Monday, December 1, 2014

Lung Cancer and Tobacco Use

Overview

Lung cancer is the uncontrolled growth of abnormal cells in the lungs; it can affect one or both lungs. These cells do not develop into healthy lung tissue like normal cells do which can lead to tumors, causing the lungs to function inappropriately. The two most common types of lung cancers are Non-small cell lung cancer (NSCLC), and small cell lung cancer (SCLC). Lung cancer is one of the most common cancers in the world. According to the American Cancer Society “Lung cancer accounts for about 27% of all cancer deaths and is by far the leading cause of cancer death among both men and women” and for 2014 there will be an estimated 159,260 deaths from lung cancer. This is a huge problem that we are facing and a lot can be done to bring these numbers down. Preventions are available in many different methods from the help of the government to community and individual interventions. Lung cancer is treatable and curable, and in some cases preventable.
There are many causes of lung cancer but the main risk factors are cigarette smoking, secondhand smoke, radon, and personal or family history. The leading the cause of lung cancer in the United States is smoking; the Centers for Disease Control and Prevention (CDC) states that “cigarette smoking is linked to about 90% of lung cancer”. You can find a toxic mix of more than 7,000 chemicals in tobacco smoke. The smoke from cigarettes, cigars or pipes can cause lung cancer; people who inhale this smoke are practically smoking.  According to the CDC (2014) “In the United States, two out of five adults who don't smoke and half of children are exposed to secondhand smoke, and about 7,300 people who have never smoked die from lung cancer due to secondhand smoke every year”. The sad fact is that tobacco is killing our population. Radon is another risk factor; this gas comes from rocks and dirt and can be found in homes and buildings, it cannot be smelled or seen. The CDC states that “Nearly one out of every 15 homes in the U.S. is thought to have high radon levels” and many people are not aware of the deadly killer. There are other substances that can be found in many workplaces like asbestos, arsenic, diesel exhaust, some forms of silica and chromium. Many of these risk factors can be avoided by changing your lifestyle or making sure policies are put in place so people can live and work in clean environments.

Social Determinants Linked with Lung Cancer

The social determinants of health are the conditions in which people are born, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. Social determinants encompass social and economic conditions such as poverty and the conditions of work and healthcare delivery; also the chemical and pollutants associated with industrial developments and the environments where we work. Social determinants play a significant role because of their indirect effects through individual risk factors and behaviors that correlate (WHO, 2014).
            All of the social determinants influence us and the way we grow up and the decisions that we make. Whether we realize it or not, everything is affecting us and the behaviors we chose to act upon. Behaviors are often the mediating steps between social determinants and cancer outcomes. Some behaviors long-recognized as important contributors to cancer include tobacco and alcohol use, poor diet, physical inactivity, high-risk sexual behaviors, and occupational hazards. (WHO, 2014)
            Cigarette smoking is the number one risk factor for lung cancer. In the United States alone, cigarette smoking is linked to about 90% percent of lung cancers. Cigarettes are definitely not the only cause of lung cancer, pipes and cigars are also major risk factors. There are about 7,000 chemicals that make up tobacco smoke, making it extremely toxic. Most of the chemicals are poisonous and at least 70 are known to cause cancer (CDC, 2014). Tobacco use is the single largest preventable cause of death and chronic disease in the world today, causing 5.4 million deaths in 2005. It is a risk factor for six of the eight leading causes of death, including heart disease and several cancers and lung diseases. Tobacco use disproportionately affects males and lower socioeconomic groups in developed and developing countries, and is increasingly prevalent in poorer parts of the world. In developed countries, multiple social disadvantages contribute independently to smoking status. Poor households in low-income countries carry a particularly heavy burden from tobacco use, with significant health, educational, housing and economic opportunity costs (CDC, 2014). 
          There are two stages of life where inequities in vulnerability and exposure to tobacco use are most evident: sadly, during adolescence, with those from lower socioeconomic backgrounds most at risk of taking up tobacco; and during adulthood, especially young adulthood, where tobacco use cessation is more difficult for those from disadvantaged backgrounds. At both stages, vulnerabilities such as social, psychological and physical health issues and disproportionate levels of exposure due to family and peer tobacco use, targeted advertising, social norms permissive to tobacco use and less access to affordable cessation services often tip the balance towards tobacco use take-up and continuation. Tobacco use is supported by a vast network of business and commercial interests (CDC, 2014).
Tobacco use is a choice. Tobacco use is a public health problem because it has been intentionally built into the social structure and environment of most societies by an industry that profits from continued trade in tobacco products. Not only is smoking detrimental to your own health, but it is also hazardous to those around you (CDC, 2014). Second hand smoke is almost unavoidable. Most exposure to secondhand smoke occurs in homes and workplaces. Secondhand smoke exposure also continues to occur in public places such as restaurants, bars, and casinos, as well as multi-unit housing and vehicles. Eliminating smoking in indoor spaces is the only way to fully protect nonsmokers from secondhand smoke exposure. Separating smokers from nonsmokers, although it sounds like a good plan, when people share the same air space, cleaning the air, opening windows, and ventilating buildings does not eliminate secondhand smoke exposure. Nonsmokers who are exposed to secondhand smoke at home or work increase their lung cancer risk by 20–30%.Secondhand smoke exposure causes an estimated more than 7,300 lung cancer deaths annually (for 2005–2009) among adult nonsmokers in the United States. African-American male workers, construction workers, blue collar workers and service workers are some of the groups who continue to experience particularly high levels of secondhand smoke exposure relative to other workers (CDC, 2014).       
Health starts in our homes, schools, workplaces, neighborhoods, and communities. We know that taking care of ourselves by eating well and staying active, not smoking, getting the recommended immunizations and screening tests, and seeing a doctor when we are sick all influence our health. Our health is also determined in part by access to social and economic opportunities; the resources and support available in our homes, neighborhoods, and communities; the quality of our schooling; the safety of our workplaces; the cleanliness of our water, food, and air; and the nature of our social interactions and relationships. The conditions in which we live explain in part why some Americans are healthier than others and why Americans, generally, are not as healthy as they could be (Healthy People, 2014).

