Outdoor Smoking Ban in Public Areas of the Community

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Table of Contents

Introduction
Policy Proposal
The Top-Down Approach to Policy Advocacy
The Bottom-up Approach to Policy Advocacy
Evaluate the Effectiveness of the Two Different Approaches
References

Introduction

Secondhand smoking, also known as passive, is detrimental to public health due to its association with chronic conditions. Passive smoking causes premature death of nonsmoking individuals, including children. It also causes respiratory complications, cancer, and cardiovascular diseases (Coughlin et al., 2015). Scientific evidence shows that chronic conditions, particularly respiratory disease and cardiovascular conditions, decrease with legislative bans for public smoking (Coughlin et al., 2015). Therefore, smoke-free legislation in public places offers an opportunity to protect the public from the negative effects of smoking, hence influencing social norms and reducing risky smoking behavior.

Policy Proposal

Public Policy Issue

Smoking continues to be major public issue considering the number of smokers in America. According to the CDC, about 18% of U.S. adults are categorized as either consistent or chronic smokers (MacArthur, n.d.). This percentage translates to around 42 million people who smoke regularly (MacArthur, n.d.). On the one hand, more than 3100 smokers are underage while about 300 start as casual substance users but later become daily smokers (MacArthur, n.d.). These statistics have contributed to the widespread efforts to educate the public regarding the need to quit smoking. However, most of the chronic smokers ignore the ramifications of the habit despite the deterioration of their health, as well as deaths.

Issue Selection

Smoking tobacco is classified as one of the leading causes of preventable deaths, given the proven scientific implications of tobacco on health. In America, smoking is associated with approximately 500000 deaths every year, with 10% of the cases being attributed to passive smoking (MacArthur, n.d.). In other words, tobacco, as well as smoking, accounts for roughly 1200 deaths daily. Besides, individuals who smoke are likely to die at least ten years earlier than their non-smoking counterparts (MacArthur, n.d.). Surprisingly, research shows that around 90% of the deaths related to lung cancer have a connection with either the use of tobacco or smoking (MacArthur, n.d.). On the same note, every year, the number of women dying from breast cancer is less than those who succumb to lung cancer.

With regard to chronic diseases and conditions, smoking is one of the primary risk factors. Evidence shows an increased risk of contracting coronary disease up to four times whenever a person smokes (MacArthur, n.d.). Smoking also increases the probability of developing diabetes by 30 to 40 %, leading to difficulty in controlling Type 2 diabetes (MacArthur, n.d.). Apart from lung cancer, smoking is associated with cancer in the various parts of the body, including mouth, tongue, colon, liver, bladder, pancreas, kidney, larynx, stomach, and blood (MacArthur, n.d.). Furthermore, smoking decreases fertility, taking into account sudden infant death syndrome, ectopic pregnancies, pre-term delivery issues, and low birth weight occurrences among the smokers (MacArthur, n.d.). Hypothyroidism and lupus are some of the autoimmune responses that are linked with smoking.

Issue Relevance

Secondhand smoking, a detriment to public health, has, over the years, reduced due to legislative efforts, especially indoor. Indoor smoking has significantly decreased as a result of policies prohibiting it in communities, cities, and states. Today, societal values have changed, implying that public smoking at social places is unacceptable (Coughlin et al., 2015). The efforts to minimize indoor smoking have, over the years, reduced levels of cotinine, a chemical produced when the body breaks down nicotine, from 90% in 1990 to 25% in 2012 (MacArthur, n.d.). As a result, taking a similar course of action concerning smoking in public places will further decrease nicotine exposure, hence low levels of cotinine.

Financial Impact

Smokers and nonsmokers exhibit different health care costs, a perspective that prompts the policymakers to reduce the relative costs of tobacco. In general, users of tobacco develop more health issues and diseases than nonsmokers, which costs the former $ 11 000 more than the latter (MacArthur, n.d.). Therefore, the former require frequent medical attention, reducing their productivity at the society level and hurting the economy. Apart from household spending on preventable diseases, smokers tend to harm their loved ones by subjecting them to secondhand smoking, which eventually affects the entire familys financial status.

