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Public Health Issue: Smoking

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Smoking is an extremely crucial public health issue which is considered to be an immediate and serious threat to many developing countries across the globe. Being one of the most significant determinants of increased rate of mortality and ill-health throughout the world, smoking is still a preventable epidemic.

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public health essay on smoking

Public Health Issue: Smoking

Public Health Issue: Smoking This essay is aimed to explore, analyse and discuss smoking in adults. Smoking is a public health issue as such is one of the major contributors to high mortality and ill-health in the adults which is preventable (Health and Excellence Care (NICE) (2012). The United Kingdom (UK) is known to have the highest number of people with a history of smoking among people with low socio-economic status (Scriven and Garman, 2006; Goddard and Green, 2005). Smoking is considered a serious epidemic in the UK and the National institute for Health and Excellence Care (NICE, 2012) stated that 28% of adults with low economic status are tobacco smokers compared with 13% of those with economic status or having professional incomes. Furthermore almost 80,000 people died in England in 2011 as a result of smoking related issues and 9,500 admissions of children died due to being second hand smokers (WHO, 2005). This essay focuses on definition of smoking, the aim is to underline the relationship between smoking and the determinants of health and then, the size, prevalence, and morbidity trend of smoking will be explored. Furthermore, some public health policies introduced to confront the issues around smoking will be investigated and finally, the roles of nurses will identify health needs the public so as to promote good health and their wellbeing. Encyclopaedia of Children’s (2013) stated that smoking is a form of inhalation of smoking from different forms of tobacco which include cigarettes, pipes, and cigars. Cancer Research (2012) and the World Health Organisation (2013) have confirmed that most tobacco products contain very high level of nicotine which can have additive effect and are made from tobacco leaf which are s... ... middle of paper ... ...ife. Furthermore smoker’s needs to be encouraged to quit thus it may take many attempts before victims can quit completely. However, good communication with smokers needs careful discussion to reduce the risk of earlier failure problems facing quitting. If nurses can make it their duty by reaching out to each of their patients about quitting smoking, then this would go a long wait in reaching a lot of people even if they don’t want to. There is already smoke free policy in the UK which is working and hopefully will still help in the reduction of smoking con gumption. It is important the government do more of anti-smoking campaigns to reach out to the manual and routine group and make follow up in regards to quitting completely. Furthermore, they need to increase tax rates on tobacco and put an end to shops that still advertising cigarette smoking in their shops .

In this essay, the author

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Public Health Issue: Smoking

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In the United States, smoking cigarettes is the number one preventable cause of morbidity and death (Bergen, 1999), and accounts for $300 Billion in health care costs and economic productivity loss (Jamal, 2015). While the national smoking rate is 16.8% (CDC, 2016), specific demographics are more susceptible to developing smoking habits: people who live below the poverty line (10.9% higher), disabled or with a limitation (6.2% higher), and males (4.7% higher) (Agaku, 2014).

Causes And Consequences Of Lung Cancer

Lung Cancer? Blood Cancer? Bronchitis? COPD? All these familiar and terrifying words have one root in common- Smoking. 9 out of 10 smokers’ first smoke is at the age of 18 and 99% try it by the age of 26(Centre for Disease Control and Prevention). Each day about 4000 youths tries cigarettes for the first time (Haugen,2004). Even after being aware of the ill effects of the so-called ‘cool thing’, smokers cannot stop themselves after their first smoke. Teenage smoking had declined steadily from 1990 to 2005 but again, it has become one of the alarming issues among teenagers (National Centre for Biotechnology Information).

Essay on Health Promotion

in order to sustain a healthier life style. This essay seeks to illustrate the impact of smoking on a

Health Inequalities Among Australians

This study examined the health inequalities among different socio-economic groups from 2004 to 2014 among Australians whose age ranging from 20 to 65 years old. According to the study, the health risk factor behaviour; smoking by sex results indicated that males smoking were higher than females during the study period. The highest rate of smoking were reported among males in 2004. Smoking status by education groups suggested that the highest rate of smoking were accounted in year 12 or below group in all three years, while university degree holders accounted for the least group. The different income groups showed that the poorest people smoking percentage were higher compared to the richest and the percentage had increased when it was moving

The Socio Economic Disadvantage Faced By Indigenous People

“Smoking rates have halved in Australians over the past 30 years, falling below 16%. Except for in Indigenous populations, smoking rates have remained at more than twice this level, with even higher rates reported in remote communities” (RACGP, 2013) The inequality that has been faced by Indigenous people is still at an unacceptable level, and has “been identified as a human rights concern by the United Nations” (Dick, 2007). Smoking is a major issue because, “it is the most preventable contributor to the gap in life expectancy between Indigenous and non-Indigenous peoples” (Ivers, 2011). “Smoking contributes to 17% of the life expectancy gap” (Australian Government: Department for Health and Welfare, 2011). The socio-economic disadvantage faced by Indigenous people leads to the addiction of tobacco, which can be caused by many factors including; their position on the social gradient, education, social exclusion, their employment status and their social support. There is a lack of developed personal skills on the health risks of tobacco, “some Aboriginals don’t identify smoking as a health issue” (Korff, 2014), due to the history of Aboriginal people around smoking. As well as first hand smoke, passive smoking also contributes to poor health, especially for children. Smoking is the major cause for heart disease, stroke, some cancers, lung diseases and a variety of other conditions (, 2013). “If we could reduce tobacco consumption levels

Time For The Very Last Puff

Next the columnist begins a strongly worded evidenced-based approach by discussing the declining percentage of regular smokers. The Editorial begins to bring in numerous sources of evidence such as Anti-Cancer Council data and the survey results of Victorians from 1998 to 2006. This use of scientific statistics shows the reader that The Editorial offers an expertise point of view into the issue and has genuine factual evidence to back up their arguments. This would reassure the reader

The Real Cost

According to “The Action of Smoking and Health,” every six seconds someone loses their life as a result of a tobacco related disease. It’s hard to realize how damaging cigarette smoking’s effect can be until you experience it first hand. It is almost certain that every one knows someone who is currently a smoker or was a smoker at some point in their life. For years smoking was the seen as the “cool” thing to do, it was how to “fit in.” There was no real emphasis placed on the dangers of this particular habit, and as a result, it became a world wide trend. In the past, technology and medicine were not nearly advanced enough to be able to determine just how harmful tobacco usage is. However, as we have made medical and

Reflective Response Paper

Researching the issue of smoking and tobacco addiction in Russia has allowed me to learn more about the history and culture of the country, and increase my understanding about the effects of smoking in Russian-speaking communities. Although no one in my close family smokes, I was surrounded by smokers when growing up and the issue of smoking remained unaddressed until I moved to Australia, where there are many anti-smoking campaigns and education about the effect of drugs on the mind and body. After researching the topic, I realised that my knowledge and understanding about this issue had been very minor before conducting this investigation.

Tobacco Cessation

In the U.S., only 20% of those at or above the poverty level smoke, compared with 30% of those below the poverty level (Hiscock, Bauld, Fidler, and Munafo, 2012). Teenage girls of families with lower SES are more likely to smoke (Hiscock et al, 2012). In addition, those with low SES are less likely to quit smoking successfully and may be less likely to intend or attempt to quit (Reid, Hammond, Boudreau, Fong, and Siahpush, 2010). Reid and coauthors surveyed over16,000 smokers in the US, UK, Canada and the United Kingdom and found that those with higher education were more likely to say they intend to quit smoking, attempt to quit and to be abstinent for between one and six months. Higher income was also associated with stated intention to quit and abstinence of at least one month (Reid et al, 2010). In addition, those with low SES

Public Health: Determinant Of Health

The table that was chosen from Health United States, 2014 report, was on the following determinant of health: “Current cigarette smoking among adults age 18 and over, by sex (female), race and age; United States, selected years 1965-2013”; this table (below) was listed as table 52 on the report, found on page 182. Using the data from the selected table, a specific health problem that should be the focus of one research subject in public health is cigarette smoking. Cigarette smoking is a specific health problem because the table, shows the trend of cigarette smoking (with some variation), on the decline for all categories for females (race and age) as years progress. The problem of cigarette smoking still needs to be addressed

Tobacco Use In Low-Income Areas

Tobacco use is still very frequent, especially in low-income areas. Not only is it detrimental for the smokers themselves in terms of health, but also it harms those around them. Some health issues that occur are “lung cancer, heart disease, and colon cancer” (Haskins). For low income areas, smoking is one of the most leading causes of death, but it is a preventable cause. In order to help smokers to quit smoking, Haskin states that one suggestion is to raise the prices of tobacco and cigarettes, and another suggestion, especially for nonsmokers, is to have designated areas for smokers only and to have cities label certain public areas such as parks and common areas to be smoke-free zones. Because tobacco is addictive, receiving and seeking

Biomedical Model Of Health

In each year between 1998 and 2002, over 106,000 deaths in the UK, around a sixth of the total, were from smoking-related causes and smoking was the direct cause of about three in five of all cancers (Westlake, Yar, 2006:

The Epidemic Of Cigarette Smoking

The century-long epidemic of cigarette smoking has caused a public health concern of epic proportions. As health concerns about tobacco developed during the 1960s, the federal government moved in and initiated Tobacco Control laws. Smoking among adults in the mid-1960’s was prevalent with 42% of the population smoking compared to 18% in 2012. In 1964, the first report of the Surgeon General’s Advisory Committee on Smoking and Health identified smoking as a cause of increased mortality.

