Cigarette smoking is the greatest preventable cause of disease and premature death in the United States. Secondhand smoke causes numerous lung cancer deaths annually. Measures have been taken in both workplaces and public places to limit exposure to secondhand smoke. The economic cost of smokers to society is phenomenal. It includes monetary costs, lost workdays and shortened work lives. Many states are establishing and maintaining comprehensive tobacco-control programs to reduce tobacco use. They provide education to our youth to prevent them from ever starting and smoking cessation programs for individuals that currently wish to stop smoking. Education and support are known ways to eventually prevent smoking in the future.
Efforts to increase the public perception of the harmful effects of tobacco must utilize a comprehensive approach that affects policy development, education strategies and health care systems. Smoking is becoming more and more unfashionable as time goes on. There are many studies conducted showing that secondhand smoke is a health hazard to both the smoker and anyone that relies on the same air supply, not to mention the unpleasantness and discomfort it causes those that do not smoke. The Environmental Protection Agency reports that it is estimated that secondhand smoke that emerges from exhaling and burning cigarettes causes approximately 3,000 lung cancer deaths and 37,000 heart disease deaths in nonsmokers each year. (Nolo, 2002). According to a 1998 Gallop poll, 94% of Americans, including both smokers and nonsmokers, agree that companies should either ban or restrict smoking to properly ventilated areas. Another Gallop poll indicates that 95% of nonsmokers, and 69% of smokers, think California's ban on smoking in almost all workplaces is positive. Some companies are now refusing to hire anyone who admits to smoking on a job application because of higher healthcare insurance, absenteeism, unemployment insurance and workers' compensation insurance associated with these individuals. (Nolo, 2002). Those that do not smoke feel it is an infringement of what they consider to be a reasonable right not to have to breath other people's cigarette smoke while at work. During the 1970's the dangers of secondhand smoke were beginning to amass and a movement for nonsmokers emerged. When it was proven that secondhand smoke was harmful to nonsmokers who inhale it passively, (Koop, C. Everett et al. 1996), the public became less tolerant of smoking in the workplace as well as public places. Exposure to tobacco smoke remains a health hazard that is completely preventable. Many state and local laws for clean indoor air reduce but do not eliminate nonsmoker's exposure to secondhand smoke and smoking bans appear to be the most effective method of reducing exposure to secondhand smoke. Although there are no federal laws that directly control smoking in the workplace, (Nolo, 2002) many city and county ordinances ban smoking in the workplace. On the other hand, half of the states make it illegal to discriminate against those who smoke during non-working hours. However, many states protect employees from unwanted smoke on the job. Workplaces nationwide have gone smoke free to provide clean indoor air to protect employees. Tobacco smoke contains thousands of different chemicals (ASH, 2001) know to be carcinogens (cancer causing substances) that are released into the air as particles or gases. To date, workers have been awarded unemployment, disability and worker's compensation benefits for illness and loss of work due to exposure to secondhand smoke. Twenty states and the District of Columbia limit smoking in private worksites and forty-one states and the District of Columbia have laws restricting smoking in state government buildings. In 1997, President Clinton signed an executive order requiring federal buildings to become smoke-free. Simply separating smokers and nonsmokers within the same airspace reduces, but does not eliminate, exposure of nonsmokers to secondhand smoke. California banned smoking in public places in 1998 and recently both the Delaware State Senate and House of Representatives passed Senate Bill 99, making Delaware one of very few states in the nation to enact a comprehensive and landmark smoking ban that includes restaurants and bars. Governor Ruth Ann Minner signed the bill into law on May 31, 2002 and the bill will become effective on November 27, 2002. (State of Delaware, 2002). When a bill of this nature becomes effective, it should eliminate the need of local governments to enact workplace-smoking restrictions within their jurisdictions. Many smokers agree that the restrictions on smoking are reasonable and even helpful as smokers try to quit or cut down on their smoking. Some have questioned if common courtesy would resolve the smoking problem and, if that were the case, we would not need any laws at all. However, people can be discourteous and inconsiderate and nonsmokers should not have to ask total strangers to stop smoking for exposure to a healthy environment. Once the Government passes such a law, a considerable amount of money and time is spent developing the regulations and determining the penalties, fines and actions against repeat offenders. It needs to be determined who will decide the amount of the fines, what the cost of the fines will actually be and who will be responsible for enforcing the law. There are many ways to educate individuals who currently smoke with regard to prevention and support. As a result of the health and economic consequences of cigarette smoking, states are establishing and maintaining comprehensive tobacco-control programs to reduce tobacco use among youth. There are seven recommendations for school health programs to prevent tobacco use and addiction. They include developing and enforcing a school policy on tobacco use, providing instruction regarding the short and long-term negative effects and social consequences of tobacco use, tobacco use prevention education in kindergarten through 12th grade, in which should be most intensive between junior high or middle school and then reinforced in the high school years, provide education to the teachers, involve parents and families in support of school-based tobacco prevention programs, support cessation efforts for students and teachers who use tobacco and assess the tobacco use prevention program regularly. Most of the United States public strongly agrees with policies that help prevent youth from starting in the first place. (MMWR. 1994). Cigarette smoking as well as smokeless tobacco use are always almost started and established during adolescence. The tobacco industry spends approximately $4 billion per year to promote and advertise cigarettes. Current research shows that universal tobacco promotion creates the perception that more people smoke than actually do, and it attempts to project that smoking is [cool]. Cigarettes smoking among our youth have not declined over the past decade and 28 percent of the nation's high school seniors currently smoke cigarettes. Preventing cigarette smoking among our youth is the means in which to end the epidemic of tobacco use in the United States. Lee, P. (1994).
