Global and Domestic Tobacco Use

Tobacco use and exposure to secondhand tobacco smoke are known human carcinogens and have contributed to a global epidemic and public health emergency. Tobacco is the leading cause of preventable death and illness in the United States and the second-leading cause in the world (U.S. Department of Health and Human Services, 2004; World Health Organization [WHO], 2005a). Tobacco use is responsible for one in three cancer deaths in the United States. Prevention of tobacco-related disease, disability, and death could be achieved through the promotion of global tobacco-use control. Nursing action is essential to solve this problem.

To address this epidemic, members of the United Nations unanimously approved the WHO's Framework Convention on Tobacco Control (FCTC), the world's first public health treaty with the potential to have a historic impact on the global tobacco-related epidemic. Forty countries have ratified the WHO FCTC, which makes it a legally binding international treaty (WHO, 2005b). The treaty calls for tobacco advertising, promotion, and supportership restrictions; tobacco smuggling control; a ban on misleading tobacco descriptors such as "low tar," "light," and "mild"; protection from secondhand smoke; and prominent pictorial health warnings on tobacco products. Global action is essential as tobacco-induced death and disability continue to increase in countries with limited healthcare resources. Efforts in the United States also are central to reducing the risk to Americans, especially youth.

The Oncology Nursing Society (ONS) acknowledges and is committed to the potential that nurses have in reducing adult and youth tobacco use, promoting cessation, actively protecting nonsmokers against secondhand smoke, and helping to increase access to tobacco use prevention and cessation services. In addition to the prevention of tobacco use to reduce cancer risk, intervention is needed to support the cessation efforts of cancer survivors at risk for increased side effects of treatment, cancer recurrence, a second tobacco-related cancer, increased morbidity, decreased survival, and diminished quality of life.

It Is the Position of ONS That

• The U.S. government should ratify and implement the WHO FCTC.

Advocacy

• All nurses and nursing organizations support local, state, and national legislative and regulatory efforts that
• Grant the U.S. Food and Drug Administration meaningful authority to regulate the production, sale, distribution, and marketing of all tobacco products, including products that might be launched in the future.
• Strengthen warning labels on all tobacco products.
• Increase the price of tobacco products through taxation and allocate part of the revenue to tobacco-control programs and tobacco-related research.
• Prohibit the sale and distribution of tobacco products, including but not limited to those available via mail order, the Internet, and vending machines, to anyone younger than 18 years of age.
• Eliminate supportership of events that appeal to youth and marketing to youth by tobacco companies.
• Develop and enforce smoke-free public spaces.
• Collaboration with other healthcare organizations, public health, and tobacco-control groups to strengthen tobacco control at all levels is essential. This includes the allocation of 25% of states' master settlement agreement funds to tobacco control and 25% to treating tobacco-related illnesses in underserved populations.
• Active participation in World No Tobacco Day be included in advocacy activities.

Treatment

• Greater investments be made in federal, state, and local tobacco-control programs to reach the Healthy People 2010 tobacco-related objectives (U.S. Department of Health and Human Services, 2000), including addressing the needs of low-income, ethnic communities targeted by the tobacco industry.
• All people have the right to obtain tobacco cessation services (e.g., pharmaceutical and behavioral therapies; counseling that is accessible, effective, and sustained).
• Interventions for individuals addicted to tobacco be promoted, facilitated, and covered by public and private health plans and insurers.
• The scientifically based Treating Tobacco Use and Dependence. A Clinical Practice Guideline (Fiore, Bailey, & Cohen, 2000) be implemented in all clinical settings. At a minimum, all nurses should assess, provide advice to quit, and refer tobacco users to existing resources, including telephone quit lines.

Public Education

• Support is needed for the development and use of culture-, gender-, age-, and literacy-appropriate educational materials and skills to address the benefits of cessation and the risks of tobacco use and exposure to secondhand smoke.
• Public campaigns that glamorize tobacco use should be eliminated.

Professional Education

• Nursing curricula should include information about the health effects of tobacco use, exposure to secondhand smoke, prevention of tobacco use, and scientifically based strategies for tobacco cessation, as well as clinical practice opportunities, to ensure that all nurses are competent in tobacco control.
• Practicing nurses should be provided with educational workshops and professional education regarding tobacco control.
• Essential competencies related to tobacco control should be included as part of basic licensure for nursing practice and as part of oncology nursing certification.
• Tobacco control should be included in the agenda of scientific and educational oncology nursing programs.

Research

• Further nursing research on tobacco use, prevention, cessation interventions, and reduction of exposure to secondhand smoke in people with and at risk for cancer should be supported.

Further, ONS recommends that

• Nurses worldwide should serve as tobacco-free role models. Cessation resources and services for all nurses who use tobacco, including those in training, should be provided.
• Healthcare professionals should hold all meetings in smoke-free environments.

References

Fiore, M.C., Bailey, W.C., & Cohen, S.J. (2000). Treating tobacco use and dependence. A clinical practice guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service.

U.S. Department of Health and Human Services. (2000). Healthy people 2010: What are the leading health indicators? Retrieved May 25, 2005, from http://www.healthypeople.gov/LHI/lhiwhat.htm

U.S. Department of Health and Human Services. (2004). The health consequences of smoking: A report of the surgeon general. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

World Health Organization (2005a). Tobacco free initiative. Retrieved April 27, 2005, from http://www.who.int/tobacco/en

World Health Organization. (2005b). The WHO framework convention on tobacco control. Retrieved April 27, 2005, from http://www.who.int/tobacco/en

Approved by the ONS Board of Directors 3/99; revised 5/00, 10/02, 4/05.