The Relationship Between Smoking And Public Health Essay

In the Acheson Report (Acheson, 1988), public health is illustrated as the art and science of avoiding disease, extending life and promoting healthy lifestyles through the organised community efforts. It emphasises on investigating and diagnosing health issues in order to protect people’s health and make the environment healthy for individuals to live (Detels et al., 2015). Smoking is strongly associated with public health because being one of the most leading causes

Dangers of Smoking Essay

For a country in our financial position the general health of Scotland is very poor. In some areas the average life expectancy is as low as 54 years old for men. A major cause of this is smoking. With the young in particular smoking is much more popular than it used to be. In October 2008, it was estimated that one third of 16-24 year olds smoke. This figure is at a 10 year high. In between the ages of 16-19 it is found that girls are more likely to smoke than boys.

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Public Health and Smoking Prevention Essay


Historically, public health efforts have been to control transmittable diseases, limit environmental hazards, and provide clean and healthy drinking water. Social, ecological, and biological factors are interconnected and hence interrelate to influence health. As such, public health needs to incorporate a broad set of spectrum. Public health practice involves organized plans to improve the health of communities. According to C.E.A. Winslow, public health is the science and art of disease prevention, lengthening life, improving physical health and efficiency through structured community determinations for environmental sanitization, managing community infections, and promoting knowledge among individuals on aspects of personal hygiene (Teutsch, 2018). The concept also consists of planning medical and nursing services for timely disease treatment and prevention and improving social infrastructure, which will enhance an individual’s living standards.

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The World Health Organization (WHO) defines public health from health described as a state of total physical, mental and social welfare. Hence, public health intends to realize impartial health delivery for the whole population (Martin-Moreno et al., 2016). Therefore, public health definitions revolve around people’s health and involve improving the entire community’s health, focusing on protection, disease prevention, and wellbeing. Public health strives to screen disease occurrences, which may be acute or chronic, prevent injuries, and develop knowledge of risk factors within communities.

Public Health Promotion

An individual’s behavior is a significant determinant of health. Personal habits such as smoking, alcohol use, exercise, and eating determine the wellbeing of an individual. Health promotion is essential for the entire community. According to the WHO, health promotion refers to the process of facilitating people to enhance their power over their health while also improving their health (Drewa and Zorena, 2017). The process has increasingly become a prominent item in public policy of most countries in recent years. The concept of health promotion stresses the community-based services of health promotion, community involvement, and health promotion programs centered on social and health systems.

The purpose of health promotion is to positively influence people and communities’ health conduct along with the living and working environments. Nurses are significant players in this aspect by enhancing people’s living standards (Zhou et al., 2016). The assessment includes community demands, education, resource identification, and plans to limit premature mortalities and reduce expenses.

Role of Nurses in Public Health and Public Health Promotion

Nurses have a significant role in stimulating public health. The part of nurses as health promoters is more than the new focus on disease prevention and transforming people’s behavior according to their health conditions. Individual perspective nurses have a holistic approach and use their activities such as helping individuals and families make health decisions (Darch, Baillie and Gillison 2017). Nurses also help the public by supporting their participation in health promotion programs (Salmond and Echevarria, 2017). Nurses have several strategies that facilitate health promotion. The approaches involve giving information to patients and offering health education.

Nurses can also participate in health promotion practices through empowerment. Nurses collaborate to enhance health empowerment through a partnership with individuals, groups, or communities through nurse-patient communication and patient community engagement. Nurses also have a duty of promoting health based on community orientation (Kim et al., 2016). Nurses use their knowledge to implement surveillance strategies and incorporate other professionals and groups while also interacting with various cultures to promote health.

Nurses in various facilities have a significant responsibility to offer preventive services and wellbeing. Nurses are the foundation and advocates of the healthcare process since they work across the health care system. Nurses can also function as case supervisors by helping individual patients and families to traverse the health care process (Darch, Baillie and Gillison, 2017). Nurses can also offhandedly work with their clients to facilitate holistic care that is essential for effective results. These professionals also work as consultants on communities to determine the healthcare needs of a particular group and promote programs and events for a specific area’s residents.

On the other hand, nurses play educators’ roles since they spend most of their time with patients. During that period, the protective direction about various practices is immunizations, nutrition, dietary, and medications (Whitehead, 2018). Strategies such as preventive efforts against heart diseases and other illnesses involve educating procedures and monitoring safety risks in different settings.

Prevalence of Smoking among Adults of Over 18 Years

The practice of smoking that started numerous centuries has increased despite its health effects and efforts to limit the act. Smoking includes drawing into the mouth and primarily lungs, smoke from burning tobacco which can be in various forms such as cigarettes, cigarillos, cigars, and water pipes (West and Shiffman, 2016). Estimations indicate that tobacco smoking leads to the premature death of about 6 million people globally every year, while a country such as the UK loses 96000 people over a similar time frame (Burki, 2016). These deaths can occur even after an individual abandons the behavior due to the devastating consequences on the victim’s health and overall wellbeing.

Smoking among adults over 18 years old is a public health issue that requires intervention due to statistical evidence of its effects over the past decades. A significant number of deaths in the United States is due to cigarette use and other burnt tobacco products. Cigarettes represent the most widely utilized tobacco product among the US population. Over 480000 deaths in the US result from cigarette smoking and secondary smoking activities (Jamal et al., 2018, p. 53). The prevalence of smoking among the adult US population has been increasing since 2016. Despite the decrease from 20.9% in 2005 to 15.1% in 2015, adults’ behavior has increased since 2016 (Jamal et al., 2018). The high prevalence rates of smoking among adults imply the need to address the behavior.

Smoking has several effects on the health of an individual. The health conditions that can result from the addiction include oral cancer, lung cancer, and heart disease. Smoking, which can consist of cigarette smoking and cigar smoking, can be fatal to human health (Roston, Corey and Gindi, 2019). E-cigarette exposure results in broad stress and inflammatory reactions in the pulmonary system, such as breathing limitations, coughing, and sneezing. The behavior also causes bronchial irritations, pulmonary irritations, and pulmonary malfunction (Glantz and Bareham, 2018). Despite the lower amounts of toxic and carcinogenic metabolites than conventional smoking, the effects are also harmful to an individual’s wellbeing. Some chemicals in e-cigarettes such as formaldehyde and acrolein and traces of nickel and lead can cause DNA malformation and mutation with possible carcinogenic impacts. The effects of conventional smoking and e-smoking imply the need to address the problem as a health risk.

Smoking in women has also been on the rise in the recent past. Smoking in women and men reduces their fertility due to alteration of hormonal composition (de Angelis et al., 2020). Pregnant women who smoke are likely to cause underdevelopment of the fetus, which would eventually increase the dangers of miscarriage, neonatal deaths, and respiratory defects in the newborns (Gustavson et al., 2017). The infants can also develop mental health problems. These effects also necessitate the need to establish cessation campaigns.

Knowledge and Perception towards Smoking

The knowledge and awareness about a particular lifestyle and behavior determine the attitude on effects and the intention to quit. The majority of smokers in different regions have moderate levels of understanding about smoking’s health risk impacts. The majority of smokers understand the health implications of lung cancer and decay in the individuals’ lungs. However, there is still low awareness among the population about other health effects such as stroke, stained teeth, impotence in male persons, and lung cancer in non-smoking people due to secondary smoking (Dawood et al., 2016). The results are similar for study findings in several countries such as Iraq, China, India, and other Western Countries and hence the general conclusion (Dawood et al., 2016). Despite the population’s awareness of smoking’s health risks, Dawood et al. (2016) indicate that a low percentage (6.5%) of smokers are willing to abandon their habit. These findings correspond to findings from other countries such as China and India, which also have low intentions to quit. However, countries such as Canada and Australia, with high levels of understanding among the smoking population on the health risks of the behavior, had relatively more than three-quarters of the group willing to abandon smoking (Haddad et al., 2020). As such, there is a need to facilitate intervention measures since knowledge of smoking health impacts has proved to be a determinant for quitting.

Healthy Lifestyle Activity for Health Promotion

Living smoke-free is a challenge that requires an individual to maintain a healthy state of mind and body. Several habits can be helpful for a person to stay healthy, positive, and inspired. First, an individual should consider the number of days after quitting and keep the spirits and motivation up due to a sense of satisfaction (Magor‐Blatch and Rugendyke, 2016). Appreciating every milestone in the quit process would also be relevant until one reaches a significant journey such as a year without smoking. Regular relaxing sessions involving massage or yoga would be considered to divert the mind from cravings for smoke.

On the other hand, diet remains an essential aspect since high-fat foods and sugary meals can initiate the urge to smoke. Eating healthy meals would include few fried foods, fruits, and fried fish noodles. Withdrawing individuals would also need enough sleep to avoid the feeling of irritation and exhaustion, which can attract smoking behavior (Kalkhoran, Benowitz and Rigotti, 2018, p. 1040). Stable social support is essential, and hence one needs to create time to spend with their loved ones, including family members and friends. Therefore, developing these habits in life can help one stay healthy, positive, and smoke-free.

