Category: Health

This paper focuses on the wellsprings of health equity in social policy, pointers of inequity, and how two national contexts and approaches to education effect better health outcomes. In particular, the paper investigates the most important manifestation of health inequity for Australian Aborigines. There being no such racially-oppressed minority in the Philippines, progress toward Millennium Development Goals becomes the framework.

The two countries subject of this paper are by no means woefully poor. Australia counts among the members of the Organization for Economic Cooperation and Development (OECD), the select club of nations that are wealthier than the rest. A Southeast Asian neighbour, the Philippines, remains among the middle-income countries but certainly leagues above the abject poverty endemic to South Asia and most of Africa.

Universal health as social good is critical to modern government policy. It is also mandated by international treaty. The World Health Organisation (WHO, 2010) has opined that, beyond hiring enough health care staff and dispersing the requisite facilities, bringing about universal health demands action on the social, political, economic and even spiritual contexts that aggravate health and contribute to the continued prevalence or spread of disease. Hence the policy statement that:

The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. The social determinants of health are mostly responsible for health inequities  the unfair and avoidable differences in health status seen within and between countries. (WHO, 2010, para. 1)

Concerned about health inequity, WHO set up the Commission on Social Determinants of Health. The Final Report, issued in 2008, called for action on two broad categories of social determinants that relevant to this analysis. The first is a call for improving living conditions  A call to action around compulsory primary and secondary education, affordable housing, potable water, general sanitation, nutrition, wholesome physical activity, full employment, fair labour practices, cradle-to-grave social protection, and universal health care. The second comprises a challenge to more equitable distribution of power, resources and funds  including such matters as allotting a fixed percentage of GDP for development aid to poorer nations, gender equity, accounting for the economic value of housework, progressive taxation and for health equity itself to be a perennial marker of good governance (CSDH, 2008).

Under the auspices of the United Nations Development Programme (2010), in addition, all 192 members of the UN have bound themselves to attain eight development goals by 2015. Three of these have to do with health indicators as signals of a better quality of life: a) Goal 4 mandates reducing child mortality by two-thirds; b) Goal 5 aims to roll back maternal mortality ratio by 75% from 1990 baselines; and, c) Goal 6 aspires to halt the spread of HIV/AIDS in all vulnerable populations, grant universal access to treatment for this syndrome, and reverse the still-rising prevalence of malaria (amongst children) and tuberculosis (for the general population).

And yet, for all the good intentions of government, citizens are free to act or not, notably in respect of adhering to disease-prevention lifestyles or cooperating with government in such health service initiatives for disease eradication as immunisation. Attitudes about maintaining health may be slack, the distance to primary health care facilities too great, money to fill prescriptions scarce, attitudes of primary care personnel intimidating, and concern about apparently-trivial symptoms misplaced. There are any number of social determinants round national health service outcomes that result in inequities. For the purposes of this paper, one investigates unequal access under the Australian Department of Health and Ageing and draws comparisons with a developing nation in Southeast Asia, the Philippines.

As with much else in political systems and governance, both nations owe their basic health service structure to former colonizers: the UK for Australia and the USA for the Philippines. In the case of Australia, (Berridge, 2008) makes one realise how historical precedent in the UK continues to shape the discourse on health service and universal access even in contemporary times. The author considers the emphasis of the UKs National Health Service on free service since inception in 1948 and labour unionist Nye Bevans serenity of health care at need the very bedrock of universal health care (Milburn, 2002). In this century, the discourse in the UK has also been shaped by promoting healthier lifestyles as a new cornerstone of NHS policy (Blair, 2006). As well, succeeding Ministers of Health argued to revive the mutualism tradition of Bevan and the Tories to make comprehensive health care a reality by permitting the establishment of primary and even tertiary care facilities owned by foundations, local communities, religious and mutual organisations (Blears, 2003; Reid, 2003).

In the Australian context, the Department of Health and Ageing (2010c) articulates its vision as Better health and active ageing for all Australians. Owing to the sheer size and low population density of the continent, one of the most obvious health service gaps is evident in poor coverage of those residing in rural areas. For this sector, DHA furnish funds to attract general practise physicians via Rural Health Workforce Australia (RHWA, the national coordinating body) and directly to the Rural Workforce Agencies. Communities where at least five percent of population reside in rural and remote areas qualify for this subsidy, associated training and other incentives (Department of Health and Ageing, 2010b). A second inequity comprises those who increase their health risks, perhaps unknowingly, by dependence on, or abuse of, alcohol, marijuana and addictive, psychoactive drugs (Australian Institute of Health and Welfare, 2010). Yet a third, qualitative inequity is the waiting time patients must endure for elective procedures in a needs-based universal health system. Since public health services can never deploy enough resources to attend immediately to non-acute and non-emergency patients, DHA have seen fit to encourage, and partner with, the private sector (Department of Health and Ageing, 2010c).

