Demographic Analysis for Policy Decision-Making - Essay Example

Running Head: Demographic Analysis for Policy Decision-Making Demographic Analysis for Policy Decision-Making Nonsmokers in dose proximity to smokers may inhale the smoke exhaled by smokers, known as "second-hand smoke." Or they may inhale the smoke produced by the burning cigarette between puffs, known as "side stream smoke." Scores of studies have uncovered serious adverse consequences from passive smoking. Nonsmokers who live with smokers generally have a 30 percent increased risk of lung cancer compared to members of nonsmoking households. They are also at greater risk of other cancers and of heart disease. Studying deaths from all causes in nonsmokers living with smoking spouses, an elevated mortality risk that was not only greater than that of persons who were not exposed to tobacco smoke, but slightly exceeded the mortality risk of smokers who consumed up to nine cigarettes a day. The children of smokers, compared to children of nonsmoking parents, have an increased number of respiratory disorders, are sick more often and miss more days of school. The Centers for Disease Control conservatively attributes 3,825 deaths in 1988 to passive smoking A report sponsored by the Environmental Protection Agency concluded that environmental smoke kills 53,000 nonsmokers a year, including 37,000 from heart disease ("Secondhand") (Schwartz JL, 1989). Canadians overwhelmingly believe that cigarette smoke is harmful to the non-smoker. Only 9% think there is no danger to the non-smoker. Canadians are most likely to identify lung cancer and bronchitis and other respiratory problems as diseases associated with second-hand smoke. Smokers and those who live with smokers are less likely to acknowledge the health effects of smoking. [Survey on Smoking in Canada, 1994-95, Cycle 2, Statistics Canada] http://www.smoke-free.ca/Second-Hand-Smoke/health_kids.htm Only 1 in 5 Canadians surveyed believed that second-hand smoke could cause ear infections. Even among those who know that second-hand smoke poses a danger, many mistakenly believe that children's health is only harmed by smoking directly around them. [Environmental Tobacco Smoke: Knowledge, Attitudes and Actions of Parents, Children and Child Care Providers, Health Canada, 1995]. http://www.smoke-free.ca/Second-Hand-Smoke/health_kids.htm Almost half of all Canadian children under the age of 15, some 2.8 million children, are exposed to second-hand smoke on a regular basis. [Parliamentary Secretary to the Minister of Health on second reading debate of Bill C-24, June 6, 1996]. Four in 10 Canadian households include someone who regularly smokes in the home. Neither the presence of children nor their age affects whether or not homes are kept smoke-free. A further 40% of Canadian homes have no regular smoker living there, but permit visitors to smoke in their home. Only 19% of Canadian homes are smoke-free. [Survey on Smoking in Canada 1994-95, Cycle 2] http://www.smoke-free.ca/Second-Hand-Smoke/health_kids.htm In smoker's homes, an average of 18 cigarettes a day is smoked. In only 1 in 5 of these households are cigarettes not smoked directly in front of children. Smokers are more likely to have mainly smokers in their social circle, and their children are more likely to be in contact with these smoking friends and relatives than are the children of non-smokers. [An Assessment of Knowledge, Attitudes and Practices Concerning Environmental Tobacco Smoke, 1995 - Ekos Research Associates] http://www.smoke-free.ca/Second-Hand-Smoke/health_kids.htm Thus, there is no doubt that tobacco smoking is harmful to the smoker. Evidence also indicates that maternal smoking during pregnancy has adverse effects on fetal development. It is now apparent that 'passive' or 'involuntary' smoking also has harmful effects. This involves non-smokers being exposed to the smoke from cigarettes or other tobacco products smoked by other people. In 1987 the Independent Scientific Committee on Smoking and Health produced a statement to the effect that passive smoking was associated with a small increase in lung cancer risk. Maternal smoking can affect the fetus and the outcome of the pregnancy. Smoking deprives the fetus of needed oxygen and other nutrients. This may result in: Deficits in intellectual ability and behavioral problems Low birth weight or intra-uterine growth retardation Spontaneous abortion (miscarriage) Stillbirth Reduced lung function in the baby Complications in pregnancy Exposure to someone else's smoking can harm an expectant mother's baby. Research into this area is still incomplete, and the full effects are still unknown. What we do know is that the best chance for a healthy baby and healthy mother is a pregnancy where both are not exposed to any tobacco smoke. [Environmental Tobacco Smoke (ETS) in Home Environments, Health Canada, 1996]. http://www.smoke-free.ca/Second-Hand-Smoke/health_kids.htm However, most studies indicated that passive smoking is associated with an increase in the risk of lung cancer. Even so, a minority of investigations have concluded that such effects are negligible or even non-existent. Passive smoking does raise many cancer risks in the range of 10-30 per cent. Most, but not all, of those who die from tobacco-related diseases are middle-aged and elderly. It is emphasized that, although some young people do die from such causes, tobacco-related premature death is usually a long-term