Smoking and Public Health
Abstract
Smoking has been closely related to public health according to studies that have been conducted throughout the years. It has been related to diseases such as cancer, respiratory diseases, and disabilities among other conditions. Smoking is a public health problem that affects all the demographics globally. Cultural differences, social norms and peer groups of smokers are causes of people to begin smoking. Due to the increase in the smoking trends, which have also affected the teenagers, policies have been put in place to reduce the tobacco products intake. Public policies put by the government and other institutions are important in ensuring that people quit smoking and improve the public health. Social influence in smoking contributes both positively and negatively depending on the social context. To curb the smoking and public health issues, policies need to be made more realistic and effective considering the morbidity and mortality rate associated with smoking.
Introduction
Smoking and public health are both correlated. A correlation between smoking and cancer was hypothesized in the early 1900s, with a few limited studies conducted in the United States. These studies did not provide a conclusive argument for the relationship between smoking and cancer, and it was not until a study that began in 1952 and concluded in 1955, interviewing and recording the health of 188,000 volunteers that the medical community in the United States believed that there was a confirmed connection between smoking and cancer (Mendes, 2014). This study was led by two members of the American Cancer Society, E. Cuyler Hammond, Ph.D., and Daniel Horn, Ph.D.
Following this study, the US Surgeon general used the American Cancer Society’s study and other associated studies to develop a conclusive federal level report in 1964 stating the fact that smoking causes cancer. Shortly after this report, in 1966 the first caution label was placed on cigarette packing warning of negative health risks associated with smoking (Mendes, 2014). Since this point in history, American culture has moved away from smoking and tobacco use products gradually. 54 years later, in modern-day 2020 America, smoking still causes a negative public health impact, with an estimated 480,000 deaths annually in the United States alone. In addition to the mortality rate, the Centers for Disease Control (CDC) estimates that over 16 million Americans live with disabilities directly related to smoking, increasing national health care costs by $170 billion annually.
To address this issue, regulations have been placed on the tobacco industry and tobacco users on both state and federal levels. These regulations have been effective in mitigating tobacco use, specifically smoking, to some extent. To more effectively mitigate healthcare impacts caused by smoking, a combination of social influence and public policy must be utilized in conjunction with one another.
Impact on the individual
There is a quantifiable disparity of impact to a wide variance of the population. Smoking can be associated more closely with particular demographic sections of the population. To develop an ability to have a positive effect on public health through public policy, regulation and social change are dependent on recognizing the most at-risk categories for smoking and developing an understanding of the underlying cause of smoking’s persistence. Key indicators based on socioeconomic class indicate an inverse relationship between income, education, and increased risk of lung disease and smoking. In 2017 approximately 4.2% of adults in America had less than a high school diploma, 28.9% of the adult population had completed high school only, and the poverty rate (annual individual income of less than $15,000) was approximately 12.7%. (United States Census Bureau, 2017) According to the CDC, adults with lower education than a high school diploma, and making less than poverty-level wages are more than twice as likely to smoke as those who make more than twice the poverty level income wage and have a college or technical school degree (CDC, 2018). This is thought to be contributed to by the social acceptance of smoking within lower-income groups, partial resistance to “social norms” generally established by more successful groups, targeted marketing by tobacco companies, and inclusion of more smokers within social groups. The adage of “iron sharpens iron” supports the thought that when surrounded by others who smoke, the ease of access to cigarettes and lack of social support to quit negatively impact cessation efforts by those in these lower socioeconomic groups.
Often thought of as the action of a masculine individual, smoking is still more predominant in the male population within the United States. In 2018, it was estimated by the CDC that 18% of adult men were smokers, while only 12 percent of women were smokers. Studies indicate that a portion of this is due to the positive reinforcement pathways in the neurological development of the male vs the female brain. Nicotine and physical habit responses have an increased impact on male neurology response by releasing increased dopamine response. Male study participants had predictive relapses in smoking cessation during times of low cortisol, a stress hormone, while typically the inverse was observed with the female study participants (Cosgrove KP, 2014). Compounding the neurological aspect of the male trend in smoking is the social acceptance for smoking to be a masculine trait. American media firms developed film and television shows showcasing men smoking regularly, and while women were shown smoking on occasion, the quintessential strong male lead character was a highlighted smoker. Early American tobacco marketing utilized female models not to encourage women to smoke, but to use a sex-driven marketing strategy to attract more male customers.
