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Running head: TOBACCO ABUSE 1

Population Health Issue: Tobacco Issue

Mini Abraham
Walden University
NURS6050, Section 5, Policy and Advocacy for Population Health
February 7, 2015

Population Health Issue: Tobacco Issue
Tobacco use is one of the most preventable cause of death and disease in the United
States. Each year, around 443,000 Americans die from tobacco-related diseases. For every
person who dies from tobacco use, 20 more people suffer with at least 1 severe tobacco-related
illness. Tobacco use also costs the U.S. $193 billion annually in direct medical expenses and lost
efficiency. In spite of these hazards, approximately 42.1 million U.S. adults currently smoke
cigarettes. And the harmful effects of smoking do not end with the smoker. Secondhand smoke
exposure causes severe disease and death, and even momentary exposure can be harmful to
health. Each year, primarily because of exposure to secondhand smoke, an estimated 7,330
nonsmoking Americans die of lung cancer and more than 33,900 die of heart disease. Coupled
with this massive health toll is the substantial economic problem. Economic costs attributable to
smoking and exposure to secondhand smoke now approach $300 billion annually. Healthy
People 2020 aims to reduce tobacco use to the point that it is no longer a public health problem
for the Nation. I would like to discuss in this paper about smoking, a major population health
issue and effective health advocacy programs and legal and ethical aspects of these programs.

Effective Health Advocacy Programs

In 2007, the Institute of Medicine (IOM) released the report, ending the Tobacco
Problem: A Blueprint for the Nation, which defined a two-pronged scheme for removing the
problem of tobacco use in the United States. This scheme included: 1) establishment and fully
executing traditional tobacco control measures; and 2) altering the regulatory setting to permit
policy improvements. The IOM Committee specifically concluded that there was convincing

evidence that comprehensive state tobacco programs can attain considerable decreases in tobacco
use. The mission of complete tobacco control programs is to decrease disease, disability, and
death related to tobacco use. A comprehensive methodone that optimizes synergy from
applying a mix of educational, experimental, monitoring, economic, and social strategiesis the
guiding principle for eliminating the health and economic burden of tobacco use. Research has
identified a number of effective strategies that will contribute to ending the tobacco use

The Healthy People 2020 Tobacco Use objectives are prepared into 3 key areas: Firstly
Implementing policies to reduce tobacco use and initiation among youth and adults. Secondly
Health System Changes: Adopting policies and strategies to increase access, affordability, and
usage of smoking cessation services and treatments and thirdly Social and Environmental
Changes: Establishing policies to reduce exposure to secondhand smoke, increase the cost of
tobacco, restrict tobacco advertising, and reduce illegal sales to minors.
From 2009-2010, major advances were made in the campaign to end the tobacco use
epidemic, including:

The U.S. Food and Drug Administration (FDA) was granted the authority to

regulate the sales, advertising, and ingredient content of all tobacco products marketed in the
United States.15

The Federal Government increased the Federal tobacco excise tax by $0.61 to

$1.01 per pack.


25 states and the District of Columbia (DC) had comprehensive smoke-free laws

eliminating smoking in workplaces, restaurants, and bars, and 14 States and DC had cigarette