consequence of a continued smoking career. Tobacco smoking causes widespread ill health in addition to its fatal effects. Smoking is associated not only with cancers, but with heart disease, bronchitis and a number of other ailments. Even young children who smoke report higher levels of respiratory symptoms than do non-smokers. Children who expose to Passive smoking often have coughs which most recognize as being associated with smoking. Young heavier smokers also report more frequent coughs, colds and shortness of breath than do non-smokers. Teenage smokers also have reduced lung function and other respiratory abnormalities. De Groh, M.; Morrison, H.I (2002) distinguished between the effects on children of maternal smoking during pregnancy and subsequent exposure to parental smoking. They concluded that parental smoking was associated with decreased child height. This analysis controlled for social class and a number of other factors. Young children are especially vulnerable to second-hand smoke in the home because: They breathe more air relative to body weight (and for the same level of exposure will absorb more tobacco smoke toxins) They are less able to complain (either because they are too young, or because their complaints are ignored) Their immune system is less protective They are less able to remove themselves from exposure http://www.smoke-free.ca/Second-Hand-Smoke/health_kids.htm Moreover, young people in the lowest socio-economic groups are those most likely to smoke. This connection between secondhand smoking and socio-economic status persists in the later stages of life. Both short-term respiratory symptoms, absence from school or work and longer-term, increasingly serious illnesses as well as premature deaths are clearly and directly attributable to tobacco use. Although secondhand smoking is not exclusively confined to those in lower socio-economic groups it imposes a disproportionate toll on those who have low incomes and who are often otherwise seriously disadvantaged in a variety of ways. Young people who are smokers are also more likely to use illicit drugs and to drink heavily. Young people from lower socio-economic backgrounds, are 'at risk' in relation to a number of problem behaviors. To reiterate, tobacco continues to be associated with massive health damage. The scale of this dwarfs the health effects associated with alcohol or illicit drugs. Most of the serious consequences of tobacco smoking do not become apparent until the middle and later years of life. Even so some health damage, such as bronchitis, is evident amongst young smokers. In addition, 'passive smoking' involves harm to people who do not smoke and, maternal smoking in pregnancy is also harmful. It is certainly a problem that the ill effects of tobacco are often not evident in the short term. This fact is probably a barrier, or at least an impediment, to health education and to the desired objective of discouraging people from smoking. (Johnson, K.C.; Hu, J.; Mao, Y., 2000) In Canada, The 'big four' injunctions of health promotion - to stop smoking cigarettes in both ways, to eat a healthy diet, to drink alcohol in moderation, and take regular exercise - have become firmly established in popular consciousness of Canada. Over the past decade the reach of health promotion has widened and deepened. Each of the big four has expanded and become more differentiated. The evils of smoking have been compounded by the perils of passive smoking. Every schoolchild knows how to calculate the units of alcohol in different beverages and the approved limits for men and women. The merits of fruit and fibre and the dangers of saturated fatty acids have been ventilated in every kitchen in the nation, just as almost every household has an exercise bike and an aerobic workout video (however rarely used). Everybody is also now aware of the dangers of exposure to sunlight, how to put a baby to sleep to reduce the risk of cot death and of the requirements of safe sex. Medical jurisdiction over lifestyle now extends into the home, the workplace, the school and the neighborhood. It also covers every moment of the life-cycle, from pre-conception counseling, through pregnancy and childbirth, infancy, childhood and adolescence, not merely women's health but also men's health, the menopause (and the male mid-life crisis), old age and death. The discovery of the dangers of 'passive smoking' in the 1980s marked the third phase of the tobacco wars and a decisive shift in the anti- smoking campaign. The first indication of this problem came in a paper from Japan in 1981; by 1986 the US Surgeon-General noted that some thirteen studies from five different countries had confirmed an increased risk. The resulting 1987 ban on smoking on US domestic air flights and the attendant controversy put the passive smoking issue decisively on the public agenda. The case against ETS transformed smoking from a self-endangering choice into an anti-social act. The smoker was not only engaging in a personally destructive practice, but one which was polluting the immediate environment and threatening a cast of 'innocent victims' - non- smoking spouses (generally wives), children, and unborn babies. Parental smoking came to be regarded as little better than child abuse (indeed it soon became a significant barrier to adoption). The campaign led to the establishment of 'smoke-free' areas and then smoking bans in workplaces, on public transport and other public