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EPIDEMIOLOGY

What is Healthy People 2010? Is smoking cessation included in its national goals?

The Department of Health and Human Services (DHHS) has been setting national objectives for Americans' health since the 1980s when it first published Health Objectives for the Nation. Subsequently, it published Healthy People 2000 and recently Healthy People 2010. DHHS is responsible for overseeing the nation's health. Their goals have been established to improve the health status of the U.S. population as well as the availability and quality of health services so the life span of Americans can be extended. DHHS encourages the establishment of prevention programs, including smoking cessation, and monitors the national health status and the achievement of the goals set in the Healthy People 2000 and 2010 reports. Every ten years, a Healthy People report that addresses the national public health trends is presented to the Secretary of DHHS, the President, and the U.S. Congress. The report also includes goals on prevention and strategies to be achieved over the next 10-year period. Both Healthy People 2000 and 2010 have two overarching goals: to increase the quality of health care during each American's lifetime and to eliminate health disparities. Ten indicators are used to measure the nation's health. Each of the indicators reflects a major health concern. The health indicators are listed as follows:

1.

Physical activity

2.

Overweight and obesity

3.

Tobacco use

4.

Substance abuse

5.

Responsible sexual behavior

6.

Mental health

7.

Injury and violence

8.

Environmental quality

9.

Immunization

10.

Access to health care

The indicators 3, 4, and 8 are factors involving tobacco use and addiction. Health indicators are selected based on the ability to motivate the public to act, the availability of the data to measure progress, and the importance of the indicator to the overall health of Americans. The selection process is done by consensus. The authors of the document are from both the private and public sectors of communities across the country. The report is the outcome of a shared vision about improving the health of the nation, preventing disease, and improving the quality of life of all citizens.

The Healthy People reports are used by many organizations, communities, and policy-makers to measure, compare, and improve the health status of local communities. Information for specific health issues is also developed and distributed to special populations, such as gays and lesbians, people with disabilities, rural health populations, women's health organizations, and healthcare professionals who work with special populations. Healthy People 2010 provides a framework for health advocates to develop strategies to improve access to quality health care. Many public health officials consider tobacco-related diseases as the most critical healthcare concern, particularly because these diseases are easily preventable through public education, legislation, and the development of prevention and cessation programs.

What are the rights of smokers and nonsmokers?

Smokers' organizations throughout the United States have developed to combat what they perceive has been a systematic effort to deprive them of their rights. The two main organizations are the American Smokers Alliance and the National Smokers Alliance. Other smokers' rights groups with international membership include Freedom Organization for the Right to Enjoy Smoking Tobacco (FOREST) and Fight Ordinances and Restrictions to Control and Eliminate Smoking (FORCES). Controversy has surrounded these organizations due to their link with tobacco companies.

Smoker's Rights

The following are the Smokers' Bill of Rights:

As a smoker, I am entitled to certain inalienable rights, among them:

The right to the pursuit of happiness

The right to choose to smoke

The right to enjoy a traditional American custom

The right to be treated courteously

The right to accommodation in the workplace

The right to accommodation in public places

The right to unrestricted access to commercial information about products

The right to purchase products without excessive taxation

The right to freedom from unnecessary government intrusion

If you do a Google search using "smokers' rights" as keywords, the R.J. Reynolds Tobacco Company comes up at the top of the list. In order to better understand the perspective of the tobacco company's positions regarding smokers' rights and the sale of cigarettes, you may visit their Web site. Below is a short excerpt that gives an example of their guiding principles and beliefs:

Guiding Principles and Beliefs

TOBACCO USE & HEALTH

Nicotine in tobacco products is addictive but is not considered a significant threat to health.

No tobacco product has been shown to be safe.

An individual's level of risk for serious disease is significantly affected by the type of tobacco product used as well as the manner and frequency of use.

TOBACCO REGULATION

Tobacco products should be regulated in a reasonable and consistent manner, and they should remain legal and consumer-acceptable. The prohibition, in any form, of tobacco products is neither practical nor desirable.

