Smoking Cessation Coverage

Abstract

Smoking cessation refers to the attempt to either stop smoking or to quit smoking. There are so many people who are struggling to stop smoking but only very few manage to control it. Some people who try to quit smoking only stop for a while and they end up going back to it, something that can easily qualify them to become chain smokers.

There care efforts that have been put forward to help those who are seriously in need of quitting smoking.  This help comes in form of medical or pharmacological therapy, reminder systems provided for the smokers, therapies that help in cessation of smoking and counseling systems from the experts are provided. (www.cdc.gov/tobacco/statesystem, 2006)

There are also methodologies employed by the government that boosts the effort of reduction in the smoking. These methodologies aim at discouraging the smokers by either making it difficult for them to afford the product for example by increasing the price, the restriction of smoking in public areas, the increase of the anti-smoking advertisements and the authorization strategy for the warning labels.

However, there are the issues that arise as a result of the laws that approve the increase in taxation. The success of the law on the increase of taxation on cigarettes relies heavily on the political will; the level of addiction that an individual has reached and the age, as it is said that the youth are more sensitive to price than the elderly.

This paper deals with the Senate Bill no. 407 enacted in the 2003 legislative session.  The bill advocated for the increase in taxation on tobacco products which was aimed at the decreasing their demand.

Introduction

It is one thing to die a normal death and another thing to die from something that is self-inflicted. That is what happens to the person who smokes. A person who smokes kills himself slowly and without really realizing that he or she is killing him/herself with the smoke from the cigarettes. Cigarette smoke, once it goes to the lungs, it burns it up and makes it susceptible to diseases. Apart from that, there are also cases like the distortion of the taste buds such that the taste of a smoking person is not effective, the smell senses are poor, chances of this person getting heart diseases, stroke, infection of the respiratory tracts and others are raised and as such makes a person more exposed to diseases and death earlier than a normal person.

 It has become the concern of the world, that smoking alone kills more people than any war, any disease or even natural death. The Senator of New York in the United States F. R Kennedy acknowledged this when he said that cigarettes killed more Americans each than they have ever been killed in any war or road traffic accidents. He said that the number of Americans who died with Lung cancer alone were five times more than those who died on the road. He also said that the cigarette industry was marketing a deadly weapon that was bound to finish the people, something like selling people’s lives, and indeed selling it to death. (Cohen, 1985).

This he said more than four decades ago, but even today, the trend is the same, and has even increased to a worse situation.

Cigarette smoking is one of the major causes of death in the United States. Reports show that it is the cause of approximately four hundred and forty thousand deaths of the American citizens every year. About forty five point one million adults in the United States are cigarette smokers. That gives a sample calculation of more than one in every five. In this number, majority smoking adult are addicted to smoking while the young are either being introduced to smoking by their peers, smoking parents or the attitude that they hold about smoking.

Many cancer cases, cases of cardiovascular and respiratory diseases are usually caused, triggered or worsened by smoking. Of those who are affected, for every one who dies of diseases related to smoking, there are twenty others who live with diseases related to smoking. (Center for Disease Control and Prevention ([CDC], 2006).

 There are chronic pulmonary patients who inhale smoke and oxygen consecutively. Their state of health is pathetic.

Smoking does not just affect the smokers. There are those who are affected indirectly by the secondhand smoke. The effects of smoke to those people are the same effects like those of the smokers. The tar that comes from cigarettes accumulates in their system just like it does in the body of a smoking person. Worse still, there are those children born of smoking parents especially the mothers. Smoking affects children whose mothers smoke cigarettes during pregnancy. At birth, these children are born with low birth weight and even after birth, we see them suffering from upper respiratory infections, and other problems brought about by the smoke from the mother. This is most unfortunate because the baby will have to live with those faults for the rest of their lives. That is the reason why pregnant mothers are advised not to smoke while they are expectant.