Smoking bans take various perspectives in light of the economic impact on the community. These financial implications are either indirect, intangible, or direct. The firms involved in tobacco processing are on the verge of lacking a sustainable market, which reduces the industrys job availability. Additionally, hospitality businesses, including restaurants and bars, are subject to the risk of reduced market value as the ban limits smokers freedom. A significant percentage of expenditure is attributed to smoking. This reserve can be used to improve the various social and economic aspects. Additionally, production and consumption of tobacco assists the economy in crating generating and economic stimulus. However, quitting smokers may decide to undergo the treatment, which can be expensive. The school-based programs reduce short-term costs for smoking, saving between $ 16,400 and $580,000. Thus, financial issues revolve around medical costs and health care aspects.

Personal Values

Assisting cigarette smokers to quit smoking is fundamental to improving their self-worth and self-respect and stabilizing their emotional well-being (Nieh et al., 2018). Legislating public smoking will also help some people who intend to quit but relapse to feel more accomplished. Core values regarding the rights of others and well-being are also crucial to promoting societal harmony. Restricted smoking is one of the indirect interventions for preventing people from smoking (Nieh et al., 2018). This measure positively impacts individuals health and finances, enabling them to live a better life. Hence, the policy will play a crucial role in bettering the future of individuals who would either be subject to premature death or chronic diseases.

Ethical Principle or Theory

Fundamental nursing principles and theories support the policys proposition to ban smoking in public places. Considering human life dignity, it is recommended that medical practitioners be committed to advocate and promote the patients health and safety (American Nursing Association, 2015). While the public members are entitled to autonomy, based on the principle of beneficence, a nurse should ensure that his or her actions are in the best interest of the community (Stone, 2018). Hence, the proposed cause of action in policy is aligned to benefiting the community and reducing preventable diseases. On the other hand, it is in the communitys best interests that medical practitioners advocate for more good than harm.

The Top-Down Approach to Policy Advocacy

Decision Maker

To enact the proposal for banning smoking in public places in Georgia, legislative assistance and action are required. The senator for Georgia, David Perdue, is considered the most effective and influential at the state level. He will receive the brief with the background information required to propose the bill in the legislature. Afterward, he will take the appropriate course of action to ensure that the corresponding recommendations are considered for law formulation.

Explanation

Banning smoking in public places is crucial to the Georgian population, given the demography and the impacts the latter has on public health. Additionally, Georgia has not enacted statewide restrictions for smoking in public spaces. Since a significant number of states have introduced regulations to control smoking in public places and relevant implications to the entire U.S.A, the senator should sponsor the bill, which will improve the health system.

Notably, in Georgia, tobacco poses major challenges concerning the consequences of smoking, such as preventable diseases and deaths. American Lung Association identifies three goals to deal with Georgias overall smoking rates, aiming to reduce them from 18% to less than 10% in 2024 (Coughlin et al., 2015). The objective is to protect the public from second-hand smoking, as well as reduce the health care burdens in Georgia. The three goals include increasing tobacco product prices, advocating for laws to promote smoke-free air, and funding control programs for cigarette cessation (Coughlin et al., 2015). These objectives can only be achieved if the elected officials will be involved in policymaking. Therefore, the senator should be involved in this course, which affects a significant population of Georgia.

Challenges

One of the issues regarding public health issue corresponds to autonomy as a stipulation for human rights. Since public smoking is restrictive, it can be termed as an infringement of human rights. In spite of the effects of smoking to the general public, most of the passive users do not consider it very harmful, hence their laxity in advocacy. Additionally, legislators might be pro-smoking, thus adamant in supporting bills that could regulate its use. On the other hand, since not all jurisdictions in the United States prohibit smoking in public spaces, the motion is likely to face significant resistance. On the same note, awareness programs, which require finance, are necessary to train the public about the impacts of smoking on public health and economic systems.

Options and Interventions

Public members should be educated about the course of the policy, given its aim to protect their health. The appropriate zones for public smoking should be established with the required infrastructure to ensure smokers do not risk the lives and health of nonsmokers. The policy should impose the relevant statewide enforcement measures, including the penalties and fines. Education and enforcement interventions are tangible due to their potential in changing undesirable conduct in public places.

Furthermore, to effectively address smoking prevalence in Georgia, it is imperative to address the issues social, political, and economic aspects. The policymaker can increase the taxes for tobacco prices (Coughlin et al., 2015). This approach is effective in reducing the affordability of cigarettes, hence reducing the widespread user. Another strategy to discourage smoking is banning promotion and advertisement in mainstream media, as well as social media platforms. This intervention is meant to decrease new users as a result of tobacco product marketing. Smoking restriction as a tool for social order will be most effective in reducing secondhand smoking (Coughlin et al., 2015). Smoking cessation programs will be used to assist those who intend to quit smoking. Finally, consumer education and related campaigns will be used to outline the harm and burden caused by smoking. As a result, it will discourage a significant number of smokers.