DHA address other health coverage gaps, crucially in the area of preventive medicine. In common with other nations boasting advanced health care systems, for instance, there is an ongoing campaign to induce more women in elevated-risk age cohorts (50+ years) to submit voluntarily for breast cancer screening, i.e. mammography. Sharing as it does the egalitarian philosophy of the UK NHS  particularly in respect of comprehensive health care  the present-day Department of Health and Aged Care (DHAC) must also see to diversity since the department gained responsibility for Aborigines and Torres Strait Islanders around 1997. There are many troubling inequities where the Indigenous population is concerned, a glaring one being that life expectancy has remained about where it was since 1900, when health authorities first began to keep reliable records. In contrast, life expectancy increased at least 50 percent for the mainstream White population, from 52 to 74 years for men and 55 to 81 years for females. With the benefit of hindsight. DHA can admit that the culprit was racism (Department of Health and Ageing, 2010a).

Conceding that Better health&for all& is a difficult enterprise, there are extant health gaps and inequities in Australia. At last count (Australian Bureau of Statistics, 2009), 15% of the population 15 years or older rated their health fair or poor, unchanged from the 200405 National Health Survey. No less than three-fourths of Australians claimed to suffer from at least one chronic disorder. Smoking incidence has shrunk but the proportion of those overweight or obese was higher than ever, likely owing much to the fact that the propensity for exercise was static. As well, risk-level alcohol consumption was unchanged.

The nadir of inequity for health and other social services has to be the Indigenous population. Though making up just 2.4% of the population (455,000 people, Australian Bureau of Statistics, 2007), Aborigines and Torres Strait Islanders deserve to be treated more humanely.

The Philippines is a democratic, Western-oriented republic in the South China Sea, between Borneo and Taiwan/Republic of China. This archipelago of some 7,107 islands has a total population of 92 million (more than four times that of Australia) and per-capita income based on parity purchasing power of just $3,520 per annum (less than one-tenth that of Australia: $38,910). The country ranks in the middle globally, so far as the Gini ratio (equality of income distribution) is concerned. Among the benefits Filipinos gained from 340 years of colonization by Spain and a half-century under the United States are a strong ethical role for the Catholic Church, a superb network of private and public schools up to the postgraduate level, a functional literacy rate of about 84 percent, English as the second language, and a widespread propensity for American movies, music, books, magazines and Web sites. As to the Millennium Development Goals, it appears that the Philippines is slightly below average in the drive to control child mortality, ensuring at least basic antenatal care, access to trained professionals at delivery, and maintaining markers of primary and secondary enrolment but has made swift progress in managing infant mortality and has the puny HIV prevalence well in hand.

The Praxis of Education to Combat Health Inequities

Given the many health service gaps and sources of health inequity, it stands to reason that education can take many forms. On a global scale, education is a crucial centrepiece of health outcomes. It is among three more of the aforementioned Millennium Development Goals considered essential to improved health status for all since Goals 1 through 3 call on governments to a) eradicate extreme poverty and hunger; b) achieve universal primary education, and, c) empower women (primary caregivers for their children), notably by promoting gender equality (UNDP, 2010, paras. 4 to 6).

The Philippines shows that one route for education to redress health inequity is, bearing mothers as caregivers in mind, embarking on multi-media campaigns to motivate attendance for free infant and child immunisation, available at all health centres nationwide. Since the mid-1980s, a succession of cost-free Expanded Programmes on Immunisation have been carried out to target such causes of infant and child mortality as vitamin A deficiency, measles, influenza and polio. Annual and seasonal campaigns run on national TV, radio, print, outdoor posters, and door-to-door drives conducted by health centre doctors, nurses and midwives. Within the limit of developing-nation status where poverty remains substantial and fiscal deficits chronic, helping redress health inequity is unequivocally central to governance. So are social marketing campaigns that motivate otherwise poorly educated mothers to take action in the face of complacency and ignorance.