Because of the concern brought about by smoking and its effects, there is a need to ensure the reduction of the consumption of cigarettes. We have the capability of reducing this significantly and as a result we reduce the weight that is put on the country’s economy and health. There are several methods that are employed to ensure that the level of cigarettes and tobacco products consumption is reduced. To ensure that we are successful in doing so, we need a united effort from the government, the states, the citizens, social, workers and even the smokers themselves, to help regulate the consumption of cigarettes and other tobacco products. Many methods have been employed and among them we have, the restriction of smoking in public areas, the anti-smoking campaigns and the authorization of the anti- smoking labels. In addition, we have the price increase strategy where the prices on cigarettes and other tobacco products are increased to discourage the consumers from over consumption. This is done through the increase in the excise tax charged on the importation and selling of cigarettes and tobacco products.

This method is believed to be one of the most simple and effective method has proved workable in the effort put to reduce the smoking habits. There have been several bills that were put down to help enforce the cessation of smoking issue. One of the bills was the Senator Bill 407 of the state of Montana.

Senate Bill 407, which was enacted in the 2003 legislative assembly, was one of the most comprehensive reforms of the Montana’s tax structure. It increased the tax charged on cigarettes and other tobacco products and provided a new limited sales tax on accommodation and rental cars. (mt.gov/revenue/legislativeinformation/taxreform/sb407-descriptionandimpacts.doc)

Significance and the Scope of the issue

The American leading national goal is to reduce the use of tobacco and promote healthy living among its people by 2010. To achieve this, control of the smoking habits among the people had to be established. This was supposed to be done during the first ten years of the 21^st century and the concern had to be in the forefront.

Smoking and the consumption of tobacco in other forms is a chronic disease that has considerable deterioration of health especially in adults. The elderly who smoke are, in most cases, less educated, have low socio-economical status that are likely to be female and have reduced probability of being aware of the cessation process, leave alone succeeding with it. In addition to this, they suffer from endless illnesses that are related to smoking. On the other hand, they get some physical, social and psychological problems that are related to cessation.

As such, the treatment of tobacco dependency in older people should be taken seriously like the treatment of any other chronic diseases. Highly recommended is the pharmacological and behavioral therapy which can boost the cessation process. It is possible for the clinicians managing the process to manage the situation irregardless of the age of the smoker or the history of smoking that the particular person has. (Andrews, Heath & Graham, 2004).

There are several problems that make the cessation process really difficult, and this is common in the young people especially. One of the major promoters of smoking are the movie makers. Smoking is glorified in some if not most of these movies. The trend is going up instead of going down as is required. Smoking is portrayed as being a cool and sexy act and this leads to the increase of the smoking habits rather than reducing it especially among the youth. Movies with a great appeal to the viewers and which are very entertaining tend to have a bigger likelihood to influence those who watch it, especially the youth. There is no doubt that if they depict smoking as being cool, all the youth viewer ship will have the drive to go and try smoking in an attempt to identify with the characters in the movie.

Apart from influence from such things like the movies, we have the influence from peers, from the parents who smoke in the home and from some people in the society who they would like to emulate. It is important that healthcare providers do well their job of educating the public on the damage especially that of smoking which causes the smokers and even the secondhand recipients of smoke multiple problems. For instance, we know that smoking can cause pre-mature death and diseases in children yet they do not smoke but are only exposed to the secondhand smoke. According to researchers, there is evidence that exposure to long term secondhand smoke can cause structural damage in the lungs and pinpointing of emphysema. In a study to estimate the rate at which lung damage occurs by the Radiological Society of North America (MRI technique) the signs of early damage was detected in sixty seven percent smokers and twenty seven percent of non-smokers who were exposed to the secondhand smoke.(Web MD medspace.com, 2007).

The Senator Bill 407 was enacted in 2003 so that the price of tobacco could be increased and that the extra revenue collected could be used to run the anti-smoking campaigns, which include the advertisements that counter the advertisements that are placed by the tobacco companies. There is also the authorization of the anti-tobacco labels. This blunts the efforts made by the tobacco producing companies to make their products appeal to the public.

