smoking and tobacco use, 2009). Research shows that more African-American men succumb to smoking-related illnesses than White men despite having a lower smoking incidence rate (Jones et al., 2010). Therefore, it is important to establish population-based approaches to minimize the use of tobacco among African-Americans. Most smokers are informed of the destructive consequences of cigarette smoking on their health. Despite this knowledge, such people go on smoking and put their lives at risk as well as the lives of people surrounding them.
This paper looks at the use of tobacco in the USA particularly in Massachusetts and proposes ways of minimizing its use following the key objectives of healthy people 2020, which is to cut down disability, sickness and loss of life from tobacco use and secondary exposure to smoke (Tobacco use, n.d.). It also takes a critical look at community and nursing interventions in this important venture.
Tobacco Use
Nicotine is the active ingredient in tobacco and is packaged in assorted ways such as cigarettes, pipes, cigars, and snuff. Nicotine is among the highly utilized addictive drugs in the U.S. Approximately 21% of the U.S. population consists of smokers (Lewis, 2008). One in every twenty smokers succumbs to smoking-related illnesses. Staying in proximity with smokers causes secondary exposure to smoke, which results in approximately 49,000 deaths annually in the United States (Smoking and tobacco use, 2009).
Massachusetts (The Greater Brockton CHNA) has about 18 % of smokers. There are more male smokers (22.6%) than female smokers (15.4%) (Smoking report for the Greater Brockton CHNA, n.d.). Out of the total number of smokers, White Non-Hispanics make up 16% while Black Non-Hispanics account for 31%. 28% of these smokers are high school graduates, whereas 12.5% of smokers possess at least a college certificate. Most smokers are middle-level earners with an income of between 25,000 and 49,999 dollars annually. Those earning less than 25,000 dollars per year comprise the second largest group of smokers. High income earners (above 50,000 dollars annually) are the smallest fraction of smokers making up 11 %. The highest proportion of smokers is between the age of 25 and 44 (19%) followed by those between the age of 45 and 64 (18.2%). There are no smokers under the age of 24 in this state. Most tobacco-related deaths in Massachusetts are caused by complications in the respiratory system. Of the pregnant women who smoke during gestation, White Non-Hispanic women form the largest group with 161 smokers followed by Black Non-Hispanic with 33 and Hispanic with 15 smokers (Smoking report for the Greater Brockton CHNA, n.d.).
Most cigarette smokers do not have a steady source of income and are below the age of 40 (Lewis, 2008). People, especially teenagers, are driven to smoke by several reasons such as peer pressure, inquisitiveness, tension, and boredom (Hayes & Plowfield, 2007). Smokers are inclined to live and work in environments that favor smoking. For example, heavy smokers are more likely to live in households that have smokers. However, some people may be unwillingly exposed to tobacco in their workplaces.
Apart from smoking, which is the conventional way of consuming tobacco, an alternative and hazardous waterpipe tobacco smoking has gained worldwide popularity. This is known as hookah or shisha. Flavored tobacco is vaporized after which the vapor traverses a water basin prior to inhalation. Waterpipe smokers think that waterpipes have less smoke toxicant quantities and a smaller number of health hazards compared to cigarettes (Eissenberg & Shihadeh, 2009). However, a study by Eissenberg and Shihadeh (2009) shows that the two forms of tobacco usage have the same level of health risk.
Secondhand Smoke
“Non-smokers are not exempt from the negative effects of SHS” (Lewis, 2008, p. 195). Secondhand smoke (SHS) can either come from the remnants of burning tobacco (sidestream smoke) or smoke exhaled by a smoker (mainstream smoke). SHS has the same toxins as those present in the actual tobacco smoke. However, sidestream smoke has more toxic components than inhaled smoke because of the disparities in temperatures used to burn the tobacco. SHS has smaller fragments than mainstream smoke and these particles stay in the air for extended periods thereby causing more harm.
Effect of Tobacco Use
Tobacco has over 4,000 chemicals including nicotine, hydrogen cyanide, carbon monoxide, toluidine, and urethane among many others (Lewis, 2008). Out of these, 60 chemicals are known to be carcinogenic. About a third of all cancer mortalities arise from cigarette smoking. In addition, it is a key “cause of cancers of the lung, larynx, oral cavity, pharynx, esophagus, and bladder, and it contributes to the development of cancers of the kidney, pancreas, cervix, and stomach” (Lewis, 2008, p. 193). Cigarette use leads to ailments of the heart (cardiovascular diseases), malignancy, stroke, male and female reproductive illnesses, and complications of the lungs such as bronchitis and constant blockages of the air passages (Smoking and tobacco use, 2009). Asthma patients and people suffering from pneumonia are likely to worsen their conditions if they smoke. Expectant mothers increase the likelihood of giving birth to babies with low birth weight if they smoke during pregnancy besides having miscarriages.
