Smoking_in_Adults

Smoking in Adults This essay will consider what has been, and what can be, done to address cessation of smoking in our society. Firstly, figures showing how many people smoke in the UK will be a briefly outline as well as health issues related to smoking. A detailed explanation of why the uptake, continuation and cessation of smoking is so divergent in different areas of the county and what influences these differences will be conducted. The government and local authorities have implemented many policies to assist the smoker in giving up the habit and these will be discussed and evaluated whilst concurrently being compared to the results of a carefully selected level 1 systemic review. Finally, when all of the above information has been analysed government and local authorities future plans to address the cessation of smoking will be included and a conclusion of all the above will be drawn. The information for this essay was gathered by using a search strategy to ensure only valid and reliable material was used (see appendix 1 for search strategy). In England in 2005, 26% of men and 22% of women in the adult population smoked. This number has been steadily falling in recent years, with those 50-59 years showing the most prominent reduction from 44% in 1980 to 24% in 2005 (National statistics 2007). The number of adults that have never taken up this habit is also increasing to 53% in 2005 compared to 43% in 1982 (National statistics 2007). 72% of adults currently smoke in Great Britain In 2006 said they wanted to give up smoking due to their health and 78% of them have already tried (National Statistics 2007). The number of smokers may be falling but diagnosed premature illness and death believed to be caused by the habit has been rising in recent years. “Smoking is the principal avoidable cause of premature deaths in the UK. Smoking kills over 120,000 people in the UK every a year- more than 13 people and hour. Every hour, every day“(Smoking Kills- a White Paper on Tobacco, 1998, Chapter 1) In England in 2005 approximately 17% of all deaths in the 35 years and over age group were believed to be caused by smoking. This amounts to a staggering 81,900 deaths that could have been prevented. 36,700 of these deaths were from cancer, 23,600 deaths from respiratory diseases, 20,00 deaths from circulatory disease and 1,600 deaths from digestive system diseases(National Statistics 2007).there are many policies aimed at reducing this devastating scene, however, the decision to give up smoking, or not, is not so cut and dry for some people. Social inequalities hugely contribute to the uptake, continuation of and cessation of smoking. Sir Douglas Black, chairman of the group that produced the Black report, provided a detailed study showing a correlation between mortality, morbidity and social class (Naidoo & Wills 2000). People from the lower social classes are more likely to participate in unhealthy behaviors such as smoking are less likely to want to give up than people from the higher social classes (See appendix 2 for bar chart). In most social classes smoking cessation rates have more than doubled since 1973 from 25% to more than 50 5 in 1996 but in the lower social class smoking cessation rates have shown very little change from 8-9% in 1973 to 10-13% in 1996 (NICE 2003). This is mostly due to the stresses of a low income (Haralambos & Holborn 2004). The Black Reports (1988) suggest s that these differences were due to social inequalities and influences such as; housing, income, employment, diet, education and work conditions and to tackle this, socioeconomic changes have been made. The Black Reports recommendations were not pursued by the Government and many people did not even know of the reports existence as only a few copies were released (BMJ 2005). THE Acheson report (1998) revealed similar finding to the Black report and was in complete agreement that mortally rates have lessened and health has improved but inequalities between the social classes has risen dramatically, therefore, policies needed to be put into place to lessen the gap but must have a greater impact on those from lower, less well off classes. More recently a public health: Making Healthy Choices Easier (DH 2004) this white paper primarily focused on improved the health of the population and was devised to make it easier for more people to adopt a healthier lifestyle and be able to stick to it. Smoking was a serious issue on this paper and action plans were put into place to ban smoking in public and work places, the NHS to become the smoke free, a stop smoking campaign adapted around these nurses, picture warnings on cigarette packs, more tobacco advertising restrictions and harsher penalties for shops selling tobacco products to children (DH 2004). These polices will be expanded on later. As already mentioned above social inequalities have many influencing factors that are mostly centred around social class and income (money). However, there are many other aspects in life that can influence someone to start or continue to smoke. A holistic approach needs to be taken in reference to the biopsychsocial model of health which considers biological, psychological and social factors. Graham & Blackburn (1998) suggest that people, especially mothers on low income, participate in unhealthy and risk taking behaviors such as smoking as a means of coping with their life circumstances, this relates to their psychological health. Continuing smoking may also be seen as a way of saving money for those who are poorer as smoking replaces food. This can relate to psychological