Looking at individuals who smoke as a vulnerable population.
In 2012, smoking attributed to 45,400 deaths in Canada which correlates to 18 percent of all deaths in 2012 (Noakes, 2017). The World Health Organization, states smoking is responsible for more than 5 million deaths annually (Health Canada, 2017). According to Health Canada in 2021, nearly five million Canadians smoked and about 48,000 Canadians die from tobacco use every year (CBC Radio, 2021). Smoking is known to cause many different disease processes. Smoking primarily leads to cancer, cardiovascular diseases, and respiratory diseases such as chronic obstructive pulmonary disease (COPD) (Health Canada, 2017). The direct cost of smoking to health care accounted for $6.5 billion. Yet people continue to smoke.
Social Determinants of Health in Smokers (Brady, 2020):
Low socioeconomic status
Poor education
Low income
Race/ethnicity
Cultural characteristics
Social marginalization (e.g., lesbian, gay, bisexual, and transgender communities, people with mental illness and substance use disorders)
Stress
Lack of community empowerment
Unequal distribution of resources and services
These are just some of the main social determinants of health (SDoH) that are found in smokers. The two biggest SDoH for these individuals is education and income. Smoking is strongly correlated with individuals with low education and low income (Brady, 2020).
Social Ecological Model of Health (SEM) of Smokers:
Individual Level:
Low socioeconomic status plays a huge role in the individual level of SEM. Many individuals who smoke have low levels of education and low income. At the individual level, Pierce and Kealey (2021) recommend tobacco education and tobacco free schools. Education will provide individuals with the knowledge needed to make an informed decision on whether to smoke or not. Additionally, creating an environment that promotes anti-tobacco beliefs and behaviors is also very instrumental in smoking cessation (Pierce and Kealey, 2021).
Interpersonal Relationships Level:
An individual’s relationships play a huge role in whether they will smoke or not. It is noted that individuals with parental and peer smokers in their lives have exponentially increased odds of smoking (Australian Government, n.d.). Additionally, nicotine exposure during childhood plays a major role in enabling smoking behavior (Australian Government, n.d.). Promoting smoke-free homes could help prevent individuals from smoking (Pierce and Kealey, 2021).
Organizational Level:
An individual’s surroundings heavily influence an individual’s smoking. Many individuals are more likely to smoke depending on the organizations they belong too. A major organization that an individual is apart of and is connected to is their job. Our job plays a huge role in our identity and makes up a major part of our lives. It is noted that physically demanding jobs are linked with heavy smoking. Work that involves high physical exertion is associated with heavy smokers, roughly 2.5 times more than people whose job involves low physical exertion (IWH, 2019). Creating smoke-free work places may help create an environment that promotes smoking cessation.
Community level:
Adults that live in rural areas smoke at a higher rate compared to adults that live in urban areas. This relates back to a lack of education and low income (Australian Government, n.d.). In these communities, smoking is more common and socially acceptable. These individuals believe that smoking is okay and ignore the negative effects associated with smoking. Creating communities that promote smoking cessation will help deter individuals from smoking.
Societal/Policy level:
The introduction of policies that deter smoking can increase smoking cessation rates. A common recommended policy is increasing taxes on tobacco products (Pierce & Kealey, 2021). Additionally, increasing insurance coverage for medical treatments such as pharmaceutical treatments and behavioral coaching can help increase smoking cessation (Pierce & Kealey, 2021). Changes in policies that promote smoking cessation can lead to creating a society that encourages people to be tobacco free.
As a respiratory therapist, smoking is considered very harmful and bad. At the hospital I work at majority of these individuals develop COPD. With COPD being a chronic disease, many of these patients are non-complaint with medications and have frequent visits to the hospital. As a result, COPD costs the health care system an estimated 1.5 billion dollars annually (Canadian Institute for Health Information, n.d.). A personal trend that I am noticing is that education for these individuals is severely lacking. There are various factors for the lack of education but a large reason in my opinion is the fact that many individuals do not want to waste their time providing smoking cessation education. Many nurses and RTs feel like their words are falling on deaf ears and that these individuals have no desire to quit. RTs and nurses prefer to rather treat and discharge these patients. I can understand and relate to these frustrations as a health care provider. Seeing the same patients come in and out of the hospital for exacerbations can be very demoralizing. Smoking is an extremely difficult habit to break and it takes multiple failed attempts before an individual will kick the habit (Pierce and Kealey, 2021). Re-enforcing smoking cessation is vital because you never know when an individual will be open to the idea of quitting unless you attempt to provide them with education. I feel like opportunities to capitalize on these moments when these types of patients have a desire to quit are being missed. As a result, theses cycles of COPD exacerbations and hospitalizations continue and are not broken. Thus, continuing the financial burden placed on the Canadian health care system.
References:
Australian Government. (n.d.). Factors influencing smoking levels among high smoking prevalence groups. The Department of Health. Retrieved March 22, 2022 from https://www1.health.gov.au/internet/publications/publishing.nsf/Content/smoking-disadvantage-evidence-brief~factors-smoking-levels#:~:text=Research%20has%20identified%20a%20range,pressure%20and%20stress%3B%20(28)
Brady, K. (2020). Social Determinants of Health and Smoking Cessation: A Challenge. The American Journal of Psychiatry, 177(11), 1029-1030 https://ajp.psychiatryonline.org/doi/epub/10.1176/appi.ajp.2020.20091374
CBC radio. (2021). How the pandemic impacted vaping and smoking rates — and why it showed vaping is 'here to stay'. CBC Radio. Retrieved March 22, 2022 from https://www.cbc.ca/radio/whitecoat/how-the-pandemic-impacted-vaping-and-smoking-rates-and-why-it-showed-vaping-is-here-to-stay-1.6068729
Canadian Institute for Health Information. (n.d.). COPD: A focus on high users — Infographic. Canadian Institute for Health Information. Retrieved March 22, 2022 from https://www.cihi.ca/en/copd-a-focus-on-high-users-infographic
Health Canada. (2017). The Costs of Tobacco Use in Canada, 2012. Government of Canada. Retrieved March 22, 2022 from https://www.canada.ca/en/health-canada/services/publications/healthy-living/costs-tobacco-use-canada-2012.html
Institute for Work & Health. (2019). Examining the link between working conditions and tobacco-smoking habits. Institute for Work & Health. Retrieved March 22, 2022 from https://www.iwh.on.ca/summaries/research-highlights/examining-link-between-working-conditions-and-tobacco-smoking-habits
Newsy. (2017). Most smokers have low socioeconomic status. Retrieved March 22, 2022 from https://www.youtube.com/watch?v=6dJ-5Zz6JF4
Noakes, S. (2017). Smoking costs 45,400 lives, $16.2B in a year, study finds. CBC News. Retrieved March 22, 2022 from https://www.cbc.ca/news/business/smoking-economic-cost-1.4357096#:~:text=Those%20costs%20include%20health%20care,the%20economy%20continue%20to%20rise.
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