tobacco cessation essay

An Issue of Smoking Cessation

How it works

• 1.1 Importance
• 2 Patient Population
• 3.2 Barriers
• 3.3 Benefits
• 4.1 References

Introduction

The purpose of the paper is to identify health promotion and maintenance of health issue among smokers in the Brooklyn and explore how to resolve the clinical issue. Smoking among African American in Brooklyn led to high rates of respiratory infection, heart disease, lung disease, premature deaths and Sudden Infants Death syndrome (SIDS).

Smoking is the number one cause of preventable diseases and death in the United states, accounting for over 480,000 deaths per year; which is about 1 in 5 deaths.

  According to the Centers for Disease Control and Prevention, the estimation of smokers in the US currently is nearly about 37.8 million ranging from 18years and older. Smoking cause about 6million death per year and it is anticipated that by the year 2030, the cause of death per year will be 8million which is an increased.  (CDC, 2018)

Percentage of smokers in the US ranging from 18 years & older in 2016 are:

13.5% are female

18-24 years- 13.3%

25-44 years- 17.6%

45-64 years- 18%

65 years old- 8.8%

Nearly 32 of every 100 non-Hispanic American Indians/Alaska Natives (31.8%)

About 25 of every 100 non-Hispanic multiple race individuals (25.2%)

Nearly 17 of every 100 non-Hispanic Blacks (16.5%)

Nearly 17 of every 100 non-Hispanic Whites (16.6%)

Nearly 11 of every 100 Hispanics (10.7%)

9 of every 100 non-Hispanic Asians* (9.0%)

The statistic is provided by the Centers for Disease Control and Prevention (CDC, 2018)

The potential negative effect of unresolved smoking leads to diseases such as lung cancer, chronic obstructive pulmonary disease, ischemic heart disease, lower respiratory disease and cerebrovascular disease. According to the CDC, secondhand smoking cause about 34,000 heart disease deaths each year and 7,300 lung cancer death each year. It also shows that the cause of health effect in children such as ear infection, more frequent and severe asthma attacks, respiratory infection like pneumonia and bronchitis and sudden infant death syndrome (2017).

Patient Population

According to the Department of Health in NY, there are over 2 million smokers and about 28,000 New Yorkers are killed. About 750,000 adults in NYS live with smoking related illness such as birth defects and other diseases (2018). In the Bronx Community Health Dashboard conducted by Montefiore hospital, it shows that Brooklyn has the second highest percent of current smokers in NYC. When comparing the overall rate of smokers, it shows that Brooklyn has about 14.9% (Rehm, 2017).

The North Brooklyn includes neighborhoods of Bushwick, Flatbush, Brownsville, Coney Island, East New York and Bedford-Stuyvesant. According to New York Department of Health and Mental Hygiene: community profiles, these communities are the poorest borough in Brooklyn. The demographics consists of African American (69.5%) and Hispanic (32%) population. North Brooklyn is severely impacted by tobacco usage and secondhand smoking.

According to the Department of Health in NYS, there are over 2million smokers and about 41,00 deaths and 400 infants’ deaths in US caused by secondhand smoking. There are so many North Brooklyn residents trying to quit but nevertheless there are still some smokers. The widespread of smoking in North Brooklyn community has put resident at risk which has force

Proposed Solution

The best solution to the above clinical problem are smoking cessation, patient teaching about the impact of not smoking (intervention), Smoke free by US department of health and human service, Every Try Counts by National Cancer Institute and Smokers hotline by NYS Department of Health.

Smoke free by US department of health and human service create tools to help smokers from smoking. The tools created are taking a questionnaire, smoke free texting programs, enforcing the use of nicotine replacement therapy, smoke free apps, smoke free social media and working closely with a counselor on how to build a plan to stop smoking which one will explore methods to quit smoking, medications and nicotine replacement therapy (n.d.).

Every Try Counts by National Cancer Institute provide trained counselor to help support quit smoking. They are very similar to smoke free but the difference are they provide in person counseling and support, telephone counseling and support, online programs, hypnosis, laser therapy and acupuncture (Smoking & Tobacco Use, 2018)

Smokers hotline by NYS Department of Health is a hotline for smokers to call to get support via phone.

The three levels of preventions for smoking are:

• Primary prevention

Smoking prevention programs such as smoke free, every try counts

Educating about the effect of smoking

• Secondary prevention

Smoking cessation programs

Testing screening

• Tertiary prevention

Provide medical and psychological support to the smoker such as behavioral and aversion therapy

Nicotine replacement therapy

The Smoke Free Act (SFAA) was created in the year 2002 to protect the health of New Yorker against harmful effects of secondhand smoking such as imposing a restriction on indoor smoking and creating a smoke free workplaces (2017).

The short-term goal for smoking cessation is creating a measurable goal such as abstaining from smoking for four months. In order to abstain from smoking, one has to identify a quit date and implement a plan on ways to abstain from smoking.  Implementing a plan can involve avoid triggers such as identifying places the triggers the urge to smoke or avoid socializing with the people one used to smoke with.

The long-term goal for smoking cessation include nicotine replacement therapy, provide intervention treatment such as bupropion, which is a drug choice for smoking cessation and providing trained counselor to help provide support to quit smoking.

Despite knowing the effect of tobacco usage, most people continue to smoke. Smokers have difficulty quitting because of the addiction to nicotine, lack of support, lower socio-economic, poor habits, stress factors and cultural norms.

The two potential barriers to the success of preventing smoking are stress management and language deficit. According to Squires, language barrier within the health care system is significantly high and about 5% of nurses identify as Hispanic or Latinos (2018). A strategy for addressing the language barrier is providing a well-trained interpreted to facilitated the conversation between the patients and healthcare providers.

Benefits of smoking cessation to the patient population will decrease lung cancer, chronic obstructive pulmonary disease, ischemic heart disease, lower respiratory disease, cerebrovascular disease, health effect in children such as ear infection, more frequent and severe asthma attacks, respiratory infection like pneumonia and bronchitis and sudden infant death syndrome according to the Centers for Disease Control and Prevention (2017).

According to the New York City Department of Health and Mental Hygiene, about 13.7% of residents and 270,000 adults’ smokers are African American and one third of death prematurely are result of smoking (2017).

A benefit of smoking cessation to the nursing profession include continue education, patient teaching and providing support to the patient. Health benefit of smoking cessation include premature death and decrease of respiratory infections.

Participants and Interdisciplinary Approach

Collaboration with various interdisciplinary such as respiratory therapist, mental health counselor and pharmacist along with the full participation of the smokers in the smoking cessation program. Though nurses provide resources to the patients, create a non-biased & non-judgmental environment for the patients, educate, teach, provide support, risk and benefit of smoking cessation. Respiratory therapist provides patients with accurate information about tobacco use, ways to quit and the consequences of tobacco use. They create a treatment planning for each individual smoker, assess, relapse prevention, professional resources, counseling and evaluate.

According to American Journal of Health-System Pharmacy, it shows that collaboration with a clinical pharmacy specialist help significantly with smoking cessation.  Study show that, “59 patients (42%) had achieved tobacco cessation, and 55 (39%) had achieved a reduction in tobacco use but not complete cessation. The remaining 26 patients (19%) were lost to follow- up, lost interest in cessation, or were transferred to other care (Litke et.al, 2018).

Mental health professional provides a non-biased and non-judgmental environment for the smokers to vent about the issues and provide support to the smokers.

Smoking cessation is one of the most effective ways to prevent smoking. New York Government have done well implementing ways to control tobacco such as imposing a restriction on indoor smoking, creating a smoke free workplaces, encourage smoker to stop smoking and creating a smoking cessation program.

Smoker joining the smoking cessation program will decrease health issues such as lung cancer, heart disease, respiratory disease, respiratory infection, premature death on infants and SIDS.

New York City also implement programs such as Smoke free by US department of health and human service, Every Try Counts by National Cancer Institute and Smokers hotline by NYS Department of Health. All of these programs were implemented to help smokers quit and provide support.

• Department of Health. (2018, June). Retrieved December 11, 2018, from https://www.health.ny.gov/prevention/tobacco_control/
• How to Quit. (n.d.). Retrieved from https://smokefree.gov/tools-tips/how-to-quit
• Litke, J., Spoutz, L., Ahlstrom, D., Perdew, C., Llamas, W., & Erickson, K. (2018). Impact of the clinical pharmacy specialist in telehealth primary care. American Journal of Health        System Pharmacy, 75(13), 982??“986.        https://doiorg.chamberlainuniversity.idm.oclc.org/10.2146/ajhp170633
• New York City Department of Health and Mental Hygiene. New York City Youth Risk Behavior Survey 2017.
• NYC Department of Health and Mental Hygiene (DOHMH). (2017, August 13). Retrieved December 12, 2018, from https://www1.nyc.gov/nycbusiness/description/smoke-free-air        act–information
• New York City Department of Health and Mental Hygiene. (2015). Community Health Profiles: Pilgrim, J. M., & Oji, O. F. (2017). Pulmonary Disease, Chronic Obstructive (COPD):        Smoking Cessation. CINAHL Nursing Guide
• Rehm, C. (2017, October 23). Bronx Community Health Dashboard: Smoking. Retrieved December 11, 2018, from        https://www.montefiore.org/documents/communityservices/OCPH-smoking.pdf
• Smoking & Tobacco Use. (2018, September 24). Retrieved December 11, 2018, from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.mSmoking & Tobacco Use. (2017, February 21). Retrieved December 11, 2018, from        https://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_fac        s/index.htm
• Squires, A (2018) Strategies for overcoming language barriers in healthcare. Nursing Management 49(4), 56

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Tobacco: Health benefits of smoking cessation

Beneficial health changes that take place:

• Within 20 minutes, your heart rate and blood pressure drop.
• 12 hours, the carbon monoxide level in your blood drops to normal.
• 2-12 weeks, your circulation improves and your lung function increases.
• 1-9 months, coughing and shortness of breath decrease.
• 1 year, your risk of coronary heart disease is about half that of a smoker's.
• 5 years, your stroke risk is reduced to that of a nonsmoker 5 to 15 years after quitting.
• 10 years, your risk of lung cancer falls to about half that of a smoker and your risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decreases.
• 15 years, the risk of coronary heart disease is that of a nonsmoker's.

Benefits in comparison with those who continued:

• At about 30: gain almost 10 years of life expectancy.
• At about 40: gain 9 years of life expectancy.
• At about 50: gain 6 years of life expectancy.
• At about 60: gain 3 years of life expectancy.
• After the onset of life-threatening disease: rapid benefit, people who quit smoking after having a heart attack reduce their chances of having another heart attack by 50%.

Quitting smoking decreases the excess risk of many diseases related to second-hand smoke in children, such as respiratory diseases (e.g., asthma) and ear infections.

Quitting smoking reduces the chances of impotence, having difficulty getting pregnant, having premature births, babies with low birth weights and miscarriage.

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1. Mahmud, A, Feely, J. Effect of Smoking on Arterial Stiffness and Pulse Pressure Amplification. Hypertension. 2003; 41(1):183-7.

2. U.S. Department of Health and Human Services. The Health Consequences of Smoking: Nicotine Addiction: A Report of the Surgeon General. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. DHHS Publication No. (CDC) 88-8406. 1988.

3. U.S. Department of Health and Human Services. The Health Benefits of Smoking Cessation. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. DHHS Publication No. (CDC) 90-8416. 1990.

4. Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ. 2004; 328(7455):1519-1527.

5.US Department of Health and Human Services 2004, The Health Consequences of Smoking: A Report of the Surgeon General, US 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, 2004.

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World No Tobacco Day

Health Promotion and Smoking Cessation Proposal Essay

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Introduction

Proposed internship activity, implications for professional development, reference list.