spaces. Despite the growing medical (and political) consensus about the dangers of passive smoking, the issue has remained controversial. The Swedish toxicologist Robert Nilsson, while accepting the plausibility of the lung cancer link and the fact that numerous studies appear to show a statistically significant increase in risk, has questioned its epidemiological significance (13). He offered estimates of the annual incidence of cancer in a population of 100,000 resulting from various environmental factors: unknown (177), diet (135), smoking (68), other lifestyle factors (45), sunshine (23)...environmental tobacco smoke (ETS) (2). By contrast, in a population which consumes Japanese seafood (which contains Arsenic) this will cause 12 cases of cancer, where there are traces of natural Arsenic in drinking water, this will cause five cases; eating mushrooms will cause three cases. In other words, the risk of ETS is comparable with that of environmental agents that are generally regarded as an insignificant threat to health. http://www.spiked-online.com/Articles/0000000CA7A4.htm Even if the more moderate increases are true - and given that passive smoking has been estimated to be equivalent to actively smoking up to half a cigarette a day - the cancer-causing potency of ETS appears to be around ten times greater than mainstream smoke. Another anomaly of passive smoking is that it appears to be associated with an increased risk of a type of lung cancer that arises from glandular tissue (adenocarcinoma) instead of from the cells lining the airways (squamous or oat cell carcinoma) which is the familiar type caused by smoking. This type of tumor appears to be more common in East Asia - where many of the studies of passive smoking have been conducted. The idea that a very low level of smoke inhalation could cause a type of lung cancer in passive smokers that vastly higher levels do not appear to cause in heavy smokers defies biology and common sense. A number of possible sources of bias or confounding in the conduct and interpretation of studies of passive smoking. The increased risk suggested by some surveys implies that passive smoking is more dangerous than smoking up to ten cigarettes a day. Perhaps the most fundamental defect of the presentation of the risk of passive smoking is the failure to distinguish between relative and absolute risk. In a critical commentary, the Australian medical research scientist Raymond Johnstone noted that the annual death rate from lung cancer among the non-smoking wives of non-smoking men is around six per 100,000, whereas among the non-smoking wives of smoking men the corresponding figure is eight per 100,000. Now this may be reported as an increased (relative) risk of 33 per cent. Yet in absolute terms it amounts to an absolute (or exposure) risk of one in 50,000, which is, for practical purposes, negligible. http://www.spiked-online.com/Articles/0000000CA7A4.htm Johnstone's conclusion was that 'the most that one can say about the alleged link between passive smoking and lung cancer is that if there is one, then it is so small that it is difficult to measure it accurately and the risk, if any, is well below the level of those to which we normally pay attention' (14). The alarming estimates of deaths attributable to passive smoking result from multiplying miniscule risks of dubious validity by vast population numbers - an effective propaganda device but statistical sharp practice. http://www.spiked-online.com/Articles/0000000CA7A4.htm The most recent scientific debate on smoking concerns the effects of passive smoking. In 1986, the Surgeon General reported a significant relationship between environmental tobacco smoke and lung cancer. In 1990, the Environmental Protection Agency ( EPA) released a draft report that reviewed 24 epidemiological studies. The EPA concluded that ETS causes 3,800 lung cancer deaths each year, corroborating an earlier report on passive smoking from the Surgeon General. The most recent scientific debate on smoking concerns the effects of passive smoking that as well appears to be a particular risk to infants and children. In a study on lung cancer and exposure to tobacco smoke in the household, 17 percent of lung cancers among nonsmokers can be attributed to high levels of exposure during childhood and adolescence. Passive smoking has also been found to be a risk factor for other cancers. For example, a case-control study of women in Utah found that exposure to ETS three or more hours a day almost triples the risk of cervical cancer in nonsmoking women. More recently, attention has turned belatedly to the possibility that tobacco smoke at concentrations commonly encountered indoors is hazardous to otherwise healthy, nonallergic nonsmokers. The risk to nonsmokers (more accurately, passive smokers, that is, people who inhale smoke involuntarily from their environment) should hardly come as a surprise in view of the large number of carcinogenic and otherwise toxic substances that have been identified in tobacco smoke. They include cadmium, oxides of nitrogen, benzo(a)pyrene and other hydrocarbons, carbon monoxide, and particulate matter. Probably many passive smokers have consoled themselves with the belief that the voluntary smokers sucking the smoldering tobacco are inhaling and absorbing most of the pollutants themselves. Unfortunately, studies have shown that the side stream smoke--that which drifts off the tip of the cigarette--contains