The revenue that is usually gotten from such taxes was distributed such that part of it went to the long-range building program and the rest was send to the state general fund.

There was also the part of the fund which was send to the department of public health and another amount to the human services. Since tobacco is among the leading causes of bad health, cessation is one sure way of reducing the health problems. The methodologies, once put in place, will help in promoting the health care those residents of an area with the increased taxes will undertake in the effort to promote good health. This in turn will save the money that they would spend killing themselves with smoke and in its place they can spend it on improving their health. The state will also save the funds it has kept for the same purpose of taking care of those affected by smoking. (www.legis.state.us, 2007)

Out of every five deaths in the United States, one is caused by smoking-related diseases. Studies show that smoking surpasses all the other death causatives like wars, HIV and AIDS, alcohol abuse, road accidents, murders, suicides, drug abuse, and fires all combined. It is also sad that the smokers die way much earlier than the other people for instance; it is given that they will die seven to eight years earlier than those who do not smoke. There is no part of the body that is not affected by the smoking of cigarettes. The only way to save yourself is through quitting smoking, and your health will be positively impacted. About two decades ago, smoking was seen as being fashionable and was advertised by movie stars of all types. The trends are considerably changing and smoking is not the in thing anymore. For instance, according to recent Center for Disease Control and Prevention (CDC) reports, the number of Americans who smoke has consistently reduced to approximately twenty five percent. (Slontic, 2007). This progress is due to the education provision by the health relations and the health professionals on the dangers of smoking and the exposure to tobacco smoke.

Economic Aspect

The tobacco industry was hit afresh by the congress’s seeking to increase the tax on cigarettes extensively from sixty one cents to one dollar per pack. Apart from the effects of smoking to the human life, there is also a bulky economic price. The cost of medication for smoking related conditions goes way beyond a hundred and fifty seven dollars per year in the United States’ budget according to Slontick, 2007 report. The level of absenteeism at work increases hence the out put goes down. There is also an increase in the use of medical facilities, especially the use of emergency rooms in clinics trying to deal with smoking related conditions. In addition to the smokers, the secondhand smokers like children will be affected thus causing absenteeism from schools because of illnesses related to secondary smoking.

The impact is also relayed to the other businesses for example the ban on smoking in public areas affects the bars and the restaurants since smoking in these areas affect the whole public. As a result, the smokers visiting certain areas that are affected by the ban will go down and business cannot be good.

Political and Ethical Consideration of Bill

The aim of the smoking cessation policy, to record less than twelve percent by 2010 is very critical to the health of the American citizens. Even though the efforts were bearing fruits as it was seen in the records that there was a decrease from about twenty four percent in 1998 to about twenty two and a half percent in 2002, the journey is still so long. The good thing is that at least we have started it. (Wallace, Glover, Stevens, 2007). For instance, about twenty two people start smoking everyday in the state of West Virginia, an approximate of about eight thousand people. Most of these are youths and children. That is the reason why there had to be an increase in the taxes so that at least the youth cannot afford the cigarettes. The increase would not affect the elderly in such a significant way because they were already addicted in most cases and can still afford even the increased price cigarettes. In addition to this, they have known all the time the way they to go about it as compared to the young ones.

One of the most important things that one can do to help and save themselves from the effects of smoking is to quit smoking. There are several benefits of quitting and they can start from as early as twenty four hours after you quit smoking, and they become even better with the advancement of the days without smoking. After twenty four hours, for instance, the chances of getting a heart attack reduce. Just two days of cessation will lead to the enhancement of the taste and smell. In about two weeks, there will be an enhancement in the circulation of blood and the walking improves with the lungs functioning in a better way. In one month’s time, the cough, sinus congestion, fatigue and shortness of breath decreases and the repair of the lungs starts. With the repair of the lungs, the chances of infection in the respiratory tract are lowered a great deal.