Evidence Based Programs and Policy Interventions and Effectiveness

CDC The Division of Cancer Prevention and Control (DCPC) is working to prevent and control lung cancer by—
  • ·         Gathering critical information about diagnoses and deaths from lung cancers in the United States.
  • ·         Supporting programs in states, tribes/tribal groups, and U.S. areas that struggle to prevent and regulate tobacco use and endorse a healthy diet.
  • ·         Applying public health interventions and counter marketing tactics to reduce smoking.
  • ·         Upholding a lung cancer Web site (Cancer Prevention and Control, 2013).

NationalCancer Institute - Population-level interventions
In addition to independently focused cessation efforts, a number of tobacco control approaches at the community, state, and national level have been recognized with reducing the commonness of smoking. Strategies include the following:
  • ·         Reducing minors’ access to tobacco products.
  • ·         Distributing effective school-based prevention programs together with media strategies.
  • ·         Raising the price of tobacco products by raising taxes.
  • ·         Using tobacco excise taxes to supply and fund community-level interventions including mass media.
  • ·         Providing verified quitting strategies through health care organizations.
  • ·         Adopting smoke-free regulations and policies (Lung Cancer Prevention, 2014). 

Educating individuals on what smoking can do to your body is the first step in having a successful intervention. The Surgeon General’s report on smoking and health, which summarized more than a decades worth of research on the adverse health effects of tobacco use, helped the use of tobacco decline considerably. The effect of subsequent education and tobacco control efforts has been considerable with an estimated 200,000 premature deaths avoided in the period from 1964 to 1978.                                    
Anti-smoking Ads are proven to be extremely effective. The first year of the federal government’s “Tips from Former Smokers” national advertising campaign exceeded all expectations, driving 1.6 million smokers to try to quit and helping more than 100,000 to succeed, according to a study published today in the medical journal The Lancet. The 2012 campaign, conducted by the U.S. Centers for Disease Control and Prevention (CDC), also inspired millions of nonsmokers to encourage friends and family members to quit smoking. Researchers estimated that, by quitting, former smokers added more than a third of a million years of life to the U.S. population.



