This presentation evaluates the impact of tobacco smoking in Nigeria with a proposed structured strategy based on theoretical approaches and public Health models to tackle this complex Health problem in a bid to improve and protect Health. Until recently, non communicable diseases still rank highest among the causes of preventable and premature deaths worldwide (WHO, 2010). These include cardiovascular diseases, diabetes mellitus, chronic lung diseases, cancers which attribute to about two-thirds of global deaths in 2008 (Global surveillance report, 2010) with about one-fourth of these deaths occur before the age of 60.
Tobacco smoking is a significant behavioral risk factor associated with non communicable diseases, harming every organ in the body and causing many diseases (CDC, 2012). Its maximal effect is highly observed among poor people in low and middle- income countries in which Nigeria happens to belong to. Background Tobacco is an agricultural product commercially available in either dried form or in other forms like cigarettes which could be sniffed or smoked. Its smoke contains about 4000 chemicals including nicotine which is known to be very addictive (Desalu et al, 2008).
About 6 million people die from tobacco smoking (directly or indirectly) annually (GSR on NSD, 2010) with about 1. 3billion people currently smoking cigarette or other products (Guindon and Boisclair, 2003). According to Peto and Lopez (2001), the global burden from tobacco is expected to exceed nine million in 2020 annually with about 60% of deaths occurring in economically developing countries. Recent decline in tobacco use observed in many industrialized countries is resulting in gradual shift in smoking from developing to the developing countries (Tobacco control country profiles, 2003).
Although Nigerians smoke less than Europeans, recent studies has described rising rates especially among the adolescents (Nwhator, 2011). A study conducted amongst patients in North – Eastern region of Nigeria in 1986 showed very low levels of cigarette smoking (males: 15. 1%, females: 0. 3%) and also a significant difference in gender predisposition (Harries et al, 1986). Current statistics based on studies have shown a smoking prevalence of about 45. 3% and 18. 4% in males and females respectively with a starting mean-age of 18years observed within this same region (Desalu et al, 2008).
This has also been the case in other regions of the country including South-western Nigeria, with about 24% prevalence rate found amongst male factory workers in Lagos state (Nwhator, 2004). High rates of about 21. 0% were also observed in the adults in South-Eastern part of the country (Aghaji, 2008). Although adequate monitoring and surveillance is needed, increased tobacco smoking rates observed within different geo-political regions of the country, especially among the youths, should not be overlooked.
Nigeria currently exists among the Sub-Saharan countries in the stage 1 of the WHO paradigm, vulnerable to the growth and transforming strategic initiative of transnational tobacco companies (Tobacco control country profile, 2003). Despite the cultural and religious traditions, adolescents still fall prey to these companies in an attempt to achieve social acceptability within the society. Bearing in mind the potentially devastating impact of tobacco smoking on the health of the population and the epidemic levels seen in Europe, this is a public health challenge and should be addressed as such.
Evaluation of current evidences Ill health doesn’t happen by chance or through bad luck, but it is highly attributed to the complex interplay between various determinants of health (Naidoo, and Wills, 2000), therefore, in order to study this risk behavior, it is important to study its variation in trends among the various geographical regions within the country. Epidemiological studies done among adults population in North-East Nigeria has linked tobacco smoking with male gender, age and low socio- economic status which comprised of the income, educational status and occupational class of the population (Desalu et al, 2008).
There are underlying factors which may encourage the display of such risky behavior. These include peer pressure, the need for social acceptance and pleasure. Poverty and illiteracy are constant findings observed among these affected population. There is scanty knowledge about the health implications of tobacco smoking and also poor access to health facilities where advice on tobacco smoking may be easily derived. Most smokers see tobacco smoking as a coping mechanism against stress and anxiety (Desalu et al, 2008).
Based on findings from different countries, the prevalence of smoking and other forms of tobacco among adolescents provides a sensitive measure of the initiation of tobacco dependence (Global Youth Tobacco collaborative Group, 2002). Nigeria, as a member of the WHO framework Convention on Tobacco Control, still falls short of the goals set by WHO in tackling Tobacco smoking with complete lack of tobacco control implementation (NCD Country profiles, 2011). Multinational companies, through political lobbying, have established a strong foundation in the country and are determined to recover whatever they have lost in other countries.
According to the Ottawa Charter (1986), the process of health promotion is one that involves the building up of people for them to be able to exert control over their health and to improve it. It also focuses on abolishing inequality in health and this involves access to life skills, supportive environment, and making opportunities available for healthy choices to be made. This calls for joint action by the health, social and economical sectors, by voluntary bodies, the local authorities, the media, communities, families and individuals.
Tackling tobacco smoking in Nigeria requires of various approaches and models in promoting health among the population (Naidoo and Wills, 2000). Smoking is a risky behavior which may be seen as a response or mechanism of coping with adverse living conditions, thus strategies for change should be directed towards health education, development of life skills and creation of more supportive environment for health (WHO health promotion glossary). The medical approach focuses on high risk groups in order to prevent smoke related medical condition and premature mortality associated with non communicable diseases.
The educational approach is based on the fact that increased knowledge gives rise to behavioral change (Naidoo and Wills, 2000). There effects are limited in that they completely ignore the social and environmental dimensions of health. Emphasis should be laid on behavioral change, social change, community and self-empowerment which are recently propagated as indispensible in most anti-smoking activities around the globe. They focus more on the complex relationship between individual behavior, social and environmental factors, viewing health as a property of the individual and only successful if the individual is ready to change.
Studies conducted in the North East and south Western regions of Nigeria showed early initiation of smoking (18 years) and relatively low consumption rate as compared to other countries (Ayankogbe, 2003). This puts the smoker in a category of people that are likely to respond positively to tobacco cessation programs (desalu et al, 2007). On the other hand, based on the low socioeconomic and educational status prevailing within these regions, a radical approach is highly required. According to Naidoo and wills (2000), social change approach aims at promoting health through changes in the physical, social and economic environment.
It provides the targeted group healthier and realistic options that are made available and accessible. Organizational development, environmental health measures, economic or legislative activities and public policies on tobacco control are key components that are useful in addressing smoking within this country. In 2004, WHO framework convention on tobacco control was held and a six-point framework was constructed to guide each member country in the control of tobacco smoking (GSR on NCD, 2010). This was based on strong evidence showing that tobacco control is cost- effective compared to other health interventions.
It involved measures on price and taxes, exposure to tobacco smoke, the contents of tobacco products, product disclosures, packaging and labeling, education, communication, training and public awareness, tobacco advertising, promotion and sponsorship and reducing tobacco dependence (WHO, FCTC, 2004). According to WHO, within an interval of one year, several low and middle income countries who raised taxes on tobacco products yielded an average of about 60% reduction of tobacco smoking and saving lives. This has been the case in Turkey, Bangladesh, and Pakistan.
Nigeria, in 2005, adopted this framework in addition to its already existing national tobacco control bill (Parties to WHO FCTC, 2010). This saw the re awakening of several activities arising in the country like banning of cigarette advertisement and billboards, ban on sale of cigarette to youth under 18. Based on emerging prevalence reports on tobacco smoking in the country, it is obvious that a lot still needs to be done in this regard. Better results can only be achieved by combining various evidence-based approaches to tackle tobacco control.
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