After one year, the heart disease risk is reduced by a half. The health improves of an individual improves tremendously. By the time five years are over, the risk of cancer of the mouth and esophagus is decreased by half. In addition to this, the chances of having stroke and other heart diseases decreases. Ten years after successful cessation, the threats that you might be having lung cancer is half that of the continuing smokers and at fifteen years, the risk of getting heart diseases goes back to the same level as that of those people who have never smoked.(medicalnewstoday.com, 2007, paragraph 2)

Proponent and Opponent Arguments

 As early as 1988, voters from the state of California had approved a proposition that increased the tax on cigarettes and funded programs that were aimed at the controlling the use of tobacco products. In 1998, ten years after the proposal, the proposition was passed and the taxes on cigarettes had increased. They were not the only ones who proposed the   bill. It was proposed by many groups.

            Though the determination of the cigarette prices is the responsibility of the companies that produce them, states were allowed to manipulate the prices through taxes. According to these states, the returns gotten from the taxes were meant for tobacco control programs and cancer problems. However, only a few states managed to enforce this increment in taxes. Apart from the Californians, the state of Arizona voters also managed to approve of this bill and the Oregon statewide coalition of healthcare and tobacco use prevention promoters began a petition that was mostly carried out by the citizens of the state. This shows that the bill was proposed by many people who were interested in the state health. It was a collective effort of the citizens, the individual state and the federal government.  Other stake holders were the health providers and the organizations that were geared at the anti-tobacco campaigns.

The federal government and the state jurisdiction argued that increased taxes would lower the rate at which smokers would afford cigarettes hence it would decrease the number of smokers in the country. In addition to this, there is the issue of increasing the revenue earned so that it could be channeled to the anti-smoking campaigns and also be used in the dealing of the health complications that are brought about by the use of tobacco.

Other high ranking proponents of this bill are the Center for Disease Control and prevention (CDC), the office on Smoking and Health, and the National Tobacco Control Programs. These organizations try as much as possible to ensure that they do everything in their power to achieve the goals they have set concerning prevention of tobacco use. Their ultimate dream is having a world free from deaths and diseases caused by the use of tobacco; they have assumed the duty of developing, conducting and supporting the strategic efforts that are put forward to protect the health of the public from the harmful effects of smoking and the use of other tobacco products. Their goal is to prevent the use of tobacco among the youth and even adults, promote the cessation of smoking among the youths and the adults, to reduce to the lowest levels possible the exposure of individuals to second hand smoke, and to spot and get rid of health issues related to tobacco use according to the Center of Disease Control and Prevention, (2007).

Employers also support the effort because the cessation will make the productivity in their companies increase. This will certainly come as a result of the decreased absenteeism from work which will be reduced by the reduction of the tobacco related illnesses among the workers. With decreased illnesses the life insurance plans of the company will reduce and in turn the premiums paid on insurance will decrease. If we pay for the cessation of smoking, we will be paying for all the insurance needed for adults that can be put at the disposal of the employees. (Ratliff, 2007).

Human Services Perspective

As a person dealing with human services, there is need to provide the best services to the human fraternity. In an attempt to do this, there is need for us to have first hand information on the effects of smoking. Armed with this information, we will be able to educate the public on the importance of ceasing to smoke. Research has shown that people’s attempts to stop smoking can be increased through counseling. Counseling lasts only about ten minutes but significantly increases the chances of cessation. Smoking is not ignorable. It is a disease that we all need to see eliminated from our society. As human servants, we know that we are obligated to ensure that the public accesses this information easily and that they know all they need to know. We should also continue to build the knowledge and education of our people. This is the reason why I support the bill for. It is a way through which we will have our work in progress; educating them and advising them on the importance of quitting smoking.

            We all know what damage smoking causes our family, friends and our people. I will therefore give support and do my best to ensure that I play my role when it comes to informing people about the dangers of using tobacco. I believe that many people wish to quit smoking but they cannot do so because they do not have information that can help them to be successful in the process.  It is my duty that all such people get the information so that the health of the nation is not put at stake.

