Policy Scope Project: Teen Smoking Prevention Policy Assessment 2 Answer

Answer :

Title: Teen Smoking Prevention Policy

Executive Summary:

The policy project has been designed with an aim to eliminate or minimise cigarette smoking among young people in Australia. The policy paper has undertaken rationale of selecting the particular area of health and social care by demonstrating adverse impacts of cigarette smoking on their physical and mental health and working ability. Costing of smoking along with outcomes if action not taken adequately also have been included. A brief literature review on the issue and its consequences have been represented and a summary of policy frameworks of other jurisdictions, Canada and the UK. The policy paper has ended with a few recommendations such as preventing teachers in smoking outside the school premise, monitoring and evaluation policy frameworks and their effectiveness in eliminating and diminishing cigarette smoking of young people.
Why is this issue important?

Background and health consequences:

Tobacco smoking is addictive behaviour that leads to more than 5 million of deaths per year globally. The World Health Organization has estimated that by 2030, the number of deaths caused by cigarette smoking will increase to 8 million. Tobacco use is one of the major preventable cause of mortality and morbidity which causes one in ten adult deaths globally. Although cigarette smoke caused deaths are in people aged over thirty five years or older, the onset of cigarette smoke generally mostly happens in adolescence. Hence adolescence are the special targets of projects that are designed to prevent smoking. The smoking trend among young had declined between 1970s and 1980s which however has increased in 1990s in both USA and Europe. Smoking prevalence is higher among disadvantaged groups, and disadvantaged smokers are likely to experience higher exposure to tobacco's harms.

According to researchers initiation of cigarette smoking at younger age results in more cigarette per day which has lower willingness to quit compared to the people who start smoking later their live. In contrast late onset of smoking may also lead to heavy smoking and become addicted to smoking. Different policies and prevention programme have been developed to target schools which is an ideal place to prevent or address smoking among youth across different age groups. However research has demonstrated that school programme are weak in minimise adolescence smoking as the adolescence receive strong peer influence in support of smoking both outside and inside of school premise. Hence some of the researchers have found environmental level measures in addressing the issue of smoking. Smoking rates were four times higher among the most disadvantaged than the most wealthy groups of people in the society. 

Although smoking is banned in school premises, research studies have shown evidence where 3 in 5 students reported that they have seen teachers smoke outside school premise while other studies have shown that majority of students reported that they have seen teachers smoking outside school building. In such studies that demonstrated teachers smoking shows very strong relationship with student smoking behaviour (Centre for Epidemiology and Evidence, 2015). Additionally it has been argued that students in schools that do not have any anti-smoking policies, find smoking as acceptable behaviour which eventually increases the risk of adopting smoking behaviour. The process of become habitual or regular users of cigarette includes a set of transitions that initiates first with a puff of cigarette (Tutt, 2018). Among adult smokers large number of people tried their first cigarette as adolescent and most of the trial has transformed to habitual smoking before they become the age of nineteen. Research have shown 36.6 % eight standard students have tried a cigarette, 12.2 % are smokers while 5.5 % are habitual smokers. 61%of 12^th graders students have tried cigarette smoking at any time of their life, 29.5% are smokers and 19% are habitual smokers (DiFranza, 2012). 

The short term health impacts of smoking include both respiratory and non-respiratory effects, nicotine addiction and that again raises the risk of other drug addiction. Long term health impacts of youth smoking shows that majority of the young people who smoke continue smoking throughout their adulthood. In adult cigarette smoking results in heart diseases and stroke, affects’ physical fitness of people trained in competitive sports, smoking at an early age increases the risk of lung cancer (World Health Organization:Tobacco Free Initiative (TFI), 2019).

Costing:

According to the estimation of An Australian Institute of Health and Welfare (AIHW), cigarette smoking was responsible for the greatest disease burden that has caused 15 551 deaths in Australia, and 9.7% of the disease burden owing to cardiovascular disease, 20.1% of the disease burden because of cancer. Economic costs of cigarette smoking for 2004–05 also has been estimated by Collins and Lapsley in Australian society that demonstrates was $31.5 billion cost that is an increase of 23.5% from the 1998–99 (Collins & Lapsley, 2008). Because of premature death and absenteeism for treatment of smoking related issues has been estimated for workforce labour costs has increased. Social cost of cigarette smoking in 2004-2005 was $19.5 billion intangible cost and $12 billion tangible cost. Intangible cost has resulted due to premature death, diminished productivity, health care for smoking related illness and substance abuse (Australian Institute of Health and Welfare, 2014). 