Interactive and Tailored Behavioral Intervention Measures for Smoking Behavior

A behavioral intervention is recommended for educating the population about healthy lifestyle choices. Depending on the needs of individuals, it is possible to introduce in-person behavioral support and counseling, telephone or online counseling, or self-help materials (American Family Physician, 2016)

The internet can influence behavioral transformation among a variety of groups due to its low cost for users. The tool reaches many people in one instance since there are over 3.5 billion internet users worldwide. The method can have a large-scale influence at a lower cost. Moreover, the internet is highly accessible at various access points such as internet cafes, smartphones and available all day and daily (Chebli Blaszczynski, and Gainsbury, 2016). For instance, of the 94.4% of the Dutch population who accessed the internet in 2016, 98.9% were individuals between 25 and 45 years old, while 98.3% were aged 45 to 65 (Cheung, Wijnen and de Vries, 2017). Moreover, eHealth health intervention in countries such as the Netherlands may not differ with education levels since the methods are highly used as recommended for people. These statistics illustrate the effectiveness of the intervention measure. Therefore, using an internet-based intervention approach would be appropriate for college students who may fail to reveal themselves as smokers or seek conventional therapies to quit the behavior.

Limitations to the Internet-Based Intervention

The internet has numerous websites with smoking cessation programs, although some lack direct intervention guidelines. The clients who wish to have information on cessation experience challenges distinguishing between the appropriate and irrelevant sites. Some of the websites fail to utilize the interactive and adapting capacity of the internet. Another hindrance to the method’s effectiveness would be that the program may reach an unintended audience. Simultaneously, the intervention measures may also fail to reach lower-income communities who are potentially smokers.

Responsibility as a Health Professional in the Intervention Process

Socio-cognitive factors are essential when considering the roles of a professional in counseling to initiate smoking cessation. I would adopt the counseling steps of the STIMEDIC guideline for the intervention (de Ruijter et al., 2017, p. 685). The first step would be to offer a piece of quit advice. Second, evaluating the smoking sketch and smoking history of the client would be necessary. It would be essential to examine the individual’s willingness to abandon the behavior, after which improvising ways to enhance motivation to quit smoking would follow. As a professional, it would be essential to identify the potential factors that could hinder quitting and discuss them before informing the client about the most appropriate cessation aids. The last and significant task would be to plan a quit date and organize a follow-up to assess the individual’s behavior (Kazemzadeh, Manzari and Pouresmail, 2017). These functions also represent the guideline for promoting intervention for smoking addiction.

The Impact of the Intervention

Online intervention programs can significantly affect individuals’ smoking behavior and help alter the prevalence of smokers in a particular population. The internet intervention involves various activities such as skills training, social support, and pharmacotherapy use which are vital components for the process (Graham et al., 2016, p. 55). Adherence to these components of smoking cessation would be more effective with adopting an internet-based intervention approach.

Public health promotion is an important phenomenon in promoting different components of public health such as disease prevention, physical health, and personal hygiene. Smoking among adults over 18 years old is a public health issue that requires intervention due to statistical evidence of its effects over the past decades. Smoking greatly contributes to various diseases among individuals, which are in turn fatal. Among the existing intervention measures to help reduce smoking prevalence, the internet-based approach is the most appropriate. Reaching a large number of people for face-to-face counseling would be costly and time-consuming, as such, leaving the internet-based strategy as the most effective.

Reference List

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Smoking as a Public Health Issue


Importance of smoking as a public health issue in the UK


Smoking is by far the single most preventable cause of death globally. Today, we have over one billion smokers worldwide, or nearly 25% of all adults. In the UK, smoking puts a significant strain on the NHS (National Health Service) on account of the health problems which are directly associated with this habit. Consequently, successive Governments in the UK have implemented varied measures and strategies in an effort to reduce the prevalence of smoking in the country. For example, the NHS is committing to providing free assistance to smokers who wish to stop smoking. The UK Government has also imposed an age restriction for smoking at 16 years. Thanks to the concerted effort by various stakeholders to deal with smoking as a public health issue, smoking fell to a record level of 16.9% in 2015.  Smoking is a leading cause of various illnesses, including heart diseases, cancers, asthma and bronchitis, and stroke. Additionally, cigarette smoking has been identified as a leading cause of health inequalities especially amongst lower socioeconomic groups where it accounts for nearly 50% of the health inequalities. In addition, smoking leads to lost working days every year. According to Cancer Research UK (2014), smoking accounts for 11 million lost work days per annum due to smoking-related illnesses

Prevalence of Smoking

Local Level

Statistics released by Public Health England (2014) reveal that Hyndburn Unitary Authority which is part of Lancashire had a 30.1 smoking prevalence. This was by far the highest rate of smoking prevalence in the UK, with Kingston upon Hull and Blackpool following closely at 29.8 percent and 29.5 percent, respectively. On the other hand, the smoking prevalence at Lancashire-12 area was estimated at 18.3%, and it not far off the national estimate of 16.9% (Office for National Statistics 2016). Conversely, the number of hospital admissions attributable to smoking in the Lancashire-12 area in 2014/15 was 1,891 per 100,000. This was slightly higher than the national average of 1,671 per 100,000. Also, in 2012-14, the Lancashire-12 area recorded a considerably higher smoking attributable mortality of 312.8 per 100,000 relative to the national average of 274.8 per 100,000 (Office for National Statistics 2016)

National Level

            Although the UK has experienced a year-on-year decline in the number of smokers, still 20 percent of women and 21 percent of men still smoke on a regular basis, with the Office of National Statistics (2011) reporting that nearly two-thirds of smokers begin to smoke before they have reached the age of 18.

A 2013 Opinions and Lifestyle Survey revealed that almost one out of five adults in the UK aged 16 and above were smokers. This represents a 19 percent prevalence of smoking among 16 years olds and above. While this represented a slight decline to the rate reported in 2012, it has nonetheless remained unchanged for the most part in recent years. Conversely, in 2003, 26 percent of adults in the UK aged 16 and above were reported to smoke or about one out of four adults (Office for National Statistics 2014). The Health and Social Care Information Centre (2015) indicates that in 2013, the highest prevalence of tobacco use in the UK was recorded amongst individuals aged 25 to 24 and 16 and 24 at 25 percent and 23 percent, in that order. On the other hand, the lowest prevalence was recorded among individuals aged 60 and over, at 11 percent.

In 2014 more men in the UK (20.7%) were likely to smoke in comparison with women (15.9%), according to the Office for National Statistics (2014).The highest smoking rate in the UK was recorded in Scotland, at 20.3%, while the lowest rate was recorded in England, at 18.0%. In addition, individuals who worked in manual or routine occupation reported the highest smoking rate, at 28.2% (Office for National Statistics 2014). At the same time, gay, bisexual, and lesbian adults were more likely to smoke (25.3%) in comparison with straight/heterosexual adults (18.4%).

According to a 2014 report by the Health Survey for England, between 1993 and 2013, there was a 9 point increase in the percentage of UK Men who did not smoke on a regular basis from 39 percent to 48 percent. Conversely, there was an 8 point increase in the percentage of women who did not smoke on a regular basis from 52 percent to 60 percent (Health Survey for England 2014). The proportion of women who currently smoke has been shown to decline steadily over the past few decades. For example, 1993, the percentage of women smokers in the UK was estimated at 26 percent. However, by 2003 it had reduced to 24 percent and by 2013, with a further decline to 17 percent by 2013 (Health and Social Care Information Centre 2015). At the same time, the proportion of current men smokers in 1993, 2003 and 2013 was estimated at 27, 27, and 24 percent, in that order. Nevertheless, the percentage of men who smoke has been shown to fluctuate year on year over the past decade, as opposed to a continuous downward trend.  

According to Thompson (2014), “smoking detrimentally affects every organ of the body and is the leading cause of preventable deaths and disease in the UK” (p.18). In 2013/14, England witnessed more than 1.6 million admissions for adults aged 35 and above, or the equivalent on 4,500 daily admissions. These adults presented with a main diagnosis that was attributed to the effects of smoking. In 2003/04, England reported 1.4 million admissions for the same age group or nearly 3,800 daily admissions. This is a clear indication that tobacco use has had a major effect on the UK health care system.  At the same time, the highest prevalence of smoking was reported among unemployed people (35 percent) while those in employment or economically inactive (for instance, those in retirement and students) was estimated at 19 percent and 16 percent, respectively.   

There has also been a significant rise in UK household expenditure on tobacco over the years. For example, in 1985 the UK household expenditure on tobacco was slightly over £7 billion but by 2014, it had increased markedly to £19.4 billion. On the other hand, the average UK household has seen its expenditure on tobacco in proportion to its total expenditure reduce over the same period. For instance in 1985, the average UK household spent 3.3 percent of its expenditure on tobacco, compared to 1.8 percent in 2014.

Global Level

In its 2016 report on the global prevalence of tobacco smoking, WHO noted that as of 2015, more than 1.1 billion individuals worldwide smoked tobacco. Of these, almost 80% are form middle-income and low-income countries (WHO 2016). These countries are also characterised by the heaviest burden of tobacco-related morbidities and mortalities. Tobacco use is associated with such undesirable outcomes as premature deaths of users, thereby depriving their families of valuable income. In addition, the families are faced with an increase in health care cost as they have to take care of smokers who contract tobacco-related illnesses, not to mention that tobacco use hinders the economic development of families especially those in low-income and middle-income countries. The number of male smokers globally is significantly higher in comparison with that of females. WHO (2016) further noted that while there has been a general global decline in the prevalence of tobacco smoking, the African Region and Mediterranean Region were experiencing an increase in tobacco use. Hunter and Ewles (2005) report that smoking is more prevalent among marginalised people such as those in prison, individuals with mental health problems, and in individuals from poorer socio-economic groups. Additionally, a higher number of younger people smoke in comparison with older people.

