[PHP Nepal Vol 3 Issue 6 June 2013] | According to World Health Organization (WHO) report on the global tobacco epidemic 2011, tobacco use continues to be the leading global cause of preventable death. It kills nearly six million people and causes hundreds of billions of dollars of economic damage worldwide each year. Most of these deaths occur in low- and middle-income countries, and this disparity is expected to widen further over the next several decades. It is also stated in the report that if current trends continue, by 2030 tobacco will kill more than 8 million people worldwide each year, with 80% of these premature deaths among people living in low- and middle-income countries.
Tobacco use is an epidemic, around the world. (US Surgeon General’s Report, 2012). The US Department of Health and Human Services reported (2004) that vast majority of smokers begin using tobacco products well before the age of 18 years. Cigarette smoking in US primarily begins in adolescence, and very few adults begin to smoke after age 26 (NSDUH 2010). In Britain (Charlton, 2001) the highest prevalence of smoking in people aged 16 years and over is among (20-24) year old. According to World Health Statistics 2009, Pakistan, tobacco use in adult males is 35.4% and in females is 6.6%. In adolescents (13-15 years) it is 12.4% in males and 7.5% in females. Among sub-Saharan African youth, rates of smoking range from 1.4% in Zimbabwe and 1.5% in Nigeria to 34.4% in Cape Town, South Africa, which is cause for concern. In Kenya, 7.2% of school-going adolescents smoke cigarettes while 8.5% use other forms of tobacco products.
Smoking trends among American high school students had sharply decreased during the late 1990s. During the early 1990s, teenage smoking rates were on a progressive rise. In 1991, an estimated 27.5% of teenagers were current smokers, according to the Youth Risk Behavior Survey (YRBS). By 1997, this percentage jumped to 36.4%. However, beginning in 1999, statistics showed a drop in adolescent smokers and continued to steadily decline for four more years. By 2003, the percentage of adolescent smokers fell by 12.9%. The counter-tobacco strategies geared towards young people that were installed during this time frame include expanding tobacco-free environments, strong smoke-free laws, encouraging school programs that promote change in health policy, increasing state excise taxes for tobacco products, expanding counter-advertising mass media campaigns, and minimizing tobacco advertising, promotions, and availability of tobacco products aimed at attracting young people.
The Health Survey for England in 2002 found a smoking rate of 26%. By 2007 the proportion of adult smokers in England had declined four percentage points to 22%. The government's multifaceted plans to reduce smoking included publicity campaign to shift attitudes and change behavior; a substantial increase in tax to reduce the affordability of smoking; an investment in customs to reduce tobacco smuggling; and smoking cessation service provided by the NHS.
According to Statistics Canada 2002 report, (from 1985 to 1991), prevalence of "current smoking" declined overall, for both sexes and all age groups except for those aged 15 to 24. Even larger declines occurred from 1991 to 2001. While current smoking prevalence for youths did not significantly change from 1985 to 1994-1995, there was a significant decrease of 6 percentage points from 1994-1995 to 2001 (from 28.5% to 22.5%). Canada has had many tobacco control initiatives, including multi-year federal strategies that began in 1986. The five strategic directions are: policy and legislation; public education; industry accountability and product control; research; and, building and supporting capacity for action. Moreover, tobacco control efforts are not limited to governmental action alone. Tobacco control advocates, as well as health professionals in general, have an important role to play in helping to educate the public about the health hazards associated to tobacco and holding their legislators accountable for developing public health policy.
In Australia the incidence of smoking is in decline, with figures from the 2011-12 Australian Health Survey showing 18% of the population to be current smokers, a decline from 28% in 1989-90. The Australian Government protects public health policies from tobacco industry interference, eliminate the advertising, promotion and sponsorship of tobacco products, and reduce the affordability of tobacco products. Other priorities focus on increasing smoke free areas, strengthening mass media and public education campaigns, improving access to evidence based cessation services, and considering further regulation of tobacco product contents, disclosure and supply.
There is need to enhance tobacco prevention efforts in developing nations (Adamson S Muula et al 2007). Advertising and promotional activities by tobacco companies have been shown to cause the onset and continuation of smoking among adolescents and young adults. (Surgeon general’s report 2012). For example, in Lilongwe, Malawi and Kampala, Uganda, adolescents are increasingly being exposed to tobacco and tobacco-related advertisements.
It is necessary to keep giving teenagers a serious anti-smoking education, provided in ways that reflect their cultures and experiences (Wendy Schwartz). Teens Against Tobacco Use (T.A.T.U) is an important part of the American Lung Association drive to eliminate tobacco use among youth. This program has 4 phases: training of adults; training of teens; teens teaching younger children and teens getting involved in community action (Charleston, WV: American Lung Association of West Virginia).
The US Surgeon General’s report 2012, concludes that coordinated, multi-component interventions that combine mass media campaigns, price increases including those that result from tax increases, school-based policies and programs, and state-wide or community-wide changes in smoke free policies and norms are effective in reducing the initiation, prevalence, and intensity of smoking among youth and young adults.
Farida Agha is an ex Principal Scientific Research Officer of Pakistan Medical Research Council, Islamabad.