Tangible costs is the sum of diminished of loss of enjoying life, treatment of cigarette smoking related health issues and psychological cost owing to premature deaths (Forouzanfar, Alexander, & Anderson, 2015). As per the estimation of Bureau of Transport Economics' reasonable valuation of lost life is about $2 million (Wakefield, et al., 2014). The Global Burden of Disease study shows that cigarette smoking to significant increase in mortality burden with worldwide deaths increased by 20% since 1990. However in Australia, post adoption of a set of policies and practices in controlling smoking control smoking prevalence has diminished from 30.8% to 16.8% from 1980 to 2012 (Lewit, E.M;Coate, D; Grossman, M.;, 2017). Given growth in population, nonetheless, this is a substantial number of smokers and large number of tobacco related illness evident from premature deaths related to tobacco use in Australia (Ng, Freeman, & T.D, 2014). The social and economic costs of cigarette smoking is estimated at AU 12,800 million per annum in Australia. 

Current policies in place: 

With increasing ill impacts of smoking, smoke free environment has become common in Australia. In 1988 throughout the Australia Public Service, smoke free work environment policy has been initiated. This policy now a condition to employment with Australia Government as well as different other professional areas. Cigarette smoking control in Australia rates basically on state and territory governments of Australia. Federal Government also has played very significant role in banning smoking on domestic flights which is the first legislative action in 1987 (Grunseit, A.C, Kite, Cotter, & Dunlop, 2012). This action also has followed in other areas controlled by federal government such as international and domestic sector flights in 1990, coaches and buses run interstate in 1988 and on all Australian flights that fly to anywhere in the world in all international flights in Australia in 1996 (White, et al., 2011). 

National Tobacco Strategy was developed 1994  that has been promoted by major ministerial group of drug policy encompassing state, federal and territory ministers of  law and health enforcement. National Tobacco Strategy 1999–2003 has been aiming at enhancing the health conditions of Australian population by diminishing or eliminating their exposure to cigarette smoking irrespective of any forms (White, Durkin, Coomber, & Wakefield, 2015).  

Potential outcomes if not taken action: 

If adequate action is not taken in minimising cigarette smoking or eliminating tobacco use, further ill health impacts on population is like to increase. Not only the smokers but others such as their friends and relatives also are likely to suffer from ill health impacts of smoking being passive smokers especially children and women. People who initiate their smoking habit at their early years, pose risk on their physical as well as mental health outcomes. Cigarette smokers are concomitant increases in other forms of substance use among young adults and adolescents that includes substance abuse, illicit drug use and binge drinking. Cigarette smoking also has very detrimental impact on one’s working ability and mental health conditions which again increases risk of diminished employability and educational performance. 

Research outcomes:

Research findings and criticism:

Although, few jurisdictions have seen to enforce laws strictly in the context of sale of tobacco products to minors, those policies have not been enforced effectively that show influence upon the potential of such policies. In order to achieve potential effectiveness of those smoking prevention or diminishing policies, enforcement is the most critical aspect. Several studies that undertook tobacco sales has shown that enforcement of laws have significantly minimised sales to minors. 

In contrast, although a number of laws and policies have been developed and enacted in Australia regarding possession, smoking and purchasing of tobacco products, no Australian jurisdiction has integrated smoking bans as comprehensive as those suggested by National Tobacco Strategy 1999–2003 guidelines. All the territories and states have implemented a few legislative actions in order to address cigarette smoking exposure in workplaces and public places. To provide smoke free environments in some public places, such as restaurants, bingo and gaming centres, shopping centres, piecemeal approach has been adopted by South Australia and Victoria. The Queensland legislation prohibits smoking prohibits cigarette smoking in the enclosed places however, residential areas, private vehicles are excluded from the ban. Since smoking free legislations only effective in three legislations, the legislations have been inefficient to cover all workplaces, workers of Australia still remain in risk of smoking exposure.  Although comprehensive smoke free public places legislations is in place in most of the jurisdiction of Australia, smoking is still permitted in venues those are licenced. 