Raising the cost of cigarettes has proven to be effective in reducing smoking in age groups 13-18, and 18-24. Eight different studies were done and the conclusion was that a negative price elasticity of demand estimate reflects a decrease in tobacco use in response to an increase in tobacco product price.  There have been many studies on the effectiveness on no smoking bans. In 2009, a report by the International Agency for Research on Cancer concluded that there is strong evidence (the second highest level of evidence under the report’s rating scale) that implementation of smoke free legislation causes a decline in heart disease morbidity. Also "in 2010, a Cochrane review of 12 studies found consistent evidence of a reduction in hospital admissions for cardiac events following implementation of smoke free laws" (CDC, 2014)
Conclusion
Finally, we would like to address the two following questions: what is a winnable battle, and what makes lung cancer a winnable battle? Winnable battles are defined by the CDC as “public health priorities with large scale impact on health and with known, effective strategies to address them” (2014). The aim of Winnable Battles is to address the health concerns of the public in effective ways which will “improve their outcomes” (CDC, 2014). Though lung cancer has not been specifically targeted by the CDC as a winnable battle one of the largest contributors to lung cancer has been identified, and that is tobacco use. In our discussion of lung cancer we have focused mainly on the use of tobacco products and programs and policies which are being implemented to help with tobacco cessation efforts. Unless there are major advances made in cancer research there is no way to prevent genetically induced cancers, but we do know that tobacco use is a major risk factor for developing cancer. Lung cancers could be significantly reduced if the use of tobacco products ceased. As shown in the Policy section, there are many interventions currently in place which are helping to decrease the number of lung cancer incidence and death including “Tips from Former Smokers” campaign and increasing the price of, and taxing, tobacco products. We need to challenge the dialogue around smoking and target people at high risk for smoking to ensure that everyone is afforded safe and clean places to live and work as well as information on the harmful effects of tobacco use. Cancer treatments are not cheap, and they are not easy on the body. Lung cancer due to tobacco use is preventable! Lung cancer due to poor living and working conditions and environmental factors such as pollution could be preventable as well. It is our responsibility to address these issues and concerns for a healthier population, and for a future where no one dies from a preventable cause such as tobacco use.

Reference List
Basic Information About Lung Cancer. (2014, October 14). Retrieved November 18, 2014, from             http://www.cdc.gov/cancer/lung/basic_info/index.htm

Cancer. (2014) Retrieved from http://www.who.int/tobacco/research/cancer/en/

Center for Disease Control and Prevention. (2014, 6 October). CDC: Tips From former smokers-Rose:         Three keys to recovery. Retrieved from http://www.youtube.com/watch?v=DungzgrI_8U
Protecting Your Lungs - American Lung Association. (n.d.). Retrieved from http://www.lung.org/lung-disease/lung-cancer/learning-more-about-lung-cancer/understanding-lung-cancer/protecting-your-lungs.html

Secondhand Smoke (SHS) Facts. (2014, April 11). Retrieved from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_facts/

Siegel, R., Ma, J., Zou, Z., & Jemal, A. (2014). Cancer statistics, 2014. CA: a cancer journal for clinicians, 64(1), 9-29.

Social Determinants of Health. (2014, 1 December). Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health

The Truth. (n.d.). You don’t always die from tobacco. Retrieved from            http://www.youtube.com/watch?v=zuh2w2sFRMI
What Are the Risk Factors for Lung Cancer? (2014, May 6). Retrieved from             http://www.cdc.gov/cancer/lung/basic_info/risk_factors.htm
What are the key statistics about lung cancer? (n.d.). Retrieved from             http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-key-statistics
(2014, 12 May).  Smoke Free Policies Improve Health. Retrieved from
http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/protection/improve_health/

(2014, 15 April). Winnable battles. Retrieved from http://www.cdc.gov/winnablebattles/

(2014, 27 February). Lung Cancer Prevention. Retrieved from             http://www.cancer.gov/cancertopics/pdq/prevention/lung/HealthProfessional/page1/AllPages#%2            0Section_252

(2013, 23 October). Cancer Prevention and Control. Retrieved from             http://www.cdc.gov/cancer/dcpc/about/initiatives.htm
(2013, 9 September). CDC’s Anti-Smoking Ad Campaign. Retrieved from             http://www.tobaccofreekids.org/press_releases/post/2013_09_09_cdc

(2001). Evidence Regarding Interventions to Reduce Tobacco Use and Exposure to Tobacco Smoke.          Retrieved from http://www.thecommunityguide.org/tobacco/tobac-AJPM-evrev.pdf

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