Table of Contents
- Executive Summary
- Tobacco Consumption – An Epidemic
- Facts about tobacco
- Tobacco consumption and South East England
- Young age tobacco consumption in South East England
- Tobacco Control programme in South East England
- Tobacco control programme for Young People 11-15 Years old
- Challenges faced by tobacco control programme for Young People 11-15 Years old
- Home Environment
- Drug use and drinking alcohol
- Truancy and exclusion from school
- Non-cooperation from retailers
- Non-cooperation from manufacturers
- Vending machines
- Illicit trade of tobacco products
- Smoking in films
- Proxy purchasing
- Media and communication challenge
- Tailoring of message
- Synchronization of local and broader campaigns
- Lack of funding and short longevity
- To stay up to date
- Availability through social sources
- Secondhand Smoke
- Social Economic Status
- Appendix 1
- Appendix 2
- Appendix 3
- Appendix 4
The paper discusses about the major challenges which the Tobacco Control Programme is facing for young people 11-15 years old in South East England. The paper starts with a brief introduction about tobacco consumption worldwide and some facts about the same. Then it goes on to explain the tobacco consumption status in England with emphasis on consumption among young people 11-15 years old. It then gives out the salient features about the Tobacco Control Programme and its effect on the control of consumption among the 11-15 years old. The report then proceeds to explain the major challenges faced by the programme. The paper had taken information from credible and accessible easily. The report has tried to incorporate all information and provided a view about tobacco consumption among young people. The evidence provided suggests the intensity of the problem in hand and the various barricades which stand in the way of getting rid of the problem. It is being hoped that after reading the report the central point of the report will be much clearer.
Tobacco consumption has been one of the most important areas of concern over the past few decades for the entire world. It has been growing at an alarming rate since the beginning of the 20th century after manufactured cigarettes came into picture (1). One of the major reasons of increase in the number of smokers worldwide is the increase in population (1). It is expected that by 2030 the number of smokers worldwide would increase by 2 billion people (1). Another major concern in this scenario is the increase in the number of female smokers in the developed countries who offset the decrease in the male smokers (1). Cigarettes form the major portion of tobacco consumed, i.e., 96% of the total sales vale (1). It is estimated that the cigarette manufacturing companies produce about half a trillion cigarettes each year, i.e., nearly a 1000 cigarettes for every individual (1). The largest consumers are Asia, Australia and Far East followed by Americas, Eastern Europe, Former Soviet Economies and then Western Europe (1). One of the most common methods of tobacco consumption is smoking (2). Smoking is a practice in which the agricultural product tobacco is mixed with other additives and then burnt and the smoke is inhaled by which the active substances such as nicotine are absorbed in the lungs (3).
Tobacco Consumption – An Epidemic
There are numerous reasons which a person may cite in his day to day life. There are reasons that not only impact an individual but also those which affect the society and world as a whole. Some of the major reasons as to why consumption of tobacco is considered to be an epidemic are
- Smoking kills.
- It exacerbates poverty.
- It contributes by world hunger by taking away land which otherwise could have been used for food production.
- It damages the environment.
- It reduces the economic productivity.
Smoking is also a major cause of various other diseases. Tobacco smoking causes cancer of mouth, lung, pancreas, kidney, bladder and the oesophagus (4). Many diseases like stroke asthma, respiratory diseases, etc are also linked with smoking (5).
Facts about Tobacco
WHO has provided some facts. Some of these facts are known to many while there are some which are completely shocking and most often undermined by us.
- Tobacco is the second major cause of death (6).
- In 2005 it killed 5.4 million people, i.e., one every 6 seconds and it is estimated that by 2030 it will cause 8 million deaths each year (6).
- It is the leading preventable cause of death (6).
- It is estimated that 1.3 billion people smoke out of which 47.5%are male as compared to 10.3% females (6).
- Most people start smoking before the age of 18, a quarter out of which begin tobacco consumption before the age of 10 (6).
- The fourth most common disease risk factor worldwide is tobacco (6).
- Due to exposure to second hand smoke at work, 200,000 employees perish per year (6).
- In poor households of low-income countries, 10% of income is spent on tobacco consumption leaving less money to spend basic requirements leading to malnutrition, increase in health care costs and premature deaths (6).
