50 Years of Smoking Progress, but Still a Way to Go
50 Years of Smoking Progress, but Still a Way to Go
The recently released Surgeon General's report on smoking, The Health Consequences of Smoking — 50 Years of Progress, informs us that despite decades of warnings on the danger of smoking, nearly 42 million adults and more than 3.5 million middle and high school students continue to smoke cigarettes (U.S. Department of Health and Human Services [DHHS] 2012). The majority (88%) started smoking before 18 years of age (DHHS, 2012). The report places blame on tobacco industry advertising and promotional activities as a cause of youth and young adults to start smoking, and further, as a cause of nicotine addiction that keeps people smoking well into adulthood and later life. Although the prevalence of current smoking among high school-aged youth has declined, for every adult who dies prematurely from a smoking- related cause each year, more than two youth or young adults become replacement smokers.
This report expands the list of diseases and other adverse health effects cause by smoking (see Figure 1). "Stroke" was added to the adverse health effects list for exposure of nonsmokers to tobacco smoke. Although we often think of adverse health effects from youth smoking occurring in adulthood, most young smokers already show signs of cardiovascular damage. For example, the abdominal aorta can show thickening of the walls and fatty streaks in smokers as young as 15 or 16 years of age.
(Enlarge Image)
Figure 1.
The Health Consequences Causally Linked to Smoking
Sources: DHHS, 2004, 2006, 2012.
Note: The condition in red is a new disease that has been causally linked to smoking in the most recent Surgeon General's report.
The report presents analysis of data from the 2011 and 2012 National Youth Tobacco Survey (NYTS) that provides an updated definition of current tobacco use, in which hookah, snus (dry snuff in a pouch), dissolvable tobacco, and electronic cigarettes were added to take into account nonconventional products that are increasing in popularity (DHHS, 2014). During 2011 to 2012:
According to the 2012 Surgeon General's report, Preventing Tobacco Use Among Youth and Young Adults (DHHS, 2012), young people sometimes use smokeless tobacco products in places where cigarettes are banned, such as school. Snus and dissolvable smokeless products that come in tablet or strips that look like candy, in particular, provide a way for smokers to maintain their addiction to nicotine, even when they cannot smoke. Most young people who use these smokeless products also smoke cigarettes.
A combination of national, state, and local initiatives have successfully reduced and prevented youth tobacco use (see Figure 2) (Centers for Disease Control and Prevention [CDC], 2007; DHHS, 2012). However, patterns of tobacco use are changing, with more intermittent use of cigarettes and an increase in use of other products. With a substantial proportion of youth tobacco use occurring with products other than cigarettes, monitoring and prevention of youth tobacco use needs to incorporate other products, including those that are new or emerging.
(Enlarge Image)
Figure 2.
Reducing Youth Tobacco Use
Sources: CDC, 2007; DHHS, 2012.
To develop and implement effective prevention strategies, pediatric nurses need to build their knowledge about the growing number of nonconventional nicotine delivery methods. Bidis, for example, are small, thin, hand-rolled cigarettes imported to the United States, primarily from India and other Southeast Asian countries. They are composed of tobacco wrapped in a tendu or temburni leaf (plants native to Asia) and may be secured with a colorful string at one or both ends. Bidis can be flavored (e.g., chocolate, cherry, mango) or unflavored. Kreteks — sometimes referred to as clove cigarettes — are imported from Indonesia and typically contain a mixture of tobacco, cloves, and other additives. Bidis and kreteks have higher concentrations of nicotine, tar, and carbon monoxide than conventional cigarettes sold in the United States. Electronic cigarettes typically contain nicotine, a component to produce the aerosol, and flavorings.
In addition to traditional prevention education about the perils of smoking, pediatric nurses can also provide information parents need to make informed decisions for their children about issues that may at first seem unrelated to smoking prevention. For example, in the past two years, portrayals of tobacco use in American films appear to have rebounded upward. In 2012, youth were exposed to an estimated 14.9 million in-theater tobacco-use impressions in youth-rated films (Polansky, Titus, Lanning, & Glantz, 2013). According to the Surgeon General's 2012 report, youth who are exposed to images of smoking in movies are more likely to smoke; those who get the most exposure to onscreen smoking are about twice as likely to begin smoking as those who get the least exposure (DHHS, 2012).
We are delighted that this issue of Pediatric Nursing features Susan Mee's exciting study, "Self Efficacy: A Mediator of Smoking Behavior and Depression among College Students." We hope her article will encourage others to conduct nursing research on this important topic.
Prevention is critical. About three out of four teen smokers become adult smokers, even if they plan to quit in a few years. Research has shown that if young people do not start using tobacco by age 26, they almost certainly will never start (CDC, 2013). Pediatric nurses can target prevention efforts in the school, community, health care settings, the public policy arena, and media campaigns.
We have come a long way in the past 50 years. However, this new report shows tobacco's continued, immense burden to our nation. Working together we can strive to reach DHHS Secretary Kathleen Sebelius' goal to make the next generation tobacco-free.