Estimates by WHO show that smoking accounts for nearly six million deaths globally every year, inclusive of some 600,000 individuals are estimated to die prematurely each year as a result of the effects of second-hand smoke.  According to WHO (2017), tobacco use accounts for 1 in 10 deaths globally. Doll et al (2004) reports that nearly 50% of all life-long smokers shall die prematurely. While tobacco smoking is mainly linked to ill-health, death and disability due to non-communicable chronic diseases, it is further linked to increased risk of death owing to communicable diseases. Elsewhere, ASH (2013) reports that about 25 percent of all cancer deaths are as a direct result of smoking, which is also a leading cause of high blood pressure. 

WHO (2016) notes that a comprehensive ban on advertising, sponsored, and promotion of tobacco could reduce its consumption by between 7 and 16%. However, only 29 countries, most of them in the developed economies, have so far managed to completely ban all types of advertisement, sponsorship and promotion of tobacco. This represents a mere 12% of the global population. WHO further reports that taxing tobacco is by far the most cost effective strategy to reduce tobacco consumption, particularly among poor and young people. For example, a 10% rise in the price of tobacco products could reduce tobacco use by nearly 5% in middle-income and low-income countries.

Social determinants of health and wellbeing

Tobacco use is a global issue of public health concern and if we do nothing to change current consumption patterns, we will be faced with high rates of mortalities and morbidities in coming years (Eriksen et al. 2015). An integration of various public health efforts have in recent years led to a general reduction in global prevalence of tobacco use; nonetheless, the global rise in population has in turn resulted in an increase in total number of smokers (Ng et al. 2014). Moreover, the most marginalised, vulnerable, and poor members of society are yet to benefits from such efforts and as such, these groups are still characterised by high rates of tobacco consumption, resulting in rising health inequalities and devastating outcomes (Hiscock et al. 2012).

Other disadvantaged people include the homeless people, people of low socio-economic status, minority and indigenous ethnic groups, as well as patients with such debilitating health conditions as HIV, tuberculosis, and mental disorders. This is quite devastating considering that the disadvantaged status of such individuals increases their probability of tobacco use as a “coping strategy”. Also, their consumption of tobacco further escalate their disadvantage through less money to cater for essentials, poor health and an increase in economic burden (Eriksen et al. 2015). If at all we are to reduce the global; consumption rates of tobacco even further, it is important that tobacco control communities focus more attention on attempts to reduce health disparities affiliated with tobacco use.

The comprehensive tobacco control and prevention strategies that have thus far been implemented include increased taxation on tobacco, smoke-free air by-laws, evidence-based cessation treatments, and anti-smoking media campaigns. These strategies have proven effective in reducing tobacco consumption ain the general population. Garrett et al. have identified tobacco control interventions as effective strategies “in addressing the social determinants of health in tobacco prevention and control to achieve equity and eliminate tobacco-related disparities” (2015, p. 893). Nonetheless, failure to implement these interventions equitably will marginalise certain population groups or worsen disparities in tobacco consumption.

Disparities in tobacco consumption are partly due to inequalities in the adoption and implementation of tobacco controls programs and polices to reach and change the lives of the most vulnerable groups in the population characterised by the higher smoking rates, such as those with lower income and education. Low social economic status us a powerful determining factor of tobacco use either alone or in combination with other factors. Other factors that interact with low social economic status to influence smoking behaviour include acculturation, ethnicity/race, stress, cultural characteristics, tobacco industry influence, limited community empowerment, social marginalisation, and lack of detailed policies to control tobacco use (Jha 2006). These factors constitute the social determinants of health and addressing them will go a long way in realising equity and eradicating disparities with regards to tobacco control and prevention. Economic and social conditions (for example, education, poverty, power, and unequal distribution of resources) cause the greatest effect on public health along with the various risk factors associated with it, including smoking (Hill et al. 2013).

Smoking constitutes a key public health issue at local, national, and global levels. Besides being a leading cause of preventable ill health, smoking is also a major cause of disability and premature death. There is a clear relationship between tobacco consumption and inequality with more deprived and/or marginalised groups characterised by higher likelihood of smoking. Tobacco use accounts for more deaths annually than tuberculosis, HIV/AIDS, and malaria. More importantly, most of these deaths are preventable. This makes tobacco smoking a leading public health concern globally, seeing as it is implicated in the causation of various forms of cancer, cardiovascular diseases and premature death.

While most developed countries, including the UK have witnessed a decline in rates of smoking over the years, developing countries in Asia and Africa have been recording an increase in prevalence of smoking. Smoking represents the single largest preventable cause of inequalities with health care. Various policies and strategies have been implemented at the local, national and international levels in order to address the factors that influencing smoking behaviour. These including increased taxation on cigarettes and imposing a ban on advertising, sponsorship and promotion of tobacco can reduce its use. Equitable and consistent implementation of policy intervention to control the use of tobacco would go a long way in dealing with the social determinants of health in tobacco control and prevention. This would in turn improve the health and wellbeing of tobacco users.

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National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2012.

Cover of Preventing Tobacco Use Among Youth and Young Adults

Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General.

1 introduction, summary, and conclusions.

Tobacco use is a global epidemic among young people. As with adults, it poses a serious health threat to youth and young adults in the United States and has significant implications for this nation’s public and economic health in the future ( Perry et al. 1994 ; Kessler 1995 ). The impact of cigarette smoking and other tobacco use on chronic disease, which accounts for 75% of American spending on health care ( Anderson 2010 ), is well-documented and undeniable. Although progress has been made since the first Surgeon General’s report on smoking and health in 1964 ( U.S. Department of Health, Education, and Welfare [USDHEW] 1964 ), nearly one in four high school seniors is a current smoker. Most young smokers become adult smokers. One-half of adult smokers die prematurely from tobacco-related diseases ( Fagerström 2002 ; Doll et al. 2004 ). Despite thousands of programs to reduce youth smoking and hundreds of thousands of media stories on the dangers of tobacco use, generation after generation continues to use these deadly products, and family after family continues to suffer the devastating consequences. Yet a robust science base exists on social, biological, and environmental factors that influence young people to use tobacco, the physiology of progression from experimentation to addiction, other health effects of tobacco use, the epidemiology of youth and young adult tobacco use, and evidence-based interventions that have proven effective at reducing both initiation and prevalence of tobacco use among young people. Those are precisely the issues examined in this report, which aims to support the application of this robust science base.

Nearly all tobacco use begins in childhood and adolescence ( U.S. Department of Health and Human Services [USDHHS] 1994 ). In all, 88% of adult smokers who smoke daily report that they started smoking by the age of 18 years (see Chapter 3 , “The Epidemiology of Tobacco Use Among Young People in the United States and Worldwide”). This is a time in life of great vulnerability to social influences ( Steinberg 2004 ), such as those offered through the marketing of tobacco products and the modeling of smoking by attractive role models, as in movies ( Dalton et al. 2009 ), which have especially strong effects on the young. This is also a time in life of heightened sensitivity to normative influences: as tobacco use is less tolerated in public areas and there are fewer social or regular users of tobacco, use decreases among youth ( Alesci et al. 2003 ). And so, as we adults quit, we help protect our children.

Cigarettes are the only legal consumer products in the world that cause one-half of their long-term users to die prematurely ( Fagerström 2002 ; Doll et al. 2004 ). As this epidemic continues to take its toll in the United States, it is also increasing in low- and middle-income countries that are least able to afford the resulting health and economic consequences ( Peto and Lopez 2001 ; Reddy et al. 2006 ). It is past time to end this epidemic. To do so, primary prevention is required, for which our focus must be on youth and young adults. As noted in this report, we now have a set of proven tools and policies that can drastically lower youth initiation and use of tobacco products. Fully committing to using these tools and executing these policies consistently and aggressively is the most straight forward and effective to making future generations tobacco-free.

The 1994 Surgeon General’s Report

This Surgeon General’s report on tobacco is the second to focus solely on young people since these reports began in 1964. Its main purpose is to update the science of smoking among youth since the first comprehensive Surgeon General’s report on tobacco use by youth, Preventing Tobacco Use Among Young People , was published in 1994 ( USDHHS 1994 ). That report concluded that if young people can remain free of tobacco until 18 years of age, most will never start to smoke. The report documented the addiction process for young people and how the symptoms of addiction in youth are similar to those in adults. Tobacco was also presented as a gateway drug among young people, because its use generally precedes and increases the risk of using illicit drugs. Cigarette advertising and promotional activities were seen as a potent way to increase the risk of cigarette smoking among young people, while community-wide efforts were shown to have been successful in reducing tobacco use among youth. All of these conclusions remain important, relevant, and accurate, as documented in the current report, but there has been considerable research since 1994 that greatly expands our knowledge about tobacco use among youth, its prevention, and the dynamics of cessation among young people. Thus, there is a compelling need for the current report.