Race can affect the prominence of smoking and the success of cessation within multiple demographic groups. When surveyed, all racial and ethnic groups show a consistent 20 percent downward trend except for American Indian or Alaskan descent. These two groups had the highest rate of smokers at 24.3% of reported males and 23.4% of reported females. Not only were these groups higher than the other racial and ethnic groups, the survey results indicated an increase in cigarette use in recent years (Cosgrove KP, 2014). Possible racial and ethnically related causes of smoking are cultural differences, social norms, and peer groups of smokers encourage new smoking and make cessation more likely to fail.
The most alarming trend is the emergence of new smokers in the age of information. In 2020, in the United States of America, information is available through internet access. There is no lack of community knowledge that smoking is expensive, losing social acceptability and damaging to the health of an individual. Many factors are involved in the creation of new smokers. Being raised in a home with smoking parents increases the likelihood that a child will smoke as an adult. The more exposure to smoking children while growing increases their likelihood of finding smoking acceptable if not becoming a smoker themselves. Lack of parental supervision, like the “latch key” generation of the late 1980s and early 1990s, also has an impact. Finally, a newly developed technology was able to temporarily skirt the US ban on smoking advertisements by creating a product that was not tobacco, but nicotine suspended in a flavored fluid, vaporized and inhaled similar to a cigarette. This new trend, referred to as “vaping” was appealing to the younger audience because it is flavored, has an attractive smell, is less detectable by adults because the odor does not linger, and has an appealing technology aspect that youth use as a social device (trading juices and devices). The use of vaping has been found to form a smoking parallel habit of use and nicotine addiction (Cancer Action Network, American Cancer Society, 2014). These addictive traits evolve into more progressive use of nicotine products and a softened view on smoking, occasionally resulting in the poly-use of tobacco products including ZEN pouches, smokeless tobacco, and cigarettes.
Introductory conclusion
Smoking is a costly, devastating public health situation that affects all demographics within the United States. In the interest of saving a life, reducing the national health care burden, and improving the quality of life for smokers now, and protecting future citizens at risk of becoming tobacco users it is imperative to develop a national effort to mitigate tobacco use. This can only happen through an effective combination of public policy and social influence.
Analysis
Effectiveness of public policy
To evaluate the effectiveness of the public policy on public health within the context of smoking by the public, a contrast can be made between the United States and Indonesia. At the federal level, the United States has enacted laws on tobacco products regulating the manufacturing, sale, and distribution of these products. As of 2019, no tobacco products will be sold anywhere in the United States to persons under the age of 21. The Food and Drug Administration (FDA) of the United States regulates the ingredients and manufacturing process of all tobacco and the application of warning labels before the retail sale (Maher, 2013). Below the federal level, individual states can choose to enact regulation more stringent than federal guidelines, but not less than. Currently, 22 out of 50 States have not passed comprehensive smoke-free workplace laws and have more lenient regulations allowing private establishments to determine to allow or deny smoking within their place of business.
In direct contrast to the United States is the Republic of Indonesia. Until 2013, there was little regulation in the tobacco industry in Indonesia. Beginning in 2013, however, the president of Indonesia, Susilo Bambang Yudhoyono, signed the Tobacco Control Regulation into country law. This regulation intended to develop an informed consumer base for tobacco products through labeling and regulation on the sales and distribution of these items. Indonesia currently has set federal standards requiring smoke-free environments in healthcare facilities, public education buildings, and places of worship (Maher, 2013). The national law in Indonesia requires the establishment of local-level regulations to support and further define national law. This results in a lack of local-level enforcement of smoking laws and often goes unchallenged as smoking can be seen regularly in individual localities within Indonesia. A 2013 documentary created by vice media group examined the tobacco centric culture of Malang, Indonesia. The culture in Malang seemingly revolves around tobacco use. As seen in the documentary, there are medical treatment providers who are not traditionally licensed promoting tobacco use as a health treatment for ailments such as non-Hodgkin’s lymphoma, hypertension, and glaucoma among other things. This practice is disputed by traditionally educated physicians in the area, but a lack of regulation allows for this activity to occur unchallenged.
While it has not been contested that tobacco can be directly linked to negative health outcomes with little benefit, the sale and use of tobacco are legal in much of the contemporary world. From a population health perspective, the ultimate solution to mitigate the negative population health effects of smoking and tobacco use would be to prohibit the manufacture, transportation, and retail sale of tobacco products globally. The tobacco industry, globally, is an approximate $808 Million per year venture. The controlling interests have a financial incentive to maintain and grow this revenue. This is evidenced by the annual revenue growth chart presented below (Statista.com, 2020). The result of the preservation of self-interests by the tobacco industry is a financial investment in political influence and marketing. The more lenient the legal guidelines are for the tobacco industry; the greater the profit margins can be attained. Currently, tobacco regulation and enforcement efforts have stalled in Indonesia as a result of political and monetary influence from the tobacco industry (Maher, 2013).