In the Northern Territories, Aboriginal infants from four weeks to one year of age are subject to multiple disadvantages: official neglect, displacement because of the rich uranium deposits in the region, poor parental education, unsanitary and crowded living conditions. On carrying out a meta-analysis, McDonald et al. realised that such inequities were strongly associated with a six-fold prevalence in hospitalisation for respiratory, diarrhoeal and parasitic diseases (2008, p. 2) compared to other Australian infants. Interventions such as community education, soap distribution and encouragement to wash hands, among others, helped to halve the incidence of diarrhoea.

Conclusion

The quote from CSDH that initiated this essay has been borne out by an examination of evidence not only from the WHO-sponsored report but equally from third sources such as the Australian DHA and, in respect of a nearby Southeast Asian nation, progress toward the Millennium Development Goals five years hence. Clearly, even the disadvantage of formal education that plagues Indigenous Australians can be redressed by community outreach for proactive testing at primary care, mass media and outdoor advertising campaigns, all in the name of redressing the serious inequity of life expectancy disastrously shorter than the rest of Australia.

References

Australian Bureau of Statistics (2007). A picture of the nation. Canberra: National Information and Referral Service.

Australian Bureau of Statistics (2009). National health survey: Summary of results. Canberra: National Information and Referral Service.

Australian Institute of Health and Welfare (2010). Alcohol and other drug treatment services in Australia 2007-08: Findings from the National Minimum Data Set. Web.

Berridge, V. (2008). History matters? Historys role in health policy making. Med Hist., 52(3): 311326.

Blair, T. (2006). Speech on healthy living (26 July 2006). Web.

Blears, H. (2003). Communities in control: Public services and local socialism. London: Fabian Society.

CSDH. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva: World Health Organisation.

Department of Health and Ageing (2010a). History of the department. Web.

Department of Health and Ageing (2010b). Rural and remote general practice program. Web.

Department of Health and Ageing (2010c). Our role. Web.

McDonald, E., Bailie, R., Brewster, D. & Morris, P. (2008). Are hygiene and public health interventions likely to improve outcomes for Australian Aboriginal children living in remote communities? A systematic review of the literature. BMC Public Health, 8:153 Web.

Milburn, A. (2002). Speech of 14 Nov. 2002. Web.

Reid, J. (2003) Localising the National Health Service: Gaining greater equity through localism and diversity. London, New Local Government Network.

United Nations Development Programme (2010). Millennium development goals. Web.

United Nations ESCAP, Asian Development Bank and UN Development Programme (2010). Achieving the millennium development goals in an era of global uncertainty: Asia-Pacific Regional Report 2009-2010. New York: United Nations.

World Health Organisation (2010). Social determinants of health. Web.

Introduction

Although modern society asserts its allegiance to the idea of universal human rights, the extent to which human individuals can exercise those rights varies significantly based on several factors. Despite prohibitions on official discrimination based on race and occasional claims of an approaching postracial era, the individuals racial classification continues to be one of those factors (Constance-Huggins 163). Indeed, racial discrimination can be regarded as one of the principal forces interfering with many peoples ability to avail themselves of their human rights. One of those rights, enshrined in Article 25 of the Universal Declaration of Human Rights, is the right to health, which includes access to adequate medical care. In this paper, I intend to gauge the enduring influence of race by examining how it can impact American citizens access to healthcare.

Persistence of Racial Essentialism

In modern Western culture, there are two competing and logically incompatible understandings of race. One, which can be referred to as racial essentialism, holds that different races, such as whites or blacks, possess distinctive and innate characteristics that naturally manifest in individuals of those races. Among those who share this understanding, the race is generally regarded as a more or less inflexible fact of human biology. The opposite position, racial anti-essentialism, regards race as a purely social construct with minimal or nonexistent connection to biology. The latter view is reinforced by historical studies that track the emergence of race as a concept, reflecting social dynamics and strategies rather than scientific understanding (Middleton 130). While pure racial essentialism has long since gone out of favor and anti-essentialism has firmly entered the mainstream, elements of both concepts continue to clash and coexist in peoples minds.

Indeed, the historic racial classifications in America appear very loosely attached to the biological category of human populations, given how arbitrary and blatantly political many of those assignments have been. The one-drop rule, codified in 1910 when the State of Tennessee officially defined blacks as persons of color with any African blood in their veins (qtd. in Middleton 11), still informs views of black identity. It is patently absurd when taken as a biological description  even if it is accepted that race is an objective and innate characteristic, why would someone who is 99% white be automatically considered black? Instead, this classification has its roots in the 19^th and 20^th-century politics of white supremacy, in which it was deemed to be essential to set up and maintain a racial hierarchy (Middleton 12). Other racial or ethnic categories in the United States, such as Hispanics or Native Americans, can likewise be shown to be political and social constructs.