Tobacco Control Developments

Since 1994, multiple legal and scientific developments have altered the tobacco control environment and thus have affected smoking among youth. The states and the U.S. Department of Justice brought lawsuits against cigarette companies, with the result that many internal documents of the tobacco industry have been made public and have been analyzed and introduced into the science of tobacco control. Also, the 1998 Master Settlement Agreement with the tobacco companies resulted in the elimination of billboard and transit advertising as well as print advertising that directly targeted underage youth and limitations on the use of brand sponsorships ( National Association of Attorneys General [NAAG] 1998 ). This settlement also created the American Legacy Foundation, which implemented a nationwide antismoking campaign targeting youth. In 2009, the U.S. Congress passed a law that gave the U.S. Food and Drug Administration authority to regulate tobacco products in order to promote the public’s health ( Family Smoking Prevention and Tobacco Control Act 2009 ). Certain tobacco companies are now subject to regulations limiting their ability to market to young people. In addition, they have had to reimburse state governments (through agreements made with some states and the Master Settlement Agreement) for some health care costs. Due in part to these changes, there was a decrease in tobacco use among adults and among youth following the Master Settlement Agreement, which is documented in this current report.

Recent Surgeon General Reports Addressing Youth Issues

Other reports of the Surgeon General since 1994 have also included major conclusions that relate to tobacco use among youth ( Office of the Surgeon General 2010 ). In 1998, the report focused on tobacco use among U.S. racial/ethnic minority groups ( USDHHS 1998 ) and noted that cigarette smoking among Black and Hispanic youth increased in the 1990s following declines among all racial/ethnic groups in the 1980s; this was particularly notable among Black youth, and culturally appropriate interventions were suggested. In 2000, the report focused on reducing tobacco use ( USDHHS 2000b ). A major conclusion of that report was that school-based interventions, when implemented with community- and media-based activities, could reduce or postpone the onset of smoking among adolescents by 20–40%. That report also noted that effective regulation of tobacco advertising and promotional activities directed at young people would very likely reduce the prevalence and onset of smoking. In 2001, the Surgeon General’s report focused on women and smoking ( USDHHS 2001 ). Besides reinforcing much of what was discussed in earlier reports, this report documented that girls were more affected than boys by the desire to smoke for the purpose of weight control. Given the ongoing obesity epidemic ( Bonnie et al. 2007 ), the current report includes a more extensive review of research in this area.

The 2004 Surgeon General’s report on the health consequences of smoking ( USDHHS 2004 ) concluded that there is sufficient evidence to infer that a causal relationship exists between active smoking and (a) impaired lung growth during childhood and adolescence; (b) early onset of decline in lung function during late adolescence and early adulthood; (c) respiratory signs and symptoms in children and adolescents, including coughing, phlegm, wheezing, and dyspnea; and (d) asthma-related symptoms (e.g., wheezing) in childhood and adolescence. The 2004 Surgeon General’s report further provided evidence that cigarette smoking in young people is associated with the development of atherosclerosis.

The 2010 Surgeon General’s report on the biology of tobacco focused on the understanding of biological and behavioral mechanisms that might underlie the pathogenicity of tobacco smoke ( USDHHS 2010 ). Although there are no specific conclusions in that report regarding adolescent addiction, it does describe evidence indicating that adolescents can become dependent at even low levels of consumption. Two studies ( Adriani et al. 2003 ; Schochet et al. 2005 ) referenced in that report suggest that because the adolescent brain is still developing, it may be more susceptible and receptive to nicotine than the adult brain.

Scientific Reviews

Since 1994, several scientific reviews related to one or more aspects of tobacco use among youth have been undertaken that also serve as a foundation for the current report. The Institute of Medicine (IOM) ( Lynch and Bonnie 1994 ) released Growing Up Tobacco Free: Preventing Nicotine Addiction in Children and Youths, a report that provided policy recommendations based on research to that date. In 1998, IOM provided a white paper, Taking Action to Reduce Tobacco Use, on strategies to reduce the increasing prevalence (at that time) of smoking among young people and adults. More recently, IOM ( Bonnie et al. 2007 ) released a comprehensive report entitled Ending the Tobacco Problem: A Blueprint for the Nation . Although that report covered multiple potential approaches to tobacco control, not just those focused on youth, it characterized the overarching goal of reducing smoking as involving three distinct steps: “reducing the rate of initiation of smoking among youth (IOM [ Lynch and Bonnie] 1994 ), reducing involuntary tobacco smoke exposure ( National Research Council 1986 ), and helping people quit smoking” (p. 3). Thus, reducing onset was seen as one of the primary goals of tobacco control.

As part of USDHHS continuing efforts to assess the health of the nation, prevent disease, and promote health, the department released, in 2000, Healthy People 2010 and, in 2010, Healthy People 2020 ( USDHHS 2000a , 2011 ). Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to encourage collaborations across sectors, guide individuals toward making informed health decisions, and measure the impact of prevention activities. Each iteration of Healthy People serves as the nation’s disease prevention and health promotion roadmap for the decade. Both Healthy People 2010 and Healthy People 2020 highlight “Tobacco Use” as one of the nation’s “Leading Health Indicators,” feature “Tobacco Use” as one of its topic areas, and identify specific measurable tobacco-related objectives and targets for the nation to strive for. Healthy People 2010 and Healthy People 2020 provide tobacco objectives based on the most current science and detailed population-based data to drive action, assess tobacco use among young people, and identify racial and ethnic disparities. Additionally, many of the Healthy People 2010 and 2020 tobacco objectives address reductions of tobacco use among youth and target decreases in tobacco advertising in venues most often influencing young people. A complete list of the healthy people 2020 objectives can be found on their Web site ( USDHHS 2011 ).

In addition, the National Cancer Institute (NCI) of the National Institutes of Health has published monographs pertinent to the topic of tobacco use among youth. In 2001, NCI published Monograph 14, Changing Adolescent Smoking Prevalence , which reviewed data on smoking among youth in the 1990s, highlighted important statewide intervention programs, presented data on the influence of marketing by the tobacco industry and the pricing of cigarettes, and examined differences in smoking by racial/ethnic subgroup ( NCI 2001 ). In 2008, NCI published Monograph 19, The Role of the Media in Promoting and Reducing Tobacco Use ( NCI 2008 ). Although young people were not the sole focus of this Monograph, the causal relationship between tobacco advertising and promotion and increased tobacco use, the impact on youth of depictions of smoking in movies, and the success of media campaigns in reducing youth tobacco use were highlighted as major conclusions of the report.

The Community Preventive Services Task Force (2011) provides evidence-based recommendations about community preventive services, programs, and policies on a range of topics including tobacco use prevention and cessation ( Task Force on Community Preventive Services 2001 , 2005 ). Evidence reviews addressing interventions to reduce tobacco use initiation and restricting minors’ access to tobacco products were cited and used to inform the reviews in the current report. The Cochrane Collaboration (2010) has also substantially contributed to the review literature on youth and tobacco use by producing relevant systematic assessments of health-related programs and interventions. Relevant to this Surgeon General’s report are Cochrane reviews on interventions using mass media ( Sowden 1998 ), community interventions to prevent smoking ( Sowden and Stead 2003 ), the effects of advertising and promotional activities on smoking among youth ( Lovato et al. 2003 , 2011 ), preventing tobacco sales to minors ( Stead and Lancaster 2005 ), school-based programs ( Thomas and Perara 2006 ), programs for young people to quit using tobacco ( Grimshaw and Stanton 2006 ), and family programs for preventing smoking by youth ( Thomas et al. 2007 ). These reviews have been cited throughout the current report when appropriate.

In summary, substantial new research has added to our knowledge and understanding of tobacco use and control as it relates to youth since the 1994 Surgeon General’s report, including updates and new data in subsequent Surgeon General’s reports, in IOM reports, in NCI Monographs, and in Cochrane Collaboration reviews, in addition to hundreds of peer-reviewed publications, book chapters, policy reports, and systematic reviews. Although this report is a follow-up to the 1994 report, other important reviews have been undertaken in the past 18 years and have served to fill the gap during an especially active and important time in research on tobacco control among youth.

Young People

This report focuses on “young people.” In general, work was reviewed on the health consequences, epidemiology, etiology, reduction, and prevention of tobacco use for those in the young adolescent (11–14 years of age), adolescent (15–17 years of age), and young adult (18–25 years of age) age groups. When possible, an effort was made to be specific about the age group to which a particular analysis, study, or conclusion applies. Because hundreds of articles, books, and reports were reviewed, however, there are, unavoidably, inconsistencies in the terminology used. “Adolescents,” “children,” and “youth” are used mostly interchangeably throughout this report. In general, this group encompasses those 11–17 years of age, although “children” is a more general term that will include those younger than 11 years of age. Generally, those who are 18–25 years old are considered young adults (even though, developmentally, the period between 18–20 years of age is often labeled late adolescence), and those 26 years of age or older are considered adults.

In addition, it is important to note that the report is concerned with active smoking or use of smokeless tobacco on the part of the young person. The report does not consider young people’s exposure to secondhand smoke, also referred to as involuntary or passive smoking, which was discussed in the 2006 report of the Surgeon General ( USDHHS 2006 ). Additionally, the report does not discuss research on children younger than 11 years old; there is very little evidence of tobacco use in the United States by children younger than 11 years of age, and although there may be some predictors of later tobacco use in those younger years, the research on active tobacco use among youth has been focused on those 11 years of age and older.

Tobacco Use

Although cigarette smoking is the most common form of tobacco use in the United States, this report focuses on other forms as well, such as using smokeless tobacco (including chew and snuff) and smoking a product other than a cigarette, such as a pipe, cigar, or bidi (tobacco wrapped in tendu leaves). Because for young people the use of one form of tobacco has been associated with use of other tobacco products, it is particularly important to monitor all forms of tobacco use in this age group. The term “tobacco use” in this report indicates use of any tobacco product. When the word “smoking” is used alone, it refers to cigarette smoking.