The targeted public health problem is smoking. Statistics show clearly that smoking is one of the leading causes of death in the world. According to the World Health Organization (WHO), tobacco kills over 6 million people annually ( CEASE: Mission & Goals , 2015). Many passive smokers are also affected by cigarette-related complications. Majority of the affected individuals live in underprivileged environments or countries. The targeted study focuses on smoking cessation. Statistics show clearly that smoking is a major challenge in different parts of the world. The study will therefore examine the efforts undertaken by CEASE to deal with smoking in South West Baltimore.

Baltimore has many smokers compared to different regions in the United States. Statistics indicate that around “69 percent of males and 50 percent of women engage in smoking” ( CEASE: Mission & Goals , 2015, para. 3). As well, the number of passive smokers has been increasing steadily in the region (Rigotti, 2012). Different government agencies and organizations are currently embracing the best measures in order to deal with this problem.

One of these organizations is the Communities Engaged in Advocating for a Smoke-free Environment (CEASE). The agency uses powerful programs in order to address this problem. The agency uses strategic plans in order to achieve the best goals (Kumar & Vijayan, 2012). Training programs are used to educate more people about the dangers of smoking. The organization also uses powerful initiatives in order to empower more youths in the region (Rigotti, 2012). The agency has implemented a powerful study approach known as Community-Based Participatory Research (CBPR). This program is used to define, evaluate, design and implement the best practices.

The potential organization for my internship is the Communities Engaged in Advocating for a Smoke-Free Environment (CEASE) in Baltimore City. I will also complete a wide range of activities in an attempt to support the agency’s goals. The first activity will be to design various smoking cessation programs. I will also be involved in every implementation process. I will also be part of every evaluation process. I will also undertake numerous studies in order to present evidence-based concepts. Such concepts will eventually deliver positive results. Such studies will outline the major challenges associated with smoking (Rigotti, 2012).

These activities will ensure more people achieve their goals. The implementation process will ensure more people benefit from the process. As well, new studies will be conducted in order to support the proposed programs (Liu & Tan, 2009). These approaches will make it easier for more people to stop smoking. The activities will ensure the implemented program addresses the major health challenges associated with smoking ( Tobacco , 2015). The important goal is to inform more people about the dangers of smoking. The strategy will also propose a powerful model that can be used to deal with smoking.

The targeted internship will equip me with powerful competencies. To begin with, I will develop new project management skills. Such skills will make it easier for me to identify and address various health challenges (Ji, Xiong, Gilpin, & Biener, 2007). I will use such skills to address various public health problems. I will acquire new decision-making, critical thinking, and problem-solving concepts (Liu & Tan, 2009). Such concepts will make it easier for me to support more smokers. I will apply such competencies in different situations in order to support more individuals. New practices such as communication and teamwork will become part of my professional practice.

CEASE: Mission & Goals . (2015). Web.

Ji, M., Xiong, C., Gilpin, E., & Biener, L. (2007). Assessing the Effectiveness of Anti-smoking Media Campaigns by Recall and Rating Scores: A Pattern-Mixture GEE Model Approach. Journal of Data Science, 5 (1), 23-40.

Kumar, R., & Vijayan, V. (2012). Smoking Cessation Programs and Other Preventive Strategies for Chronic Obstructive Pulmonary Disease. Supplement to JAPI, 60 (1), 53-60.

Liu, H., & Tan, W. (2009). The Effect of Anti-Smoking Media Campaign on Smoking Behavior: The California Experience. Annals of Economics and Finance, 10 (1), 29-47.

Rigotti, N. (2012). Strategies to Help a Smoker Who Is Struggling to Quit. JAMA, 308 (15), 1573-1580.

Tobacco . (2015). Web.

• Lieberman’s Book as a Last Call For People to Start Living Healthy Lifestyles
• Why Do People Prefer to Pop Drugs/Pills Rather Than Change a Lifestyle
• Baltimore’s Fiscal 2012 Budget Analysis
• Nursing Interventions for Smoking Cessation
• Effectiveness of the Cognitive Behavioral Therapy for Smoking Cessation
• Food Work in the Family and Gender Aspects of Food Choice
• Food and Grades of Students at School
• Why People Choose a Healthy Lifestyle Compared to Unhealthy Lifestyle?
• Contemporary Approaches to Lifestyle Management
• The Stability of Exercise-Related Identity
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IvyPanda . "Health Promotion and Smoking Cessation." April 17, 2022. https://ivypanda.com/essays/health-promotion-and-smoking-cessation/.

Home — Essay Samples — Nursing & Health — Tobacco — Cessation Of Tobacco Use: Overview Of The Alternatives

Cessation of Tobacco Use: Overview of The Alternatives

• Categories: Tobacco

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Published: Oct 25, 2021

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Tobacco Smoking Cessation

Health issue of concern, addiction institute of mount sinai, prevention agenda briefs, services provided, gaps in services provided, addressing the gaps, interventions that can be used to reduce tobacco use, interventions that can be added, works cited.

About 34 million adults in the US smoked cigarettes as of 2018. A study done by the Centers for Disease Control and Prevention CDC (par 1) confirmed that out of every 100 18-years and above adults in the US, 14 are cigarette smokers. The World Health Organization (par 2) estimates the number of tobacco users to have fallen from 1.397 billion in 2000 to 1.337 billion in 2018 globally. Tobacco use can be taken in different forms. It can be through smoking, vaping e-cigarettes, chewing tobacco, and hookahs.

The organization’s interventions alleviate the economic and social burdens caused by tobacco use. The organization was developed based on the need for resources to support teens in their attempts to stop smoking. The organization uses a cognitive-behavioral approach and uses motivational strategies to encourage teens to reconsider their tobacco use behaviors. The program has various activities that require the input of the participants rather than the program developers, whose focus is only to create an enabling environment. Teens are informed on tobacco smoking risks and how to effectively and successfully quit tobacco smoking. The organization maintains, strengthens, and refines adequate tobacco control infrastructure.

The program promotes a policy change through its evidence-based strategies, which alter the behavior of individuals in society, thereby making tobacco less desirable, accessible, and acceptable. The organization utilizes tobacco-related reports from the Bureau of Tobacco Control. The bureau contains all the information related to tobacco use and the successful interventions in facilitating individuals to quit smoking. These include the independent evaluation report, prevention agenda briefs, outcome indicator reports, etc. Maximizing impact and improving the outcomes of the interventions and activity is the organization’s primary goal. These form the parts of the measurable objectives. The systemic evaluation of all the efforts and interventions of the organization facilitates maximization effects and improvement of the healthcare outcomes.

Patient empowerment and motivational interviewing interventions are effective for individuals younger than 50. Tobacco smokers are empowered by health education on the harmful effects of exposure to tobacco smoke or tobacco smoking. In motivational interviewing, the organization uses its guiding principles to promote behavior change (Guydish et al., 2019). The organization also offers tobacco addiction treatment.

The organization uses evidence-based scientific models for the treatment of addiction. The treatment provided includes the patch, nicotine gum, spray or inhaler containing low doses of nicotine, and certain medications. Behavioral and psychological interventions such as hypnotherapy, cognitive behavioral therapy, and neuro-linguistic programming are also offered. The organizations serve teenagers and adults commonly but mainly focus on teenagers.

Paid media campaigns and advertisements are critical in reaching those individuals who cannot access the program. The organization has strategically placed advertisements on radios, television, billboard, and print form to reach every member in each corner of the state. Countermarketing strategy exposes the manipulative and deceptive marketing strategies to reduce the prevalence of tobacco use. Studies show that counter-marketing strategy curbs smoking initiation in teenagers and promote smoking cessation among adults. Smoker’s quitline gives individuals a platform to call and access any information related to tobacco use and addiction.

Variances in tolerability make it difficult for healthcare providers to standardize treatments. This can lead to serious adverse events. Reduced compliance in some individuals interferes with the effectiveness and the cost of the interventions. Reduced compliance with specific interventions such as nicotine replacement therapy could lead to severe adverse reactions. The high cost of treatment leads to inadequate dosage or full implementation of interventions.

All the drugs should be affordable to all individuals who wish to quit smoking. The organization can increase the adoption of low-cost and low-technology strategies to address tobacco addiction treatment. In improving the organization, the government needs to be encouraged to fund the program to reduce the social and economic burden on the state. Compliance increases the effectiveness of treatment and reduces the cost of treatment. Adherence also minimizes the likelihood of occurrence of a treatment-related adverse reaction.

Several health promotion strategies can reduce the number of tobacco users further, cutting its costs, diseases, conditions, and deaths. Health education through media increases the awareness of individuals in New York. Health education in schools, workplaces at homes, and at community levels should also be done to equip people with the knowledge of the effects of tobacco use and what they can do to stop it.

CPSTF is a collection of resources that will help the workers in the organization select interventions that will improve health and prevent disease in New York. The community guide helps identify gaps that exist due to inadequate or insufficient research.

Guydish, Joseph, et al. “Tobacco Cessation Services in Addiction Treatment: What Do Clients Say?.” Psychiatric Services 70.3 (2019): 229-232.

Centers for Disease Control and Prevention CDC. Current Cigarette Smoking Among Adults in the United States (2019). Web.

World Health Organization. “ WHO Launches New Report on Global Tobacco Use Trends. ”(2019). Web.

Mount Sinai. Addiction Institute(2021). Web.

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StudyCorgi. (2022, October 6). Tobacco Smoking Cessation. https://studycorgi.com/tobacco-smoking-cessation/

"Tobacco Smoking Cessation." StudyCorgi , 6 Oct. 2022, studycorgi.com/tobacco-smoking-cessation/.

StudyCorgi . (2022) 'Tobacco Smoking Cessation'. 6 October.

1. StudyCorgi . "Tobacco Smoking Cessation." October 6, 2022. https://studycorgi.com/tobacco-smoking-cessation/.

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StudyCorgi . "Tobacco Smoking Cessation." October 6, 2022. https://studycorgi.com/tobacco-smoking-cessation/.

StudyCorgi . 2022. "Tobacco Smoking Cessation." October 6, 2022. https://studycorgi.com/tobacco-smoking-cessation/.

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Am Fam Physician. 2021;103(12):online

Related Putting Prevention into Practice: Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons

As published by the USPSTF.

Summary of Recommendations

The USPSTF recommends that clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and U.S. Food and Drug Administration (FDA)–approved pharmacotherapy for cessation to nonpregnant adults who use tobacco ( Table 1 ) . A recommendation .

The USPSTF recommends that clinicians ask all pregnant persons about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant persons who use tobacco ( Table 1 ) . A recommendation .

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of pharmacotherapy interventions for tobacco cessation in pregnant persons  ( Table 1 ) . I statement .

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of electronic cigarettes (e-cigarettes) for tobacco cessation in adults, including pregnant persons. The USPSTF recommends that clinicians direct patients who use tobacco to other tobacco cessation interventions with proven effectiveness and established safety  ( Table 1 ) . I statement .

See the Practice Considerations section for more information on recommended behavioral interventions and pharmacotherapy and for suggestions for practice regarding the I statements.