SHS also has detrimental effects to non-smokers as platelets develop tackiness as soon as the individual is exposed to a smoky setting. This initiates the destruction of the inside layer of blood vessels leading to diminished coronary blood flow. SHS also aggravates the symptoms of asthma and other respiratory difficulties by narrowing the air passages. It is known that coming into contact with SHS for lengthy periods raises the possibility of developing cancer of the lung by about 30 % (Lewis, 2008). In addition, sudden infant death syndrome claims the lives of most children whose parents are smokers (Lyons, 2011). Such children may also suffer from infections of the middle ear and other problems encountered by smokers.
Apart from the health impact of smoking, tobacco use also has economic implications. The U.S. government for instance loses billions of dollars on productivity and health care expenses. Between 2000 and 2004, the government lost more than 193 billion dollars to smoking of cigarettes and secondhand smoke (Smoking and tobacco use, 2009).
Current Interventions on Tobacco Use
The U.S. government plays a significant role in trying to curb tobacco use through various initiatives. The first initiative is providing funds to help in the running of smoking cessation programs. The other initiative is to ensure that every local authority provides smoking cessation services to its citizens (Sadler, 2012). Services offered in the smoking cessation programs include rigorous behavioral assistance, counseling, online sources, and self-help resources (Sadler, 2012). Guidance may be offered to smokers either as individuals or in groups. This information may be conveyed through telephone conversations, in person or using focus group discussions. Medications that help in quitting of smoking include bupropion (Hopkins et al., 2001), varenicline, and NRT (Sadler, 2012). NRT achieves elevated rates of cessation if used for a brief duration prior to attempts to quit smoking because it has small amounts of nicotine as part of the ingredients.
Current Research
To reduce the prevalence of tobacco use and its related complications, it is imperative that current and reputable information is availed. This is only possible by carrying out extensive research on tobacco use. Contrary to popular opinion, it is now known that the use of smokeless tobacco (snuff, leaf tobacco and chew) and waterpipe tobacco are as harmful as smoking. Smokeless tobacco (SLT), for example, is easily taken in via the mucous membranes when put in the mouth, and presents double the dosage of nicotine present in a regular cigarette. Despite having no smoke content, SLT contains carcinogens that elevate the chances of developing oral cancer within the initial 5 years of use (Lewis, 2008). Waterpipe tobacco, on the other hand, augments smoke exposure because of its high carbon monoxide quantities (Eissenberg & Shihadeh, 2009). There is immense ongoing research on how best to rehabilitate smokers. The available help options are compared to establish the most suitable method. For example, techniques such as hypnotherapy, pharmacotherapy, self-help, as well as group and individual counseling are compared for efficacy (Sadler, 2012).
Nursing Concerns and Challenges
The cigarette industry expends billions of dollars every year on advertising its products and claims that such advertising is intended to capture consumers within the legal smoking age. However, a recent report reveals that the marketing of flavored tobacco merchandise attracts more underage smokers. A large number of high school students are reported to use the flavored products and have no intention of quitting. The flavored brands increase the number of tobacco-addicted young adults. In addition, most smokers start to smoke in their teens and continue with the habit way into adulthood. This creates a crop of seasoned smokers with high chances of relapsing if they try to quit smoking.
An 80 % relapse rate occurs in people who try to quit smoking in the initial three months with only 6 % of them succeeding in stopping the habit (Lewis, 2008). The exceedingly high relapse rate can be attributed to immense nicotine dependence. The hankering and withdrawal signs associated with nicotine dependence are similar to those observed in cocaine addiction (Lewis, 2008).
Community Interventions
One effective way of minimizing secondhand exposure to tobacco is the implementation of smoking bans. Enlightening the masses on the dangers of tobacco use and the availability of treatment programs eases the execution of these smoking bans and restrictions. Effective community-based interventions in the U.S. include impeding the minors’ right to use tobacco, minimizing contact with secondhand smoke and telephone support lines designed for smoking termination (Jones et al., 2010). Measures to regulate tobacco use propose the utilization of community-based tactics to get rid of health discrepancies. Such interventions take advantage of the shared strength in the community thereby increasing chances of success since the developed interventions are tailor made to suit the inhabitants of the community.
