Smoking and Tobacco Use
The contemporary society is extremely developed and technologically advanced in all respects. As a result, it can solve many health problems with the help of new drugs, treatment methods, and intervention strategies. Besides, people become increasingly aware of various existing social, environmental, healthcare, and other issues that may have a profound impact on their daily life and well-being. Governments and different non-governmental organizations develop and implement all kinds of measures to solve such acknowledged existing problems and minimize their impact on human beings and other related stakeholders, including animals, plants, and the environment in general. However, there exists an extremely serious problem that the modern society often seems to ignore in favor of solving other supposedly more urgent issues. The problem is smoking and tobacco use that have spread virtually across the entire globe and have become a persistent and integral part of the international society. Anyway, the extents of integration into different communities in different countries may vary greatly.
There are miscellaneous reasons why the given problem is frequently overlooked, one of which consists in popularization of the harmful habit by means of explicit and implicit advertising sponsored by the multibillion tobacco industry. The other reason why no measures have been implemented relates to the addictive nature of nicotine present in all tobacco products and e-cigarettes that have recently become a wide-spread substitute for conventional cigarettes. Nonetheless, the problem of smoking is usually discussed as a harmful habit that is a personal choice of every individual rather than a kind of addiction with long-lasting profound impacts on both the smoker and the society on the whole. Therefore, it seems imperative to review the issue of smoking and tobacco use as a topical social problem that calls for taking some urgent measures aimed at reducing and ultimately eliminating the problem for the sake of ensuring well-being and healthy continuation of the society. Moreover, it is reasonable to provide the discussion of the issue on the basis of a comparison between two highly-developed countries, the governments of which have acknowledged existence and severity of the social problem under consideration and have adopted respective initiatives to address it. In the current paper, the two countries are the USA and Canada that have been chosen due to their geographic proximity and close connections existing between their societies. As a result, it is assumed to have some influence on the prevalence rate and attitudes to the issue of smoking and tobacco use.
Both Canada and the USA are similar in many respects, including their superb healthcare systems, high level of populations’ literacy and awareness of healthcare and other issues and their consequences. Additionally, the countries provide their citizens with such aspects as availability of the Internet and access to other informative sources, quality education systems, and overall society-oriented governmental policies aimed at improving the quality of life and promoting longevity and happiness of the population. Besides, the social problem under consideration is extremely important for the two countries as it is among the primary causes of deaths and serious health problems among their populations. Furthermore, the two countries have displayed a decline in the prevalence rates throughout the past decade, which may be explained by new measures introduced by their governments to address the problem. Consequently, available statistics shows that the decline has virtually stopped in both countries in the recent past. Hence, the USA and Canada have to develop new measures and initiatives aimed at reducing the social problem under consideration in the short run and eliminating it in the long run.
Extent of the Problem in the Two Countries
Overall, smoking and tobacco use have been acknowledged as a global problem since 2005. At that time, the World Health Organization declared that the world was witnessing a global tobacco epidemic that had drastic consequences for health of the international community and caused millions of deaths annually, not mentioned ever-increasing related healthcare costs (World Health Organization, 2015). Thus, in 2005 the WHO developed a respective Framework Convention on Tobacco Control and MPOWER measures to be adopted and implemented by as many countries of the world as possible, including the USA and Canada as two of the most developed Western states committed to ensuring well-being of their citizens (World Health Organization, 2015). Although some of the initiatives adopted by the two countries are similar, it is seen that the extent of the social problem and effect of the measures taken may be deemed similar as well.
According to the recent statistics, nowadays 17.8% of the entire US adult population is represented by current smokers, which amounts to more than 42 million of people (Bach, 2015). Out of such amount, more than 20% are men and more than 15% are women, which means that the gender difference under this social problem is not extremely prominent. As of 2009, the three US states with the highest prevalence rate of current smokers included Kentucky with 25.6%, West Virginia with 25.6%, and Oklahoma with 25.5% (“State-specific prevalence of cigarette smoking and smokeless tobacco use among adults – United States, 2009”, 2010). In turn, the three states with the lowest rate were Utah with 9.8%, California with 12.9%, and Washington with 14.9% (“State-specific prevalence of cigarette smoking and smokeless tobacco use among adults – United States, 2009”, 2010). However, such rates show an overall significant decline in the country as compared to the 1990s when approximately a half of the entire population could be identified as current smokers.