Introduction

Tobacco use is the leading preventable cause of disease, disability, and death in the United States. In 2014, it was estimated that 480,000 deaths annually are attributed to cigarette smoking, including secondhand smoke. 1 Smoking during pregnancy can increase the risk for miscarriage, congenital anomalies, stillbirth, fetal growth restriction, preterm birth, placental abruption, and complications in the offspring, including sudden infant death syndrome and impaired lung function in childhood. 1 – 4 In 2019 (the most recent data currently available), an estimated 50.6 million U.S. adults (20.8% of the adult population) used tobacco; 14.0% of the U.S. adult population currently smoked cigarettes; and 4.5% of the U.S. adult population used e-cigarettes. 5 According to data from the National Vital Statistics System, in 2016, 7.2% of women who gave birth smoked cigarettes during pregnancy. 6 There are disparities in smoking behaviors associated with certain sociodemographic factors: Smoking rates are particularly high in non-Hispanic American Indian/Alaska Native persons; lesbian, gay, or bisexual adults; adults whose highest level of educational attainment is a General Educational Development certificate; persons who are uninsured and those with Medicaid; adults with a disability; and persons with mild, moderate, or severe generalized anxiety symptoms. 5 According to the 2015 National Health Interview Survey, which reported responses from 33,672 adults, 68% of adults who smoked reported that they wanted to stop smoking, and 55% attempted quitting in the past year 7 ; only 7% reported having recently quit smoking, and 31% reported having used cessation counseling, medication, or both when trying to quit. 7

USPSTF Assessment of Magnitude of Net Benefit

The USPSTF concludes with high certainty that the net benefit of behavioral interventions and FDA-approved pharmacotherapy for tobacco smoking cessation, alone or combined, in nonpregnant adults who smoke is substantial .

The USPSTF concludes with high certainty that the net benefit of behavioral interventions for tobacco smoking cessation on perinatal outcomes and smoking cessation in pregnant persons is substantial .

The USPSTF concludes that the evidence on pharmacotherapy interventions for tobacco smoking cessation in pregnant persons is insufficient because few studies are available, and the balance of benefits and harms cannot be determined.

The USPSTF concludes that the evidence on the use of e-cigarettes for tobacco smoking cessation in adults, including pregnant persons, is insufficient , and the balance of benefits and harms cannot be determined. The USPSTF has identified the lack of well-designed, randomized clinical trials on e-cigarettes that report smoking abstinence or adverse events as a critical gap in the evidence.

See Table 2 for more information on the USPSTF recommendation rationale and assessment. For more details on the methods the USPSTF uses to determine net benefit, see the USPSTF Procedure Manual. 8

Practice Considerations

Patient population under consideration.

This recommendation applies to adults 18 years or older, including pregnant persons. The USPSTF has issued a separate recommendation statement on primary care interventions for the prevention and cessation of tobacco use in children and adolescents. 9

DEFINITIONS

Key definitions related to tobacco use are reported in Table 3 . 10 , 11 Although tobacco use refers broadly to the use of any tobacco product, cigarette smoking has historically been the most prevalent form of tobacco use in the United States, and most of the evidence surrounding cessation of tobacco products relates to quitting combustible cigarette smoking. Thus, the current USPSTF recommendations focus on interventions for tobacco smoking cessation. Additionally, although e-cigarettes are considered a tobacco product that should also be the focus of tobacco prevention and cessation efforts, for this recommendation statement, the evidence on e-cigarettes as a potential cessation aid for cigarette smoking was also evaluated.

ASSESSMENT OF TOBACCO USE

All patients should be asked about their tobacco use, whether or not risk factors for use are present, and encouraged to stop using tobacco. When smoking is identified, all patients should be provided interventions to quit smoking. Higher smoking prevalence has been observed in men; persons younger than 65 years; non-Hispanic American Indian/Alaska Native persons; persons who are lesbian, gay, or bisexual; persons whose highest level of educational attainment is a General Educational Development certificate; persons with an annual household income less than $35,000; persons with a disability; and persons with mild, moderate, or severe anxiety symptoms. 5

Common approaches for clinicians to assess patients' tobacco use include the following.

The 5 A's: (1) ask about tobacco use; (2) advise to quit through clear, personalized messages; (3) assess willingness to quit; (4) assist in quitting; and (5) arrange follow-up and support. 12

“Ask, Advise, Refer,” which encourages clinicians to ask patients about tobacco use, advise them to quit, and refer them to telephone quit lines, other evidence-based cessation interventions, or both. 12

Vital sign: Treating smoking status as a vital sign and recording smoking status at every health visit are also frequently used to assess smoking status. 12

Because many pregnant persons who smoke do not report it, using multiple choice questions to assess smoking status in this group may improve disclosure. 12

INTERVENTIONS FOR TOBACCO CESSATION AND IMPLEMENTATION CONSIDERATIONS

Nonpregnant Adults . Effective tobacco smoking cessation interventions for nonpregnant adults include behavioral counseling and pharmacotherapy, either individually or in combination. 13 , 14

Combined Behavioral Counseling Interventions and Pharmacotherapy . Combining behavioral and pharmacotherapy interventions has been shown to increase tobacco smoking cessation rates compared with either usual care/brief cessation interventions alone or pharmacotherapy alone. 13 Most combination interventions include behavioral counseling involving several sessions (≥ 4), with planned total contact time usually ranging from 90 to 300 minutes. 13 The largest effect was found in interventions that provided 8 or more sessions, although the difference in effect among the number of sessions was not significant. 13

Behavioral Counseling Interventions . Many behavioral counseling interventions are available to increase tobacco smoking cessation in adults. These interventions can be delivered in the primary care setting or can be referred to community settings with feedback to the primary care clinician. Effective behavioral interventions include physician advice, nurse advice, individual counseling with a cessation specialist, group behavioral interventions, telephone counseling, and mobile phone–based interventions. 13 Behavioral counseling interventions used in studies typically targeted individuals who were motivated to quit tobacco smoking. 13 For additional information about behavioral counseling interventions in nonpregnant adults, see Table 4 . 12 , 13 , 15 – 45

Pharmacotherapy . The current pharmacotherapy interventions approved by the FDA for the treatment of tobacco smoking dependence in adults are nicotine replacement therapy (NRT; including nicotine transdermal patches, lozenges, gum, inhalers, or nasal spray), bupropion hydrochloride sustained-release, and varenicline. 46 All 3 types of pharmacotherapy increase tobacco smoking cessation rates. Using a combination of NRT products (in particular, combining short-acting plus long-acting forms of NRT) has been found to be more effective than using a single form of NRT. 13 Based on a smaller number of studies, varenicline appears to be more effective than NRT or bupropion sustained-release. 13 Information on dosing regimens is available in the package inserts of individual medications or in the 2020 Surgeon General Report on Smoking Cessation. 47

Pregnant Persons. Behavioral counseling interventions . Providing any psychosocial intervention to pregnant persons who smoke tobacco can increase smoking cessation. The behavioral counseling intervention type most often studied in pregnant persons who smoke was counseling. Behavioral interventions were more effective when they provided more intensive counseling, were augmented with messages and self-help materials tailored for pregnant persons, and included messages about the effects of smoking on both maternal and fetal health and strong advice to quit as soon as possible. 12 , 13 Although smoking cessation at any point during pregnancy yields substantial health benefits for the expectant mother and infant, quitting early in pregnancy provides the greatest benefit to the fetus. 12 , 13 Other interventions included feedback, incentives, health education, and social support, although provision of health education alone, without counseling, was not found to be effective. For additional information about behavioral counseling interventions in pregnant persons, see Table 4 . 12 , 13 , 15 – 45

ADDITIONAL RESOURCES

Primary care clinicians may find the following resources useful in talking with adults and pregnant persons about tobacco smoking cessation.

Centers for Disease Control and Prevention

Health care clinician resources for treatment of tobacco use and dependence

https://www.cdc.gov/tobaccoHCP

Tips from Former Smokers

https://www.cdc.gov/tobacco/campaign/tips/partners/health/index.html

U.S. Department of Health and Human Services

SmokeFree.Gov Health Professionals Page

https://smokefree.gov/help-others-quit/health-professionals

SmokeFreeWomen

http://women.smokefree.gov/pregnancy-motherhood

In addition, the following resources may be useful to primary care clinicians and practices trying to implement interventions for tobacco smoking cessation.

Million Hearts tools for clinicians for tobacco cessation

https://millionhearts.hhs.gov/tools-protocols/tools/tobacco-use.html

Centers for Disease Control and Prevention state and community resources for tobacco control programs

https://www.cdc.gov/tobacco/stateandcommunity

U.S. Department of Veterans Affairs Primary Care & Tobacco Cessation Handbook

https://www.mentalhealth.va.gov/quit-tobacco/docs/IB_10-565-Primary-Care-Smoking-Handbook-PROVIDERS-508.pdf

World Health Organization's toolkit for delivering brief smoking interventions in primary care

http://www.who.int/tobacco/publications/smoking_cessation/9789241506953/en/

In 2020, the Surgeon General issued a Report on Smoking Cessation. 47 The report's findings were largely similar to those of the USPSTF. The Surgeon General's report issued some additional findings regarding internet-based interventions for cessation and describes some suggestive but not sufficient evidence about specific e-cigarette use behaviors and increased cessation. Overall, the Surgeon General's report found that there is inadequate evidence to conclude that e-cigarettes increase smoking cessation. More information on the Surgeon General's Report on Smoking Cessation is available at https://www.cdc.gov/tobacco/data_statistics/sgr/2020-smoking-cessation/#fact-sheets .

SUGGESTIONS FOR PRACTICE REGARDING THE I STATEMENTS

Pharmacotherapy for Pregnant Persons . According to data from the National Vital Statistics System, in 2016, 7.2% of women who gave birth smoked cigarettes during pregnancy, 6 and among 1,071 pregnant women aged 18 to 44 years, 3.6% reported using e-cigarettes. 48 Smoking during pregnancy reduces fetal growth, increases the risk of preterm birth, and doubles the risk for delivering an infant with low birth weight. It also increases the relative risk for stillbirth death by 25% to 50%. 1 , 2 Quitting smoking early in pregnancy can reduce or eliminate the adverse effects of smoking on fetal growth. 47 For pregnant persons for whom behavioral counseling alone does not work, evidence to support other options to increase smoking cessation during pregnancy are limited. Few clinical trials have evaluated the effectiveness of NRT for smoking cessation in pregnant women. Although most studies were in the direction of benefit, no statistically significant increase in cessation was seen. 13 There is limited evidence on harms of NRT from trials in pregnant persons. Potential adverse maternal events reported in studies of NRT include slightly increased diastolic blood pressure and skin reactions to the patch. 13 Potential adverse events reported in nonpregnant adults include higher rates of low-risk cardiovascular events, such as tachycardia. 13 It has been suggested that NRT may be safer than smoking during pregnancy given that cigarette smoke contains harmful substances in addition to nicotine. The USPSTF identified no studies on bupropion sustained-release or varenicline pharmacotherapy for tobacco smoking cessation during pregnancy.

In the absence of clear evidence on the balance of benefits and harms of pharmacotherapy in pregnant women, clinicians are encouraged to consider the severity of tobacco dependence in each patient and engage in shared decision-making to determine the best individual treatment course.

e-Cigarettes in Nonpregnant Adults and Pregnant Persons . No tobacco product use is risk-free, including the use of e-cigarettes. Tobacco smoking cessation can be difficult for many individuals; thus, having a variety of tools available to help persons quit smoking would potentially be helpful. Findings from small surveys and qualitative data report mixed findings on whether physicians are recommending e-cigarettes to patients to help them quit smoking. 13 , 49 – 51 Few randomized trials have evaluated the effectiveness of e-cigarettes to increase tobacco smoking cessation in nonpregnant adults, and no trials have evaluated e-cigarettes for tobacco smoking cessation in pregnant persons. 13 Overall, results were mixed on whether smoking cessation increased with e-cigarettes; however, continued e-cigarette use after the intervention phase of trials remained high, indicating continued nicotine dependence. Trial evidence on harms of e-cigarettes used for smoking cessation is also limited. The most common adverse effects from e-cigarette use reported in trials included coughing, nausea, throat irritation, and sleep disruption. 13 Generally, no significant difference in short-term serious adverse events associated with e-cigarette use was reported. 13 Evidence on potential harms of e-cigarette use in general (whether for tobacco smoking cessation or not) has been reviewed in the National Academies of Sciences, Engineering, and Medicine report Public Health Consequences of E-Cigarettes. 52 For example, the report found conclusive evidence that in addition to nicotine, most e-cigarette products contain and emit numerous potentially toxic substances. Additionally, an outbreak of e-cigarette, or vaping product, use–associated lung injury that occurred in the United States in late 2019 also suggests potential harms of e-cigarette use. The vast majority of cases have been associated with tetrahydrocannabinol-containing e-cigarettes. 53

Given the high rates of e-cigarette use in children and adolescents currently in the United States, 54 the USPSTF recognizes that an overall public health question remains on whether the potential use of e-cigarettes as a tobacco smoking cessation aid (if ever proven effective) could be balanced with the high rates of e-cigarette use in youth as a driver for increasing overall tobacco use. The USPSTF has issued a separate recommendation statement on the prevention of tobacco use, including e-cigarettes, in children and adolescents. 9 The current USPSTF recommendation statement for adults evaluated the evidence on the benefits and harms of e-cigarettes to increase tobacco cessation; the USPSTF found this evidence to be insufficient. Given the proven effectiveness of behavioral counseling interventions in both nonpregnant and pregnant adults, and of pharmacotherapy in nonpregnant adults, the USPSTF recommends that clinicians focus on offering behavioral counseling and pharmacotherapy to increase smoking cessation in non-pregnant adults, and behavioral counseling to increase smoking cessation in pregnant persons.