Counseling goes a long way in helping smokers to quit smoking. A Glasgow study as reported by Sadler (2012) shows that attending counseling sessions as a group leads to higher success rates than individual pharmacy counseling sessions. This research highlights the efficacy of group counseling but “raises concerns about the effectiveness of pharmacy-based support. As community pharmacies serve local communities, it is considered they should have the potential to reach large numbers of people who smoke” (Sadler, 2012, p. 27). Pharmacies being businesses have little time to spend on adequate counseling of smokers leading to the low rate of smoking cessation. Therefore, certified professional counselors can train pharmacists on effective ways of counseling smokers in the little time they can spare to increase the rates of success attained from pharmacy-based support.
In Brockton, three main agencies are involved in educating the public on smoking cessation. These agencies include public health nurses, social workers and community-based organizations such as QuitWorks and MassHealth Tobacco Cessation Benefit (Community fact sheet, 2011). Public health nurses counsel smokers and refer them to the QuitWorks for further assistance. The MassHealth Tobacco Cessation Benefit provides resources that facilitate smoking cessation. Approximately 1,500 smokers from Brockton take advantage of these resources. The advantage of social workers is that they can reach out to smokers in their homes and advise them on smoking cessation. However, nurses and social workers cannot do much in cases where smokers are unwilling to quit smoking. At such points, these community-based organizations are very helpful. For example, about 600 smokers were referred to the QuitWorks plan between 2004 and 2009 (Community fact sheet, 2011). In addition, a significant fraction of those smokers called the program’s helpline for assistance in smoking cessation. The disadvantage of these organizations is that they do not reach out to smokers extensively. Therefore, the organizations do not maximize their potential in advocating for smoking cessation.
Nursing Interventions
Nursing interventions are grouped into primary, secondary and tertiary interventions. Primary interventions are procedures that prevent disease occurrence. Nurses need to educate the masses on the dangers of tobacco use as the key primary intervention measure. It is also important to manage impending smoking hazards in one’s surroundings by advising smokers’ on how to live with their family members without exposing them to smoking-related risk.
Secondary interventions, on the other hand, are measures to prevent the progression of a disease that is still in its early phases. Smokers are at risk of developing smoking-related complications and ought to take frequent screening exams. Talking to smokers is the only proven way to assist people to quit smoking (Lewis, 2008) as few people are ready to give up smoking even after being admitted in hospitals for heart failure. According to Lewis (2008), between 22% and 30% of patients assisted to refrain from smoking during hospitalization finally stop smoking. Medical-surgical nurses are better placed to reach out to patients as part of secondary interventions on smoking. Smoking cessation needs to be an important component of the discharge directives for any smoker irrespective of what caused the patient’s admission (Hayes & Plowfield, 2007). Nurses ought to persuade patients to take part in smoking cessation programs, which are very effectual if they integrate medication and psychotherapy besides support group activity. In addition, smoking cessation should be initiated early enough before a smoker becomes physiologically dependent on smoking (Hayes & Plowfield, 2007)
Tertiary interventions manage the negative effect of tobacco use such as cardiovascular disease and lung ailments. These interventions aim to prevent the worsening of disease conditions thereby improving the quality of lives. They include the formation of support groups for patients, chronic pain management plans and cardiac treatment plans. Combinations of these three forms of interventions (primary, secondary and tertiary) are usually necessary to accomplish a significant degree of prevention.
Since community based interventions have high rates of smoking cessation success, it is imperative that nurses together with other health care experts work in partnership with community-based organizations towards tobacco control endeavors. In this particular community (Massachusetts) much emphasis needs to be placed on educating women on the dangers of smoking as closeness to their children places the young ones in danger of smoking complications.
Summary and Conclusion
Smoking is the chief cause of deaths that can be otherwise avoided. People get exposed to tobacco either by smoking or secondhand exposure. Both methods of exposure pose the same level of health hazards. Smokeless tobacco is dangerous if not more harmful than smoking. To mitigate the effects of tobacco use, there is a need for cooperation among health care experts, governmental and non-governmental organizations as well as the entire society. Community interventions towards smoking cessation need to be tailored to address the needs of each community. Group therapy is the most effective way of promoting smoking cessation. In addition, personal contact between tobacco addicts and health care professionals such as nurses plays a significant role in preventing relapses. Therefore, nurses need to play their roles dutifully to ensure that as many people as possible quit smoking and achieve the realization of the objectives of healthy people 2020, which seeks to lower disability, bad health and fatality from tobacco use and secondary exposure to smoke.
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