(Statista.com, 2020)
Since the institution of regulation on the tobacco industry in 2013, Indonesia’s smoking rates have continued to slowly rise until 2016, which is the most recent data available at the time of this report. In 2011, Statists reported 57.96 million smokers, and in 2016, the same survey reported 63.33 million smokers, an increase of almost 10% in 5 years (Centers for Disease Control, 2018). The United States has shown a sharp decline in smoking in the same period, in 2011 with 43.8 million smokers, and trending downward to 37.8 million smokers. A decline of approximately 14% and 6 million people.
The two notable factors in the decline in smoking in the United States that are not present within the Indonesian community are governmental regulation on the national, state, and local level and the social trending of society to move away from tobacco use. Unlike the 1950s when many characters portrayed in television and film were smoking, modern Americans have developed an observable shift away from the social acceptance of tobacco use. This is evident in media, where smoking occurs rarely, and if it does, it is likely portrayed in a negative light. Restaurants and bars in 28 states have been restricted by state-level laws and enforcement to prohibit smoking indoors, while other retail facilities have chosen to prohibit smoking as a response to an increase in revenue, or a local patchwork of city and town level laws (Cancer Action Network, American Cancer Society, 2014). To further expand on the financial advantages of a smoke free environment in the public sector, research indicates that smoking cessation will reduce the number of sick days used, reduce doctor’s office visits, lower insurance costs, and improve quality of life for the employee. A better quality of life will likely result in a more positive employee and workplace environment.
In Indonesia, the prevalence of smoking has constantly been on the rise annually and more so in the adolescent's groups. In the United States, research shows that adolescents consume tobacco products every day. Smoking has become a more important issue among adolescents globally. Due to these statistics, the Indonesian government has set policies to deal with smoking behaviors. These policies include several regulations geared toward regulating cigarette advertisements, smoking-free areas, and healthy living behaviors. In schools, smoking behaviors are tackled through health education on the health dangers of smoking and setting up free smoking areas (Kumboyono, Hamid, Sahar & Bardosono 2020). However, these policies are not enough to curb the rate at which smoking is increasing. It is therefore important for the government to come through in developing strategies that will assist in overcoming the smoking behaviors. For these strategies to be effective, the government has to involve the community for them to be successful. Adaptive response for the community is significant to help prevent and control this smoking behavior in early adolescents. The response is used to expound protective features in the prevention of the developing process of smoking risk factors. The protective features in the community can be used to strengthen early adolescents to reject being initiated in smoking behavior. Protective features can come from internal circumstances within adolescents, the relationship between the adolescent, his peers, and the family, and the health promotion program. Through this, community response is the ability of adolescents, having the support of peers, parents, nurses, teachers in charge of the health program against smoking.
Smoking has been closely associated with leading risk factors for premature death and disability. It has been estimated to be the cause of death, approximately taking the lives of 6 million people annually. To reduce this problem, mass media cessation program campaigns have been seen to have a positive impact. Campaigns vary in different ways for them to be effective and research found out that harm focused messages appear to have more impact in developing quitting cognitions and behavior compared to those that focus on anti-industry or themes on how to quit. A campaign dubbed Stoptober was designed putting its focus on creating a positive quit prompt for many people and support a social program around a particular movement that was not to smoke for 28 days. The campaign was publicized through traditional and modern mass media including social media platforms. The key psychological principle for the campaign was the use of Specific, Measurable Attainable Realistic, and Time-sensitive objectives (Brown et al 2013). SMART objectives are aimed to help people attain a difficult behavioral goal by inspiring them to start with a realistic goal. The stopober campaign set people out for the challenge of not smoking in October. This was reinforced by a positive message conveying that individuals who would achieve this goal would be five times closer to becoming permanent ex-smokers by being able to recover from cravings and withdrawal symptoms. Another key psychological understanding was the use of the PRIME theory which is a theory of motivation which suggests that the motivational system is not stable and needs balancing inputs to maintain a persistent behavioral pattern. This is because the theory maintains that behavior is determined on a time to time basis by motivational inputs. The stoptober campaign appears to have been effective because according to their survey, a third of a million and more smokers quit smoking in October 2012.