According to the Centers for Disease Control (MMWR, 1994) 83% of current smokers wish they did not smoke and nearly one-third of all smokers quit for at least one day each year. 93% of smokers who try to quit start smoking again within one year. There are many medications to help those that want to quit smoking. They include oral medications, nicotine gum, a nicotine inhaler, nicotine nasal spray or a nicotine patch. Most can benefit from using a medication and all of these medications can as much as double ones chances of quitting and quitting for good. There are three treatment categories for smokers that clinicians should consider when determining a strategy. First, those who smoke cigarettes and are willing to quit should be treated using the "5 A's" (Ask, Advise, Assess, Assist, and Arrange). Secondly, those that smoke cigarettes but are unwilling to quit should be treated with the "5 R's" motivational intervention (Relevance, Risks, Rewards, Roadblocks, and Repetition). Thirdly, those who have recently quit using tobacco should be provided relapse prevention treatment. Studies have shown that the five keys for quitting include getting ready, getting support, learning new skills and behaviors, getting medication and using it properly and be prepared for relapse or difficult situations. (U.S. Public Health Service, 2000).
The costs to both society and individuals that smoke are phenomenal. Approximately 60% of the direct health cares costs in the United States are used to treat tobacco related illnesses and 20% or 1 in 5 of all deaths in the United States are a result of smoking (Shubinski, 1999). There are many factors to consider when determining the economic costs. These factors include adult medical spending, smoking during pregnancy, lost workdays, lost output from shortened work lives and smoking- induced fires for a total cost of roughly $130 billion annually. The Centers for Disease Control and Prevention estimate that the economic costs for smokers is approximately $7.18 in medical costs and lost productivity for every pack of cigarettes sold in the United States. In 1999, 22 billion packs of cigarettes were sold. Annual economic costs in 1998 were $81.9 billion in productivity losses from deaths and $75.5 billion in excess medical expenditures, for a total of more than $150 billion. These losses were larger than previous estimates of $53 billion and $43 billion each. According to researchers, states receive about $16 billion in revenue each year from tobacco companies for lawsuit settlement payments and state tobacco excise taxes, while allocating $861 million in fiscal year 2002 for tobacco prevention and cessation programs. (Blakey, 2002). The Surgeon General recently testified that the United States spends roughly $50 billion per year treating smoking related illnesses. Public funding -- primarily Medicare and Medicaid -- paid over 40 percent of those costs, or more than $20 billion. The price of tobacco plays an important role on the demand for tobacco products, especially among young people. The future medical costs of a young person taking up smoking today can be about $13,700 over a course of a lifetime in today's dollars. Because women live longer than men do typically, the extra medical costs as a result of their smoking will differ by gender. A young man who starts smoking can expect to generate as much as $12,700 in excess medical costs over the course of his life or up to $19,000 if he smokes more than a pack of cigarettes a day. A study showed that, on average, smoking costs men 13.2 years of their life and women 14.5 years of their life. An estimated 440,000 Americans died prematurely of smoking every year. It has been found that smoking while pregnant increases the severity of complications during pregnancy and delivery and also costs about $8,000 more on average than a non-smoker who develops complications. It also doubles the risk of delivering a low birth-weight baby and is responsible for about 48,000 low birth-weight babies per year. Studies show that 5 to 15 minute counseling sessions conducted by a trained provider and supported with self-help materials can double, and in some cases triple, the rate at which pregnant women quit smoking. (U. S. Department of Health and Human Services, 1994). As a nation, we can come together to take the necessary steps to reduce the harmful effects of cigarette smoking to both smokers and nonsmokers. References
Blakey, R. (2002). CDC finds costs of smoking twice previous estimates, Retrieved May 16, 2002, from http://www.cnn.com/2002/HEALTH/04/11/smoking.costs/
Centers for Disease Control (1994). Morbidity and Mortality Weekly Report, Guidelines for School Health Programs to Prevent Tobacco Use and Addiction, (Vol. 43). No. RR-2.
Lee, P.R. (1994). Preventing Tobacco Use Among Young People, A Report of the Surgeon General, Retrieved June 7, 2002, from http://www.cdc.gov/tobacco/sgryth2.htm.
Nolo Law for All, (2002). Smoking in the Workplace: Still a Burning Issue, Retrieved May 16, 2002, from http://www.nolo.com.lawcenter/ency/article.cfm/objectID/5622E54E-4494-B
Office of the Surgeon General, You Can Quit Smoking, U.S. Department of Health and Human Services (2002). Retrieved June 10, 2002, from http://www.surgeongeneral.gov/tobacco/consquits.htm.
State of Delaware, (2002, May 31). Governor Ruth Ann Minner Signs Landmark Ban on Smoking In Delaware's Indoor Public Areas, Retrieved June 4, 2002 from http://www.state.de.us/governor/news/2002/05May/053102-SB99.htm.
University of Nevada, Reno, Robert Shubinski, M.D., (1999, March 9). Costs of Tobacco Use, Retrieved May 16, 2002 from http://unr.edu/homepage/subinsk/smokost1.htm
U.S. Department of Health and Human Services, Preventing Tobacco Use Among Young People, A Report of the Surgeon General, (1994).