This chapter begins by providing a short synopsis of other reports that have addressed smoking among youth and, after listing the major conclusions of this report, will end by presenting conclusions specific to each chapter. Chapter 2 of this report (“The Health Consequences of Tobacco Use Among Young People”) focuses on the diseases caused by early tobacco use, the addiction process, the relation of body weight to smoking, respiratory and pulmonary problems associated with tobacco use, and cardiovascular effects. Chapter 3 (“The Epidemiology of Tobacco Use Among Young People in the United States and Worldwide”) provides recent and long-term cross-sectional and longitudinal data on cigarette smoking, use of smokeless tobacco, and the use of other tobacco products by young people, by racial/ethnic group and gender, primarily in the United States, but including some worldwide data as well. Chapter 4 (“Social, Environmental, Cognitive, and Genetic Influences on the Use of Tobacco Among Youth”) identifies the primary risk factors associated with tobacco use among youth at four levels, including the larger social and physical environments, smaller social groups, cognitive factors, and genetics and neurobiology. Chapter 5 (“The Tobacco Industry’s Influences on the Use of Tobacco Among Youth”) includes data on marketing expenditures for the tobacco industry over time and by category, the effects of cigarette advertising and promotional activities on young people’s smoking, the effects of price and packaging on use, the use of the Internet and movies to market tobacco products, and an evaluation of efforts by the tobacco industry to prevent tobacco use among young people. Chapter 6 (“Efforts to Prevent and Reduce Tobacco Use Among Young People”) provides evidence on the effectiveness of family-based, clinic-based, and school-based programs, mass media campaigns, regulatory and legislative approaches, increased cigarette prices, and community and statewide efforts in the fight against tobacco use among youth. Chapter 7 (“A Vision for Ending the Tobacco Epidemic”) points to next steps in preventing and reducing tobacco use among young people.

This report of the Surgeon General was prepared by the Office on Smoking and Health (OSH), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), USDHHS. In 2008, 18 external independent scientists reviewed the 1994 report and suggested areas to be added and updated. These scientists also suggested chapter editors and a senior scientific editor, who were contacted by OSH. Each chapter editor named external scientists who could contribute, and 33 content experts prepared draft sections. The draft sections were consolidated into chapters by the chapter editors and then reviewed by the senior scientific editor, with technical editing performed by CDC. The chapters were sent individually to 34 peer reviewers who are experts in the areas covered and who reviewed the chapters for scientific accuracy and comprehensiveness. The entire manuscript was then sent to more than 25 external senior scientists who reviewed the science of the entire document. After each review cycle, the drafts were revised by the chapter and senior scientific editor on the basis of the experts’ comments. Subsequently, the report was reviewed by various agencies within USDHHS. Publication lags prevent up-to-the-minute inclusion of all recently published articles and data, and so some more recent publications may not be cited in this report.

Since the first Surgeon General’s report in 1964 on smoking and health ( USDHEW 1964 ), major conclusions concerning the conditions and diseases caused by cigarette smoking and the use of smokeless tobacco have been based on explicit criteria for causal inference ( USDHHS 2004 ). Although a number of different criteria have been proposed for causal inference since the 1960s, this report focuses on the five commonly accepted criteria that were used in the original 1964 report and that are discussed in greater detail in the 2004 report on the health consequences of smoking ( USDHHS 2004 ). The five criteria refer to the examination of the association between two variables, such as a risk factor (e.g., smoking) and an outcome (e.g., lung cancer). Causal inference between these variables is based on (1) the consistency of the association across multiple studies; this is the persistent finding of an association in different persons, places, circumstances, and times; (2) the degree of the strength of association, that is, the magnitude and statistical significance of the association in multiple studies; (3) the specificity of the association to clearly demonstrate that tobacco use is robustly associated with the condition, even if tobacco use has multiple effects and multiple causes exist for the condition; (4) the temporal relationship of the association so that tobacco use precedes disease onset; and (5) the coherence of the association, that is, the argument that the association makes scientific sense, given data from other sources and understanding of biological and psychosocial mechanisms ( USDHHS 2004 ). Since the 2004 Surgeon General’s report, The Health Consequences of Smoking , a four-level hierarchy ( Table 1.1 ) has been used to assess the research data on associations discussed in these reports ( USDHHS 2004 ). In general, this assessment was done by the chapter editors and then reviewed as appropriate by peer reviewers, senior scientists, and the scientific editors. For a relationship to be considered sufficient to be characterized as causal, multiple studies over time provided evidence in support of each criteria.

Table 1.1. Four-level hierarchy for classifying the strength of causal inferences based on available evidence.

Four-level hierarchy for classifying the strength of causal inferences based on available evidence.

When a causal association is presented in the chapter conclusions in this report, these four levels are used to describe the strength of the evidence of the association, from causal (1) to not causal (4). Within the report, other terms are used to discuss the evidence to date (i.e., mixed, limited, and equivocal evidence), which generally represent an inadequacy of data to inform a conclusion.

However, an assessment of a casual relationship is not utilized in presenting all of the report’s conclusions. The major conclusions are written to be important summary statements that are easily understood by those reading the report. Some conclusions, particularly those found in Chapter 3 (epidemiology), provide observations and data related to tobacco use among young people, and are generally not examinations of causal relationships. For those conclusions that are written using the hierarchy above, a careful and extensive review of the literature has been undertaken for this report, based on the accepted causal criteria ( USDHHS 2004 ). Evidence that was characterized as Level 1 or Level 2 was prioritized for inclusion as chapter conclusions.

In additional to causal inferences, statistical estimation and hypothesis testing of associations are presented. For example, confidence intervals have been added to the tables in the chapter on the epidemiology of youth tobacco use (see Chapter 3 ), and statistical testing has been conducted for that chapter when appropriate. The chapter on efforts to prevent tobacco use discusses the relative improvement in tobacco use rates when implementing one type of program (or policy) versus a control program. Statistical methods, including meta-analytic methods and longitudinal trajectory analyses, are also presented to ensure that the methods of evaluating data are up to date with the current cutting-edge research that has been reviewed. Regardless of the methods used to assess significance, the five causal criteria discussed above were applied in developing the conclusions of each chapter and the report.

The following are the conclusions presented in the substantive chapters of this report.

Chapter 2. The Health Consequences of Tobacco Use Among Young People

Chapter 3. The Epidemiology of Tobacco Use Among Young People in the United States and Worldwide

Chapter 4. Social, Environmental, Cognitive, and Genetic Influences on the Use of Tobacco Among Youth

Chapter 5. The Tobacco Industry’s Influences on the Use of Tobacco Among Youth

Chapter 6. Efforts to Prevent and Reduce Tobacco Use Among Young People

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Public Health Issue of Smoking

Info: 6268 words (25 pages) Dissertation Published: 13th Dec 2019

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Tagged: Health Public Health

The aim of this essay is to analyse the public health issue of smoking, which has major effects on the health of society and individuals within the adult population in England and Wales. Using evidence from a variety of sources including seminal texts, it will look at the cost to the NHS (National Health Service) and the policies that have been put in place by the government to address the issues surrounding tobacco use. It will also examine how the role of the nurse can promote healthy lifestyles in order to improve the health of individuals and the community.

Tobacco use is seen as the leading cause of preventable mortalities in adults aged thirty-five and over worldwide. In the UK (United Kingdom), as of 2017, there were over 7.4 million adult smokers (Office for National Statistics, 2017), 16.1% of the population in Wales smoke with 1 in 5 mortalities attributed to smoking (Welsh Government, 2012) and 14.9% of the population in England with tobacco use causing around 17% of the mortalities (Public Health England, 2015). The cost to the NHS for smoking-related illnesses in England was £2.6 billion in 2015 (Public Health England, 2017), in Wales it was £386 million in 2012/13 (Public Health Wales, 2013).

Public Health is described as the science of protecting and promoting healthy lifestyles and the well-being of individuals and their communities, to change their behaviours. This is achieved through the efficiency and organised efforts of the governments and local communities, working with individuals to make informed choices in order to minimise the risk of disease, ill health and to prolong life. (Naidoo & Wills, 2016; Scriven, 2017).

This is attained through health promotion, to work with communities and individuals to have more control in promoting and improving aspects of their health. Health promotion focuses not only on the individual but also on the social and environmental factors that affect the health and well-being of individuals to enable them to have a quality of life (World Health Organization (WHO), 1986).

Health promotion has an important role in public health. Its function is to support, empower and enable individuals and their communities to become more aware of lifestyle behaviours, in order to improve health and well-being (Scriven, 2017). This is achieved by educating communities and targeting individuals, who are considered at high risk of developing conditions that could affect their health (Naidoo & Wills, 2016). Nurses have an important role in public health and have a duty of care to prevent illness and protect the health of communities through health promotion. It is a fundamental skill of an adult nurse, in the healthcare setting to use their knowledge and skills to promote well-being, providing choice, while working in conjunction with the population, and other healthcare professionals to educate individuals on how to maintain their health, therefore prolonging life (Royal College of Nursing (RCN), 2016).

In accordance with the Nursing and Midwifery Council (NMC) The Code (2015), all names and locations have been changed in order to ensure patient confidentiality.

Smoking tobacco has been deemed as one of the leading health concerns in the world. It is believed to be the primary cause of many illnesses and the highest cause of preventable mortalities in the UK (Grant, 2017).