health as this is a behavior which is believed to be acceptable and social health as trying to save money directly relates to income and employment (Haralambos & Holborn 2004). Those people on a lower income tend to have immensely lower levels of psycho-social health than people who are financially better off which means they usually get involved with less social activities which is mainly due to financial reason. They indulge in more activities that are bad for them because that is what most people around them in their community are doing and behaviors such as smoking help them deal with stress. Often people from low income area have a limited knowledge of what is good for them and limited access to facilities and help which is down to poor education and health promotion in their area (Haralambos & Holborn 2004). It is now clear to see why certain areas have a higher prevalence of smoking than others. The Government has recongnised these problems and put many policies into place in a bid to combat them. Some of the polices implemented by the Government to combat smoking and to help motivate and support smokers who want to quit are as follows; NHS stop smoking services have been made available across England led by specially trained nurses or pharmacists who aid people who want to quit smoking by means of counseling and support. In the years 2003-2006 £138 million was allocated to the NHS stop smoking services (DH 2007). The use of nicotine replacement therapy (NRT) which was available on prescription April 2001 was the most common form of quitting aid as 79% of people who set a quit date received it. Zyban (buporpion) which was available on prescription June 2000 and also proved to be popular aid (DH 2007). The DH funded a team from Glasgow University to conduct and evaluation to look at cost of effectiveness of NTR and Bupropion to see if it really helped smokers to quit. The study showed that services are cost effective and smokers that use NRT and/or Zyban were four times likely to quit than those who were quitting by willpower alone (DH 2007). These finding were also confirmed in a carefully selected systematic review. This review showed beyond no doubt, that using NRT (gum and patches) as an aid to stop smoking was ore effective than willpower alone and also proves to be more cost effective than any other interventions for smoking cessation. The smoking cessation programme in England & Wales is estimated to cost the NHS £67 - £202 million a year, 45,000 – 135,000 people would quit by using the service saving approximately 90,000 – 270,000 life years, therefore cutting NHS costs (NHS Centre for Reviews & Dissemination 2002). Advertising under the new proposed laws published on the 17th June 1999 the European Government planned to ban all forms of direct and indirect advertising in magazines and newspapers and on billboards from December 10th 1999. However, behind the counter display units and price lists were still allowed (DH 1999). July 2003 will see the end of tobacco sponsorship except for formula 1 as they depended highly upon the advertising of tobacco products for sponsorship. They were given three extra years on the condition that they reduced tobacco advertising by fifth for each of those three years (DH 1999). September 2006 saw the ban on tobacco advertising on the internet come into action (DH 2007). Regular Tobacco Products; Pack Labelling in 2003 larger health warning on tobacco packs were introduced and were designed to have more impact on the smoker. 2003 also forbid the use of terms such as low tar, midland light as they were deemed misleading and maxim tar, carbon monoxide and nicotine levels were introduced (DH 2007). An announcement in August 2007 introduced the use of picture warning on cigarette packets which we should see by the end of 2008 and on other tobacco products in 2009 (DH 2007). Smoke free England was introduced in England on July 1st 2007. It prohibited smoking in nearly all enclosed public and work places in a bid to reduce the effects of second hand smoke on a persons’ health. This means it is now illegal to smoke in pubs, restaurants, night clubs, membership clubs, and shopping centres (etc). This also includes public transport and company vehicles used by more than one person for work (NHS 2007). Age Change for Selling Tobacco As of 1st October, in England, it became illegal to sell tobacco products to anyone under the age of 18 years. This action has been taken to stop children becoming addicted at a young age, as a child of 15 years is more likely to die from cancer due to smoking than an adult who starts smoking in the early twenties. It is believed that this action will help combat the rising of number of young smokers. A consideration for cutting down the number of young smokers, by removing what is more affordable to them, is to ban the sale of 10 packs of cigarettes. The former health secretary, Patricia Hewitt, has also considered the ban on cigarettes being displayed in supermarkets and removing vending machines from pubs in a bid to reduce access to young smokers (Times Online 2007). Another proposed ban being considered by DH is to stop people from smoking when driving. Britain’s senior road safety campaigners believe this action would prevent a number of road accidents on our roads (The Guardian 2007). As we have seen, the Government is doing a lot in a bid to reduce the number of smokers in England and we have seen examples of what else they have planned. Local authorities are responsible for meeting smoking cessation targets in their area by enforcing Government polices and coming