The purpose of the paper is to identify health promotion and maintenance of health issue among smokers in the Brooklyn and explore how to resolve the clinical issue. Smoking among African American in Brooklyn led to high rates of respiratory infection, heart disease, lung disease, premature deaths and Sudden Infants Death syndrome (SIDS).
Smoking is the number one cause of preventable diseases and death in the United states, accounting for over 480,000 deaths per year; which is about 1 in 5 deaths. According to the Centers for Disease Control and Prevention, the estimation of smokers in the US currently is nearly about 37.8 million ranging from 18years and older. Smoking cause about 6million death per year and it is anticipated that by the year 2030, the cause of death per year will be 8million which is an increased. (CDC, 2018)
Percentage of smokers in the US ranging from 18 years & older in 2016 are:
13.5% are female
18-24 years- 13.3%
25-44 years- 17.6%
45-64 years- 18%
65 years old- 8.8%
Nearly 32 of every 100 non-Hispanic American Indians/Alaska Natives (31.8%)
About 25 of every 100 non-Hispanic multiple race individuals (25.2%)
Nearly 17 of every 100 non-Hispanic Blacks (16.5%)
Nearly 17 of every 100 non-Hispanic Whites (16.6%)
Nearly 11 of every 100 Hispanics (10.7%)
9 of every 100 non-Hispanic Asians* (9.0%)
The statistic is provided by the Centers for Disease Control and Prevention (CDC, 2018)
The potential negative effect of unresolved smoking leads to diseases such as lung cancer, chronic obstructive pulmonary disease, ischemic heart disease, lower respiratory disease and cerebrovascular disease. According to the CDC, secondhand smoking cause about 34,000 heart disease deaths each year and 7,300 lung cancer death each year. It also shows that the cause of health effect in children such as ear infection, more frequent and severe asthma attacks, respiratory infection like pneumonia and bronchitis and sudden infant death syndrome (2017).
According to the Department of Health in NY, there are over 2 million smokers and about 28,000 New Yorkers are killed. About 750,000 adults in NYS live with smoking related illness such as birth defects and other diseases (2018). In the Bronx Community Health Dashboard conducted by Montefiore hospital, it shows that Brooklyn has the second highest percent of current smokers in NYC. When comparing the overall rate of smokers, it shows that Brooklyn has about 14.9% (Rehm, 2017).
The North Brooklyn includes neighborhoods of Bushwick, Flatbush, Brownsville, Coney Island, East New York and Bedford-Stuyvesant. According to New York Department of Health and Mental Hygiene: community profiles, these communities are the poorest borough in Brooklyn. The demographics consists of African American (69.5%) and Hispanic (32%) population. North Brooklyn is severely impacted by tobacco usage and secondhand smoking.
According to the Department of Health in NYS, there are over 2million smokers and about 41,00 deaths and 400 infants’ deaths in US caused by secondhand smoking. There are so many North Brooklyn residents trying to quit but nevertheless there are still some smokers. The widespread of smoking in North Brooklyn community has put resident at risk which has force
The best solution to the above clinical problem are smoking cessation, patient teaching about the impact of not smoking (intervention), Smoke free by US department of health and human service, Every Try Counts by National Cancer Institute and Smokers hotline by NYS Department of Health.
Smoke free by US department of health and human service create tools to help smokers from smoking. The tools created are taking a questionnaire, smoke free texting programs, enforcing the use of nicotine replacement therapy, smoke free apps, smoke free social media and working closely with a counselor on how to build a plan to stop smoking which one will explore methods to quit smoking, medications and nicotine replacement therapy (n.d.).
Every Try Counts by National Cancer Institute provide trained counselor to help support quit smoking. They are very similar to smoke free but the difference are they provide in person counseling and support, telephone counseling and support, online programs, hypnosis, laser therapy and acupuncture (Smoking & Tobacco Use, 2018)
Smokers hotline by NYS Department of Health is a hotline for smokers to call to get support via phone.
The three levels of preventions for smoking are:
- Primary prevention
Smoking prevention programs such as smoke free, every try counts
Educating about the effect of smoking
- Secondary prevention
Smoking cessation programs
- Tertiary prevention
Provide medical and psychological support to the smoker such as behavioral and aversion therapy
Nicotine replacement therapy
The Smoke Free Act (SFAA) was created in the year 2002 to protect the health of New Yorker against harmful effects of secondhand smoking such as imposing a restriction on indoor smoking and creating a smoke free workplaces (2017).
The short-term goal for smoking cessation is creating a measurable goal such as abstaining from smoking for four months. In order to abstain from smoking, one has to identify a quit date and implement a plan on ways to abstain from smoking. Implementing a plan can involve avoid triggers such as identifying places the triggers the urge to smoke or avoid socializing with the people one used to smoke with.