Tobacco use has accounted for almost 78 thousand preventable mortalities that occurred in England in 2016 and over five thousand five hundred mortalities in Wales every year (Office for National Statistics, 2017).

It is thought there are over four thousand different chemicals found in tobacco smoke, including tar, nicotine, benzene and ammonia. Of these four thousand chemicals, more than fifty are said to cause cancer (ASH, 2014).

That being said, the Centre of Disease Control and Prevention (CDC) agree that smoking is linked to a number of serious health issues such as lung cancer, chronic obstructive pulmonary disorder (COPD) and illnesses concerned with the cardiovascular system. Along with other organs in the body that could prematurely cause the death of half of the lifelong smokers (Centres for Disease Control and Prevention, 2018). The WHO concur with this information, confirming that people who smoke at least a packet of cigarettes a day are reducing their lives by at least seven years compared to those who don’t smoke (Da Costa e Silva, 2003).

As of 2017, there is around 15.1% of the population, that’s 7.4 million people who smoke in the UK, with Wales having 16.1% of smokers, this is equivalent to 386 thousand people. England currently has the lowest percentage of smokers with 14.9%, equivalent to 6.1 million people (Office for National Statistics, 2017). In 2010 both England and Wales had 25% of their population smoking, when the information is compared to 2017 it shows the prevalence of tobacco use has decreased by 8.9% in Wales and 10.1% in England (Public Health Wales Observatory & Welsh Government, 2012 & Office for National Statistics, 2017).

Studies have also shown that men are still more likely to smoke than women (National Institute on Drug Abuse, 2018). This could be due to the fact that more men among the unskilled manual workers, use tobacco to obtain the effects of the nicotine, by activating the reward pathway when they smoke (Graham, Jefferis, Manor, Power, 2004). Whereas women are less likely to do manual labour and more likely to do office work, where smoking is seen as a social disapproval (Fong & Hitchman, 2011), however, Women are given a false belief that smoking assists them to lose weight and with increasing numbers of women working in male-dominated occupations, receiving pressure from the job causes them to suffer from mental health conditions (Gardiner & Tiggemann, 2010), and smoke as a way to relieve stress and regulate mood (National Institute on Drug Abuse, 2018). In some countries, however, women are being empowered to smoke, thus closing the smoking rates between men and women (Fong & Hitchman, 2011).

In 2010 in the UK it can be seen the smoking population was made up of 21% of men and 20% of women who smoked, when this is compared to 2016 it shows the prevalence of smokers has decreased to 17.7% of men and 14.1% of women, ASH, 2017).

Since the smoking ban came into force in 2007, the cost of a packet of cigarettes has increased from £5.33 to a staggering £9.91, making the annual cost to the individual who smokes 20 a day, over £3500 (Statista, 2018). With the cost of cigarettes increasing, the prevalence of tobacco use has declined, with people more willing to quit and choose a healthier lifestyle. However, despite the downward trend of smokers, 39% of children are still being exposed to second-hand smoke (Welsh Government, 2012).

Even with the decline in smokers, the cost to NHS England in 2015 was £2.6 billion, with over 520 thousand admissions into a hospital from smoking-related illnesses in 2015/16 in adults over 35 years old (Public Health England, 2015). However, while the NHS cost is high for tobacco-related illnesses, it can be argued that the government in the 2017/18 financial year made over £8,827 million from the duty paid on cigarettes, profiting from people who smoke, therefore if the UK was to become smoke free, the country would be worse off financially (Dickson & O’Kane, 2018).

While across the border in Wales the cost to the Welsh NHS was £302 million in 2017. This is a result of 26489 smoking-attributable admissions into hospital, placing a significant burden on the Welsh NHS services (Public Health Wales Observatory, 2017). This does not include the cost to the Welsh government. Their cost is a staggering £790 million every year as a consequence of smoking-related fires, in homes and businesses, clearing up cigarette ends from the streets and also absences from work which have resulted in an estimated 1 million days that are lost. (Grant, 2017).

This also costs businesses approximately £8.7 billion a year, due to lost productivity, as a result of the number of smoking breaks and absences taken due to smoking-related illnesses (Centre for Economics and Business Research, 2014). To reduce the amount of days that are lost due to absences and improve productivity, the employer could support the employee to quit smoking (Healthy Working Wales, 2018), by encouraging them to attend smoking cessation support sessions without the loss of pay and also promote the employees to participate in no smoking days (Healthy Working Wales, 2018). This could save a company up to four thousand pounds a year as a result of less sickness and employees having shorter breaks (Healthy Working Wales, 2018).

Looking at the local health board area, tobacco use has decreased in the ABMU ( Abertawe Bro Morgannwg University Health Board ) area from 23% in 2013/14 to 19% in 2015. This result is a promising start showing the prevalence of tobacco use is falling and ABMU is on target to reach 16% of smokers by 2020 (Newbury Davies, 2017).  It is also said 22% of the population in Swansea are currently smoking with the lowest rate in Cardiff with 14%.

Even though the prevalence has fallen, it is believed that smoking has risen in the unemployed by 2%, (ASH Wales, 2018) possibly as a result of psychosocial factors. Suggesting those who smoke are affected by the stress, low self-esteem, and financial issues of being unemployed (Santinello & Vogli,2005). This epidemiology data does not provide an accurate account of current smokers but it does allow us to identify important information in the health of the population. However, it only provides part of a picture and consideration needs to be given to the socio-economic and environmental factors that affect the health of the individual and communities (Scriven, 2017).

Socio-economic and environmental factors known as determinants of health such as education, employment, housing and social status are said to have an influence on the health of both the community and individual (Matthews, 2015). With tobacco use is said to be linked to the different socio-economic groups, being at least four times higher in the most deprived areas in the UK than the most affluent areas. It is also said that the social and economic inequality in social classes is one factor that determines the increasing variation of life expectancy between classes (Amos, Bauld, Hiscock, & Platt, 2012).

It can be argued that people in the lower social groups living in the deprived areas of the UK, where they may have insecurities from low income, mental health or even homelessness are more at risk of smoking as a way of dealing with their concerns (Matthews, 2015). Therefore, being at higher risk of stroke or heart disease which will have a detrimental effect on their health and well-being (Kozier et al., 2012).

Tobacco use in 2017 was found to be higher in the unemployed with 29% compared to 15.5% of employed people (Office for National Statistics, 2017). However, this could be due to a decline in the employed people smoking, whereas the unemployed there is only a slight decline (Amos et al., 2012). It also found that the people from the lower class who were employed in routine and manual occupations such as lorry drivers, care workers and bar staff, accounted for 25.9% of the smokers in the UK. This, however, could be as a result of the lower class smoking habit, having the opportunity to smoke and peer pressure (Coleman & Sherriff, 2012) While those in the higher classes working in managerial and professional occupations such as teachers, lawyers and nurses have accounted for 10.2% of smokers. This shows that there is a significant difference between the higher and lower echelons of the working class, with the lower echelons twice as likely to smoke (Office of National Statistics, 2017).

Social inequality in health can also be explained further by other risk factors in the lifestyle and behaviours of individuals. These include the lack of physical exercise and the number of unhealthy foods that are eaten. Even though these are considered to be common lifestyle choices in the socio-economically worse off and can be attributed to serious health issues such as cardiovascular disease,  (Marchman Anderson, Oksbjerg Dalton , Lynch , Johansen , & Holtug , 2013). It can be argued that it is a result of the level of income they receive, with the more money they receive the better their health and well-being as they less likely to eat unhealthily, so will feel better in themselves and more likely to exercise (Rowlingson, 2011).

Social factors that could influence an individual to start smoking may exert from different routes, such as pressure from peers or groups of friends, where they all smoke, showing 19.7% of smokers are between the age of 25 to 34 years’ old (Office for National Statistics, 2017). Family members who may see smoking as part of a normal lifestyle, or even people exposed to misuse of drugs, alcohol and also stress therefore increasing the likelihood of the individual to start smoking (mental health Foundation, ND).

One of the main psychological factors that may account for individuals to choose to smoke as a lifestyle choice, maybe down to the individual having stress or even having mental health issues (Mental Health Foundation, ND). Once the individual has had that first hit of nicotine, it is said to improve their mood and concentration, especially if they are stressed. It is also said to decrease anger and suppress appetite (Mental Health Foundation, ND). The nicotine does, however, cause an addiction in the body, with regular smoking the dose of nicotine the body receives leads to changes in the brain. To function normally, the brain begins to rely on the nicotine, when individuals smoke they are exposed to the other chemicals, which can cause smoking-related conditions (Benowitz, 2017). When the individual attempts to quit smoking, the body doesn’t get the nicotine it’s come to rely on and the individual begins to experience withdrawal symptoms such as irritability, anxiety and increased appetite (Mental Health Foundation, ND). These factors can impact health inequalities, especially in the lower socio-economic group

In 2008, the WHO introduced a framework on the convention of tobacco control in the global population. It provided the world with six evidence-based control measures, aimed at reducing the use of tobacco in each country. These guidelines were known as (MPOWER), referring to (M) monitoring the use of tobacco and prevention policies, (P) protecting populations from tobacco smoke, (O) offering people programmes that help them to quit. (W) Warn the population of the risks, (E) enforce bans on advertising, sponsorship and promotion of tobacco use and (R) raise the taxes on tobacco products (WHO, 2015).

In 2013, the World Health Organisation (WHO) then put together a world tobacco target, with aims to reduce the number of smokers worldwide by 30%, in order to protect the next generation of people. This is a consequence of tobacco being the only legal drug that prematurely causes the mortality of at least 6 million smokers and non-smokers worldwide (WHO, 2015).