excise tax rates of at least $2 per pack.Over the coming decade, more States are poised to
strengthen smoke-free laws and increase the price of tobacco, further reducing tobacco use and
initiation throughout the Nation.
A community encompasses a diverse set of entities that reach across multiple sectors,
including voluntary health agencies; civic, social, and recreational organizations; businesses and
business associations; city and county governments; public health organizations; labor groups;
health care systems and providers; health care professionals societies; schools and universities;
faith organizations; and organizations for racial and ethnic minority groups. To counter
aggressive pro-tobacco influences, communities are encouraged to change the knowledge,
attitudes, and practices of tobacco users and nonusers and also engage in strategies to address the
manner in which tobacco is promoted, the time, manner, and place in which tobacco is sold, and
how and where tobacco is used. State and local governments play an integral role in achieving
the goals of the Family Smoking Prevention and Tobacco Control Act (FSPTCA), which granted
the Food and Drug Administration (FDA) the authority to regulate tobacco products. The
FSPTCA permits states and local governments to impose specific bans or restrictions on the
time, place, and mannerbut not the contentof cigarette advertisements. States may adopt or
continue to enforce requirements pertaining to tobacco products that are in addition to, or more
stringent than, many requirements of the law. However, although the law preserves a substantial
amount of the states authority to regulate tobacco products, some state and local requirements
are preempted.37 Effective community programs involve and influence people in their daily
environment. Therefore, community engagement and mobilization are essential to programs
addressing tobacco control.39,40 Implementing strategies that can impact societal organizations,
systems, and networks necessitates the involvement of community partners. Decreasing

disparities in tobacco use occurs largely through engagement in evidence-based community
Policy I would do
Promoting cessation is a core component to reduce tobacco use. Encouraging and helping
tobacco users to quit is the quickest approach to reducing tobacco-related disease, death, and
health care costs. Quitting smoking has immediate and long-term health benefits. Although
quitting smoking at any age is beneficial, smokers who quit by the time they are 35 to 44 years of
age avoid most of the risk of dying from a smoking-related disease.
Fully funding tobacco control programs and increasing the price of tobacco products.

Enacting comprehensive smoke-free policies.

Controlling access to tobacco products.

Reducing tobacco advertising and promotion.

Implementing anti-tobacco media campaigns. Each day in the Unites States, the

tobacco industry spends nearly $23 million to advertise and promote cigarettes. During the same
period, more than 3,200 youth younger than 18 years of age smoke their first cigarette and
another 2,100 youth and young adults who are occasional smokers progress to become daily

Prevent initiation among youth and young adults. Promote quitting among adults

and youth. Eliminate exposure to secondhand smoke.

Ethical considerations
According to the ANA code of ethics Provision eight ,The nurse collaborates with other
health professionals and the public in promoting community, national and international efforts to
meet health needs and Provision nine, The profession of nursing value, for maintaining the

integrity of the prosession and its practice, and for shaping social policy. There are strategic
elements in planning public health campaigns, besides the ethical considerations. Antismoking
messages, as a form of message that targets to change peoples approaches or actions by moving
on profoundly held personal likings and values, are bound to raise ethical questions. Ethical
issues can be found in every phase of a communication program, from the beginning of aims,
selection of target populations, and design of messages to implementation and evaluation
(Burdine et al. 1987, Doxiadis 1990, Guttman 2000, 2003). On the other hand, communication
that aims to bring about positive changes in peoples lives concerning health may be considered
inherently as a virtuous effort or benevolent endeavor that is premised morally upon the noble
justification (Rogers 1994) and has no effects that can be described as bad or undesirable
(Seedhouse 1988). Theoretically, such orientation on consequences as the main factor of the
ethicality of a community health message is a teleological perspective. Teleological ethics are
best summed up by utilitarianism, which principles competence and consequences through the
idea of maximizing the greatest good for the greatest number within societys limited resources.
Guttman (2000) observed that the essential concerns in health communication ethics are related
to persuasion and paternalism. In the context of speech acts, the communication activities in
health communication include exposing, threatening, predicting, promising, encouraging,
warning, and recommending, each with its attendant ethical implications. Another set of
concerns focuses on the violation of autonomy, of which one facet is associated with truth
telling. Messages that do not fully disclose all the facts, distort or exaggerate information, or
make claims that deprive individuals of the ability to make autonomous decisions can be
considered as manipulative or deceptive. Based on utilitarian reasoning, the use of persuasion
techniques such as exaggeration, omission, fear, and other emotional appeals in antismoking