Nonetheless, the problem of smoking and tobacco use remains alarmingly pervasive and deeply rooted among young adults and adolescents, who represent the most vulnerable group of population in terms of the risk to acquire the habit. Thus, the percentage of high school students who are current smokers amounts to 15.7% or 2.7 million with boys accounting for 16.4% and girls for 15% (Bach, 2015). Other sources claim that the number of high and middle school students who regularly smoke reaches 3.6 million, while even more students are encouraged to try smoking and consequently become addicted to nicotine due to the targeted advertising in the USA (Benjamin, 2012). The percentage of children aged 3-11 exposed to passive smoking is even more staggering as it reaches more than 40% (Bach, 2015). It has been estimated that every day more than 2,500 children aged under the age of 18 try smoking for the first time with approximately one third of them becoming current smokers and carrying on with the habit into adulthood (Bach, 2015). Besides, “out of every three young smokers, only one will quit, and one of those remaining smokers will die from tobacco-related causes” (Benjamin, 2012).
Furthermore, smoking and tobacco use represent one of the major causes of death in the USA with approximately 500,000 individuals dying annually, including 50,000 deaths caused by exposure to passive smoking (U.S. Department of Health and Human Services, 2012). For all current smokers, half of them is predicted to die from smoking-related causes unless they quit, while the other half “will suffer from cancer, stroke, heart attack, and other serious tobacco-related diseases” (U.S. Department of Health and Human Services, 2012). Currently, more than 16 million of Americans suffer from some smoking-related diseases (Bach, 2015). Some of them include lung cancer, pancreatic cancer, cardiovascular diseases, pulmonary diseases, reproductive dysfunctions, and a wide range of other conditions caused by the fact that smoking affects all organs in a human organism. Hence, lung cancer is the most prevalent and lethal disease caused by smoking and tobacco use in the USA accounting for more than 30% of all cancer deaths in the country (Seffrin et al., 2011). Chronic obstructive pulmonary disease is also caused primarily by smoking and tobacco use with approximately 90% of all deaths related to this conditions occurring due to the harmful habit (Seffrin et al., 2011). Withal, the CDC claims that “smoking kills more people than alcohol, AIDS, car accidents, illegal drugs, murders, and suicides combined with thousands more dying from spit tobacco use” (Bach, 2015).
In addition to smoking as such, millions of US citizens engage in other kinds of tobacco use, including smokeless tobacco use and e-cigarettes use. Since the late 1990s, the rate of smokeless tobacco use has declined in the country similarly to the overall smoking rate. It is also evident on the basis of a decline in smokeless tobacco sales volumes by 11% from 1986 to 2003 even though the sales rate increased significantly during the period for moist snuff and dip by 87% (Nelson et al., 2006). Besides, the rate of smokeless tobacco use has decreased for all groups by approximately 26% except for adult males aged 25-45, who represent the largest group of current smokers and have displayed almost no decline in use (Nelson et al., 2006). Smokeless tobacco use is more prevalent among men, rural residents, American Indians, Alaska Natives, residents of Western and Southern states, and people from lower socioeconomic classes (Nelson et al., 2006).
In turn, nowadays e-cigarettes are advertised as a safe alternative to conventional smoking. Still, regardless of the fact that their use is associated with inhaling of a lower amount of toxins and at lower rates, they still include nicotine in doses similar to conventional cigarettes, which makes them hazardous for health (Dutra & Glantz, 2013). Recent researches have proved that in the USA e-cigarettes do not discourage conventional smoking due to the frequently dual use of both means (Dutra & Glantz, 2013). Besides, they are associated with a higher rate of smoking experiments among adolescents and lower abstinence levels among current smokers (Dutra & Glantz, 2013). E-cigarettes are also viewed as a potential way of reentry of the smoking group by former smokers who have previously quitted. Some of the trends related to smoking and tobacco use in the USA have been revealed by researches dedicated to the current issue. Firstly, over the past decade and a half there has been a significant increase and then subsequent decrease in the general smoking prevalence rate (Nelson et al., 2008). Secondly, since the early 1990s and till the present times there has been revealed a steep decline in the smoking rate among African Americans (Nelson et al., 2008). Thirdly, a gender gap among current smokers has been gradually decreasing, especially among such groups as young adults and older adolescents (Nelson et al., 2008). Fourthly, since the 1990s almost all groups of the US population have been displaying similar trends relating to smoking and tobacco use (Nelson et al., 2008). Finally, there has been seen a significant decline in the smoking rate among young adults with less than high school education (Nelson et al., 2008). As evident from the above discussion, smoking and tobacco use are pervasive in the US society and require immediate solutions.