Smoking restrictions should exempt adult venues such as bars and taverns.

HARM REDUCTION

Decreasing the health risks and harm directly associated with the use of tobacco products is in everyone's best interest.

Adult tobacco consumers should have access to a range of tobacco, nicotine and cessation products and should be given information in order to make an informed choice on the relative risks of each product.

Nonsmoker's Rights

Organizations like the Group Against Smoking and Pollution (GASP), founded in 1971, developed anti-smoking chapters throughout the country to limit smoking in public areas, including restaurants, airplanes, trains, and buses. The organization developed a Bill of Rights for Nonsmokers. It focused attention on environmental smoke. By the 1990s, anti-smoking groups and public health advocates had effectively influenced state legislators to limit public use of tobacco products. By then, consumers no longer tolerated even low risks to health from secondary smoke. The following is the Bill of Rights for Nonsmokers.

I have the right to:

Be smoke-free in any situation

Review my list of reasons to stop smoking frequently, particularly before any social gathering

Ask others not to smoke in my home, office, or car

Sit in nonsmoking sections

Support legislation to protect nonsmokers from the dangers of passive smoking in public places

What are the current trends in quitting smoking?

The number of smokers in the United States is declining, as public awareness regarding the dangers of smoking have become more widely accepted and more local communities are banning smoking in public places. Among Americans, smoking rates shrunk by nearly half in three decades (from the mid-1960s to mid-1990s), falling to 23% of adults by 1997. However, worldwide, especially in poor countries, the number of smokers is growing. In the developing world, tobacco consumption is rising by 3.4% per year. In the developing world, concerns about the use of tobacco are not considered as important as concerns about adequate nutrition, safe drinking water, and communicable diseases.

What is the prevalence of tobacco use?

Prevalence refers to the current number of people suffering from a particular illness or engaged in a particular activity relative to the population at large over a specified period of time. Point prevalence refers to a defined point in time (such as January 1, 2009) while period prevalence refers to a defined period in time (such as January 1, 2008 through January 1, 2009). It is defined in terms of the ratio of people with a condition compared to the total population.

Worldwide, especially in poor countries, the number of smokers is growing. In the developing world, tobacco consumption is rising by 3.4% per year.

Today one out of every five adults smokes regularly. A 2007 Time magazine article on the "Science of Addiction" reported that there are 71.5 million tobacco users in the United States, of whom 23.4% are men and 18.5% are women. Among cigarette smokers, the lowest rate of smokers live in the western section of the country and the highest live in the Midwest and the southeast tobacco-producing states. The proportion of smokers in the adult population has fallen from a high of 46% in 1950 to 21% in 2004. The World Health Organization in 2003 estimated that there were 1.3 billion smokers worldwide. The numbers may vary from source to source, but all of the data point to a worldwide epidemic of pandemic proportions (Table 7).

The numbers are expected to reach 7 billion by 2025. The growth will be among people living in poor developing countries and the uneducated.

What are the mortality rates from smoking in the United States? Worldwide?

Table 7 smoking Prevalence

smoking Prevalence

Source: 2000, World Health Organization estimates.

Mortality rates are the rates of deaths in a population during a given time and in a given place. Smoking kills over 435,000 U.S. citizens each year. More Americans die each year from tobacco than from fires, car accidents, illegal drugs, murders, and AIDS combined. Tobacco kills more people in two days than crack and cocaine kill in a year. More than 50,000 Americans die from secondhand smoke, according to the Centers for Disease Control and Prevention (CDC). Sixteen million people lost their lives because of an addiction to nicotine between 1950 and 2000. These numbers add up to a thousand American deaths each day from smoking cigarettes. Most of the deaths occur to people between the ages of 35 and 69 years. Nearly five million people died from smoking worldwide in 2000, and smoking killed nearly as many people in developing countries as in developed countries. The World Health Organization (WHO) estimates that tobacco kills a person every 10 seconds worldwide and, at the current growth rate for both the general population and number of smokers, the death rate from smoking may exceed 10 million a year in 30 years.


 
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