Despite the reduction of US smoking adults, research shows that smoking is still high in socioeconomically disadvantaged groups and the e-cigarette increase in young people. Even with the celebration of the reduction, there is still a need to focus on tobacco regulating efforts. The solution for enforcing these regulating measures includes establishing tobacco-free rules for indoor and outdoor environments. Prices for cigarettes should be elevated by increasing the taxes to discourage the consumers which have been implemented in most of the states. Additionally, three government organizations have continuing interventions, for example, the CDC’s pieces of advice from past smoker's campaigns. This includes individuals who are living with disabilities and diseases which were are a result of smoking (Printz 2019). This acts as a convincing strategy that was effective and convinced half a million Americans to stop smoking from the year 2012-2016. The CDC also plays the roles of funding quitlines in 50 states which connects individuals to behavioral counseling and free nicotine substitute treatment. Another program is the FDA “every try counts campaign” which provides pieces of advice and message provision programs. There is also the National cancer institute’s quitline and the smokefree.gov website. Cigarette smoking rates have declined in the past two decades but have stalled in 2017 and 2018.
The E-cigarette has shown a significant increase with an increased number of users including high school and middle school students. The e-cigarette has been used immensely by students of which some did not know it contained nicotine but used them because of the many flavors they contain. The conversation about getting rid of the e-cigarettes to help students and younger adults not to use it is contradicted by the e-cigarette companies pointing out that the products help adults to quit smoking. They also argue that different flavors attract adults. Following this, many states have been prohibition the sale of e-cigarettes that have been flavored, and the FDA who had proposed the banning of e-cigarettes handed out a draft suggestion which required the stores to only make it available in places that can hardly be reached by persons not older than 18 years of age. Other countries have also put strict measures toward regulating these products. Countries such as Hong Kong and Israel have banned all e-cigarettes, the United Kingdom restricts particular quantities of nicotine in the item for consumption and the allowable e-cigarette rate has been lowered.
Impact of Social Influence
Social influences such as close associates and relatives are thought to influence decisions made about quitting smoking. Research shows that the smoking rates are higher among unmarried people or those that live alone, people with low social-economic positions, and the socially secluded ones (Martin et al. 2019). Studies showed that being married or having and living with a companion contributes highly to the chances of a smoker quitting. Also having a partner that does not smoke surges the probabilities of quitting. Evidence too has shown that having a companion was a smoker and quit may have a better influence over smoking cessation compared to a partner who does not smoke. Studies about the influence of social-economic positions on smoking cessation maintain that there may be a social incline in the accomplishment to quit. It may be less successful for women of lower social-economic status to quit smoking compared to men. Participating in social events might also have a positive impact on smoking cessation.
Evidence shows that smoking for adolescents is associated with the social setting in which it happens. The smoking behavior of an adolescent tends to be similar to that of his peers. The debate over the similarity of the smoking behavior suggests that it is caused by peer influence. Studies show that isolated adolescents are more likely to smoke and the social setting of their peers plays a significant role in influencing their smoking deeds. Emotional support is positively connected to smoking in that the closeness that is developed from a person who supports the other one emotionally strengthens the social bond as friends and peers smoke together. Through the bonds developed through emotional support and friendships, adolescents can also use that to support each other in quitting smoking and remaining non- smokers (Lakon, Hipp & Timberlake 2010). This friendship and emotional support bond could be significant for an intervention established for a school. This could be used to either help the adolescent to remain nonsmokers or assist each other to quit smoking. This strategy could be enforced by educating minorities on how to use emotional support as a way to help each other not to indulge in smoking and also to consider quitting. From this adolescents could also learn self-regulatory methods to assist each other in identifying the signals in the social environment that prompt interest in smoking. Every participating adolescent in this strategy could create task forces in schools and start smoking awareness movements. Common associations could become a network through which anti-smoking messages infuse individual and school systems. Studies outline that famous youths tend to set the standards in a school context, therefore if a popular youth smokes, others will emulate him. Hence it is important to strive towards popular youths adopting antismoking norms for the programs to be effective. These interventions will include educating adolescents on the dangers associated with smoking, hoping that they will embrace the antismoking norms, which will be emulated by their friends.