In light of this, the British government continue to aim for a tobacco-free country and following the guidelines from the WHO, the British government to date has banned television and tabloid advertising of tobacco products. They have also banned smoking in enclosed spaces, in an attempt to protect non-smokers from second-hand smoke (Department of Health and Social Care, 2015).  In 2016 the government made it law for all tobacco products to be sold in plain packets with pictures of the effects smoking has on the body and a strongly worded health warning, they also set high taxes on tobacco products in the hope to reduce the number of young adults and those on low incomes from smoking (Department of Health and Social Care, 2015).

The Welsh government is also wanting to improve the health of the communities and have taken some major steps to lower the number of Welsh smokers. They are striving to achieve this by setting laws to protect people. Since the smoking ban in 2007, where it was made illegal to smoke in enclosed spaces, air quality has improved and the exposure of second-hand smoke in adults has reduced (Malam, 2015).

In 2015 the Welsh government made it law for all shops to cover their displays of tobacco products and made it an offence to sell e-cigarettes to under eighteen, in the hope that by reducing the advertising of tobacco products, adults would be less likely to start smoking. It was also made illegal for adults to smoke in their cars whilst a child is present, reducing the risk of children being exposed to second-hand smoke (Welsh Government, 2017). This can be argued that the new policy is an invasion of privacy and infringed the rights of people’s freedom (Bain et al., 2014).

The Welsh government have produced a review of services aiming to achieve a smoke-free Wales and improve the health and well-being of the population. Working with seven local health boards, local governments and private sectors, all with the aim of improving the health and quality of life of individuals and communities, by providing services in areas that are deemed to be in most need (Public Health Wales Observatory, 2015).

Wales has goals to protect the well-being of future generations by providing a national framework that allows Wales to improve and grow as a nation and reduce the smoking population by 5% in the next four years, through the services currently available. Currently, the policies that are in place, aim to improve the quality of life and health of individuals in Wales (George, Griffiths, Tomlinson, Scholey & Williams, 2018).  However, these policies are designed to enable individuals who are at greater risk of health issues to choose and live healthy lifestyles. Our healthy future focuses on preventing ill-health by having a strategic plan which addresses issues such as social and environmental determinants, including housing, transport, education and exercise. To achieve this, commitment is needed from the public, private and third sectors (Public Health Wales Observatory, 2015).

To reduce health inequalities, it is imperative to target community areas that are most deprived, with smoking being a single factor that causes ill-health. It is important to reduce the number of individuals who use tobacco, this can be achieved through health promotion (Public Health Wales Observatory, 2015).

There are four behaviour change models in health promotion, that aim to change the behaviour of patients. These are the cognition model; focusing on the individual and how they think. Social cognition model; focuses on the influence others have on the individual’s behaviour. Empowerment; takes into account the difficulties individuals have to change their behaviour. However, these models are unlikely to work on their own, so Prochaska and DiClemente (1982) devised the trans-theoretical stages of change model, which incorporates the three other theories. (Evans, Coutsaftiki & Patricia Fathers, 2017).  It is believed individuals go through each stage when improving their lifestyles and can relapse at any time. These techniques enable health professionals to improve the success rate of individuals who quit smoking (Davies, 2011).

There are five stages to the model. Pre-contemplation; contemplation; preparation; action and maintenance. The task of the health professionals is to determine the readiness of the patient to change and assist them to move from one stage to another. It aims to educate and support people, hoping lifestyle choices and behaviours can be changed in order for them to lead a normal healthy life (Evans et al., 2017).

With six in ten people wanting to quit each year and some attempting to quit with no help, the Welsh government produced a number of initiatives that have been tailored to assist and motivate smokers to quit. These services have to be readily available to the public (Evans, 2017).

To provide these services, healthcare providers need to have good professional values, knowledge of various roles, responsibilities and also good patient-centred communication. This is fundamental if the patient is going to attempt behaviour change (Davies, 2011).

Utilising the skills in the framework developed by the public health and health and social care, which is based on Prochaska and DiClemente’s stages of change and also incorporating evidence-based practice to stop smoking, produced by NICE guidelines. Which has made recommendations that include providing behaviour support that is delivered by trained staff, nicotine replacement therapy and advice (National Institute for Health and Care Excellence, 2018). Which involves assessing the smoking behaviour of the patient past and present, provide information on the effects of smoking and not smoking, options for additional support and advice on medications (National Centre for Smoking Cessation and Training, 2018).

MECC (Making every contact count) aims to educate all NHS organisations in improving the health and well-being of the population (Making Every Contact Count, 2018). To bring together service and education providers along with individuals to change the systems and improve healthcare responsibilities, promoting all areas that affect the health and well-being such as psychological, socio-economic and environmental factors (Evans, 2017).

By adopting a systematic approach, working effectively in partnership with other organisations in the different sectors, focusing on individuals who are ill to improve their health and protect the population against potential ill-health, with the aim of improving the quality of health and reducing the life expectancies between classes (Department of Health, 2013).

Nurses have a major role in promoting healthy lifestyles, using day to day interactions that involve the local people to provide positive changes in their physical and mental well-being. They have the opportunity to improve nurse-patient interactions and engage with individuals and the communities, to change health behaviours and following the guidelines produced by MECC, they will be able to communicate in a way that encourages individuals to be open, acknowledging the individual’s rights to make their own decisions about their health.  Nurses will also gain the confidence and competence to provide advice that encourages behaviour change and direct patients to the appropriate services (Making Every Contact Count, 2018).

Services that are currently available in Wales are Stop Smoking Wales, currently supported by public health Wales. ABMU Health board have; Help Me Quit, this service provides one to one support over the phone and face to face. There are also eighty-four community pharmacies that have been trained to level 3, which allows them to support smokers in the most deprived areas (Newbury Davies, 2017). However, even though lower economic classes will use the stop smoking sessions, they may not completely stop, this could be due to the lack of motivation or having a stressful lifestyle, being nervous and depressed or have a lack of support outside the services, leading to smokers relapsing (George et al., 2018).

This essay has looked at the public health issue surrounding the use of tobacco, which is currently the leading cause of preventable mortalities in the UK and has had major effects on the health of society and also the individual. Having used evidence from a variety of sources, looking at costs to the NHS and local governments, the policies that are in place and what the nurse’s role is to promote healthy lifestyles.

This evidence showed that there is still 7.4 million people who use tobacco in the UK. Life expectancy is reduced by seven years for every packet of cigarettes smoked a day and over 50 cancer-causing chemicals found in the smoke of cigarettes. Individuals in the lower classes continue to smoke more than the affluent, being more common in men of the 25 to 34-year age group. This could be a result of social-economic and environmental factors, as smoking is seen to be linked to the unemployed, homeless and those who are socio-economically worse off, it can often be an attribute to other health conditions such as stroke and heart disease.

Smoking-related illnesses are currently costing the Welsh NHS £302 million a year with over 26 thousand admissions to hospital. However, it is also said that while costs for the NHS are high, the government is profiting from the sale of cigarettes.

Since the smoking ban in 2007 the prevalence of smokers has declined, with the government wanting to eradicate smoking, policies have been put in place to help smokers to quit and reduce the numbers of people starting to smoke. This is done with the hope that by reducing the number of smokers will reduce some of the inequalities and the life expectancy between classes will be minimised.

Services currently in place, like Help Me Quit and the 84 pharmacies are to aid the individual to become a non-smoker. By using a framework designed to assist in changing behaviour, nurses can support individuals in all areas, but mainly in the most deprived to provide motivation and support to change their lifestyle and improve their well-being.

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  1. Masters of Public Health Essay Questions

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  2. Public health issue: smoking Essay Example

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  3. (PDF) Sick cities: getting the measure of urban public health. Essay review

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  1. Smoking as a Public Health Issue

    1.1 Overview of the Report. The report is designed to highlight the key epidemiological evidences pertaining to cigarette smoking, based

  2. Public Health Issue: Smoking

    The rationale for choosing this topic is because smoking is an important public health issue. The smoke is very toxic to every

  3. Public Health Issue: Smoking

    In this essay, the author · Explains that smoking is the leading cause of preventable death in the united states. · Explains that smokers are at greater risk of

  4. The Relationship Between Smoking And Public Health Essay

    Cigarette smoking is a leading public health issue worldwide and has a negative impact on the health of millions of individuals each year (American Cancer

  5. Public Health Issue: Smoking

    Free Essay: Public Health Issue: Smoking This essay is aimed to explore, analyse and discuss smoking in adults. Smoking is a public health issue as such is.

  6. Public Health and Smoking Prevention

    Smoking among adults over 18 years old is a public health issue that requires intervention due to statistical evidence of its effects over

  7. Smoking as a Public Health Issue

    Besides being a leading cause of preventable ill health, smoking is also a major cause of disability and premature death. There is a clear relationship between

  8. Introduction, Summary, and Conclusions

    As with adults, it poses a serious health threat to youth and young adults ... the public's health (Family Smoking Prevention and Tobacco Control Act 2009).

  9. Public Health Issue of Smoking

    The aim of this essay is to analyse the public health issue of smoking, which has major effects on the health of society and individuals

  10. Essay on Smoking in English for Students

    Tobacco can have a disastrous impact on our health. Nonetheless, people consume it daily for a long period of time till it's too late. Nearly one billion people