a smoke free england , the effects of legislation

Tobacco smoking is among the leading cause of death worldwide (WHO 2013).Tobacco smoking is one of the greatest cause of preventable death worldwide with a prevalence of about 1 billion and a mortality of 5million/year (Golechha M 2016). Tobacco smoking and its associated sequellae, is a major contributor to modifiable cause of complications and death in the UK and health care (Muller et al 2017). Despite available information and widespread efforts in spreading the negative effects of smoking, about 24% of the UK population still smokes with resultant attributable death among smoker of about 120000/year and 10000/year among passive smokers. Most of these deaths are due to chronic obstructive pulmonary disease (COPD), cancers and ischaemic heart disease. Its of note that chronic obstructive pulmonary disease (COPD) constitute 13th highest admission in the UK with an incidence of about 622/100000/year.Due to the high incidence of morbidity and mortality from tobacco smoking which was preventable, the world health organisation came up with a strategy for tobacco control with the first global public health treaty ”Framework Convention on Tobacco Control (FCTC)” adopted at the world health assembly on 21st may 2003 though became effective in February 17th 2005 (WHO 2005). These interventions directed towards reduction in tobacco smoking has been Shown to be effective (Pierce et al 2011). A significant body of evidence now exists in the UK and worldwide demonstrating that the smoke free laws are effective in reducing negative effects of smoking, exposure to second hand smoking(SHS) (Sims M et al). There have been several attempts at reducing rate of smoking and its negatives effects (Akter et al 2007, WHO 2007), one of such include the white paper called ‘Smoking kills’ which was issued by the government to ban smoking in homes, as well as public places (ASH 2011). United Kingdom Health Policy Act 2006 smoke free England which came into effect in the year 2007 is a public health initiative with the aim of protecting the public effect from the negative effects of second hand smoking. (DH 2008). Its worth nothing that the introduction of smokefree legislation in England led to significant reduction in population exposure to second hand smoking (SHS) Sims et al. The Stoptobacco initiative commenced in October 2012 was aimed at reducing the number of smokers, decreasing negative effect of attributable to tobacco smoking by promoting healthy lifestyle and discouraging unhealthy lifestyles (DH 2012). This aim was achieved as there was a significant reduction in workplace related smoking, smoking at home and positive from relations and relationships as regards tobacco smoking (PHRC 2009). This positive response to this initiative can be attributed to efforts from establishment of the legislation, its enforcement by all involved participants which included the health personnel, support staffs, smokers and the media (PHE 2018). For instance the level of undectable cotinine level fell by 27% which was 1.5 times higher prelegislative era (Sims et al 2012). Despite this success, it was also noted that there was a huge disparity on the population of smokers in the developed areas of England compared to their counter parts in remote areas PHE 2018.The cost of sustaining these successes so far in the fight against reduction in tobacco related morbidity and mortality has been multifactorial including the cost on the government funding legislation and ensuring it is worked, taxation of smoking, mass advertising campaigns in the media, peer education programs, community mobilization, motivational interviewing, health warnings on tobacco products, marketing restriction and banning smoking in public places (Golecha 2016). This is in cognisance with the application of basic concepts of health promotion model including personal factors, environmental factors, nursing collaboration with individuals, family, community to create a favourable conditions Pander NJ et all 2011. Some of the challenges could be expressed in diverse means Smoke-free rule had its own challenges as earlier mentioned which include citizens having to oppose smokefree legislation as they believed it would displace cigarettes into homes, endangering the lives of children (Callinan et.al, 2010) in addition to people criticizing it could have been voluntary and not compulsory as certain fines were attached (Arnott et.al 2013).In fact, the public saw the law as a form of social Isolation because those who have acquired certain smoke-related symptoms Such as chronic obstructive pulmonary disease (COPD) and lung cancer are likely to miss or cancel appointments due to stigma (Bell et.al, 2010 and Lock et.al, 2010). Likewise, Bell et.al (2010) argues that the legislation has exacerbated health inequalities by reducing smokers ‘ socialization and creating a self-stigmatizing environment. However, young Somali women were observed in London, resulting in increased social isolation among adult smokers (Lock et.al 2010). It was noted hat notes that the removal of vehicles from smoke-free laws has led to children being exposed to second-hand smoke, and that the prohibition of cigarettes with exemptions does not make government policy more effective in increasing health disparities (ASH 201)1. For the part of the government also, the law enforcement officers have reported challenges to the entry of certain premises that deliberately deny them access to their building for inspection, hidden or inaccessible camera (such CCTV) areas and refusal to make phone calls (UK Gov, 2015). Tobacco companies argue that smoking free legislation would have a negative impact on the economy, commerce and jobs in enclosed areas such as restaurants and pubs (Pyles et al, 2007). Considering health workers, positive claims have been made regarding the reduction of the toxic effect of tobacco exposure in hospitals and bar staff (Scollo et al 2012).Participation of health care professionals is essential in the fight against preventable disease such tobacco smoking related mortality and morbidity by ensuring that health care practitioners should make adequate contact with every clients and patients by promoting healthy behaviours, discouraging unhealthy behaviours and life style such as smoking through effective communication (NHS 2016). There is enough evidence to support that cessation of smoking reduces negative effects of smoking among at risk individuals and the general population of smokers (Muller KA et al 2017).Training of health care practitioners and their participation in health education to improve her knowledge, skills and proficiency with effective communication is essential to provision of health education on the benefits of embracing healthy lifestyle, avoidance and cessation of smoking is beneficial (NMC 2015).The introduction of leading changes over the years into the framework of nursing training and practices including the 6Cs towards preventive and health promoting measures in England has been helpful in achieving these success so far (NMC 2015,NHS 2016).The law has a positive impact on nursing practices as it has minimized healthcare employees’ exposure to second-hand smoke (Semple et.al 2009) as well as on the public (Haw et.al, 2007). And also a reduction in admission rate of cases like chronic obstructive pulmonary disease, myocardial infarction and lung cancers (Sims et al 2010). Hence compliance with “Smoke Free”” laws

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