- The land occupied by tobacco for its use deprives about 10 to 20 million people of food (6).
- Tobacco uses lots of wood, water and pesticides which damages the environment (6).
- Child labour is a major requirement in the tobacco industry (6).
Tobacco Consumption and South East England
Tobacco came into Britain in the sixteenth century when people smoked through pipes (7). But then it was limited to a few people who had access to and knowledge about its consumption once when the cigarette making machines were invented in the 19th century, mass consumption of tobacco became possible (7). From then the number of people consuming tobacco has been on a steady increase. Initially only men used to smoke but now it has also became a common practice among women and children. Refer Appendix 1. The economic cost of tobacco consumption is also a very alarming figure. Such huge costs could be put on to a much more beneficiary cause rather than prevention and cure of tobacco consumption (8). Refer Appendix 2.
Young Age Tobacco Consumption in South East England
Underage or Yong people smoking make up a significant portion of people smoking regularly (7). The statistics about the same are quite alarming. One of the most important things to notice is that though sale of tobacco products to minors is illegal, still they become regular smokers by adulthood (7). It is estimated that around 14% of children below 15 years of age in England have already regular smokers (7). Around 9% of children between the age of 11-15 years smoke 1 cigarette each week in England in 2008 (7). Number of girls smoking regularly has been increasing exponentially now even surpassing the proportion of boys. Around 17% of girls aged 15 years smoke regularly as compared to 11% of boys (7). On an average a regular child smoker smokes around 39 cigarettes a week (7). Refer Appendix 3.
Tobacco Control Programme in South East England
Tobacco Control is a term which describes the number of activities which are involved with the aim of reducing tobacco use and the harm caused by tobacco (9). There are main 3 aims of the tobacco control programme. They are:
- To reduce the prevalence of smoking.
- Reduction in the availability of tobacco and tobacco products.
- Reduction in the exposure to secondhand smoke.
Department of Health’s six strand approach guides the tobacco control activity in England (10). The six strands followed are:
- Supporting smokers to quit (10).
- Reduction in the exposure of non-smokers to secondhand smoke (10).
- Running of effective communications and education campaigns (10).
- Reduction in tobacco advertising, marketing and promotion (10).
- Regulation of tobacco products (10).
- Reduction in the availability and supply of tobacco products (10).
Some of the major achievements of the tobacco control programme in England have been,
- Introduction of Landmark comprehensive Smokefree legislation in July 2007 (10).
- Comprehensive ban on tobacco advertising is now in place (10).
- Pictorial warnings on cigarette packs introduced from 2008 (10).
- Legal age for selling of tobacco products to minors have been raised to 18 years (10).
Future steps to be taken by government in order to reduce tobacco consumption further are:
- Reduction in the health inequality among people which is the result of tobacco use (10).
- Continuation in the use of tax as a weapon to increase prices and reduce demand (10).
- Finding alternatives for nicotine addicted people unable to quit (10).
- National level investment in social marketing initiatives to support smokers to quit (10).
- To devise methods to control sale of cheap illicit tobacco (10).
A Tobacco Control Programme for Young People 11-15 Years Old
Tobacco control programme also aims at reducing tobacco consumption among young people. So far the programme has had success in reducing tobacco consumption among young people (11). According to statistics, prevalence of smoking in young people aged 11-15 years have reduced from 13% in 1996 to 9% in 2007, exceeding the Smoking Kills target of 11% four years ahead of time (11). However complete eradication is still a goal very far away. There are various methods and steps taken through which this goal has been achieved. Some of them are:
- Increasing the age of sale of tobacco from 16 to 18 years (11).
- Increased the sanctions against retailers who sell tobacco products to people who are underage (11).
- Availability of nicotine replacement therapy on prescription to 12-18 years old (11).
- The government has also put a ban on the display of tobacco products in public places (11).
- Advertisement at point-of-sale has also been limited (11).