Implications of research:

The research findings show that although different policies and legislations have been develop and implemented in Australia regarding cigarette smoking to eliminate or reduce the risk of smoking and its related health issues, there remains loopholes in Australian legislations that has limited the effectiveness of those policies and laws. Additionally with ineffective legislative policies and laws, Australians are still exposed to the risk of tobacco smoking and its related health impacts. 

Experience in other jurisdiction

Summarize policy framework and outcomes

Smoking legislation regulating age in Canada of accessing and smoking in public places have contributed to minimising smoking prevalence among all age groups of people in Canada. Despite a number of policies and legislations have been developed and implemented thousands of young Canadians initiative their cigarette smoking habit every year. The Chronic Disease and Injury Indicator Framework demonstrates annual prevalence of cigarette smoking among Canadian youth aged between 15 and 19 since 2013 (Harvey & Chadi, 2016). Territorial and provincial legislation in order to protect youth and children from the ill outcomes of smoking are increasingly strengthened. According to Health Canada and Statistics Canada in 2013 about eleven percent of youth aged between fifteen and nineteen were smokers in 2013 compared to twenty percent in 2001. 

Although smoking rates have been able to tackles to some extent, indigenous and LGBTQ youth, smoke cigarette more than average rates. In order to eliminate cigarette smoking a wide range of effective measures are in place in Canada such as labelling deterrents, high taxes on tobacco products, bans on advertising to minors and displays and smoke free areas such as vehicles (Government of Canada, 2012). Different federal agencies and departments health, anti-corruption, finance, and agriculture are included to control tobacco in developing measures such as taxation, legislation and educational awareness. Tobacco Demand Reduction Strategy included in National Action Plan was developed to address smuggling in Canada which was announced in 1994 by federal government. $50 million was allocated by the Tobacco Control Initiative in order to conduct policy, research, information sharing, public education, program development and enforcement of legislation. Prevention and cessation program was developed under the Tobacco Demand Reduction Strategy for the communities that are at right risk of cigarette smoking prevalence or with low response to previous program. 

Multiple aspects approach has been targeted by the current Tobacco Control Initiative to work at various priority groups such as women, youth, aboriginals, low literacy and low income groups. Additionally the Community Action Initiatives Program (CAIP) has been designed by Health Canada to allocate project funding in order to promote, support and implementing anti-tobacco programmes based on communities. Application of Health Canada’s Quit-4-Life self-help kit have demonstrated that 77% of teens using the kit have efficient to minimise their cigarette smoking while 20%of them have been able to quit in three months (Mullen, et al., 2017). National Workshop on Women and Tobacco was developed for low income pregnant and young women and cessation and educational programs for women.  

Focus on packaging on tobacco products carry out strong messages for health and information on the ill effects of smoking. That has been focused by Office of Tobacco at Health Canada. Office of Tobacco Reduction Programs funded a survey within Health Promotion and Programs Branch  for Smoke free Canada have shown that little number of medicine colleges, nursing, psychology or pharmacy have included information on counselling on the health education of smoking and its impact. Regardless of different policies and legislations are in place, increasing number of young adults became regular smokers post their 18 years of age (Reutter, Neufeld, & Harrison, 2016). In contrast, In 2011, smoking rate in Canada among young people aged 12 year and older was 19.9 percent which has diminished from 25.9 percent in 2001. Rates of cigarette smoking have dropped both in women and men by 6 percent, men from 28.1% to 22.3% and women from 23.8% to 17.5% (Thrasher, et al., 2016). 