OTHER RELATED USPSTF RECOMMENDATIONS

In 2020, the USPSTF recommended that primary care clinicians provide interventions, including education or brief counseling, to prevent the initiation of tobacco use (including e-cigarettes) in school-aged children and adolescents. 9 The USPSTF found the evidence on primary care interventions for the cessation of tobacco use in youth to be insufficient.

This recommendation statement was first published in JAMA . 2021;325(3):265–279.

The “Update of Previous USPSTF Recommendation,” “Supporting Evidence,” “Research Needs and Gaps,” and “Recommendations of Others” sections of this recommendation statement are available at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions .

The USPSTF recommendations are independent of the U.S. government. They do not represent the views of the Agency for Healthcare Research and Quality, the U.S. Department of Health and Human Services, or the U.S. Public Health Service.

The complete version of this statement, including supporting scientific evidence, evidence tables, grading system, members of the USPSTF at the time this recommendation was finalized, and references, is available on the USPSTF website at https:// www.uspreventive services task force.org/.

National Center for Chronic Disease Prevention and Health Promotion Office on Smoking and Health. The health consequences of smoking—50 years of progress: a report of the Surgeon General; 2014.

US Dept 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. Women and smoking: a report of the Surgeon General; 2001.

US Dept 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. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the Surgeon General; 2010.

World Health Organization. WHO Recommendations for the prevention and management of tobacco use and second-hand smoke exposure in pregnancy; 2013.

Cornelius ME, Wang TW, Jamal A, et al. Tobacco product use among adults—United States, 2019. MMWR Morb Mortal Wkly Rep. 2020;69(46):1736-1742.

Drake P, Driscoll AK, Mathews TJ. Cigarette smoking during pregnancy: United States, 2016. NCHS Data Brief. 2018(305):1-8.

Babb S, Malarcher A, Schauer G, et al. Quitting smoking among adults—United States, 2000–2015. MMWR Morb Mortal Wkly Rep. 2017;65(52):1457-1464.

US Preventive Services Task Force. Procedure manual. Updated 2017. Accessed November 24, 2020. https://www.uspreventiveservicestaskforce.org/uspstf/procedure-manual

US Preventive Services Task Force. Primary care interventions for prevention and cessation of tobacco use in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2020;323(16):1590-1598.

U.S. Food and Drug Administration. Products, ingredients & components. Updated May 28, 2020. Accessed November 24, 2020. https://www.fda.gov/tobacco-products/products-guidance-regulations/products-ingredients-components

Centers for Disease Control and Prevention. About electronic cigarettes (e-cigarettes). Updated November 16, 2020. Accessed November 24, 2020. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/about-e-cigarettes.html

US Dept of Health and Human Services. Treating tobacco use and dependence: 2008 update; 2008.

Patnode CD, Henderson JT, Melknikow J, et al. Interventions for tobacco cessation in adults, including pregnant women: an evidence update for the U.S. Preventive Services Task Force. Evidence synthesis no. 196. AHRQ publication 20-05264-EF-1. Agency for Healthcare Research and Quality; 2021.

Patnode CD, Henderson JT, Coppola EL, et al. Interventions for tobacco cessation in adults, including pregnant persons: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2021;325(3):280-298.

Morgan GD, Noll EL, Orleans CT, et al. Reaching midlife and older smokers: tailored interventions for routine medical care. Prev Med. 1996;25(3):346-354.

Orleans CT, Rimer BK, Fleisher L. Clear Horizons: A Quit Smoking Guide Especially for Those 50 and Over . Fox Chase Cancer Center; 1989.

Canga N, De Irala J, Vara E, et al. Intervention study for smoking cessation in diabetic patients: a randomized controlled trial in both clinical and primary care settings. Diabetes Care. 2000;23(10):1455-1460.

Glynn TJ, Manley MW. How to Help Your Patients Stop Smoking: A National Cancer Institute Manual for Physicians . U.S. Dept of Health and Human Services; 1998.

Hurt RD, Dale LC, McClain FL, et al. A comprehensive model for the treatment of nicotine dependence in a medical setting. Med Clin North Am. 1992;76(2):495-514.

Weissfeld JL, Holloway JL. Treatment for cigarette smoking in a Department of Veterans Affairs outpatient clinic. Arch Intern Med. 1991;151(5):973-977.

Clearing the Air: How to Quit Smoking and Quit for Keeps . National Cancer Institute; 1987.

Fiore MC, McCarthy DE, Jackson TC, et al. Integrating smoking cessation treatment into primary care: an effectiveness study. Prev Med. 2004;38(4):412-420.

Glasgow RE, Whitlock EP, Eakin EG, et al. A brief smoking cessation intervention for women in low-income planned parenthood clinics. Am J Public Health. 2000;90(5):786-789.

Bock B, Heron K, Jennings E, et al. A text message delivered smoking cessation intervention: the initial trial of TXT-2-Quit: randomized controlled trial. JMIR Mhealth Uhealth. 2013;1(2):e17.

Strecher VJ, Rimer BK, Monaco KD. Development of a new self-help guide—Freedom From Smoking for you and your family. Health Educ Q. 1989;16(1):101-112.

Orleans CT, Schoenbach VJ, Wagner EH, et al. Self-help quit smoking interventions: effects of self-help materials, social support instructions, and telephone counseling. J Consult Clin Psychol. 1991;59(3):439-448.

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McBride CM, Scholes D, Grothaus LC, et al. Evaluation of a minimal self-help smoking cessation intervention following cervical cancer screening. Prev Med. 1999;29(2):133-138.

Curry SJ, McBride C, Grothaus LC, et al. A randomized trial of self-help materials, personalized feedback, and telephone counseling with non-volunteer smokers. J Consult Clin Psychol. 1995;63(6):1005-1014.

Ellerbeck EF, Mahnken JD, Cupertino AP, et al. Effect of varying levels of disease management on smoking cessation: a randomized trial. Ann Intern Med. 2009;150(7):437-446.

McClure JB, Westbrook E, Curry SJ, et al. Proactive, motivationally enhanced smoking cessation counseling among women with elevated cervical cancer risk. Nicotine Tob Res. 2005;7(6):881-889.

Rigotti NA, Park ER, Regan S, et al. Efficacy of telephone counseling for pregnant smokers: a randomized controlled trial. Obstet Gynecol. 2006;108(1):83-92.

Solomon L, Quinn V. Spontaneous quitting: self-initiated smoking cessation in early pregnancy. Nicotine Tob Res. 2004;6(suppl 2):S203-S216.

Windsor R, Woodby L, Miller T, et al. Effectiveness of Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) methods in Medicaid-supported prenatal care: trial III. Health Educ Behav. 2011;38(4):412-422.

Fiore MB, Bailey WC, Cohen S, et al. Smoking cessation: clinical practice guideline no. 18. Agency for Health Care Policy and Research; 1996.

Windsor RA, Cutter G, Morris J, et al. The effectiveness of smoking cessation methods for smokers in public health maternity clinics: a randomized trial. Am J Public Health. 1985;75(12):1389-1392.

Windsor RA, Lowe JB, Perkins LL, et al. Health education for pregnant smokers: its behavioral impact and cost benefit. Am J Public Health. 1993;83(2):201-206.

Windsor R, Crawford M, Woodby L. Commit to quit smoking during and after pregnancy. DVD. Society for Public Health Education: 1998; edited 2004.

Windsor R. A Pregnant Woman's Guide to Quit Smoking . Society for Public Health Education; 2005.

Laine C, Davidoff F. Patient-centered medicine. A professional evolution. JAMA. 1996;275(2):152-156.

Bullock L, Everett KD, Mullen PD, et al. Baby BEEP: a randomized controlled trial of nurses' individualized social support for poor rural pregnant smokers. Matern Child Health J. 2009;13(3):395-406.

Lee M, Miller SM, Wen K-Y, et al. Cognitive-behavioral intervention to promote smoking cessation for pregnant and postpartum inner city women. J Behav Med. 2015;38(6):932-943.

Pollak KI, Lyna P, Bilheimer A, et al. A pilot study testing SMS text delivered scheduled gradual reduction to pregnant smokers. Nicotine Tob Res. 2013;15(10):1773-1776.

Stotts AL, Groff JY, Velasquez MM, et al. Ultrasound feedback and motivational interviewing targeting smoking cessation in the second and third trimesters of pregnancy. Nicotine Tob Res. 2009;11(8):961-968.

Hoffmann TC, Glasziou PP, Boutron I, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687.

U.S. Food and Drug Administration. Want to quit smoking? FDA-approved products can help. Updated December 12, 2017. Accessed November 24, 2020. https://www.fda.gov/consumers/consumer-updates/want-quit-smoking-fda-approved-products-can-help

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. Smoking cessation. A report of the Surgeon General; 2020.

Liu B, Xu G, Rong S, et al. National estimates of e-cigarette use among pregnant and nonpregnant women of reproductive age in the United States, 2014–2017. JAMA Pediatr. 2019;173(6):600-602.

Kandra KL, Ranney LM, Lee JGL, et al. Physicians' attitudes and use of e-cigarettes as cessation devices, North Carolina, 2013. PLoS One. 2014;9(7):e103462.

Ofei-Dodoo S, Kellerman R, Nilsen K, et al. Family physicians' perceptions of electronic cigarettes in tobacco use counseling. J Am Board Fam Med. 2017;30(4):448-459.

Nickels AS, Warner DO, Jenkins SM, et al. Beliefs, practices, and self-efficacy of US physicians regarding smoking cessation and electronic cigarettes: a national survey. Nicotine Tob Res. 2017;19(2):197-207.

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Centers for Disease Control and Prevention. Outbreak of lung injury associated with the use of e-cigarette, or vaping, products. Updated February 25, 2020. Accessed November 24, 2020. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html

Wang TW, Gentzke AS, Creamer MR, et al. Tobacco product use and associated factors among middle and high school students—United States, 2019. MMWR Surveill Summ. 2019;68(12):1-22.

This series is coordinated by Joanna Drowos, DO, contributing editor.

A collection of USPSTF recommendation statements published in AFP is available at https://www.aafp.org/afp/uspstf .

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Essay on Smoking

500 words essay on  smoking.

One of the most common problems we are facing in today’s world which is killing people is smoking. A lot of people pick up this habit because of stress , personal issues and more. In fact, some even begin showing it off. When someone smokes a cigarette, they not only hurt themselves but everyone around them. It has many ill-effects on the human body which we will go through in the essay on smoking.

Ill-Effects of Smoking

Tobacco can have a disastrous impact on our health. Nonetheless, people consume it daily for a long period of time till it’s too late. Nearly one billion people in the whole world smoke. It is a shocking figure as that 1 billion puts millions of people at risk along with themselves.