messages may be justified even if such message strategies may be problematic or cause harms to
individuals, such as creating undue anxiety, labels or stigmas, or triggering contradictory
reactions. Earle (2000) provided an example that a former cocaine addict was reminded of his
enjoyment from the drug and nearly started using drugs again. Theoretically in contrast with the
teleological perspective is the deontological view. Some scholars have questioned the
teleological focus in health communication by suggesting that a message should be assessed for
its intrinsic moral worth rather than its outcome (e.g., Guttman 1997, 2000, 2003, Kirby and
Andreasen 2001). This orientation on messages intrinsic moral value is a deontological
perspective. Based on deontological ethics, antismoking messages that employ exaggeration or
fear appeals would be wrong even if they could effectively change target audiences attitudes or
behaviors. Research on the ethics of public health communication has been very limited. Most of
the little discussion is philosophical or prescriptive (e.g., Guttman 2000, 2003). The endeavor of
attending to ethical issues in public health communication is not only a moral prerequisite but
also carries pragmatic significance (Guttman 2003, Lee and Cheng 2010). In the study by Lee
and Cheng (2010) that content analyzed 826 antismoking ads from the CDC, significant
relationships were found between ethicality and the ads thematic frames, emotion appeals,
sources, and target audience. Their findings present compelling evidence about a link between
ethicality and message attributes, suggesting that judicious framing of health messages is a
necessary component in public health communication. Thus, in addition to exploration on the
strategic development process of antismoking messages in the United States, the current study
also examines how US public health officials view different message appeals, which may carry
future implications for theoretical discussion on the ethical dimensions in health communication.

Ethical considerations written codes of ethics for tobacco control work were found to be
nonexistent. Most of the interviewees did not use and were not supportive of the creation of
codes of ethics for the design and execution of antismoking ads. However, ethics appears to be
an integral and implicit component of the decision-making process, in different ways. First, some
public health communicators rely on teleological ethics or a utilitarianism perspective, focusing
on consequences and the idea of changing individuals behaviors for their own sake. Based on
this reasoning, some interviewees considered the use of tools of persuasion such as exaggeration,
omission, fear, and other emotional appeals in public health communication messages may be


We know what works to effectively reduce tobacco use, and if we were to fully invest in
and implement these proven strategies, we could significantly reduce the staggering toll that
tobacco takes on our families and in our communities. We could accelerate the declines in
cardiovascular mortality, reduce chronic obstructive pulmonary disease, and make lung cancer a
rare disease. With sustained implementation of state tobacco control programs and policies, the
Healthy People 2020 objective of reducing adult smoking prevalence to 12% or less by 2020
could be attainable. Preventing tobacco use and helping tobacco users quit can improve the
health and quality of life for Americans of all ages. People who stop smoking greatly reduce their
risk of disease and premature death. Benefits are greater for people who stop at earlier ages, but
quitting tobacco use is beneficial at any age .Full implementation of comprehensive tobacco
control policies and evidence-based interventions at CDC-recommended funding levels would

result in a substantial reduction in tobacco related morbidity and mortality and billions of dollars
in savings from averted medical costs and lost productivity in the United States. Full
implementation of comprehensive tobacco control policies and evidence-based interventions at
CDC-recommended funding levels would result in a substantial reduction in tobacco related
morbidity and mortality and billions of dollars in savings from prevented medical costs and lost
productivity in the United States.


Centers for Disease Control and Prevention. Annual smoking-attributable mortality, years
of potential life lost, and economic costsUnited States, 19951999. MMWR. 2002;51(14):3003 [cited 2009 Aug 18
Cheng, I., & Lee, S. T. (2012). Strategic and ethical issues in antismoking message
development: how US public health campaigners conceptualize efficacy and ethicality.
International Journal Of Health Promotion & Education, 50(5), 238-250.
(From walden library)

Best Practices for Comprehensive Tobacco Control Programs2014. Atlanta: U.S.

Department of Health and Human Services, Centers for Disease Control and Prevention,
National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and
Health, 2014