Tobacco consumption remains the world's foremost cause of avoidable deaths. Currently, the world’s population of smokers stands at close to one and a third of a billion. People who die out of smoking issues number up to five million people per year (Greenhalgh, Stillman, & Ford, 2016). The death toll is approximated to rise by the year 2020 up to ten million people per year if the current rate of use is sustained. Tobacco is known to be a cause of cancer in the mouth, throat, stomach, pancreas, cervix and the kidney. Other than that, the list of conditions brought about by tobacco use keeps on growing. These include cardiovascular and chronic pulmonary diseases, reproductive system damages, cataracts, acute and myeloid leukemia, abdominal aortic aneurysm and pneumonia.
Other than diseases brought by tobacco use, health care providers list tobacco dependency as a disease on its own, characterized by relapse and need for nicotine addiction treatment. Other than being harmful to its users only, millions of other people including children are in the danger of exposure to second-hand smoking. Health care practitioners have realized a link between passive smoking and respiratory diseases, infant death syndrome and ear infections (Gichuki, Opiyo, Mugyenyi, & Namusisi, 2015). The approach to curbing passive smoking exposure takes a societal scope with health care providers at the front.
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In an attempt to curb deaths and diseases caused by tobacco use, states have opted to increase the age of smoking and vaping to twenty-one years. The tobacco 21 policy is a national movement embraced by states and communities. The policy has been adopted in nine states of the USA, and recently Florida. The tobacco 21 policy intends to save lives by reducing the number of youths using tobacco. Youth and adolescents who smoke cigarette are in the danger of severing long-lasting damage to brain development due to nicotine use and addiction (Greenhalgh, Stillman, & Ford, 2016). The projected impact of tobacco 21 includes decreasing tobacco use by twelve percent and cutting tobacco-related deaths by 10 percent by the time current teenagers become adults. The population of first-time smokers will reduce averagely by twenty percent for youth between age 15 and 20. Looking at national projections, the number of tobacco use related deaths will be around two hundred and twenty-three thousand people born in the last two decades.
The state of Florida has recently followed suit in raising the legal purchase age of cigarettes and electronic devices for tobacco dispensing. This rule also bans sales of tobacco through vending machines, while decriminalizing sale of the same to minors. Thus a fine of not more than five hundred dollars will be levied non-criminally from first-time offenders, increasing up to a thousand dollars for repeat offenses (Schweers, 2019). This paper describes the policy in relation to nursing practice as a way of tobacco control.
Description of How the Policy Is Intended For a Specific Population, Program or Organization
Youth use of cigarettes is promoted by various activities that made the policy focus on people between the age of fifteen and twenty-one. According to research provided by American Lung Association, an increase of ten percent to prices of tobacco commodity result in a seven percent decrease in youth consumption of cigarettes. In return, Cigarette companies in the industry invest billions of dollars in ensuring the affordability of their products to the youth. In 2016, more than 5.5 billion dollars were spent as incentives to retailers to effect affordable prices for cigarettes (ALA, 2019). Also, another research conducted in the year 2007 showed that marketing of cigarettes at retail level enhances the need to start smoking by the youth (ALA, 2019).
Many reasons lie behind raising the age limit of cigarette smoking to 21 years old. The American Lung Association found out that more than eighty percent of adult smokers smoked first when they were minors. Another finding was that minors get access to cigarettes mostly through their older counterparts not older than twenty-one years old. Since those above that age usually out of high school, it makes it easier to restrict all high school students. The second reason shows that there is a need to counter the cigarette industry’s focus on young people. This is mainly because at that age is when most experimental smokers transition to regular smoking. By intervening here, the turnover rate of people changing into regular smokers will be reduced. Thirdly, raising the alcohol use age to 21 enabled counter the rate of alcohol consumption and dependency among the youth. Other positive results included the reduction of fatalities resulting from drunk driving. Results of the same magnitude are expected with the adoption of the tobacco 21 laws.
The tobacco 21 policy comes along with enforcement guidelines that elaborate the fines and penalties for non-adherence. Vendors selling tobacco products to minors will incur penalties or fines levied by the jurisdictions (ASTHO, 2018). While some states give penalty, some including Florida, have valid reasons not to punish minors found in possession of tobacco products. These calls for educative programs that encourage cessation from smoking (ASTHO, 2018). There are exemptions to particular cases of the target group. The first qualification for exemption is being an enlisted member of the military. This is a provision by the states of California and Maine, allowing military personnel the ability to purchase any legal product (ASTHO, 2018). A grandfathering program allows those who were allowed to legally purchase tobacco products before the age of 21 to continue without any restrictions (ASTHO, 2018). In doing so, there would be least criticism against the tobacco 21 law with the view that it takes away individual rights and privileges.