several times as much of the main pollutants as the mainstream smoke inhaled by the voluntary smoker. Obviously, the side stream smoke is diluted by surrounding air before being inhaled by the passive smoker, but the dosage can still be substantial. Concentrations of particulate matter in excess of 3000 g /m 3 have been measured in smoke-filled rooms at parties, or 40 times the U.S. standard for outside air. In public places, concentrations of particulate matter from tobacco smoke have been measured at up to 400 g /m 3. Carbon monoxide concentrations in smoke-filled rooms reach at least 40,000 g /m 3 and prolonged smoking in enclosed automobiles has produced CO concentrations of 100,000 g /m 3. Studies of the carboxyhemoglobin content in the blood of voluntary and passive smokers indicate that the passive smoker in unusually smoky conditions receives the equivalent of smoking one to two cigarettes per hour, and under conditions common in homes, offices, bars, and theaters receives the equivalent of smoking a cigarette a day. (Khuder, S.A.; Simon, Jr., V.J., 2000) Demonstrating conclusively that these kinds of exposures actually can cause disease (as distinguished from aggravating preexisting disease or allergy) among nonsmokers. A large population of subjects must be kept track of over an extended period if a statistically significant effect is to be discerned, many other kinds of insults will be operating in the same population at the same time, and some of the other insults may interact synergistically with passive smoking, and so on. The most informative studies of which are aware of investigated the incidence of bronchitis, pneumonia, and other respiratory ailments among young children whose parents were heavy smokers; the children had a significantly higher incidence of the ailments than the children of nonsmoking parents. It is conceivable, of course, that the same part of the genetic makeup of certain persons predisposes them to respiratory ailments and also predisposes them to take up smoking; if this were true, there would be a correlation between smoking and respiratory disease in the smokers and their children, but it could not be said that the smoking "caused" the disease. Most authorities consider this hypothesis of a common genetic origin of smoking and respiratory disease to be inconsistent with the medical evidence. Whether there is a threshold in level of exposure to cigarette smoke, below which no lasting harm occurs, is not known and would be very difficult to establish. The appropriately cautious approach taken by most regulatory authorities in dealing with other insults, such as radiation, have been to assume for purposes of analysis that no threshold exists. If, on this assumption, the data for lung-cancer risk versus exposure to tobacco smoke among active smokers is extrapolated into the range of exposure suffered by passive smokers, the conclusion is that passive smokers exposed to the equivalent of one to two cigarettes per day may suffer a doubled risk of dying of lung cancer as a result of this exposure. At five cigarettes per day, the active smoker suffers a roughly fivefold increase in risk of dying from lung cancer, compared to the "spontaneous" incidence. The likelihood that otherwise healthy nonsmokers are being damaged by inhaling other people's smoke, coupled with the certainty that passive smoking is harmful to persons unfortunate enough to be allergic to tobacco smoke or suffering from a variety of preexisting diseases, make society's tolerance for public smoking in an era of growing environmental concern an ever more striking anomaly. As of 1976, a few other major political entities had passed laws restricting smoking in public buildings and public transportation systems. These measures are a good beginning, but there is ample reason to go much further. In situations where nonsmokers literally have no escape (such as on buses and aircraft, whose ventilation systems are incapable of maintaining a real distinction between smoking and no- smoking zones), smoking should long ago have been banned outright. There is no doubt, of course, that voluntary smoking provides a great many people with a great deal of pleasure. But it seems to us that this activity should be legally confined, as certain other pleasurable (and considerably less dangerous) activities are, to consenting adults in private. References: De Groh, M.; Morrison, H.I., "Environmental tobacco smoke and deaths from coronary heart disease in Canada," Chronic Diseases in Canada 23(1), 2002. Johnson, K.C.; Hu, J.; Mao, Y., "Lifetime residential and workplace exposure to environmental tobacco smoke and lung cancer in never-smoking women, Canada 1994-97," International Journal of Cancer 93: 902-906, 2001. Johnson, K.C.; Hu, J.; Mao, Y., "Passive and active smoking and breast cancer risk in Canada, 1994-97," Cancer Causes and Control 11: 211-221, 2000. Schwartz JL: Review and Evaluation of Smoking Cessation Methods: The United States and Canada, 1978-1985. US DHHS, National Cancer Institute, Division of Cancer Prevention, Public Health Service, National Institutes of Health, Division of Cancer; NIH Publication No 87-2940: 1989. Khuder, S.A.; Simon, Jr., V.J., "Is there an association between passive smoking and breast cancer," European Journal of Epidemiology 16(12): 1117-1121, 2000. http://www.smoke-free.ca/Second-Hand-Smoke/health_kids.htm http://www.spiked-online.com/Articles/0000000CA7A4.htm Read More