Challenges Faced by Tobacco Control Programme for Young People 11-15 Years Old
Though the tobacco control programme has been successful and performed better than expected still there is a need to completely wipe off tobacco consumption among the young people (11). Some of the major challenges which are faced by the various organizations aiming at achieving this goal are:
Children aged 11-15 years and who live with at least another person who smokes are more likely to take up regular smoking (11). Now this is a major concern for the authorities as they do not have any control over the home environment of a child. Yes, they can plead the person living with the child to stop smoking but they cannot take the child away from that environment.
Drug Use and Drinking Alcohol
According to studies, an 11-15 years old odds of becoming a regular smoker is increases with the number of units of alcohol consumed in the previous week (11). So, it could be seen that in order to reduce smoking consumption and use of alcohol and drugs must first be abolished at young age. Alcohol and drugs consumption should also be treated with the same concern as tobacco.
Truancy and Exclusion from School
According to studies, young adults who were removed from school or having truanted are twice likely to take up smoking (11). Not only education should be provided at school about the harmful effects of smoking but also, if any such event happens with any student then proper counselling and guidance be provided to him/her so they may not take up smoking as a means to release their frustration.
Non-Cooperation from Retailers
Tobacco retailers are not willing to cooperate to these restrictions and bans (11). The retailers want to maximize their profit and this could be achieved through maximum sales. However, restrictions of advertisements and displays even at the point-of-sale are severely affecting their profitability. Smaller retailers have more concern as sale of tobacco products constitute about 20-30% of their total turnover (11).
Another major concern of retailers is security (11). They have expressed their concern by saying that placing of tobacco products above or below the counter due to ban on promoting them might expose their staff to crimes such as theft and robbery as tobacco products are a major item for theft (11). They also state that removing tobacco products from sight requires expenditure (11). Re-fitting costs are high and the retailers do not want to bear it (11). So, some mid way solution need to be arrived at to fulfil the ultimate goal.
Non-Cooperation from Manufacturers
Studies show that most customers make up their brand about which brand to smoke long before they even go to a store (11). Banning of advertisements and promotions will also affect their sales and profits as they won’t be able to distort the image of their competitors in the minds of consumers and hence won’t be able to compete (11). This might lead to a loss in the market share and so they try to lure customers and provide advertisements, distort information whenever possible.
One option available with the government was to impose plain packaging (packaging with no graphics and colours) in order to cancel out the positive feeling given out by them (11). Studies have shown that taking such an initiative young people taking up smoking will reduce substantially as they are attracted to style and positive effect of the packaging (11). However, there is also a doubt that by doing this the cigarette manufacturers won’t have anything else to compete on other than price which will make cigarettes cheaper and thus defeat the whole idea (11).
Vending machines are distributed all over the country (11). It is the easiest place for young people to get cigarettes from as there is no one to regulate them (11). Young people attain cigarettes from such sources un-monitored.
Illicit Trade of Tobacco Products
Illicit trade of tobacco is a major hindrance in achieving the goal of eradication of smoking among young people (11). Illicit traders provide cigarettes at cheaper rates and sometimes in loose numbers other than packs which is more affordable by young people (11). Thus all the steps taken fail once it comes to illicit trade. Illicit trading can be described in two points:
Smuggling is the illicit carriage, transmission and selling of tobacco products (12). In England the intense level of traffic enable various criminal gangs, ship crew’s, commercial drivers and other sources to gain exponential financial profits due to low risk in smuggling (13). This is a major hindrance as this provides cheap products to the consumer (13). This beats the purpose of increasing the price or taxes on tobacco products as the products again become available to young people at affordable prices.
This is the illegal manufacturing of tobacco products which can be sold by avoiding tax and thus cheaper than available in market (14). This again has the same impact as smuggling.
Smoking in Films
Studies have shown that smoking in films is a major initiator of smoking among young people (11). Films create positive attitude towards smoking and this being a huge industry is very hard to control (11). However government has taken up action against such portrayal by rating the movies as adult but still a stricter law needs to come in place (11).
Another way young people get tobacco products even after laws on purchase and sell by and to young people is through proxy purchasing (11). Proxy purchasing is buying of tobacco products by adults for the young people (11). It is almost impossible to stop and detect such an activity. The government needs to come up with a law or method to overcome this problem.