Specific Legislators Involved In the Policy Development and Dissemination
The policy to control tobacco use by raising the legal age for purchasing cigarettes and vaping electronics took effect in Florida State. The sponsor of the bill was Senator David Simmons (Schweers, 2019). His initiative was supported by the majority who allowed the state of Florida to raise the age of purchasing cigarettes and vaping equipment to twenty-one years. The same law would also make it a non-criminal offense for minors being in possession of tobacco.
Senator Debbie Mayfield passed the bill that would restrict teenagers below the age of 21 from purchasing tobacco products in Florida State (Schweers, 2019). Mayfield draws from experience a recount of her late husband’s battle with cancer before his death in the year 2008. Mayfield presented her case during a discussion of the bill by the Senate health policy committee. Another legislator supporting the bill was Senator Darryl Rouson, who couldn’t find it any way easier than voting yes for it to be a law. However, criticism against the tobacco 21 policy also got a share of the discussion. Senator Aaron Bean of Jacksonville was against the bill, which he felt was eliminating choices for people who already are adults in the eyes of the law. Senator Manny Diaz of Miami also echoed Aaron’s sentiments regarding the age factor. He didn’t intend to deny freedom to someone at an age that could get enlisted for war (Schweers, 2019).
Role of the APRN in Assisting With the Policy or Refuting the Policy
APRNs play a significant role in the control of tobacco use. The population dramatically trusts in its health care providers, who can offer their opinions to the media, political and social arenas and the civilians at large (Greenhalgh, Stillman, & Ford, 2016). The public values views from nurses on the harms of tobacco use and their effect on passive smokers. In communities, the health care providers are viewed as the most knowledgeable people who act based on their knowledge; thus they are role models. In a cancer prevention initiative, the promotion of tobacco cessation is one of the required steps. With a considerable proportion of APRNs working in the primary health care setting, they are responsible for making screening and prevention recommendations. This means that they can use their cancer screening engagement time to pass knowledge regarding tobacco’s effect on health and cessation.
The voices of APRNs as health professionals also matters into global and national tobacco control efforts such as increasing tax, and in supporting WHO’s Framework Convention on Tobacco Control. Finally, health care providers exercise leadership through championing for the Health Professional Code of Practice on Tobacco Control (Greenhalgh, Stillman, & Ford, 2016). APRNs also come in handy at helping users of tobacco in overcoming addiction. When working at the community level, health care providers promote some of the policy measures through engaging people in campaigns that call for a smoke-free working environment, or extending the access to cessation resources (Greenhalgh, Stillman, & Ford, 2016). All health professionals are valuable in the reduction of tobacco use and its adverse effects. Problems related to tobacco and the control measures for tobacco use cut across several health disciplines. First, they are responsible for ensuring there is preparation and willingness to support by those admitted for tobacco-related conditions or issues. Alongside other practitioners, APRNs have many roles to perform while working in unison.
Like other nurses, APRNs activity can help promote their general feeling for tobacco use, which is harmful. Nurses’ support for tobacco control can be expressed by participating in the legislation of tobacco control policies. It has also become ethical for nurses to fight tobacco use through all means, from individual effort to industrial levels. Nurses are required to say no to tobacco money and partnership requests by the tobacco industry. Finally, they can use advocacy groups that represent those who have succumbed to tobacco use. For instance, they can attend corporate meetings held by tobacco companies to present victims’ woes.
Discuss how the policy influences clinical practice and is used to promote best outcomes
Traditionally, tobacco control was not a significant part of nursing practice. In some instances, nurses had been used in advertising cigarettes. Basically, nurses also had little knowledge of tobacco use and were afraid of stressing and discomforting patients when addressing tobacco use. The leading cause to the situation then included inadequacy of tobacco-related content in learning institutions. As a result, there have been initiatives to promote cessation knowledge among nurses, also impacting well in helping smoker nurses too. These interventions educate nurses on psychological, pharmacological and behavioral interventions to help to stop smoking habits.
Nurses train as counselors to adequately carry out cessation work as specialists. All health care providers can have an impact in enabling cessation by providing the same insight into the health effects of tobacco use and dependency. Practitioners can also opt to learn simplified approaches such as the 5A’s recommended by the US Department of Health and Human Services. This approach treats tobacco use and dependence by guiding practitioners in asking about use, advising all users to quit, assessing willingness for cessation, assisting a patient in quitting, and arranging for follow up sessions (Greenhalgh, Stillman, & Ford, 2016).