Course of Action

Significant approaches to effectively address public smoking are the interpolation of the relevant health, economy, and community issues. In essence, the educational approaches, taking into account fact-checking and expert opinion, effectively instigate a change at legislative and community levels. While awareness programs before introducing a ban are critical to gaining support for the policy, they are not sufficient to mitigate the risks associated with secondhand smoking (Berg et al., 2016). Hence, a policy and enforcement framework must be developed across Georgia. To address the difficulties associated with passing the policy motion, informative measures should be used to convince the administrators.

The following actions steps will result in a succinct address of the policy issue:

Chose an organization to popularize and promote the policy issues based on the benefits.
Create the capacity to create cessation programs and centers.
Offer public awareness and education to the community and household members concerning smoking.
Start a legislative motion after attracting public interest.
Passing the bill into law.
Providing social, economic, and political support for enforcement of the policy

Once the issue is popular in public, they will take necessary cautions. Additionally, they will not be adamant about the adverse effects of smoking (Berg et al., 2016). Gaining public support for the issue by working with a local organization will ensure the popularity and support of the majority of the elected officials. Finally, the opposition due to conflict of interest from the industry players and pro-smoking legislatures will not stand the public opinion.

The success of the Policy Brief

The briefs success will be determined by the support the proposal gains from Georgias senator, the extent to which the legislator will involve stakeholders, including advocacy teams, and the elements to be included in the policy. In essence, the effective development of the brief will prompt the decision-maker to not only advocate for restrictions to smoking in public places but also seek statewide educational and awareness programs.

The Bottom-up Approach to Policy Advocacy

Identified Organization or Community

Advocacy and non-profit organizations are instrumental in initiatives for public policies. American Lung Association (ALA) is one of the institutions that can help address the issue of public smoking (American Lung Association, 2020). The organization has been involved in creating awareness regarding the detriments of tobacco on human health (American Lung Association, 2020). Furthermore, its initiative, Freedom from Smoking, assist addicts in quitting smoking. Hence, working with the institution will scale advocacy at local and legislative levels.

Summary of Expressed Interest

American Lung Association advocates for the regulation of tobacco products and their use. It is also vibrant in promoting sufficient funding for cessation, education, and prevention programs (American Lung Association, 2020). It is also involved in promoting policies and laws related to reducing smoking, such as increasing tobacco products taxes (Coughlin et al., 2015). Therefore, the American Lung Association, given its presence capacity in handling policy issues in Georgia, stand better chances to make significant impact concerning the policy proposal.

Community-Based Participatory Research

Awareness programs will be established to educate the locals on the negative impacts of secondhand smoking (Wagner et al., 2018). Another strategy to reduce the overall resistance to policy change is creating cessation programs and facilities (Estreet et al., 2017). These facilities are known to be effective, especially when they involve motivators as opposed to healthcare workers (Alagiyawanna et al., 2017). The other mechanism to deal with this challenge in community settings is sponsoring community-based discussions, workshops, and public activities to identify and evaluate costs associated with smoking in a wider community perspective.

While cessation programs and the popularization of the initiative to reduce smoking in public places will help build community-focused capacity, it is imperative to employ the relevant collaboration approaches. In this regard, the community and the organization must collaborate to achieve the corresponding benefits (Wagner et al., 2018). CBPR requires partnerships to be equal and mutually engaging. In response to this requirement, the partners will develop a document consolidating the involvement of every stakeholder. The framework for cooperation will also outline the role of each party, including the community members (Estreet et al., 2017). The aim is to ensure that all the parties involved are accountable for equitable power sharing and collaboration, as well as ensuring sustainable partnerships.

Concerning sustainability and commitment to long-term goals related to reducing smoking prevalence, this initiative will focus on iteratively revisiting the community needs. Relevant staffing measures, including cutting related costs, will ensure the partners long-term engagement with the community (Estreet et al., 2017). Based on the sustainability goals, the non-governmental partners, as well as other state stakeholders, will contribute to formalizing cessation programs and related centers to ensure long term cooperation with community members (Estreet et al., 2017). This course will ensure that the programs extend beyond the policy initiative.