Teenagers always want to be accepted by their friends and the social environment and through this, they are bound to be influenced positively or negatively, smoking is being one of the negative influences. The inclusion of youths in different groups gives a teenager confidence which helps them ion the development of social skills. The friendly environment for adolescents has a great contribution to the initiation of smoking and adopting smoking behaviors. Research shows that adolescents smoked to make sure they followed the smoking rules of certain social groups or rules of a friend who smokes. There is also an influence on teenagers got from advertisements. There is a direct and indirect promotion of tobacco products which seems to be pushing young individuals to smoke. In the U.S.A, 20% of outdoor billboards show tobacco products, and about 3% of teenagers in the US were influenced by advertisements. A study that was carried out on teenage smoking showed that the prevalence of systematic teen smokers is high and might be because there are no antismoking policies put in place. Another reason for this could be the prevention programs that are not effective (Vasilopoulos, Gourgoulianis, Hatzoglou & Roupa 2015). Scientists agree to the fact that smoking advertisements have an influence on adolescents and drive them to start smoking. Advertising encourages teens to begin smoking through the message presented that smoking is a sign of independence and freedom. These studies show that there is a need for careful design and a comprehensive smoking policy for young people. According to Bellatorre, Choi & Bernat (2015), to curb the youth and adolescent smoking social influences, public policy initiatives to increase taxes on tobacco products should be made effective. Indoor smoking should be banned and tobacco products advertisements and point of sales of these products should be restricted for minors.
The consumption of tobacco by adolescents in Indonesia is among the highest globally. The negative outcomes of smoking which include diseases that harm organs in the body and affect the overall health of an individual are mostly experienced by the low and middle-income nations. The impact is severely felt in these areas because the prevalence of smoking is extremely high. There is little regulation of tobacco companies in most of these nations. The habits of smoking cigarette and getting addicted according to research is likely to begin during adolescence. Nicotine is very addictive and can damage brain development in adolescents. This calls for the push for tobacco control methods that should be focused on stopping the early instigation of smoking. In Indonesia, research conducted in 2011 showed that 33% of young adults with 15 years and above smoke daily. The connection between smoking and social-economic aspects was from a study that showed that smoking prevalence was higher in areas where individuals were poor and uneducated (Kusumawardani, Tarigan, Suparmi, & Schlotheuber 2018). It also indicated that the general prevalence of recent smoking was more in the middle- income nations compared to low-income nations. In Indonesia, adolescents who only attended primary school had a greater prevalence in smoking compared to those that had furthered their education to secondary or higher education. The urban-rural prevalence showed a minor difference indicating a higher prevalence in the rural areas compared to the urban areas. These social-economic differences display the need for the tobacco control measures to apply precise policies founded on gender, age, economic positions, and the physical location of youths. Creating appropriate tobacco- control strategies targeted on these sub-groups is a crucial part of the intervention in and outside schools. This intervention will be used to reduce the prevalence and prevent the instigation of smoking which is likely to produce achievements in reducing illnesses and deaths that are caused by smoking in Indonesia.
Discussion
To curb this critical issue of smoking and public health, the tobacco control association should advocate for policies that will support smokers to acquire effective treatments, both pharmacologic and behavioral. This will help smokers to overcome their nicotine addiction. The tobacco control association should remove the bureaucratic hindrances that slow down the delivery and interrupt the reimbursement of smoking cessation treatments delivered in health care settings (Cummings 2016). The association should incentivize healthcare organizations to focus on providing tobacco cessation support to their patients. Policies that improve the training of clinicians on effectively treating nicotine addiction should be promoted. They should promote policies that encourage companies to create and market cost competitive harm reduction replacements for cigarettes. They should stop commercial welfare for tobacco companies, permit them to collect profits from selling cigarettes while passing off the downstream healthcare costs of treating the addiction of nicotine and other related diseases to the taxpayers. Increasing tobacco taxes that compensate the state for the healthcare expenses and saving money to cover the costs of smoking cessation services would be a good move. Federal and state policies that defend the cigarette manufacturers from being liable for selling defective products need to be remedied. The cigarette industry needs to be held accountable for manufacturing and promoting products that cause diseases and even death.
Cigarette smoking is a health hazard that needs immediate appropriate remedial action. These remedial actions need to be adopted globally to ensure that smoking does not harm public health. This will help to prevent premature death and other related diseases caused by smoking. Some of these remedial policies that need to be adopted and have worked in the past include, spreading of information and public education. The public information and education interventions would be accomplished through warning labels on the cigarette packets, and advertisements (Warner 2014). Television and radio stations need to give airtime to antismoking messages which will balance the pro-smoking advertisements. Informing people about the dangers of smoking, using real people who have suffered because of smoking would be effective. This will help individuals work towards quitting and encourage non-smokers not to start. Health education on tobacco in schools should be made a priority to save the teenagers and the younger generation. Teachers should be well trained and given enough resources to manage health education on tobacco programs.