Additional avenues that nurses departments coordinate such as home health care and pediatric primary care can be used for tobacco control. Tobacco interventions can be integrated into areas of practice such as child health and maternal care. Nurses can educate pregnant and lactating mothers on the health effects of tobacco use to their bodies and the development of their babies. These avenues can benefit from improved research on prevalence and need for cessation, as well as the impact of nurse interventions at different settings ( Thomas, Abramson, Bonevski, & George, 2017) .
How the policy can be used by the inter-professional team to ensure coordinated and comprehensive care for the specific population
The strategy to control tobacco needs to be broad and involving all levels. It is consensual that without the involvement of multiculturalism and multi-professional players, the control efforts become futile (Greenhalgh, Stillman, & Ford, 2016). Within the government, other ministries and departments can support the department of health in achieving its tobacco control goals. The relevant departments include those concerned with finance and trade, justice, foreign affairs, education, customs among others. Within the local setting, Non-governmental organizations and professional associations are essential in controlling tobacco use. For the best result, the whole community is supposed to get involved.
Health professionals are at the center of ensuring there are comprehensive and coordinated processes in tobacco control. The health care practitioners, in this case, are represented by nurses, physicians, midwives, psychologists, dentists, psychiatrists, pharmacists and other professionals in the health field. The impact of these professionals on paving the way for tobacco-free lifestyles depends on their role and image. Their activities aimed at achieving goals include giving guidance on the health effects of tobacco and answering questions on tobacco use. They are well place to educating the public, providing a reference for the media and effecting policy making.
Conclusion
Nursing practice involvement in tobacco control is a significant prevention initiative. Nurses together with other members of the community have major roles to play in reducing deaths and ailments emanating from direct or passive use of tobacco. Given that many diseases have been linked to tobacco use through cigarettes and electronic vaporizers, it remains as one leading causes of deaths in the world. To nursing practice, these deaths are preventable and require active participation in controlling tobacco use.
Members of the state of Florida voted for the tobacco 21 policy alluding to its success in other states that implemented it before it. From the above-discussed projections, the state stands a chance to benefit from reduced deaths due to tobacco-related issues, reduced spending in health care, and lesser converts to regular smoking. Nurses and other health practitioners have played significant roles in ensuring the success of the bill. These include advising the legislators and providing necessary information supporting the adoption of the policy.
Nursing practice has been instrumental in tobacco control globally. The work ethics of nurses concerning tobacco use has enabled them to champion various anti-tobacco moves. On the other hand, tobacco control initiatives have helped to shape nursing practice by introducing research for new knowledge bases and disciplines such as treatment of tobacco dependencies and providing cessation support to patients. Other than working alone in this endeavor, other disciplines prove to add value to nurses’ efforts in containing tobacco use through policies.
References
ALA. (2019). Tobacco 21 Laws: Tracking Progress Toward Raising the Minimum Sales Age for All Tobacco Products to 21. American Lung Association. Retrieved on 16 April 2019, from https://www.lung.org/our-initiatives/tobacco/cessation-and-prevention/tobacco-21-laws.html
ASTHO. (2018). Tobacco 21 legislative policy analysis. Association of State and Territorial Health Officials. Retrieved on 16 April 2019, from http://www.astho.org/ASTHOBriefs/Tobacco-21-Legislative-Policy-Analysis/
Gichuki, J. W., Opiyo, R., Mugyenyi, P. & Namusisi, K. (2015). Healthcare Providers’ Level of Involvement in Provision of Smoking Cessation Interventions in Public Health Facilities in Kenya. Journal of Public Health Africa, 6 (2), 523
Greenhalgh, E. M., Stillman, S., & Ford, C. (2016). 7.10 Role of health professionals and social services. In Scollo, M. M & Winstanley, M. H. (eds). Tobacco in Australia: Facts and issues . Melbourne: Cancer Council Victoria. Retrieved from https://www.tobaccoinaustralia.org.au/chapter-7-cessation/7-10-role-of-general-practice-and-other-health-pro
Schweers, J. (2019). Florida committee approves raising legal age for buying tobacco products to 21. Tallahassee Democrat. Retrieved on 16 April 2019, from https://www.tallahassee.com/story/news/2019/03/25/senate-committee-approves-bill-raising-smoking-age-21/3270185002/
Thomas D., Abramson, M. J., Bonevski, B., & George J. (2017). System change interventions for smoking cessation (Review). Cochrane Database of Systematic Reviews, 2017 (2), 1-41
Truth Initiative. (2018). Tobacco use in Florida. Retrieved on 16 April 2019, from https://www.truthinitiative.org/tobacco-use-florida