The social problem under consideration is similarly pervasive and deeply rooted in Canada, as well. Hence, according to the recent statistics, 16.1% of all adult Canadians, i.e. approximately 4.6 million, are current smokers. Anyway, the Canadian prevalence rate is lower than the one in the USA (Reid et al., 2014). Prevalence is higher for males with 18.4% than for females with 13.9%, which means that the gender correlation is similar with the one in the USA (Reid et al., 2014). Just like in the USA, the rate was declining rapidly in late 1990s and early 2000s, but it has slowed over the past decade. The most prevalent group of current smokers in Canada is a little younger than in the USA, being aged 20-34 versus 25-45 in the latter country (Reid et al., 2014). Just like in the USA, education level has had a profound impact on the decline of the smoking prevalence rate in Canada, while individuals with less than high level education are more prone to be current smokers. Hence, the prevalence of smoking is almost twice as high for representatives of the least educated group as for university graduates in Canada (Reid et al., 2010). Highly-educated smokers are also more likely to quit than individuals with little education. Such statistics has remained relatively stable over the last decades despite the recent decline in the overall prevalence rate in the country (Reid et al., 2010). Besides, in Canada, there are significant differences between provinces in terms of smoking prevalence rate, which is also similar to the situation in the USA with differences noted across states. Overall, the highest smoking rates across all age, gender, and socioeconomic groups are evident in Saskatchewan and Quebec.
In terms of adolescents and children in Canada, 10.9% of adolescents aged 15-19 are reported to be current smokers with the overwhelming majority of the group being represented by 19-year-old boys and girls (Reid et al., 2014). However, over 65% of current smokers aged 15-19 are seriously considering quitting in the nearest six months with 63% having tried to quit during a year preceding the survey conducted at the end of 2014 (Reid et al., 2014). 15.5% of children aged below 15 are reported to have tried smoking, having obtained the cigarette from social sources (Reid et al., 2014). At the same time, the rate of quitting is relatively high in Canada and is reported to be higher than in the USA as six out of ten Canadian smokers have successfully quitted it. Besides, about two-thirds of all current smokers are seriously considering such option in the nearest six months and three out of ten are going to quit within one month after the survey (Reid et al., 2014). In terms of quitting plans, there are no significant differences by age and gender in Canada. Moreover, concerning past quit attempts, the highest rates are noted among young adults and adolescents, while the rate of abstinence after the quit attempt seems to be higher for males than for females.
The use of smokeless tobacco products is less prevalent in Canada than in the USA, but in Canada people use a wider range of tobacco products besides conventional cigarettes, including mostly cigars and cigarillos (Reid et al., 2014). In terms of e-cigarettes use, less Canadians tend to use them on a regular basis compared to Americans. One of the possible explanations for such difference between the two countries relates to the prohibition of e-cigarettes with nicotine in Canada. Although the overall use rate of e-cigarettes is reported to increase nowadays in Canada, Anyway, only 1% of former and current adult smokers use them regularly, while 4% report to have tried them once (Czoli et al., 2014). The situation is alarming when it comes to adolescents and young adults as one fifth of them have reported trying e-cigarettes with many non-smokers reporting trying them, which constitutes a risk of their becoming current smokers (Czoli et al., 2014). Reasons for trying are various, but a wish to decrease the number of conventional cigarettes smoked daily is the most prevalent among current smokers. Finally, it should be noted that overview of the smoking and tobacco use history in Canada reveals that declines in the prevalence rates like the one seen nowadays have been usually associated with implementation of new tobacco control measures by the government, for instance, during such periods as 1963-1969, 1982-1991, and 1997-2006 (Collishaw, 2009). Therefore, today the Canadian government should review existing measures and develop additional initiatives with a view to preserving the declining rate of smoking and tobacco use so that it could become gradually less pervasive.
Efforts to Reduce/Eliminate the Social Problem under Consideration
The two countries under consideration herein have undertaken quite similar measures aimed at reducing smoking and tobacco use, primarily relating to legislative actions prohibiting smoking in public places and taxation of the tobacco industry. Moreover, compliance with international initiatives like the WHO Framework intended to stop the global tobacco epidemic in force since 2005. Overall, such measures have proved to be successful in both countries, which is evident from the decline in the prevalence rate. However, the problem requires additional efforts to be eliminated as the decline has almost stopped in the recent past and tobacco companies have started targeting younger population groups that at the highest risk of acquiring the habit and becoming regular smokers.