Cigarettes have a major impact on the lungs. Around a third of all cancer cases happen due to smoking. For instance, it can affect breathing and causes shortness of breath and coughing. Further, it also increases the risk of respiratory tract infection which ultimately reduces the quality of life.

In addition to these serious health consequences, smoking impacts the well-being of a person as well. It alters the sense of smell and taste. Further, it also reduces the ability to perform physical exercises.

It also hampers your physical appearances like giving yellow teeth and aged skin. You also get a greater risk of depression or anxiety . Smoking also affects our relationship with our family, friends and colleagues.

Most importantly, it is also an expensive habit. In other words, it entails heavy financial costs. Even though some people don’t have money to get by, they waste it on cigarettes because of their addiction.

How to Quit Smoking?

There are many ways through which one can quit smoking. The first one is preparing for the day when you will quit. It is not easy to quit a habit abruptly, so set a date to give yourself time to prepare mentally.

Further, you can also use NRTs for your nicotine dependence. They can reduce your craving and withdrawal symptoms. NRTs like skin patches, chewing gums, lozenges, nasal spray and inhalers can help greatly.

Moreover, you can also consider non-nicotine medications. They require a prescription so it is essential to talk to your doctor to get access to it. Most importantly, seek behavioural support. To tackle your dependence on nicotine, it is essential to get counselling services, self-materials or more to get through this phase.

One can also try alternative therapies if they want to try them. There is no harm in trying as long as you are determined to quit smoking. For instance, filters, smoking deterrents, e-cigarettes, acupuncture, cold laser therapy, yoga and more can work for some people.

Always remember that you cannot quit smoking instantly as it will be bad for you as well. Try cutting down on it and then slowly and steadily give it up altogether.

Get the huge list of more than 500 Essay Topics and Ideas

Conclusion of the Essay on Smoking

Thus, if anyone is a slave to cigarettes, it is essential for them to understand that it is never too late to stop smoking. With the help and a good action plan, anyone can quit it for good. Moreover, the benefits will be evident within a few days of quitting.

FAQ of Essay on Smoking

Question 1: What are the effects of smoking?

Answer 1: Smoking has major effects like cancer, heart disease, stroke, lung diseases, diabetes, and more. It also increases the risk for tuberculosis, certain eye diseases, and problems with the immune system .

Question 2: Why should we avoid smoking?

Answer 2: We must avoid smoking as it can lengthen your life expectancy. Moreover, by not smoking, you decrease your risk of disease which includes lung cancer, throat cancer, heart disease, high blood pressure, and more.

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Tobacco Use Cessation Health Promotion Plan

Tobacco use remains a major health concern in the United States. The number of smokers continues to increase due to changes in technological and social patterns that impact tobacco use in unpredictable ways. Although cigarette smoking remains the most commonly used tobacco product, other alternative products have emerged, such as vaping e-cigarettes, chewing tobacco, and hookah. Exposure to and use of tobacco products is linked to serious health problems and diseases such as cancer and respiratory problems (US Preventive Services Task Force, 2020). Therefore, there is a need to design and implement health promotion initiatives to control tobacco use. These measures involve voluntary patient-centered behavioral acts and legislation policies that minimize the selling and use of tobacco products. Thus, with the increasing number of smokers worldwide and the rapid emergence of flavored tobacco products, creative efforts are needed to protect adolescents from tobacco use and promote cessation programs to achieve a smoke-free world (Navas-Acien, 2017). More than 480,000 people lose their lives due to tobacco use, while most continue to smoke due to addiction (CDC, 2021). The plan will seek to effectively stop tobacco use and promote the users’ health and wellbeing, thus reducing tobacco-related diseases and death.

The Chosen Population and Characteristics

The health promotion plan focuses on young African American adults aged between eighteen and forty. These individuals have mostly been introduced to tobacco products in their teenage, especially during social associations. Approximately 25 percent of the users consume tobacco products for leisure or as a stimulant (Navas-Acien, 2017). Considering gender orientation, there are more males than women who smoke cigarettes or vape. As part of recreation, the young adults engage in poly tobacco use that combines smoked products such as cigars and kreteks. Another characteristic of the Africa-Americans tobacco users is that they are economically disadvantaged (Stokes et al., 2021). They live in low-income areas, and the majority are jobless. They are exposed to high poverty levels characterized by low living standards, where drug and tobacco abuse is prevalent. The low-income levels make the majority uneducated or drop out of school due to a lack of school fees (Stanton & Halenar, 2018). They become predisposed to drug abuse to cope with stress and emotional burnout. Therefore, there is a need to address the social and economic factors among this population to address the issue of tobacco use.

Why are African Americans Predisposed to Tobacco Use?

The high rate of tobacco use among African-Americans young adults can be attributed to various factors that increase their vulnerabilities. First, the group uses the various cigar flavors for multiple purposes. Flavors mask the bitter taste of tobacco and reduce pain sensations and throat irritation caused by combustible tobacco products (Stokes et al., 2021). Therefore, flavored cigar smoking is most prevalent among young African American adults who smoke and drink alcohol. These dual users use flavored alcohol cigars for recreation and mood-boosting (Chen-Sankey et al., 2019). The availability of flavored cigars is appealing to the youths (Stokes et al., 2021). Besides, tobacco is considered a stimulant; thus, college students have the notion that vaping and smoking will increase their concentration resulting in gradual addiction.

Moreover, across all ethnic and racial subgroups, there is a notable decrease in tobacco initiation age. Most people, including African Americans, are exposed to tobacco products through direct consumption or passive use. Therefore, based on an individual survey done from 2005 to 2015, 77.66 percent of the participants began smoking between the ages of twelve and fifteen, while 83.87 were between the ages of eighteen and twenty-five (Cantrell et al., 2018). Early initiation age predicts greater future dependence, low chances of quitting, and a high risk of tobacco-related health conditions. Comparing the whites with Africa Americans, the former are initiated early than the latter. However, studies have shown that African Americans have low chances of successfully quitting tobacco use (Nargis et al., 2019). There is a need to design targeted tobacco prevention and control policies to include the age of purchase restriction.

Additionally, surveys have indicated that African Americans and Hispanics with low socioeconomic status are likely to use cigars and cigarillos. These products are cheaper than other substances as they are sold in smaller packages and attract low taxation rates (Stokes et al., 2021). Again, tobacco advertisements and purchasing outlets are common in Hispanic and African American low-income communities (Stokes et al., 2021). The proximity to tobacco shops and access to marketing decrease the initiation age and negatively impact cessation strategies.

Based on these social and economic vulnerabilities, a health promotion education program will benefit the African American population. The cessation of tobacco use plan will significantly impact reducing tobacco-related diseases. According to US Preventive Services Task Force (2020), tobacco cessation improves health and quality of life by preventing addiction and dependency. Again, educating the youths and adults will create awareness of healthy living, thus reducing the costs related to healthcare, minimizing the risk of premature death, and lowering the rates of tobacco-related diseases such as cancer and respiratory problems.

A sociogram is a representational tool that shows inter-relationships within a specific community or group. Healthcare workers utilize the sociogram to identify the social links between people and the patterns that characterize a targeted population. For the tobacco cessation educational plan, the sociogram will include the group’s age, education level, living conditions, and proximity to tobacco outlets (Cantrell et al., 2018). Culturally, the sociogram will include knowledge about tobacco use and its health effects, attitude towards quitting, tobacco initiation age, and the risky behavioral activities predisposing the population to smoke. In addition, the plan will incorporate lifestyle elements such as cigarette packs smoked daily, the type of tobacco product consumed, and the reasons for smoking (Rigotti, 2022). Besides, the sociogram will economic behaviors such as governmental policies on tobacco taxation, individual income, packaging, and size requirements of cigarettes.

Potential Learning Needs

The tobacco use cessation health promotion plan can educate young African Americans about the adverse effects of tobacco use. By the end of the education session, 95 percent of the participants will know and understand tobacco-related health conditions and the need to prevent these illnesses. The second learning need is defining tobacco-use risk behaviors. The goal will be: by the end of the session, 95 percent of all participants will be able to identify risky and lifestyle behaviors predisposing them to tobacco use. The third learning need is understanding addiction and dependence and the importance of quitting. The corresponding goal is: by the end of the training session, all participants will be able to discuss the benefits of quitting and planning for cessation exercise and nursing follow-up achievable in six months. These objectives align with Healthy People 2030 goals to reduce tobacco use among adolescents and adults and improve health and wellbeing (Healthy People.gov, 2022).

Current Behaviors, Expectations, and Suggestions for the Educational Session

The current behaviors of African Americans include early-age tobacco initiation, vaping and smoking for recreational purposes, use of e-cigarettes to boost moods, and developing an addiction that makes quitting difficult (Zhang et al., 2021). The promotion plan will help identify addicts, equip them with knowledge of the health effects of tobacco use, and motivate users to quit smoking. Recommendations for tobacco cessation are to come up with clinics that provide supportive services for tobacco users, including nicotine replacement therapy to addicted smokers, and enforce the tobacco control policy of age 21 purchase restriction (US Preventive Services Task Force, 2020). Smokers should be involved in the planning process for the program to be effective.

Tobacco use is a major health problem among the young African American population. The socioeconomic factors that influence living standards and the availability of cheap tobacco products predispose the group to health issues. There is a need to promote health by developing and implementing an educational program to create awareness about tobacco use and negative health impacts, and the need to quit smoking.

Cantrell, J., Bennett, M., Xiao, H., Mowery, P., Rath, J., Hair, E., & Vallone, D. (2018). Patterns in first and daily cigarette initiation among youth and young adults from 2002 to 2015.  Plus One . https://doi.org/10.1371/journal.pone.0200827

CDC. (2021). Health effects of cigarette smoking.  Smoking & Tobacco Use . https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm

Chen-Sankey, J. C., Choi, K., Kirchner, T., Feldman, R., ButlerIII, J., & Mead, E. (2019). Flavored cigar smoking among African American young adult dual users: An ecological momentary assessment.  Drug and Alcohol Dependence, 196 (1), 79-85. https://doi.org/10.1016/j.drugalcdep.2018.12.020

Healthy People.gov. (2022). Tobacco use.  Healthy People 2030 . https://health.gov/healthypeople/objectives-and-data/browse-objectives/tobacco-use

Nargis, N., Yong, H.-H., Driezen, P., Mbulo, L., Zhao, L., Fong, G., & Siahpush, M. (2019). Socioeconomic patterns of smoking cessation behavior in low and middle-income countries: Emerging evidence from the Global Adult Tobacco Surveys and International Tobacco Control Surveys.  PLoS ONE . https://doi.org/10.1371/journal.pone.0220223

Navas-Acien, A. (2017). Global tobacco use: Old and new products.  Annals of the American Thoracic Society, 15 (2). https://doi.org/10.1513/AnnalsATS.201711-874MG

Rigotti, N. (2022). Patient education: Quitting smoking (Beyond the Basics).  Nursing Update . https://www.uptodate.com/contents/quitting-smoking-beyond-the-basics

Stanton, C., & Halenar, M. (2018). Patterns and correlates of multiple tobacco product use in the United States.  Nicotine & Tobacco Research . https://doi.org/10.1093/ntr/nty081

Stokes, A., Wilson, A., Lundberg, D., Xie, W., Berry, K., Fetterman, J., . . . Sterling, K. (2021). Racial/ethnic differences in associations of non-cigarette tobacco product use with subsequent initiation of cigarettes in US youths.  Nicotine & Tobacco Research, 23 (6), 900–908. https://doi.org/10.1093/ntr/ntaa170

US Preventive Services Task Force. (2020). Primary care interventions for prevention and cessation of tobacco use in children and adolescents.  JAMA, 323 (16), 1590-1598. https://doi.org/10.1001/jama.2020.4679

Zhang, L., Huang, X. L., Luo, T. Y., Jiang, L., Jiang, M. X., & Yan, H. (2021). Impact of tobacco cessation education on behaviors of nursing undergraduates in helping smokers to quit smoking.  Tobacco Induced Diseases, 19 (58). https://doi.org/10.18332/tid/139024.