Taxation on tobacco products has been known to cause a decrease in consumption. This is a strategy that should be adopted because it has been effective in the past both for adults and youth. Taxation causes people to quit smoking and also reduce consumption due to the price increase which is more impactful on youths because they are more price responsive compared to adults. The lower-income smokers will also be affected by the price rise and will therefore quit smoking meaning that taxation will contribute to public health. Smoke-free workplace policies need to be implemented, prohibiting smoking in all workplaces, including restaurants, bars among others (Warner 2014). Complete smoke-free workplaces will help achieve public health benefits such as workers will not be exposed to toxins from cigarette smoke and there will be a decrease in the daily consumption by smokers. The employer costs for healthcare are bound to decrease and reduce exposure to respiratory diseases and other related diseases. A truth campaign through the media would be an effective intervention to help decrease the number of youths that engage in smoking and also encourage smokers to quit. This will involve strategies such as having real people who have been affected directly or indirectly by smoking. Tobacco products advertising and promotion should be banned and this will contribute to public health. This is because individuals will not be introduced to or constantly be reminded of tobacco products through advertisements. Tobacco products should be regulated including smokeless tobacco products. Laws that prohibit the use and possession of tobacco for youths should be strictly adhered to and action taken for those that do not adhere to them.
For the younger generation, school intervention programs should be practiced, focusing more on the early training of students against being influenced to experiment smoking. Social skill training could assist students to resist the temptations from their peers to start smoking. Students need to learn at an early age the health dangers of smoking, know the influences of relatives, peers, beliefs, and other related factors (Pierce, White & Emery 2012). They need to develop personal abilities to fight back temptations and practice the decision-making abilities to defend themselves against use. These interventions should be included in the school curriculum which means that the teachers need to have proper training about this topic. They also need to be given the required resources to be able to effectively perform their duties concerning the Schools should involve parents and families in these interventions and support cessation for teachers, staff, and students. This will help avoid and reduce the initiation of minors into smoking which will be an enhancement in public health. Cautionary labels and plain packaging on the cigarette packets will be an effective initiative since it serves in providing health information for smokers and non-smokers and more so the minors. Restricting the access of cigarettes to minors is an initiative that should be followed by all the stores that sell tobacco products to ensure that it is successfully implemented.
Health promotion is significant in reducing the growing burden of chronic diseases globally caused by the consumption of tobacco products. Public education is a significant part of the efforts of preventing the initiation of smoking and encouraging smoking cessation. By providing information and knowledge about smoking cessation techniques, health professionals can encourage smokers who are interested in quitting (Golechha 2016). Peer education is one of the health promotion methods which includes sharing information in small groups or among peers. Peer education will work towards educating, motivating peers about behavioral skills, and the effects of smoking. The theatre should be used as a platform for creating awareness about good health. People love being entertained meaning that through the theatre, many people will gain information through dramas associated with the effects of smoking and peer influence.
Media advocacy as a health promotion intervention will help to pass information through the media platforms with the perception of altering the public mind about smoking. Social marketing which is a systematic application of marketing techniques to develop, communicate, and provide value to influence a target audience to acquire specific behavioral goals will be a good initiative. It is a behavioral methodology that helps to develop a long term sustainable effect upon the choices people make (Golechha 2016). Motivational interviewing could be used to encourage positive behavior change to smokers and non-smokers. This is done by showing sympathy, supporting self-efficiency, developing divergence, and progressing with resistance to have a successful smoking cessation.
Community-level programs that work towards mobilizing individuals to educate them about the health risks of smoking will be effective (US Department of Health and Human Services 2012). This is because the programs will be focused on a particular group or community hence they will be developed according to the beliefs, norms, and practices of that particular community. Well co-ordinated, community programs will work towards reducing smoking among the minors and will work better and efficiently compared to single strategies. Because of the several strategies combined to make up these programs, when the programs reach many communities, the outcome will be positive. The good thing about community-level programs is that they try to reach as many people as possible, people from all genders and ages will be included in these programs.
Other intervention strategies should include increasing the age of individuals purchasing any tobacco item for consumption to twenty-one years. The use of e-cigarettes should be barred in smoke-free zones. Public health messaging movements should be developed for the young people, guardians, instructors among others focusing on the point that nicotine has a high rate of addiction and also affects the developing brain and could cause addiction to other drugs (Printz 2019). These interventions will help to reduce the initiation of young people to smoking, help people quit smoking, and protect their overall health.
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