Smoking has various dimensions: cultural, political, religious, geographical, racial, ethnic, health, corporate and gender. To counter smoking, public health also had to use multi-dimensional approach. In the February edition of 2006, American Journal of Public Health (AJPH ) discuss the status and perception of smoking among physicians in the earliest twentieth century. Tobacco companies exclusively used doctors to market their brands as pharmaceuticals companies do today to sell its drugs. For example, to advertise camel brand cigarette, Reynolds Company in 1940s,used catchy quotation, “More doctors smoke Camels than any other cigarette.” Advertisements of various cigarettes brands kept medial journals and organizations solvent. It finally came to rest when American Medical Association (AMA) publicly disapproved the Kent Ad campaign. . In short, smoking cigarette was fashion and was believed healthy those days. Manufacturer Allen and Ginter were even offered prize for innovative work of building machine to fasten the process of producing cigarettes at higher rates. First world war also helped in popularizing smoking among soldiers. They believed that smoking relieved them from stress. And they even considered tobacco as important as guns in war.
Those days, stomach cancer was the leading cause of cancer deaths. Lung cancer was rapidly taking the second position because of increasering reports of new lung cancer cases. Fritz Lickint,German physician first published the possible association between smoking and lung cancer. Few years later, Muller reported the finding of case control study, which underlined smoking as the cause of lung cancer. In the United States, Hammond and Wynder provided evidence for the causation link.
More than 50 carcinogens have been reported in cigarette ingredients as potential carcinogens. Smoking causes elastin damage and cause peri-acinar emphysema, it also damages cilia epithelium. It hastens multiple sclerosis and other white matter degeneration disorders. The association between lung cancer anf smoking is well established. However, not every lung cancer is related to smoking, for example bronchoalveolar cancer and carcinoid are not associated with smoking. Smoking is strong risk factor for cardiovascular diseases. It is also concluded from the analysis that if with zero smolers in the United States, one in three cancers are completely avoidable. Smoking effect is highly perceived in head neck cancer studies; it is routine independent variable for many multivariate model. Smoking also has effect on the pregnant women and their babies. There are more cases of still births, preterm births and ectopic pregnancy in pregnant women who are smokers. Risk of developing diabetes is high in smokers compared to non-smokers. Smoking even decreaes the productivity at work place, and increase utilization of health care services, resulting in increase health care cost.
Center for disease control and prevention (CDC) estimates that 42 million adult Americans are smokers, which stands at 18% (declined from 20% to 18% from 2005 to 2012) of adult population of country and prevalence of smoking is more in men than women. Adding further, people who are below poverty lines are more likely to smoke (27% vs 18%). Applying GIS knowledge, Midwest of United States has higher prevalence of 26% while west has far less prevalence of 14%. Prevalence of smoking in Harlem is 22%, which is more than national average of 18% and far more than northeast region 16.5%. 20% of children in Bronx have asthma, and smoking prevalence in the area is the key reason. Globally,Russia has one of the highest prevalence of smoking, around 40% population of Russia smokes. Cigarettes shortage triggered riots in Russia some twenty years ago.It is 29% in Europe. Indonesia and East Timor has more than two third men indulge in smoking, which elucidates the dangerous trend in these countries. In developing countries, smoking is more common in men than women. But for few years, percentage of new smokers among women has been increasing.
I lived in more than 20 neighborhoods in New York, and generally I observe smoking pattern on the street or open space. So in my observation, I found that there could be high prevalence of smoking in the Flushing area. Further supporting my observation, I am also adding my experience of living in the Flushing neighborhood. Wonderful place for food , great diversity and good nightlife! I was sharing apartment with Chinese friends . I don’t know why that house didn’t have the smoke detector in place. I became public health officer for our apartment. My African friend also moved from DC to stay in our house. It was African, Chinese and Indian staying under same roof. We had always-friendly altercation on smoking issue. My observation was apparently right; except for Native Americans (ritual value for smoking), Chinese American has the highest prevalence rate of smoking than all other ethnicities.
Native Americans have used tobacco for religious/ceremonial reasons. Judaism and other religions prohibited smoking once its harmful effects were established. For example, Rabbi Kagan prohibited smoking on the basis of health effects. Zorastrism prohibit smoking but with different rationale. It actually termed it abuse of fire. Sikhism is the religion, which clearly denounced smoking on the basis of Gurus teaching.
Few examples of the past witness the policy of smoking ban, for instance, Roman catholic banned smoking in mexican church, but I didn’t get any evidence that it was because of any health concern. Policy in United States has taken a long miles journey to reach the situation where we are comfortably placed. New York City reflects successful story in the framework of public health to counter smoking. Ex-mayors Bloomberg’s work was exemplary, and perhaps why many people termed him public health mayor. It wasn’t easy walk. It wasn’t cakewalk. Corporate interests were fought first time in the history for the cause of public health. Corporate were the interest group and pressure group for every government, but public health advocacy made biggest impact. It is the biggest victory when we think in terms of health policy. Now even CUNY has anti-smoking polic in place. Restaurants and bars do not allow smoking now. Policy included increasing prices of cigarettes, researched found that with every 10 cent increases, smoking reduced by 2 to 5 percent. Banning at public places, and issuing harsh fine also work. New Yorks clean air indoor act has resulted in positive changes. Eight percent of population favored the law where one their to one half of adult smokers. As a result of strong policy in place, significant drop was noted in nicotine by-products in the air at restaurants and bars. New York city extended this ban to Beeches and parks.As a result of policy, smoking rates in the city has come dramatilly down.