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Kicking the habit of smoking: Exploring safer alternatives for tobacco cessation in India

It is time for india to rethink its approach to tobacco cessation. here are safer tobacco alternatives that can be embraced to transform smoking habits.

The fight against tobacco addiction is a critical public health endeavour, with a profound impact on the lives of millions and in India , despite concerted efforts, the prevalence of smoking remains alarmingly high, posing significant risks to individuals’ health and placing a burden on the healthcare system. Public health experts believe it is imperative to explore and adopt innovative approaches that have demonstrated success in other countries but the conventional approaches to quitting tobacco in India need reinforcement, and it is time to consider alternative strategies that have shown promising results in other parts of the world.

In an interview with HT Lifestyle, Dr Narender Saini, Former General Secretary at the Indian Medical Association, shared, “Tobacco cessation is the process of quitting tobacco use.. It is well-established that smoking is a leading cause of preventable diseases, including cancer, cardiovascular diseases, and respiratory illnesses. Conventional methods of smoking cessation, such as counselling, nicotine replacement therapies (NRTs) and pharmacological treatments, play a vital role in helping individuals quit smoking. However, the high relapse rates and the deeply ingrained smoking culture in India highlight the need for additional strategies.”

Learning from global success stories

Countries like Sweden, the USA, the UK and Japan, have adopted novel approaches to tobacco cessation with remarkable success. Dr Narender Saini shared, “These countries have embraced heated tobacco products (HTPs) as a safer alternative to conventional cigarettes, significantly reducing smoking rates. The Japanese experience, in particular, offers valuable insights into the potential of HTPs to revolutionize tobacco cessation efforts.”

Japan has witnessed a dramatic decline in cigarette sales, halving over the past decade due to the widespread adoption of HTPs. Dr Narender Saini revealed, “According to a study published by the Global State of Tobacco Harm Reduction, the introduction of HTPs in Japan contributed to a 52% reduction in cigarette sales from 2015 to 2023. This unprecedented transition highlights the effectiveness of HTPs in encouraging smokers to switch to less harmful alternatives. In Japan, HTPs like IQOS, Ploom TECH, and glo have become popular due to their ability to deliver nicotine without burning tobacco. Unlike traditional cigarettes, which combust at high temperatures and release harmful chemicals, HTPs heat tobacco at lower temperatures, reducing the levels of toxicants and carcinogens. This significant reduction in harmful emissions makes HTPs a viable harm reduction tool for smokers who find it difficult to quit using conventional methods.”

The need for innovative approaches in India

India's tobacco burden is unique, with both traditional forms like bidis and modern cigarettes contributing to widespread tobacco use. Dr Narender Saini highlighted, “Despite stringent tobacco control measures, approximately 267 million people in India still use tobacco, leading to nearly one million deaths annually from tobacco-related illnesses. This statistic underscores the urgency for innovative and effective cessation strategies.”

He gushed, “The success of HTPs in Japan suggests that alternatives to conventional smoking methods should be explored. It is crucial to create a favourable legislative environment that encourages the use of scientifically backed, safer tobacco smoking products. Such measures could help reduce smoking rates and alleviate the public health burden. One of the key lessons from the Japanese experience is the importance of providing smokers with a range of cessation options. Not all smokers are ready or able to quit abruptly, and having access to safer alternatives like HTPs can make a significant difference. It's crucial to educate the public about the relative risks of different tobacco products and empower them to make informed choices about their health.”

Kay takeaways from a multi-pronged approach

According to Dr Narender Saini, the fight against tobacco addiction requires a multi-pronged approach, combining traditional cessation methods with innovative harm reduction strategies. He concluded, “As a public health expert, I urge policymakers, healthcare providers, and the public to consider the potential benefits of HTPs and other novel alternatives. By learning from global success stories and adapting these strategies to the Indian context, we can make significant strides toward a smoke-free future. Remember, quitting tobacco is a journey, not a destination. By adopting a comprehensive and innovative approach to tobacco cessation, we can make strides towards a healthier, smoke-free India. Let's support smokers with all the tools at our disposal, including exploring potentially safer alternatives and seize this opportunity to bring about change and improve the lives of millions.”

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Lysanderhöhe (Am Trakt Mennonite Settlement, Samara Oblast, Russia)

Lysanderhöhe was a village of the Am Trakt Mennonite settlement in the province of Samara , Russia , founded in 1864, consisting in 1897 of 22 farms, with a population of 119. A part of the population joined the trek to Turkestan in 1891, while others immigrated to America. In 1914 the population was 146. Franz Bartsch , the author of Unser Auszug nach Mittelasien, was the teacher of the village school. After the Revolution of 1917 the cultural and economic level of the village began to decline. Some of the inhabitants went to Canada and others were exiled. Little is known about the fate of those who remained and the later status of the village.

Bibliography

Dyck, Johannes J. based on a text by W.E. Surukin. Am Trakt: A Mennonite Settlement in the Central Volga Region . Translated by Hermina Joldersma and Peter J.Dyck. Winnipeg: CMBC Publications, 1995.

Hege, Christian and Christian Neff. Mennonitisches Lexikon , 4 vols. Frankfurt & Weierhof: Hege; Karlsruhe: Schneider, 1913-1967: v. II, 709.

Surukin, W. E. und Johannes J. Dyck. Am Trakt, Eine Mennonitische Kolonie im Mittleren Wolgagebiet .North Kildonan, Man., 1948.

Cite This Article

Krahn, Cornelius. "Lysanderhöhe (Am Trakt Mennonite Settlement, Samara Oblast, Russia)." Global Anabaptist Mennonite Encyclopedia Online . 1957. Web. 9 Sep 2024. https://gameo.org/index.php?title=Lysanderh%C3%B6he_(Am_Trakt_Mennonite_Settlement,_Samara_Oblast,_Russia)&oldid=144294 .

Krahn, Cornelius. (1957). Lysanderhöhe (Am Trakt Mennonite Settlement, Samara Oblast, Russia). Global Anabaptist Mennonite Encyclopedia Online . Retrieved 9 September 2024, from https://gameo.org/index.php?title=Lysanderh%C3%B6he_(Am_Trakt_Mennonite_Settlement,_Samara_Oblast,_Russia)&oldid=144294 .

©1996-2024 by the Global Anabaptist Mennonite Encyclopedia Online. All rights reserved.

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Russian Company LLC "BRUSKO FACTORY"

Brief profile.

active Commercial

Facts to Consider

Significant drop in the revenue for the year (by 38.7%).

A significant amount of the taxes paid (96.5 mln. RUB.).

The organization has registered trademarks

show 1 more positive fact

Complete Profile

• 1. General Information
• 2. Registration in the Russian Federation
• 3. Company's Activities
• 4. Legal Address
• 5. Owners, Founders of the Entity
• 6. LLC "BRUSKO FACTORY" CEO
• 7. Entities Founded by Company
• 8. Number of Employees
• 9. Company Finance
• 10. Timeline of key events
• 11. Latest Changes in the Unified State Register of Legal Entities (USRLE)
• 12. Contact details

General Information

Full name of the organization: LIMITED LIABILITY COMPANY "BRUSKO FACTORY"

TIN: 6312208069

KPP: 631201001

PSRN: 1216300028933

Location: 443077, Samara Oblast, Samara, ul. Metallistov, 30, kom. 29

Line of business: Manufacture of products from tobacco and shag: cigarettes, cigarettes, cigars, cigarillos, smoking tobacco, pipe tobacco, chewing tobacco, sucking tobacco, snuff, hookah tobacco, smoking and snuff shag (OKVED code 12.00.1)

Organization status: Commercial, active

Form of incorporation: Limited liability companies (code 12300 according to OKOPF)

Registration in the Russian Federation

The organization LIMITED LIABILITY COMPANY "BRUSKO FACTORY" was registered in the Unified State Register of Legal Entities 3 years 2 months ago 17 June 2021.

The average age of legal entities for the type of activity 12.00.1 "Manufacture of products from tobacco and shag: cigarettes, cigarettes, cigars, cigarillos, smoking tobacco, pipe tobacco, chewing tobacco, sucking tobacco, snuff, hookah tobacco, smoking and snuff shag" is 4 years. The age of this organization is approximately equal to the industry average.

The tax authority where the legal entity is registered: Mezhraionnaia inspektsiia Federalnoi nalogovoi sluzhby № 20 po Samarskoi oblasti (inspection code – 6312).

Registration with the Pension Fund: registration number 077002135392 dated 23 June 2021.

Registration with the Social Insurance Fund: registration number 630200520363021 dated 17 June 2021.

Company's Activities

The main activity of the organization is Manufacture of products from tobacco and shag: cigarettes, cigarettes, cigars, cigarillos, smoking tobacco, pipe tobacco, chewing tobacco, sucking tobacco, snuff, hookah tobacco, smoking and snuff shag (OKVED code 12.00.1).

Before 12/30/2021, the main activity of the organization was listed as Manufacture of other food products not elsewhere classified (OKVED code 10.89).

Additionally, the organization listed the following activities:

LLC "BRUSKO FACTORY" holds license entitling to carry out the following activities:

The organization has 1 registered trademark 1034510 .

The organization is included in the Roskomnadzor registry as a personal data processing operator .

Legal Address

LLC "BRUSKO FACTORY" is registered at 443077, Samara Oblast, Samara, ul. Metallistov, 30, kom. 29. ( show on a map )

Also at this address is OOO "B-GRUPP" .

Owners, Founders of the Entity

The founder of LLC "BRUSKO FACTORY" is

LLC "BRUSKO FACTORY" CEO

The head of the organization (a person who has the right to act on behalf of a legal entity without a power of attorney) since 17 June 2021 is director Veniaminov Aleksandr Nikolaevich (TIN: 631627198290).

Entities Founded by Company

LLC "BRUSKO FACTORY" is not listed as a founder in any Russian legal entities.

Number of Employees

In 2023, the average number of employees of LLC "BRUSKO FACTORY" was 71 people. This is 69 people less than in 2022.

Company Finance

The Authorized capital of LLC "BRUSKO FACTORY" is 10 thousand RUB. This is the minimum authorized capital for organizations established in the form of a LTD.

As of December 31, 2023, the organization's total assets were 385 million RUB This is 37.3 million RUB (by 10.7 %) more than a year earlier.

The net assets of LLC "BRUSKO FACTORY" as of 12/31/2023 totaled 210 million RUB.

The LLC "BRUSKO FACTORY"’s operation in 2023 resulted in the profit of 73.1 million RUB. This is by 51.1 % more than in 2022.

The organization is not subject to special taxation regimes (operates under a common regime).

The organization is listed in the small businesses registry. In accordance with the legislation of the Russian Federation, organizations with the annual revenue of up to 800 mln RUB and up to 100 employees fall into the small business category.

Information about the taxes and fees paid by the organization for 2022

The organization had no tax arrears as of 05/10/2024.

Timeline of key events

Latest changes in the unified state register of legal entities (usrle).

• 05/25/2024 . Submission by the licensing authority of information on the renewal of documents confirming the existence of a license (information on the renewal of a license).
• 04/23/2024 . Representation by the licensing authority of information about the grant of a license.
• 02/15/2022 . Change of information about a legal entity contained in the Unified State Register of Legal Entities.
• 01/18/2022 . Change of information about a legal entity contained in the Unified State Register of Legal Entities.
• 12/30/2021 . Change of information about a legal entity contained in the Unified State Register of Legal Entities.
• 12/14/2021 . Change of information about a legal entity contained in the Unified State Register of Legal Entities.
• 07/28/2021 . Entering information about registration in the Pension Fund of the Russian Federation.
• 06/22/2021 . Entering information about registration in the FSS RF.
• 06/17/2021 . Entering information about accounting with the tax authority.