Approach and Collaboration

American Lung Association (ALA) has the capacity to establish cessation and awareness programs and events. Therefore, this collaboration will be useful in addressing public smoking legislation and community capacity. To better achieve community participation goals, the corresponding programs should be established across the state (Wagner et al., 2018). The non-profit organization will be useful in creating corresponding outreach programs. Therefore, the institution will be involved in providing training, awareness, and motivation activities.

To effectively collaborate with ALA, it is imperative to develop the plan for collaboration, including funding requirements and relevant proposals. These two documents provide the basis for the course the company will support. Boardroom meetings and discussions will be scheduled to deliberate on the collaboration (Wagner et al., 2018). During these engagement sessions, the initiative will demonstrate its alignment to the ALAs values, mission, and vision. After successfully involving the relevant parties concerning the partnership, Georgia leadership will be engaged for strategic future and sustainability initiatives and other long-term goals (Wagner et al., 2018). The agreement of the partnership will culminate into the determination of each partys role. Memorandum of Understanding (MOU) will be developed to ensure appropriation of roles and engagement terms.

Goal Alignment

Both the American associations public participation programs and goals are aligned to the current public policy issue, which aims at legislating smoking in public places. First, to promote lung health and related complications, the public and policymakers must be involved. Secondly, while advocacy and public policy are essential to this course, it is imperative to conduct the necessary interventions to curb smoking in the community, as well as households. Hence, the American Lung Association will be crucial to achieving public policy with substantial support from the publics members.

Action Steps

One of the fundamental initiatives is the creation of capacity in society and governance. To achieve this goal, the involved stakeholders must undertake the due political and social activities, including educating the community about the need to minimize smoking, more so in the public domain. After educational and awareness programs, the relevant stakeholders should seek individuals to participate in the cessation of public policy (Wagner et al., 2018). Thus, the creation of centers for cessation programs is a fundamental requirement (Estreet et al., 2017). The successful candidates will be empowered to scale the discourse to the community to support the legislation process. The community and organizational advocacy programs will convince the policymakers, hence the issues progression and support to the state assembly.

Roles and Responsibilities

Every stakeholder has a role to play in advocacy, education, and policy implementation. The healthcare workers involved will be useful in demonstrating and training the community workers to effectively conduct their duties. The American Lung Association will facilitate the creation of cessation facilities, community-based education and awareness programs (Estreet et al., 2017). The widespread knowledge of the detriments of public smoking and benefits gained from cessation programs will strengthen the case for legislation. In this regard, the members of the public will be involved in advocacy. Finally, the non-profit organization will be involved in the higher-level decision making by documenting the necessary course of action with respect to policy formulation and public health interventions. The policymaker will present the motion for the corresponding law and desired policies.

Each stakeholder is charged with roles and responsibilities to ensure the collective goal achievement. ALA will provide the capacity-building resources associated with training the locals regarding smoking adversities and interventions. Trainers and educators will assist in the cessation programs and insights regarding the health burdens. The management will offer critical insights regarding social work and public health approaches to address the community needs.

Key Elements of Evaluation Plan

The evaluation plan is instrumental in aligning the corresponding activities to achieve the main goal effectively. In this regard, the plan must meet fundamental collaboration requirements. The following elements in line with CBPR principles will be useful in the evaluation plan: trust levels between the stakeholders, integration of the teams to achieve the collective goal, and widespread familiarity of the public policy issue among the stakeholders. Mutual knowledge and corresponding course of action, iterative processes to examine success in terms community-based objectives, and sharing of knowledge among all parties are also vital.

The plan for evaluation will entail phases and activities to examine the success of objectives, as well as collaboration goals. Processes will be evaluated on the basis of the established plans, development, and execution (Wagner et al., 2018). The involved stakeholders should examine the progress in alignment with collaboration and sustainability goals. This approach also provides options for erratic or problematic issues to improve mutual cooperation. With respect to community and stakeholders engagement, impact evaluation will be utilized, focusing on consistency with goals related to capacity building, collaboration, and sustainable course (Wagner et al., 2018). The final stage will be outcome evaluation, which will examine the extent to which the community-based objectives are achieved.

Community/Organization Plan

The program must be evaluated against the goals at the individual, household, and community levels. It should also be examined with respect to public health and political process success. In evaluating the community plan, it is imperative to consider the scope of the work and processes. The activities and goals must be aligned to the particular demography, and the programs must cover all areas and meet representation requirements. This particular process must reach a substantial population of the people affected by the problem through household targeting, cessation programs, and popularization events (Estreet et al., 2017). The other measurement for achieving the objectives will be quantitative efficiency for cessation programs.