Scientific racist scholarship that depicts traits like intelligence and competence as directly connected with racial categories has been largely discredited in modern academia. It has also acquired a substantial social stigma, though this does not prevent it from being occasionally deployed in political rhetoric at the highest level of government (Cogburn 748). However, the more pervasive and impactful racial essentialist survivals in present-day American culture tend to be informal and often unspoken or unconscious (Shah 25). The automatic stereotypical association of blackness with violence and lack of intelligence is a classic example (Cogburn 749). Such stereotypes survive in part due to the lingering influence of earlier racial essentialist propaganda, but partly also because of observable social phenomena. The lower average living standards of blacks make it more likely that they would be less educated, less assertive, or more involved in crime than whites, reinforcing negative stereotypes (Shah 30). As the prevalence of such stereotypes damages the life prospects of members of disadvantaged racial groups, this creates a vicious cycle that ensures the survival of racial essentialist perceptions.

Problems of Race and Healthcare

One particular area of concern in which the impact of the vicious cycle of negative stereotyping and social disadvantage can be observed is access to healthcare. Studies from around the world have confirmed significant disparities in health and healthcare outcomes based on socially-assigned race (White). In other words, people who are perceived as belonging to a less privileged group tend to be both less healthy and receive inferior care. The causes of this inequality cannot be reduced to socioeconomic factors, as racial health disparities can also be found among higher-status or upwardly mobile blacks and Hispanics, sometimes in more pronounced forms (Cogburn 738). Racial inequality in healthcare outcomes can manifest both in access to adequate medical care and in the quality and effectiveness of engagement with health professionals (White). This disparity, in turn, exacerbates the inequality in health and overall living standards.

The disparity in healthcare outcomes can reflect the influence of multiple forms of racial bias. At this point in Americas history, conscious individual and institutional discrimination based on race no longer represent the most significant obstacle to more equitable outcomes in health (Shah 29). After all, the official policy of healthcare institutions is to provide equal treatment regardless of race, and the majority of healthcare providers do not regard themselves as racist. Though well-intentioned, the color-blind stance adopted by most of those institutions often serves to obscure the disparities caused by structural factors affecting racial minorities. For example, lower average education leads to poorly informed patients who are less able to derive full benefits from doctor visits, and lower economic status makes compliance with prescriptions more difficult (Shah 30). It also blinds health professionals to their own unconscious biases, hindering their interactions with patients as well as any attempts to mitigate healthcare inequality at the institutional level.

Further problems for reducing the disparity in health outcomes lie on the plane of national health politics. For many people, both the availability and the quality of medical care depend primarily on government healthcare programs, and this is particularly true for members of racial minorities. The partisan debate over healthcare, which has become especially acrimonious and racially tinged during the Obama administration, makes any progress in this area particularly difficult. Partisan polarization and the decrease in pragmatism in both federal and state politics make policymaking more vulnerable to racial bias. Morone notes that Medicaid expansion was rejected in eight out of ten states with the largest proportional black populations, but accepted in Republican-controlled states with small black minorities (841). This outcome can be partly attributed to the common stereotypical perception that the new recipients of Medicaid in the former states would be lazy and anti-social, and therefore unworthy of it. With Republicans and Democrats increasingly acting as parties of the white majority and racial minorities respectively, the partisan considerations in healthcare policy grow more complex and less tractable.

Even assuming that the influence of broader societal factors on racial health disparities could be widely accepted and that the vagaries of politics could be navigated, the question of how to overcome those disparities remains. The two approaches available to policymakers are to focus on population health goals without regard to race or to provide targeted assistance to disadvantaged racial groups (Cogburn 744). While the former strategy is seemingly more consonant with a universal and egalitarian approach to healthcare, it can leave serious problems affecting specific groups completely unaddressed. Meanwhile, the latter path requires serious adjustments to institutional procedures and structures to be genuinely successful.

How to Make Healthcare More Equitable?