Despite decline of smoking rates over past 20 years in the UK, regular smoking of young people is a public health issue. Prevalence of smoking in youth in the UK aged between 11 and 15 is 9%. The rate of current smokers in Canada in 2004-2005 among children aged between 10 and 11 was 1.7% while it was 6.8% among middle school children in the US. Girls 10% aged between 11 and 15 more than boys 7% are more likely to smoke in the UK. Restricting access to tobacco and related products is the key aspects of tobacco legislation that aim at preventing and minimising the prevalence of smoking. The UK has also adopted the ‘public health’ model and thus followed implementing smoke free laws and giving health warning messages on cigarette products, advertising restrictions, increasing cigarette taxes, and media campaigns with an aim to minimise population exposure to hard caused by cigarette smoking. Smoking prevalence has dropped from 28 percent in 1998 to 21 percent in 2007 which is a reduction of 25%. The UK has implemented a comprehensive cessation treatment policy which targets high risk population and combine medical model with public health model. In ‘SimSmoke’ model, cigarette taxes are increased so that smoking cost can be increased and thus target to minimise people’s smoking behaviour. Smoking restricting are implemented in workplaces, bars and restaurants, public transportations  according to ‘Smoke-free air policy’. Smoke-free legislation covers almost all enclosed public places which first was came into action in 2006 (Gov.UK: Tobacco and smoking: policy, regulation and guidance, 2018). MPOWER distinguishes enforcement of direct and indirect marketing. With complete ban on marketing prevalence has been able to diminish by 5% and initiation by 6%. The UK has partial ban on marketing which has been increased to sporting of tobacco-sponsored events. Four level health warning also are provided by MPOWER in cigarette packets such as none, minimal, moderate and complete that cover about 50 percent of display area and tis policy has been able to diminish prevalence by 0·25% and increases elimination by 1.5% . Three level of media campaigns are promoted by ‘SimSmoke’ such as low, medium and high. Access to tobacco and related products has been minimised with the strict policy implementation of ‘restricting youth cigarette purchases’ by 30 percent among who aged below 16years and 20 percent those who aged above 17 years (Gov.UK:Public Health England, 2017). 

Access to treatment, treatment availability and health, quitlines and interventions of care providers are included in ‘Cessation treatment’ policy. Despite National Guidelines highlights the significance of importance of physician advice, advice with regular follow up is less which however has increased from 25% percent in 1998 to 50 percent in 2006. All policies work together to minimise by 4·75 percent and cessation is surged by 39% (Nagelhout, Levy, & Blackman, 2012).  The Children and Families Act 2014 has reinforced Secretary of State for Health in initiating rules ad regulations in protecting children from tobacco by ban on smoking in cars when children are present, a ban on the sale of e-cigarettes to children, and the prohibition of buying tobacco or e-cigarettes by adults on behalf of children. These measures were taken into action in October 2015. Moreover standardised tobacco packaging from May 2016 was also standardised with an aim to protect children from tobacco promotion.

Implications:

It can be summed up that both Canada and the UK have developed, implemented and promoted various policies I order to minimise cigarette smoking as well as prevent introducing smoking among young adults. Different policies that have been aimed at minimising and cessation of cigarette smoking behaviour ad address its related health impacts are probation of promoting or advertising cigarette, prohibition of smoking in public places such as transport, public spaces such as restaurants, bars and shopping centres, educating and information people amount its ill effects particularly population who are at risk, prohibition of selling tobacco or related products to young adults, and access of health care service in treatment of illness caused by cigarette smoking. Despite a wide range of policy have bene develop and implemented, expected outcome in diminishing or cessation of cigarette smoking and its impacts could not be achieved, however the policies have able to diminish prevalence of smoking among people to small extend. 

Recommendations

Following recommendations can be given in improving the outcomes of cigarette smoking cessation and diminishing its ill health effects among young people in Australia:

• Although different policies to smoking eliminating or minimising cigarette among youth have been developed, those need to be implemented strictly. In schools, colleges, and public places where youth are exposed to cigarette smoking must be kept free from smoking in relation to the issues that has been pointed out in this particular report that majority of the students have seen their teachers smoking either outside their school campus or outside their school building. Since they are more prone to follow adults at this age they must be provided with adequate information and awareness about smoking and its ill health impacts through educational curriculum. Additionally teachers must be made aware about their smoking behaviour so that they keep away from smoking anywhere near to their educational institutes as this behaviour is likely to have impact on the youth and lead to smoking behaviour. 
• Some of the policies have bene implemented effectively but in order to obtain expected outcome on smoking cessation or minimization further evaluation and monitoring of the policies need to be carried out so that gaps in the policies can be identified. Additionally strict procedures must be adopted for not abiding those policies such as smoking in closed area or public places. Different promotional campaigns and awareness program also must be developed in order to keep the youth aware of the negative effects of smoking.