The bill does not however get full support. There are a few groups that are against the price increase bill in support of the cessation of smoking goal. A common argument arose against the increase of the excise tax rate. Those who raised this argument were saying that the bill will either lead to illegal smuggling of the tobacco products and cigarettes across the state borders. There is the belief that not all dealers in cigarettes will want to pay the raised taxes. As a result they will resort to the cheaper sources which are bound to be illegal. In connection with this, the smokers will find other cheap sources that will make the government not have the required revenue. Luckily, in those states where the raise of the tax was implemented, there were no such cases reported and the revenue increased tremendously.

Policy/Bill Recommendations

There has been so much representation in papers with repeated information about the damages that are caused by smoking and the use of tobacco products and the harm it inflicts on the human body. Therefore, this bill is of paramount importance in the fight for cessation of smoking. This bill aims at the reduction of supply of tobacco products to the smokers by making it more expensive and hence reducing the quantity that is supplied. Cessation strategy is important for the repair of the health of the people of the nation. With the reduction of the smoking, all the other benefits come. With a good cessation strategy will come the good health, and then less money spend buying the cigarettes and tobacco products. Ultimately, there will be less ill health and in the end we will have a small budget for the medication. It would be a great success if the bill is passed by every particular state. However it will not be a guarantee for the improvement or even elimination of the problem.

It is the duty of the healthcare providers, nurses, and patients to ensure that they are doing their best to be tobacco free themselves before they embark on the task of making smokers quit smoking. This will ensure a truly healthy future. I would like to see the bill implemented so that there is collective effort to ensure that the bill is effective. The increase on the taxes on cigarettes should be increased without any reflection on non-smokers.

Conclusion

In conclusion, we must understand that the smoking cessation program is a very important program. There is no doubt that cigarette smoking is causing more diseases and deaths than any war known, any disease or any other traffic accidents known. Pollution to the environment is not an exceptional. There are many other harmful effects that might need more than this paper to study and lay bare to the smokers and the rest of the public. This is the reason we needed a system, out of public demand to make sure that we can curb the smoking habit. This was the whole reason for the conception of the cessation program.

It is clear that there are several methods that have been employed which include, the restrictions on smoking in public areas, the promotion of the anti-tobacco campaigns, the authorization of the anti-tobacco labels and finally the increase of excise tax. Of these methods, the most effective one is the increase in excise tax on cigarettes and other tobacco products. This has been proved to be simple and workable. Research shows that the increase on the taxation lead to increase in price and in turn, the reduction of consumption of cigarettes and other tobacco products. This was mostly observed in the youth who feel the strain on the price because most of them start smoking while they are not earning. Smoking to them is an extra expense and they do it due to peer pressure and maybe because of having a few extra coins, or when they have too much money to spend. On the other hand, we can see that for this to succeed, all stakeholders-citizens, federal government and the states’ administration should put in a collective effort for this to succeed. We also need the smokers to help us to achieve any success in this, because after all, they are the ones who are the center of focus here.

On the contrary, the increase of taxes may not be effective in the cessation process. This might be because the smokers might be addicted as it mostly happens in the adults. They will not be scared of prices because they have always been smoking anyway. For these people, there has to be an understandable way of showing them that smoking is harmful. In addition to the tax increase program, we should try other programs that will help those who are smoking for example those put forward in publication by the Center for Disease Control and Prevention in the publication, Best Practices for Comprehensive Tobacco Control Programs. It is significant that there be coordination of the onset of taxes and the delivery, awareness or education campaign, to encourage cessation. Additionally, the funds collected should be spared for the effective cessation services only.

In this same effort, we know that only one method cannot be all round in solving the problem. In this regard, I would like to recommend that other methods for cessation should not be ignored even if they only contribute a small amount of effort for the success. I believe that collective effort will be a perfect solution.

There is need that the levels of tobacco smoking be brought down with whatever method that seems to be working.

References

Centers for Disease Control and Prevention (CDCP). (1999). Best Practices for Comprehensive Tobacco Control Programs – August 1999. Atlanta, GA: Centers for Disease Control and   Prevention.