Contact details

The data presented on this page have been obtained from official sources: the Unified State Register of Legal Entities (USRLE), the State Information Resource for Financial Statements, the website of the Federal Tax Service (FTS), the Ministry of Finance and the Federal State Statistics Service.

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• Russia-InfoCentre - Samara, Russia
• CRW Flags - Flag of Samara Region, Russia
• Samara - Student Encyclopedia (Ages 11 and up)

Samara , city and administrative center, west-central Samara oblast (region), western Russia . It lies along the Volga River at the latter’s confluence with the Samara River . Founded in 1586 as a fortress protecting the Volga trade route, it soon became a major focus of trade and later was made a regional seat. In 1935 the city was renamed after Valerian Vladimirovich Kuybyshev (1888–1935), a prominent Bolshevik . The city’s growth was stimulated during World War II by its distance from the war zone and the evacuation there of numerous government functions when Moscow was threatened by German attack. The postwar development of the Volga-Urals oil field also helped. The city reverted to its old name in 1991.

Samara is now one of the largest industrial cities of Russia and the center of a network of pipelines, with oil refining and petrochemicals the major industries, especially in the satellite town of Novokuybyshevsk . There are huge engineering factories making a wide range of products, including petroleum equipment, machinery, ball bearings , cables, and precision machine tools, and there are many building-materials and consumer-goods industries. Much of the city’s power comes from a hydroelectric-power plant completed in 1957 at Zhigulyovsk, a few miles upstream. A group of industrial and residential suburbs and satellite towns ring the city. Samara has excellent communications by ship along the Volga and along rail lines connecting it to European Russia, Siberia , and Central Asia . The city has cultural and research establishments and several institutions of higher education . Pop. (2005 est.) 1,151,681.

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Impact of National Tobacco Control Policy on Rates of Hospital Admission for Pneumonia: When Compliance Matters

Associated data.

Data on annual hospital admissions are not public; they are obtainable from the official national official hospital discharge statistics database at the Data centre the Russian Research Institute of Health. For this study, hospital admission data were provided by the Russian Research Institute of Health upon official request. Data on smoking prevalence for the years 2013, 2018 and 2019 were obtained from Population Surveys of the Federal State Statistics Service, provided upon request. Population data by age group (0–17 years and ≥18 years) and data on hospital bed-population ratio were taken from the Federal State Statistics Service official database available on the website of the Federal State Statistics Service: https://gks.ru/bgd/regl/b20_14p/Main.htm . (accessed on 3 April 2023).

A number of studies claim that tobacco control (TC) regulations are associated with reductions in smoking-related hospitalisation rates, but very few have estimated the impact of TC laws (TCL) at both countrywide and regional levels, and none of them have studied the impact of TCL in relation to compliance with TC regulations. This study evaluates the effects of Russian TCL on hospital admission (HA) rates for pneumonia countrywide and in 10 Russian regions and the extent of these effects in connection with the compliance with TCL. Methods: HA rates for pneumonia from 2005–2019 were analysed to compare the periods before and after the adoption of TCL in 2013. An interrupted time series design and a Poisson regression model were used to estimate the immediate and long-term effects of TCL on pneumonia annual hospitalisation rates after the TCL adoption, compared with the pre-law period. The 10 Russian regions were compared using the TCL implementation scale (TCIS) developed on the basis of the results of the Russian TC policy evaluation survey; Spearman’s rank correlation and linear regression models were employed. Results showed a 14.3% reduction in HA rates for pneumonia (RR 0.88; p = 0.01) after the adoption of TCL in Russia with significant long-term effect after 2013 (RR 0.86; p = 0.006). Regions with better enforcement of TCL exhibited greater reductions in pneumonia HA rates (rsp = −0.55; p = 0.04); (β = −4.21; p = 0.02). Conclusions: TCL resulted in a sustained reduction in pneumonia hospitalisation rates, but these effects, varying by region, may depend on the scale of the TCL enforcement.

1. Introduction

Smoking is known as a risk factor for many cardiovascular and respiratory diseases: active and passive smoking increase morbidity and premature mortality from lung cancer, acute coronary syndrome and respiratory diseases [ 1 , 2 ]. Smoking-related diseases are a cause of premature mortality and account for 87% of the total mortality in Russia [ 3 ].

A growing body of evidence from different countries indicates that tobacco control (TC) regulations, including bans on smoking in public places, can reduce hospital admissions for acute cardiovascular disease [ 4 , 5 , 6 , 7 ] and respiratory diseases [ 8 , 9 , 10 ], along with affecting the incidence of lung cancer in the long term [ 11 , 12 ].

Several studies have discovered a reduction in hospital admission (HA) rate for acute lower respiratory tract infections in children, following the introduction of smoking bans in public places and other TC regulations [ 13 , 14 , 15 , 16 ]. Evidence of the effect of TC provisions on respiratory diseases in the general population showed mainly a reduction in hospital admission rates for exacerbations of chronic bronchitis, COPD or asthma [ 17 ], while very few studies did so in relation to the admissions for pneumonia in adults [ 18 ].

Existing studies have primarily assessed the impact of smoking bans in indoor public places on hospital admission rates. However, other TC measures may also affect hospital admission rate for smoking-related acute conditions. Moreover, all of these studies evaluated the direct impact of TC measures on the monthly rate of hospital admissions for smoking-related conditions [ 5 , 13 , 14 , 15 ] over one or two years after the introduction of such laws, making it difficult to verify the long-term effects of TC legislation. Finally, very few studies have estimated the impact of national TC legislation at both countrywide and regional levels [ 5 , 13 , 14 , 15 ], and none of them have done so in relation to compliance with these regulations.

In 2013, Russia introduced one of the most comprehensive TC laws in Europe, aimed at protecting public health from the effects of tobacco smoke and the consequences of smoking. In accordance with the provisions of the WHO Framework Convention on Tobacco Control (FCTC), the Russian Tobacco Control Law (RTCL) introduced a complete ban on smoking in indoor and outdoor public places, workplaces and all public transport; a ban on advertising, promotion and sponsorship of tobacco products, including open display of tobacco products at points of sale; restrictions on the retail sale of tobacco products, e.g., near educational facilities; annual increase in excise taxes on tobacco products; information-communication measures to raise awareness of health risks associated with tobacco use and passive smoking; and measures to help smokers quit smoking. These regulations aim to reduce the prevalence of smoking as well as smoking-related morbidity and mortality in the population. Despite the notable progress made by Russia after the ratification of the FCTC, the prevalence of smoking is still high, at 27.3%: 46.4% in men and 14.6% in women in 2018 [ 19 , 20 ]. The slowdown in the rate of decrease in smoking prevalence by only 3.5% compared with 2013, i.e., after five years of RTCL implementation, should be noted [ 19 , 20 ]. However, both the prevalence of smoking and its changes varied across different regions of Russia [ 19 , 20 ].

Hence, we hypothesized that the effects of RTCL on the prevalence of smoking and its impact on public health may depend on the degree of enforcement and implementation of these regulations in the regions of Russia. We evaluated the implementation of the law by measuring the compliance with the TC regulations. With this goal in mind, we conducted an evaluation survey in 2017–2018 based on a random sample of 11,625 participants in 10 constituent entities of the Russian Federation. Our Russian Tobacco Control Policy evaluation survey was representative both of the entire country and of the regions. This survey established different levels of compliance with TC measures across the 10 regions. This survey established different levels of compliance with TC measures across the 10 regions. In some of these regions, e.g., Chuvash Republic, the results of the survey showed high compliance with smoking bans, existence of tax and price policies, and comprehensive support of smoking cessation. In other regions, such as Arkhangelsk Oblast, these measures were implemented to a lesser extent. Using the scoring system of the Tobacco Control Scale by L. Joossens and M. Raw [ 21 ] and the results of our Russian Tobacco Control Policy evaluation survey, we developed an original scale to assess the implementation of the most cost-effective existing TC measures (viz., the WHO MPOWER provisions) in the regions of Russia, and we have named it the Tobacco Control Implementation Scale (TCIS) [ 22 ]. Our previous studies demonstrated a significant relationship between TCIS scores and changes in smoking prevalence in 10 regions over a five-year period after the introduction of RTCL [ 19 ].

Our two previous studies assessed changes in monthly hospitalization rates for acute coronary events (ACE) in three regions of Russia and annual hospital admission rates for ACE in the entire country and 10 regions of Russia [ 23 , 24 ]. The latter study [ 24 ] showed a significant reduction in hospital admissions for both angina and myocardial infarction (16.6% [RR 0.83, 95% CI 0.74–0.93] and 3.5% [RR 0.96, 95% CI 0.96–0.97], respectively) after the nationwide introduction of RTCL vs. the period before the adoption of this law, as well as effects of varying magnitude in 10 regions. Regions with better enforcement of the TC law experienced greater reductions in hospital admission rates for angina and myocardial infarction.

In this study, we sought to analyse the impact of Russian TC regulations on hospital admission rates for all-cause pneumonia in adults, which may be especially important in an era of the COVID-19 pandemic or other viral infections. In addition, we intended to analyse the extent of these effects in various regions of Russia in connection with the implementation of TC legislative measures.

2. Materials and Methods

2.1. study design and data sources.

We analysed hospitalization rates for all-cause pneumonia to compare periods before and after the adoption of RTCL in 2013, adjusting for possible confounding factors and long-term trends. We used an interrupted time series analysis to quantify the change in hospital admissions for pneumonia after the adoption of RTCL vs. the preceding period. To demonstrate that immediate and gradual changes in hospitalisation rates for pneumonia were associated with RTCL, we also analysed asthma hospitalization rates for comparison. We assumed that since asthma has been routinely and legitimately monitored and controlled for many years at the outpatient level, the effect of RTCL on hospital admission rates for asthma should not be apparent. We also analysed hospitalization rates for rheumatic heart disease (RHD) for comparison (as a disease not associated with smoking), which should not be affected by TCL, and which has also been routinely controlled like asthma at outpatient level. The models were based on the time series of annual hospitalizations for all three diseases in the Russian Federation and 10 regions over the period of 2005–2019.

We also analysed the change in hospital admission rates after the adoption of RTCL, compared with the pre-law period in 10 regions of Russia, depending on the degree of enforcement of the TC regulations. To compare regions with different levels of compliance with RTCL, we used the TCIS developed in our previous study [ 22 ].

Annual data on hospital admissions for pneumonia and bronchial asthma in the adult population that occurred in Russia and its 10 regions between 2005 and 2019 were obtained from the national official hospital discharge statistics database, which included the following information: the diagnosis at discharge, age category (0–17, including 0–1, and ≥18 years old), and region of residence. Respiratory outcomes were defined according to the International Classification of Diseases—10 codes for all-cause pneumonia (J12–18) and asthma (J45, J46).

We analysed the changes in the rate of hospitalization for pneumonia per 100,000 adult residents (aged ≥18 years) in the Russian Federation and its 10 constituent entities: the Chuvash Republic, Krasnodar and Primorsky Krais, and Arkhangelsk, Astrakhan, Belgorod, Novosibirsk, Orenburg, Samara and Tyumen Oblasts.

Smoking prevalence in the years 2013, 2018 and 2019 was taken from the population surveys database of the Federal State Statistics Service; population data by age group (0–17 years and ≥18 years), as well as data on as hospital bed-population ratio, were taken from the official statistics of Federal State Statistics Service [ 20 , 25 , 26 ].