The long-term goal for smoking cessation include nicotine replacement therapy, provide intervention treatment such as bupropion, which is a drug choice for smoking cessation and providing trained counselor to help provide support to quit smoking.
Despite knowing the effect of tobacco usage, most people continue to smoke. Smokers have difficulty quitting because of the addiction to nicotine, lack of support, lower socio-economic, poor habits, stress factors and cultural norms.
The two potential barriers to the success of preventing smoking are stress management and language deficit. According to Squires, language barrier within the health care system is significantly high and about 5% of nurses identify as Hispanic or Latinos (2018). A strategy for addressing the language barrier is providing a well-trained interpreted to facilitated the conversation between the patients and healthcare providers.
Benefits of smoking cessation to the patient population will decrease lung cancer, chronic obstructive pulmonary disease, ischemic heart disease, lower respiratory disease, cerebrovascular disease, health effect in children such as ear infection, more frequent and severe asthma attacks, respiratory infection like pneumonia and bronchitis and sudden infant death syndrome according to the Centers for Disease Control and Prevention (2017).
According to the New York City Department of Health and Mental Hygiene, about 13.7% of residents and 270,000 adults’ smokers are African American and one third of death prematurely are result of smoking (2017).
A benefit of smoking cessation to the nursing profession include continue education, patient teaching and providing support to the patient. Health benefit of smoking cessation include premature death and decrease of respiratory infections.
Participants and Interdisciplinary Approach
Collaboration with various interdisciplinary such as respiratory therapist, mental health counselor and pharmacist along with the full participation of the smokers in the smoking cessation program. Though nurses provide resources to the patients, create a non-biased & non-judgmental environment for the patients, educate, teach, provide support, risk and benefit of smoking cessation. Respiratory therapist provides patients with accurate information about tobacco use, ways to quit and the consequences of tobacco use. They create a treatment planning for each individual smoker, assess, relapse prevention, professional resources, counseling and evaluate.
According to American Journal of Health-System Pharmacy, it shows that collaboration with a clinical pharmacy specialist help significantly with smoking cessation. Study show that, “59 patients (42%) had achieved tobacco cessation, and 55 (39%) had achieved a reduction in tobacco use but not complete cessation. The remaining 26 patients (19%) were lost to follow- up, lost interest in cessation, or were transferred to other care (Litke et.al, 2018).
Mental health professional provides a non-biased and non-judgmental environment for the smokers to vent about the issues and provide support to the smokers.
Smoking cessation is one of the most effective ways to prevent smoking. New York Government have done well implementing ways to control tobacco such as imposing a restriction on indoor smoking, creating a smoke free workplaces, encourage smoker to stop smoking and creating a smoking cessation program.
Smoker joining the smoking cessation program will decrease health issues such as lung cancer, heart disease, respiratory disease, respiratory infection, premature death on infants and SIDS.
New York City also implement programs such as Smoke free by US department of health and human service, Every Try Counts by National Cancer Institute and Smokers hotline by NYS Department of Health. All of these programs were implemented to help smokers quit and provide support.
- Department of Health. (2018, June). Retrieved December 11, 2018, from https://www.health.ny.gov/prevention/tobacco_control/
- How to Quit. (n.d.). Retrieved from https://smokefree.gov/tools-tips/how-to-quit
- Litke, J., Spoutz, L., Ahlstrom, D., Perdew, C., Llamas, W., & Erickson, K. (2018). Impact of the clinical pharmacy specialist in telehealth primary care. American Journal of Health System Pharmacy, 75(13), 982??“986. https://doiorg.chamberlainuniversity.idm.oclc.org/10.2146/ajhp170633
- New York City Department of Health and Mental Hygiene. New York City Youth Risk Behavior Survey 2017.
- NYC Department of Health and Mental Hygiene (DOHMH). (2017, August 13). Retrieved December 12, 2018, from https://www1.nyc.gov/nycbusiness/description/smoke-free-air act–information
- New York City Department of Health and Mental Hygiene. (2015). Community Health Profiles: Pilgrim, J. M., & Oji, O. F. (2017). Pulmonary Disease, Chronic Obstructive (COPD): Smoking Cessation. CINAHL Nursing Guide
- Rehm, C. (2017, October 23). Bronx Community Health Dashboard: Smoking. Retrieved December 11, 2018, from https://www.montefiore.org/documents/communityservices/OCPH-smoking.pdf
- Smoking & Tobacco Use. (2018, September 24). Retrieved December 11, 2018, from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.mSmoking & Tobacco Use. (2017, February 21). Retrieved December 11, 2018, from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_fac s/index.htm
- Squires, A (2018) Strategies for overcoming language barriers in healthcare. Nursing Management 49(4), 56