The recently released Surgeon General's report on smoking, The Health Consequences of Smoking — 50 Years of Progress, informs us that despite decades of warnings on the danger of smoking, nearly 42 million adults and more than 3.5 million middle and high school students continue to smoke cigarettes (U.S. Department of Health and Human Services [DHHS] 2012). The majority (88%) started smoking before 18 years of age (DHHS, 2012). The report places blame on tobacco industry advertising and promotional activities as a cause of youth and young adults to start smoking, and further, as a cause of nicotine addiction that keeps people smoking well into adulthood and later life. Although the prevalence of current smoking among high school-aged youth has declined, for every adult who dies prematurely from a smoking- related cause each year, more than two youth or young adults become replacement smokers.
This report expands the list of diseases and other adverse health effects cause by smoking (see Figure 1). "Stroke" was added to the adverse health effects list for exposure of nonsmokers to tobacco smoke. Although we often think of adverse health effects from youth smoking occurring in adulthood, most young smokers already show signs of cardiovascular damage. For example, the abdominal aorta can show thickening of the walls and fatty streaks in smokers as young as 15 or 16 years of age.
(Enlarge Image)
Figure 1.
The Health Consequences Causally Linked to Smoking
Sources: DHHS, 2004, 2006, 2012.
Note: The condition in red is a new disease that has been causally linked to smoking in the most recent Surgeon General's report.
The report presents analysis of data from the 2011 and 2012 National Youth Tobacco Survey (NYTS) that provides an updated definition of current tobacco use, in which hookah, snus (dry snuff in a pouch), dissolvable tobacco, and electronic cigarettes were added to take into account nonconventional products that are increasing in popularity (DHHS, 2014). During 2011 to 2012:
Electronic cigarettes use nearly doubled among both middle school (0.6% to 1.1%) and high school (1.5% to 2.8%) students.
Hookah use increased among high school students (4.1% to 5.4%).
Bidis and kreteks use among both middle and high school students decreased.
Dissolvable tobacco use among high school students decreased.
According to the 2012 Surgeon General's report, Preventing Tobacco Use Among Youth and Young Adults (DHHS, 2012), young people sometimes use smokeless tobacco products in places where cigarettes are banned, such as school. Snus and dissolvable smokeless products that come in tablet or strips that look like candy, in particular, provide a way for smokers to maintain their addiction to nicotine, even when they cannot smoke. Most young people who use these smokeless products also smoke cigarettes.
A combination of national, state, and local initiatives have successfully reduced and prevented youth tobacco use (see Figure 2) (Centers for Disease Control and Prevention [CDC], 2007; DHHS, 2012). However, patterns of tobacco use are changing, with more intermittent use of cigarettes and an increase in use of other products. With a substantial proportion of youth tobacco use occurring with products other than cigarettes, monitoring and prevention of youth tobacco use needs to incorporate other products, including those that are new or emerging.
(Enlarge Image)
Figure 2.
Reducing Youth Tobacco Use
Sources: CDC, 2007; DHHS, 2012.
To develop and implement effective prevention strategies, pediatric nurses need to build their knowledge about the growing number of nonconventional nicotine delivery methods. Bidis, for example, are small, thin, hand-rolled cigarettes imported to the United States, primarily from India and other Southeast Asian countries. They are composed of tobacco wrapped in a tendu or temburni leaf (plants native to Asia) and may be secured with a colorful string at one or both ends. Bidis can be flavored (e.g., chocolate, cherry, mango) or unflavored. Kreteks — sometimes referred to as clove cigarettes — are imported from Indonesia and typically contain a mixture of tobacco, cloves, and other additives. Bidis and kreteks have higher concentrations of nicotine, tar, and carbon monoxide than conventional cigarettes sold in the United States. Electronic cigarettes typically contain nicotine, a component to produce the aerosol, and flavorings.
In addition to traditional prevention education about the perils of smoking, pediatric nurses can also provide information parents need to make informed decisions for their children about issues that may at first seem unrelated to smoking prevention. For example, in the past two years, portrayals of tobacco use in American films appear to have rebounded upward. In 2012, youth were exposed to an estimated 14.9 million in-theater tobacco-use impressions in youth-rated films (Polansky, Titus, Lanning, & Glantz, 2013). According to the Surgeon General's 2012 report, youth who are exposed to images of smoking in movies are more likely to smoke; those who get the most exposure to onscreen smoking are about twice as likely to begin smoking as those who get the least exposure (DHHS, 2012).
We are delighted that this issue of Pediatric Nursing features Susan Mee's exciting study, "Self Efficacy: A Mediator of Smoking Behavior and Depression among College Students." We hope her article will encourage others to conduct nursing research on this important topic.
Prevention is critical. About three out of four teen smokers become adult smokers, even if they plan to quit in a few years. Research has shown that if young people do not start using tobacco by age 26, they almost certainly will never start (CDC, 2013). Pediatric nurses can target prevention efforts in the school, community, health care settings, the public policy arena, and media campaigns.
We have come a long way in the past 50 years. However, this new report shows tobacco's continued, immense burden to our nation. Working together we can strive to reach DHHS Secretary Kathleen Sebelius' goal to make the next generation tobacco-free.
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