up with their own drives. Telford and Wrekin and Shropshire County have a Help 2 quite scheme which is their main smoking resource and this is delivered in GP surgeries, pharmacies and schools by trained nurse. The Telford and Wrekin council also launched a road show at Telford shopping centre to coincide with the National no smoking day. The Department of Health (DH) published the ‘Priorities and Planning Framework 2003-2006’ document which included targets to be met for smoking cessation. Their aim is to improve smoking cessation uptake in the over 65s and reduce the numbers of adults smokers locally to 21% by 2011 (Telford & Wrekin PCT). Efforts will be directed more towards groups to enable a possible 6% decline amongst routine and manual groups from 32% in 1998 to 26% by 2011. This means that the average PCT will have to produce 900 successful quitters at four of being quit (NHS 2003). The Shropshire county and Telford and Wrekin primary care trust (PCTs) are the only two PCTs meeting the national target for cessation of smoking in the west midlands ( Shropshire County PCT). This essay has considered the health risks related to smoking and what factors influence a person to smoke. Inequalities in health have been explored and an explanation of Government white paper aimed at reducing inequalities has produced. The Government have implemented many policies to enable smoker to quite more effectively and these policies and their success can be seen a local levels. The Government are considering a number of new bans to aid in smoking cessation and only time will see if these will be implemented. Overall, smoking cessation in England is increasing but we can not expect to see any overnight changes, it takes time to reduce an action that is so prevalent but evidence shows that we are doing the right things and showing good progress. References Acheson, D (1998) independent Inequalities in Health Report. London, Stationary Office Department of Health (2004) Choosing Health; Making Healthy Choices Easier. London, Stationary Office Department of Health (2007) NHS Stop smoking Services & Nicotine Replacement Therapy [Accessed on 30/05/ 2010]. http://wwwdh.gov.uk/en/Pplicandguidance/healthandsocialcaretopics/tabacco/Tobaccogeneralinformation/DH Department of Health (2007) Reducing Tobacco Products [Accessed on 20/05/ 2010]. http://www.dh.gov.uk/enPolicyandguidance/Healthandsocialcaretopics/Tobacco/Tobaccogeneralinformation/DH Department of Health (1998) Smoking Kills: A White Paper on Tobacco. London, The Stationary Office. http://ww.archive.officaldocuments.co.uk/documents/cm/htm [Accessed on 30/04/10]. Department of Health (1999) Tobacco Advertising to End By December http://www.dh.gov.uk/en/publictionandstatistics/pressreleases.DH [Accessed 2010] Dowrick,C et al (1996) The Biopsychoscial Model of General Practice: rhetoric or reality' The British Journal of General Practice. http://www.pubmedcentral.nih.gov/articerender.fcgi'tool=pubmed&pubmedid=8855018 [Accessed 2010] Graham & Blackburn (1998) (cited in) Haralambos, M & Holborn (2004) Sociology Themes and Perspectives (Sixth edition) London, Collins Haealambos, M. & Holborn, M (2004) Sociology Themes and Perspectives (Sixth edition) London, Collins Naidoo, J & Wills (2010) Health Promotion: Foundation For Practice ( edition). London, Bailliere Tindall. National Institute for Health and Clinical Excellence (2003) Rapid mapping study of smoking project and services targeted at people living on low income and/or minority ethnic groups http://www.nice.org.uk/aboutnice/whoweare/abouttehda/hdapublication/rapidmappingstudyofsmokingprojectandservicestargetedatpeople livingonlowincomeand/orminorityethnicgroups.jsp [Accessed on 07/06/2010] National Statistics (2003) Twentieth Century Mortality trends In England and Wales. http://www.statistics.gov.uk/articles/HSQ/msrtalityTrends [Accessed 2010 ] NHS (2007) A Healthier England from July 1st 2007; Individuals http:/www.smokefreeengland.co.uk/what-do-i-do/individuals.html [Accessed 2010 ] NHS Center for reviews & Dissemination (2002) A rapid and systematic review of the clinical and cost effectiveness of bupropion SR and nicotine replacement therapy (NRT) for smoking cessation. University of York. http:/www.nice.org.uk/nicemedia/pdf/Buprpronreview. [Accessed 2010 ] NHS Direct (2007) why has the age you’re allowed to buy cigarettes increased' http:/www/nhsdricet.nhs.uk.article.aspx'articled [Accessed 2010 ] Shaw, Met al (2005) Labours “Black Report” moment' BMJ Publishing Group Limited. http://www.bmj.com/cig/content/full [Accessed 2010] Shropshire County Primary Care Trust (2007) Health Improvement Quarterly Performance Improvement Report Quarter5 2008/9 http://www.shropshirepct.nhs.uk/bordpapers/ [Accessed 2010] Telford & Wrekin Council (2007) 83,000 lives in the west middles could be saved if smoker quit for good http://wwtelford.gov.uk/Council+democracy/Press+Releases Accessed [2010] Telford & Wrekin Primary Care trust (2005) Plan for Health Improvements and Health Services improvements for the Population of Telford & Wrekin http://www.telford.gov.uk/NR/rdonlyres/76DFF-0919-4CE2-8F91-BBED273981DF/0/TandWPrimaryCareTurstPlans [Accessed 2010] The Sunday Times (2007) Ten-cigarette packs face ban to put off teens. http://wwwtimesonline.co.uk/tol/news/health/article [Accessed 2010] Townsend,P & Davidson,N,(1998) Inequalities in health-the Black Report, Pelican. West, Ret al. (2003) Meeting Department of Health smoking cessation targets, Recommendation for Primary care Trust. London, Health Development Agency. http://www.scsrn.org/policy/smo [Accessed 2010]