2.2. Tobacco Control Implementation Scale

To compare changes in the hospital admission rate for pneumonia before and after the adoption of RTCL in different regions in terms of adherence to TC regulations, we used the scores of TCIS [ 22 ]. The scale indicates how well the six MPOWER activities were implemented in each investigated region. Table A1 in Appendix A shows how the scale applies to the 10 Russian regions, where the investigation was carried out and the ranks of the regions according to the scores of TCIS, characterising the performance of the MPOWER measures in each of the region.

The scores characterising the performance of the MPOWER package and each of its six measures were used as independent variables in the correlation and linear regression analyses [ 19 , 22 ].

2.3. Statistical Data Processing

We used standard methods for interrupted time series (ITS) to evaluate the effects of RTCL [ 27 ]. The immediate effect was modelled as a step function including an indicator variable that changed after 2013, whereas the gradual effect was investigated via an interaction term between the RTCL impact and time. We employed a generalized Poisson regression model with calculation of the incidence rate ratio (RR) and a 95% confidence interval (95% CI) to estimate the immediate and long-term effects of RTCL.

The following regression model was used:

where Yt represents the outcome at time t; T is the time elapsed since the start of the study in with the unit representing the frequency with which observations are taken (year); Xt is a dummy variable indicating the pre-intervention period (coded 0) or the post-intervention period (coded 1); and β 0 represents the baseline level at T = 0, β 1 is interpreted as the change in outcome associated with a time unit increase (representing the underlying pre-intervention trend), β 2 is the level change following the intervention and β 3 indicates the slope change following the intervention (using the interaction between time and intervention: TXt).

Scaling corrections were applied to the model to avoid overdispersion and misestimation of standard errors. The models were also tested for autocorrelation.

To assess the relationship between the relative change in hospital admission rates after the adoption of RTCL (%), smoking prevalence rates in each region (dependent variable) and scores characterizing the degree of implementation of TC legislative measures (independent variable), we performed Spearman’s rank correlation analysis and linear regression analysis.

The analyses were carried out using the Stata v.11.2. statistical software (StataCorp, Lakeway, TX, USA).

A total of 5,785,673 hospital admissions for pneumonia and 2,575,561 for bronchial asthma occurred among the Russian population during the study period. Of these, 2,395,953 cases of pneumonia and 865,994 cases of asthma were detected after the adoption of RTCL in 2013.

Figure 1 presents data on annual age-adjusted hospital admission rates for pneumonia, bronchial asthma and rheumatic heart disease per 100,000 residents from 2005 to 2019 in Russia. These data are shown in Figure 1 by year, along with the predicted regression curves. The figure demonstrates the trends in annual hospital admission rates for pneumonia (1A) and asthma (1B) in the Russian Federation from 2005 to 2019, i.e., before and after the introduction of RTCL in 2013. Dynamics of hospitalization rates after the introduction of RTCL (solid line) in comparison with the predicted trend without TC measures (dashed line) is shown in Figure 1 as well.

HA rates for pneumonia, asthma and RHD per 100,000 residents in the Russian Federation during the period of 2005–2019. Observed (solid lines) and predicted (dashed lines) adjusted HA rates for pneumonia ( A ), asthma ( B ) and RHD ( C ) in the adult population.

We observed a significant decrease in hospital admission rates for pneumonia by 14.3% after the adoption of RTCL (2014–2019), compared with the pre-law period (2005–2013): the RR was 0.88 (95% CI 0.79–1.00) ( p = 0.01).

We also revealed evidence of a gradual effect of RTCL; change in the main trend of hospital admission rate for pneumonia after 2013: RR = 0.86 (95% CI 0.77–0.96) ( p = 0.006).

As for asthma and rheumatic heart disease, there was no statistically significant reduction in hospital admission rates after the adoption of RTCL vs. the preceding period: RR = 1 (95% CI 0.97–1.1) ( p = 0.779) and RR = 0.94 (95% CI 0.83–1.06) ( p = 0.332).

Secondary analyses conducted among the adult population in 10 constituent entities of Russia yielded similar effects of RTCL in different regions. However, these effects had different magnitudes, and the decrease in the hospital admission rates for pneumonia after the adoption of RTCL was statistically significant in only 4 out of 10 regions ( Table 1 ).

Changes in hospitalisation rates for all-cause pneumonia after the adoption of RTCL compared with the preceding period.

* IRR—Incidence Rate Ratio

Moreover, adjusting for factors potentially affecting hospital admission rates, such as hospital bed-population ratio, did not significantly change the results.

Table 1 demonstrates changes in hospital admission rates for pneumonia after the adoption of RTCL, compared with the preceding period, in 10 regions of the Russian Federation.

Thus, we hypothesized that the degree of reduction in hospital admission rates after the adoption of the RTCL vs. the preceding period in the regions may be related to the degree of this law enforcement.

To check this hypothesis, we measured the correlations and the associations between the relative changes of hospital admission rates for all three conditions and the TCIS scores characterising the extent of the implementation of TCL measures in the 10 regions by conducting Spearman’s correlation analysis and a linear regression analysis.

Table 2 presents the correlations of reduction in the rate of hospital admissions for pneumonia (RR%) with the degree of implementation of six MPOWER measures in 10 regions of Russia based on the TCIS scoring system ( Appendix A , Table A1 ).

Correlation between changes in hospital admission rates for pneumonia (RR%) after the adoption of RTCL vs. the pre-law period, prevalence of smoking in adult population, and TCIS scores.

* rsp—Spearman’s rank correlation coefficient; ** bold font designates statistically significant results: p < 0.05.

We detected significant correlations between the reduction in hospital admission rates for pneumonia and TCIS scores for smoking ban rsp = −0.55 (95% CI −1.08, 0.02) ( p = 0.042) and for offering support in smoking cessation: rsp = −0.763 (95% CI −1.11, −0.41) ( p < 0.001).

An inverse correlation was also established between the decrease in hospital admission rate for pneumonia and the prevalence of smoking in 2019 in the regions: rsp = 0.7 (95% CI −0.08, 2.25 ( p < 0.05).

Linear regression analysis yielded significant associations between the decrease in hospital admission rates for pneumonia (RR%) and the TCIS score for offering smoking cessation support (β = −4.21; 95% CI −7.61, −0.82; p = 0.02), as well as with the prevalence of smoking in 2019 (β = 2.40; 95% CI 0.34, 4.45; p = 0.027). Both relationships were significant for pneumonia, but not for asthma ( Table 3 ).

Association between changes in hospital admission rates for pneumonia and asthma (RR%) after the adoption of RTCL vs. the preceding period, and TCIS scores for smoking cessation support and smoking prevalence in 2019, identified by linear regression.

* β—regression coefficient; ** bold font designates statistically significant results: p < 0.05.

We did not reveal any statistically significant correlations or significant associations between the reduction in the rates of hospital admissions for asthma and rheumatic heart disease and the extent of implementation of either TCL measures or smoking prevalence in 10 regions of Russia.

4. Discussion

Our analysis, based on nearly six million hospital admissions, showed for the first time the long-term (over 15 years) trends of annual hospitalisation rates for all-cause pneumonia. We established a reduction in the rates of hospital admission for all-cause pneumonia among the adult population over the entire study period after the adoption of a comprehensive TC law in Russia. The observed decrease was similar across regions of Russia and was stronger in constituent entities with better compliance with TC regulations.

Our findings are consistent with several previously published studies demonstrating a reduction in hospital admissions for acute lower respiratory tract infections associated with adoption of a municipal or national smoking ban. A. Nyman et al. observed a 33% decrease in hospital admissions for respiratory diseases during a restaurant ban in Toronto [ 17 ]. A study by J.-P. Humair et al. demonstrated that smoking bans resulted in a very significant reduction in hospitalizations for exacerbations of COPD and no significant changes in hospital admissions for pneumonia and acute asthma in the Canton of Geneva [ 9 ]. However, changes in hospitalization rates in these studies were limited to the short period of smoking ban introduction and did not extend to the longer period after the ban. V. Ho et al. described the association between smoking bans, as well as higher excise taxes on cigarettes, with reduced rates of hospital admission for pneumonia in individuals 60 to 74 years of age in a nationwide study conducted in the USA [ 18 ].

Unlike most previous studies on smoking bans, we measured the relationship between implementation of a comprehensive TC law and hospitalization rates nationwide. In addition, by analysing data on the implementation of RTCL in 10 constituent entities of the Russian Federation, we determined which of the TC measures had the greatest impact on reducing hospitalization rates for pneumonia among adults.

In our study, we assessed the gradual effect of reduced hospital admissions for pneumonia depending on the degree of enforcement of RTCL in 2017–2018. Our results implied that more effective implementation of anti-tobacco measures in the regions and the degree of their enforcement in 2017–2018 (assuming they were similar from the first year of RTCL adoption) could affect the change in rates of hospitalization for pneumonia.

Because we were looking at annual rather than monthly hospitalization rates, there was no need to adjust the models for seasonality. However, we adjusted the model for potential confounders, such as hospital bed-population ratio, which did not affect the results in any way.

TC regulations aim to reduce the prevalence of smoking and smoking-related morbidity and mortality in the long term. L. Palmieri et al. demonstrated a reduction in smoking prevalence in Italy from 31.7% to 21.8% between 1980 and 2000, which led to a decrease in mortality from coronary heart disease [ 28 ]. Smoking is a risk factor for developing pneumonia. A meta-analysis by V. Baskaran et al. showed that current smokers and ex-smokers were 2.7 and 1.5 times, respectively, more likely to develop community-acquired pneumonia, compared to “never smokers” [ 29 ]. Their other finding was that current heavy smokers had a significantly higher risk of developing pneumonia than light smokers.

Our study suggests that greater relative changes in smoking prevalence over the five-year period of RTCL implementation (2013–2018) and lower smoking prevalence in 2019 may be associated with lower hospitalization rates for pneumonia and better RTCL enforcement.

There are some strengths and limitations of the study that should be mentioned.

Among the strengths of this study, we should mention its large sample size, encompassing all nationwide hospital admissions for pneumonia over a 15-year period. It explored the immediate and long-term impact of comprehensive tobacco control legislation on all-cause pneumonia in adults, which were not previously studied. In addition, relationships between the impact of comprehensive RTCL and individual legislative measures on hospitalization rates and the degree of implementation of these measures in different regions, based on large representative survey data, were investigated, which increased the strength of our study as well.

The limited number of investigated regions can be seen as a limitation of the study in terms of its ability to explore possible relationships in correlation and linear regression analyses. However, despite the limited number of regions, we still revealed statistically significant relationships.

Another limitation of our study is related to the data of a representative survey of the population assessing the Russian Tobacco Policy in 10 constituent entities of the Russian Federation. We assumed that the degree of compliance with anti-tobacco regulations, measured in 2017–2018 in 10 regions of Russia, was similar over the entire study period starting from the first year of RTCL adoption.

5. Conclusions

The results of this study conducted on a large population sample over a long follow-up period suggest that a comprehensive tobacco control policy can lead to an immediate reduction in hospital admission rate for all-cause pneumonia with a gradual effect. This finding has important public health implications, especially in the era of the COVID-19 pandemic and/or other viral infections. Smoking regulations represent a simple, effective and inexpensive way to prevent respiratory diseases, and the degree of compliance with the regulations can be important for the prevention of these ailments.

Ranking of 10 Russian federal subjects by the Tobacco Control Implementation Scale.

Funding Statement

This research received no external funding.

Author Contributions

Conceptualization, M.G. and A.K.; methodology, M.G. and A.K.; formal analysis, M.G.; investigation, M.G.; resources, A.K.; writing—original draft preparation, M.G.; writing—review and editing, M.G. and A.K.; supervision, O.D.; project administration, A.K. and O.D.; funding acquisition, O.D. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

The study did not require ethical approval.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the Russian Tobacco Control Evaluation Survey, the results of which are used in this study. The database on hospital admissions does not contain personal data.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

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