Media and Communication Challenge
One of the major challenges which the government needs to overcome is the mass media communication barriers (15). This challenge can be explained with respect to the various discrepancies as described below
Tailoring of Message
Every group has its own needs (15). The communication should be tailored for each of the respective groups to increase its effectiveness (15). If the communication or the message is not related to that group then the effect on that group is minimal and thus the whole exercise is a waste. The government has not been able to successfully implement this as it is too costly and recognizing the needs of each group and then creating a message pertaining to them is a very tedious and difficult job.
Synchronization of Local and Broader Campaigns
A common creative theme of the campaigns between the local and broader campaigns is not in place in UK (15). There are times when the themes of both are competing creating confusion among people and thus ignorance of both the messages (15). While designing the campaigns of broader scale the local requirements should be kept in mind. Also proper communication should be made to the local authorities about the national campaign and help them in aligning their campaign with the broader one.
Lack of Funding and Short Longevity
It has been seen that the campaigns lack funding (15). Organizations which fund such campaigns do not want to invest in long term campaigns (15). So most of the campaigns are short lived and thus cannot provide that impact (15). Tobacco industry is well developed and is rather growing. In order to beat a long term strategy and programme needs to be in place (15). Short term campaigns die out in their adolescence and do not have the required impact which leads to a total waste of already limited funds.
To Stay Up to Date
Another challenge is to stay up to date with the ever-changing media sector (15). New technologies and medium of communications change very quickly (15). By the time one form is analysed a newer form comes up (15). It is required that to provide an impact one must be up to date so that proper challenge could be given to the tobacco manufacturers. Further as the information is to be communicated to youth, who know about newer technologies at the ready will also feel a greater impact if we are updated regularly (15).
Availability Through Social Sources
Most of the young people in England procure their cigarettes through social sources like friends, siblings and parents (15). Refer Figure 3. This is a very common place for them to get cigarettes without having any difficulty (15). The social sources that could provide cigarettes to young people are very hard to control. They need to be educated about the ill they are doing to these young ones.
Secondhand smoke is one of the most important causes of illness due to smoke among young people. Young people living around people who smoke are more likely to get diseases associated with smoking (16). When both the parents of a child smoke, then the child is prone to a have a nicotine level of 80 cigarettes a year (17). This causes addiction and later on taking up of smoking. Parents must be educated about the situation and the dark consequences they may face due to their smoking around their children (18). This problem is very hard to deal with as it is the adults who must first be stopped from smoking in order to prevent a child in doing so.
Social Economic Status
Another important factor that promotes smoking is the social economic pressure which can be associated with poor mental health or poor environment (17). This is a major concern as it is hard to guarantee a proper environment for everyone by the government (19). It is the duty of the people in a child’s environment to guarantee it.
As we can see, consumption of tobacco is a major problem worldwide. The figures are quite alarming. Even more serious is the consumption of tobacco among young people at a tender age of 11-15 years. Organizations have been working hard to tackle this situation and have also produced some fruitful results. But they need to work harder in order to eradicate it completely. There are many barriers and challenges to reach to the desired place, but still proper effort and planning could lead to success. The tobacco control programme has been a major success and more such programmes should be developed to overcome this situation. One of the main points that the organizations should keep in mind is that this job will take a long time and there will be many tradeoffs to make. However, they must not lose sight of their ultimate goal of common good.
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Source: Cancer Research UK. Smoking – statistics : Cancer Research UK. Cancer Research UK. [Online] December 2, 2009. [Cited: January 7, 2010.] http://info.cancerresearchuk.org/cancerstats/types/lung/smoking/.
Source: South East Public Helath Group. A framework for action on tobacco control in the South East. Surrey : Goverment office for the South East, 2005.
Source: Cancer Research UK. Smoking – statistics: Cancer Research UK. Cancer Research UK. [Online] December 2, 2009. [Cited: January 7, 2010.] http://info.cancerresearchuk.org/cancerstats/types/lung/smoking/.
Source: Lindsay Richardson, Patrice Allen, Lucy McCullough, Linda Bauld, Sunaina Assanand, Lorraine Greaves, Amanda Amos, Natalie Hemsing, Karin Humphries. Interventions to Prevent the Uptake of Smoking in Children and Young People. London : British Columbia – Centre of Excellence for Women’s Health, 2007.