Evaluate the Effectiveness of the Two Different Approaches

Strengths of Each Approach

The top-bottom approach is an efficient methodology in situations where time and resources are limited. This mechanism does not require a lot of time to formulate and enact policies. In essence, it only involves a few and influential stakeholders, hence the ease in decision making and understanding of the issue. Since the stakeholders are mostly specialists or top-executives, achieving consensus is straightforward, saving time and resources. Therefore, it is cheaper and less time consuming due to the engagement of a few stakeholders, as well as short processes. Concerning the current issue, this method will be instrumental in faster implementation of the policy and low enactment costs.

The bottom-up approach is associated with three major strengths, motivation, empowerment, and positive influence and reception. This strategy empowers and encourages engagement with stakeholders from all walks of life. The result is empowerment in terms of knowledge for the subject matter, reception of policies at both lower and upper levels of the community, and the stakeholders motivation to implement the policy. These positive outcomes are due to acceptability and reception in the public domain. In terms of public smoking legislation, this particular approach is effective as it will be based on knowledge regarding the subject matter.

Challenges of Each Approach

The top-bottom may be subject to influence from wrong players and low participation. Wrong players can result in improper decisions, as well as self-centered decisions. Minimal public participation, especially in public health issues, may result in inefficient policing due to low levels of awareness and knowledge. Furthermore, the policy may also face resistance or impartial following, given the public social places where the offenders may not be reported.

The bottom-up approach can be subject to issues due to multiple stakeholders involvement, as well as different goals and interests, resulting in incoherent and slow processes. On the other hand, the involvement of the public implies reliance on less experienced individuals. Furthermore, the variations in goals, as well as ulterior motives, can lead to poor decisions. For the current issue, the entities in the tobacco products manufacturing can influence policing and corresponding interventions negatively; furthermore, this process, while educative, can take longer to implement.

Most Effective Approach

The bottom-top approach is likely to be more effective than the bottom down approach due to the nature of the public policy issue. Since legislative advocacy affects a significant population, it is imperative to foster public participation. This method will also help to tackle chronic smoking through cessation programs (Estreet et al., 2017). It is also likely to gain community support, hence the efficiency in the related public health issues. Unlike the top-bottom approach, which can be subject to resistance at the community level, the bottom-up approach will lead to risky behavior and perceptual change.

References

American Lung Association. (2020). American Lung Association mission. Lung.org. Web.

Alagiyawanna, P., Hewageegana, N., & Gunawardena, N. (2017). The impact of multiple interventions to reduce household exposure to secondhand tobacco smoke among women: A cluster randomized controlled trial in Kalutara district, Sri Lanka. BMC Public Health, 17(810), 1-12.

American Nurses Association. (2015). Code of ethics with interpretive statements.

Berg, C., Smith, S., Bascombe, T., Maglakelidze, N., Starua, L., & Topuridze, M. (2016). Smoke-free public policies and voluntary policies in personal settings in Tbilisi, Georgia: A qualitative study. International Journal of Environmental Research and Public Health, 13(2), 156.

Coughlin, S., Anderson, J., & Smith, S. (2015). Legislative smoking bans for reducing exposure to secondhand smoke and smoking prevalence: Opportunities for Georgians. Journal of the Georgia Public Health Association, 5(1), 2-7.

Estreet, A., Apata, J., Kamangar, F., Schutzman, C., Buccheri, J., OKeefe, A., Wagner, F., & Sheikhattari, P. (2017). Improving participants retention in a smoking cessation intervention using a community-based participatory research approach. International Journal of Preventive Medicine, 8(1), 116.

MacArthur, S. (n.d.) Smoking as a public health issue. Mph Online.

Nieh, H., Wu, W., Yen, L., Hurng, B., & Chang, H. (2018). Will personal values predict the development of smoking and drinking behaviors? A prospective cohort study of children and adolescents in Taiwan. Journal of Health Psychology, 23(7), 982-992. Web.

Stone, E. (2018). Evidence-based medicine and bioethics: Implications for health care organizations, clinicians, and patients. The Permanente Journal, 23, 18-30. Web.

Wagner, F., Sheikhattari, P., Buccheri, J., Gunning, M., Schutzman, C., & Bleich, L. (2018). A community-based participatory research on smoking cessation intervention for urban communities. Journal of Health Care Poor Underserved, 27(1), 35-50.

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