Lecture #32 - Tobacco Flashcards
Why is smoking important? 9
- It globally causes 6 million deaths per year
- Tobacco epidemic in low income countries e.g. India, China
- Smoking is an important factor in the production of carcinoma of the lungs (lung cancer)
- US Surgeon General’s report in 1964 identified tobacco as major cause of ill-health, including heart disease and cancer (not just lung cancer)
- Tobacco cases disease and disability to almost every organ in the body
- Second hand smoke risks - even if you’re not smoking, still have health outcomes due to passive smoking exposure
- Smoking in pregnancy causes multiple risks like miscarriage, premature birth etc
- It’s also NZ’s leading cause - each since death is preventable of the 5000 that smoking kills every year
- Lastly, tobacco epidemic’s impact is fundamentally unequal (tobacco plays a role in exacerbating poverty)
What is NZ’s 2025 smoke free goal?
How many need to quit?
Reducing tobacco availability to minimal levels and reducing smoking to less than 5% in all populations
Need like half million people to quite and prevent people picking up smoking (current prev is 17%).
I remember her saying have 5% because tourists, international and stuff people are hard to control because they aren’t in country for long
Who smokes in NZ? 4 groups to discuss: gender, Maori, youth and deprived
-Male smoke more than females
- Maori and pacific have higher prevalence than asian and Euro
- Maori females have higher prev than Maori males
- So prevalence interventions haven’t worked to reduce smoking, clearly
- More deprived people are more likely to smoke: most deprived 3.1 times as likely to smoke than least deprived (measurement not attached to individuals - this is people based and where you live)
- Youth smoking (daily and regular) seems to have gone down and there is increasing prevalence in ‘never smoker’ for youth
Why do people smoke? (3 big things)
It’s not just one or two factors - you need to look at the broad view of health. See how people environment etc leads them to smoking (that determinants of health models is what’s key here)
Individual level factors:
- beliefs, attitudes, (mis)interpretations like it’s cool or it’s not that bad or it’s normal so all good
- stress reduction/relaxation
- weight concerns
- quitting is really difficult
Community level factors:
- smoking amongst friends, parents, colleagues etc (so you’re more likely to smoke too)
- smoking visible everywhere at community nations (even have ‘smoko breaks’ in some workplaces)
- socio-cultural reasons e.g. gifting tobacco
Society wide factors
- tobacco marketing and promotion
- accessibility of tobacco (physical - it’s everywhere, affordable, ease of purchase - age limits but yeah)
- nicotine = addictive
- smoking in media (even video games)
- the tobacco inductor - they are real intense with marketing and also try hard to find loopholes in legislations
Like, it’s been proven that people who are exposed to racks of smokes in a shop are more likely to have tried smoking
What interventions have already been implemented? 6 things
WHO’s MPOWER framework:
Monitor tobacco use and prevention policies
Protect people from tobacco smoke
Offer help to quit tobacco use
Warn about dangers of tobacco
Enforce bans on tobacco advertising, promotion and sponsorship
Raise taxes on tobacco
=model framework that aims to guide countries to implement a range of tobacco control policies which include MPOWER - basic set of WHO recommendations
Interventions to achieve a smoke-free nation by 2025
- What are the universal strategies being implanted?
- What are the targeted strategies?
- Individual strategies?
There isn’t a govt strategy but National Smokefree Working Group have a Smokefree Aotearoa 2025 Action Plan.
UNIVERSAL STRATEGIES:
- Taxation/pricing measures - keep rising the price because people smoke less then. It’s important for young people because won’t encourage people to start. But some companies have lower brands that circumvent that or put 26 in a pack not 25. Downside - tobacco is addictive and those who are poor will connive to spend so less disposable income for food, clothing etc. But we have really good quit-lines to help these people
- Reducing the number of outlets selling tobacco (increase use if increase outlets). They wanna see if tobacco can only be available at pharmacies - would help to decrease incidence and help those who want to quit
- Extend smoke-free environments e.g. parks, playgrounds
- Denormalise tobacco smoking - change the misconception
TARGETED STRATEGIES:
- Aimed at priority populations e.g. Maori, smokers who wanna quit, youth (18 - 24)
- Targeted media campaigns
- Increase min purchase age (decrease social supply among peers)
- De-nictonisation of cigarettes (nicotine isn’t dangerous but it’ll help wean people off)
INDIVIDUAL STRATEGIES:
- Improved smoking cessation support
- health services polices, innovative programmes, pay people to quit, nicotine inhalers (diff to e-cigs, e-cigs are too new for quitting etc)
To conclude……
Tobacco control plays a crucial role in primary prevention of a range of diseases and adverse health outcomes
Epidemiological studies help identify the causes and consequences of tobacco use, and the populations most affected
A range of interventions (individual, targeted and universal) is needed to achieve 2025
Briefly describe the descriptive epidemiology of tobacco use in New Zealand.
According to 2013/14 data, in New Zealand, Maori are 2.7 times as likely to smoke as non-Maori; Pacific are 1.3 times as likely to smoke as non-Pacific; and Asians are 0.4 times as likely to smoke as non-Asians. Men are 1.2 times as likely to smoke as women and the most deprived are 3.5 times as likely to smoke as the least deprived.
Identify one intervention at the population level and explain how it may contribute to New Zealand reaching the goal of being smoke-free by 2025.
Taxation OR smoke-free areas OR advertising and sponsorship bans OR access restriction
Decrease the perceived normalcy of smoking behaviours, restrict uptake of smoking behaviours, and incentivise current smokers to cease smoking behaviours.
Identify one intervention at the individual level and explain how it may contribute to New Zealand reaching the goal of being smoke-free by 2025.
Nicotine Replacement Therapy OR personal counselling (e.g. Quitline) Increase the likelihood of high-risk individuals cessing smoking behaviours.