In the USA, the US Department of Health and Human Services and the FDA are the two main governmental agencies dealing with the social problem under consideration. The former has developed the Strategic Action Plan within the framework set by Healthy People 2020, including such objectives as reduction of tobacco use by adolescents and adults, reduction of the amount of new smokers among all groups, increase of the cessation rate, and decrease in exposure to passive smoking (U.S. Department of Health and Human Services, 2012). The problem with governmental initiatives relates to the fact that different states can implement different measures with varying success rates. Currently, California is among the states with the strictest tobacco-related laws, which should be considered for adoption in other states, as well. Besides, the federal government has prohibited smoking in air transport, introduced obligatory warnings on tobacco products, documented addictive and lethal nature of tobacco, prohibited some commercials on television and in other media, informed the public of the dangers of smoking and exposure to passive smoking, and supported national, state, and local research and education initiatives against smoking and tobacco use.
The Canadian government has implemented similar measures, but they can be deemed stricter and more prohibitive, for instance, with respect to advertising and smoking in public places. The role of NGOs in Canada is more prominent at the national level than in the USA. For example, the Canadian Public Health Association is among the most active organizations striving to eliminate the social problem in the country. It calls for the federal government to implement the WHO Framework Convention on Tobacco Control in full, including the 2015 requirement to increase tobacco-related taxes, In addition, such measure can also be implemented as launching social media campaigns against smoking, prohibiting remaining advertising of tobacco products, banning menthol in cigarettes, increasing graphic warnings on products to 90% of the package surface, prohibiting flavorings in smokeless tobacco predicts, and introducing a moratorium on new tobacco products (Canadian Public Health Association, 2011). In such way, the government predicts that the problem can be eliminated by 2035 (Canadian Public Health Association, 2011).
In any case, the above mentioned measures do not represent an exhaustive list of all steps taken in the two countries to tackle the social problem under consideration. Even though both governmental initiatives and those of various NGOs functioning in both Canada and the USA have proved to be relatively successful (as evident from the overall declining prevalence rate), they can hardly be deemed sufficient for eliminating the social problem. The matter is that the multibillion tobacco industry has been extremely resourceful and flexible in adapting to changing legal environments all over the world, since it does not want to lose its enormous profits. Therefore, it can be expected that it will devise plans of maintaining the amount of smokers high despite governmental and nongovernmental initiatives. However, the WHO’s recommendation to increase tobacco-related taxes seems to be an effective and efficient measure that should be considered by Canadian and US governments in their fight against the tobacco epidemic in their respective countries.
Withal, the social problem will hardly seize to exist within the next ten years in the two countries, but the decline rate is forecasted to be higher in Canada as more Canadians report quitting with relatively low initiation levels. In turn, the US population is marked by relatively low successful quitting levels and some groups like males aged 25-45 report little or no planned quitting attempts in the nearest future. Nonetheless, the main concern for both countries should be development of means to prevent children and adolescents from becoming regular smokers.
The above discussion has been aimed at comparing the situation with smoking and tobacco use in Canada and the USA. The comparative analysis of the two countries has shown that they have many similarities, for instance, relating to the recent decline in the prevalence rate and influence of education level on smoking incidence rate. Anyway, there exist some differences relating the varying rates of quitting and intentions to quit in the nearest future. However, long-term forecasts for the two countries differ, since Canada seems to be more dedicated and successful in its fight against the tobacco epidemic. In turn, the tobacco industry seems to be quite powerful and influential in the USA, as well as reaping more profits due to a larger number of citizens. Therefore, it will surely try to develop ways to adapt to harsher governmental measures and at least preserve the current prevalence rate. Nonetheless, the two countries should realize that such pervasive social problem may have detrimental consequences on the well-being and health of their nations. It is caused by the fact that smoking and tobacco use are related with a wide range of serious and often lethal diseases like lung cancer, cardiovascular diseases, pulmonary diseases, and many others. The tobacco-related death rate is extremely high, which should encourage the governments and NGOs of the two countries to be more persistent and radical in terms of measures and initiatives they develop and launch. Comparison of the two particular countries seems to be beneficial for understanding how neighboring countries can implement similar measures with a view to reducing and ultimately eliminating the social problem under consideration. Furthermore, Canada and the USA are among world leaders in terms of their development and they can assist other countries by providing an example in their fight against the global tobacco epidemic in case their measures and initiatives prove to be successful.