I believe that providing its constituents with maximally equitable access to healthcare constitutes one of the primary duties of government. This understanding follows naturally from the social contract principle, according to which the purpose of the society is to secure the individual interests of its members through collective action. By allocating resources and creating an organizational framework for a healthcare system, a government can ensure better health outcomes than what individuals could achieve by themselves. However, every individuals access to this shared pool of health resources is complicated by various factors. Conscious and unconscious racial prejudice, stereotypes, and ignorance of particular obstacles faced by racial minorities in society are some of the most significant factors in question (Cogburn 738). Individuals who are perceived as belonging to the racial majority studies access and utilize healthcare services with greater ease and effectiveness than those who appear to belong to historically oppressed minority groups (White). This discrepancy confirms that the problem is caused in large part by specific social constructions of race.

While perfect equality in health and healthcare outcomes may not be attainable, reducing disparities based on socially-assigned externals like race is both possible and desirable. It seems to me that the optimal way to tackle this elusive general problem is to focus on resolving specific issues that keep racial minorities from making full use of healthcare. Targeted assistance to communities that are particularly disadvantaged in terms of health outcomes can be one part of this solution, and perhaps necessary to alleviate the most pressing predicaments. In the long run, however, a change in institutional culture and norms is essential, which can be best attained through adjustments to medical education (Cogburn 751). If healthcare providers are trained from the start to recognize the structural obstacles that their patients face due to their race, they will be better equipped to assist them and win their cooperation (Shah 30). To provide the necessary structural support for this shift, though, the healthcare system as a whole would need to shed the counterproductive color-blind approach, which obscures racial disparities but cannot make them go away.

Why Racial Inequality in Healthcare Matters

The principle of universal human rights mandates that societies must extend a guaranteed minimum of resources and protections to all of their members. Of those rights, the right to health is one of the most critical, as it impacts on all areas of human activity, whether it is business, education, or family life. The insufficient ability to exercise the right to health can even undermine the more fundamental human right to life. As such, the disparity in access to quality healthcare based on socially-assigned race has grave implications for racial inequality in society more generally (White). Identifying the causes of this disparity is necessary both to improve health outcomes and for broader social progress.

This question is a particularly urgent one for American citizens, given the current fraught state of health politics in the United States. Writing before the divisive 2016 election, Morone speculated that after the Obama administration, the partisan controversy that overtook health policy might either fade away or become the new normal (843). The developments that occurred since then, including the continued political battle over the Affordable Care Act, point towards the latter scenario. Ideological and political considerations, which are informed by cultural racism, override the usual impetus towards compromise and pragmatic policymaking. While this situation damages the short-term prospects of a more fair and consistent approach to healthcare, it also makes it crucial for policymakers and citizens to think about the shape of that approach. Given the ubiquitous and endemic nature of racial inequality in health and healthcare outcomes, any such conversation must address this issue.

Conclusion

The principle of the right to health requires governments to provide their citizens with access to adequate medical care. While ideally, all citizens should be able to exercise their right to health equally, in practice, this is complicated by external factors. I see no reason to doubt that socially-assigned race is one of those factors. Stereotypes and prejudice, as well as pure ignorance of structural problems connected to race, play a significant role in the inequality of healthcare outcomes between racial groups. This dynamic plays out on several levels, from political decisions regarding access to health resources to quality of engagement with health professionals. I think that promoting racial sensitivity throughout the healthcare system represents the most promising method of mitigating this inequality, as it would empower medical professionals to address specific obstacles faced by their patients. If this is done, it will lead to greater equality in health outcomes and all other parts of life, resulting in an America that is healthier in both physical and socioeconomic terms.

Works Cited

Cogburn, Courtney D. Culture, Race, and Health: Implications for Racial Inequities and Population Health. The Milbank Quarterly 97, no. 3, 2019, pp. 736-761.

Constance-Huggins, Monique. Critical race theory and social work. The Routledge Handbook of Critical Social Work, edited by Stephen A. Webb, 2019, pp. 163-170.

Shah, Karishma. The Dyadic Conversation of Racial Inequality in Employment, Criminal Justice, and Healthcare: Using the Color-Blind Fallacy to Understand Differing Perceptions. Hinckley Journal of Politics 20, 2019, pp. 25-33.

Middleton, Stephen, et al., editors. The Construction of Whiteness: An Interdisciplinary Analysis of Race Formation and the Meaning of a White Identity. University Press of Mississippi, 2016.

Morone, James A. Partisanship, Dysfunction, and Racial Fears: the New Normal in Health Care Policy? Journal of Health Politics, Policy and Law 41, no. 4, 2016, pp. 827-846.

White, Kellee, et al. Socially-Assigned Race and Health: a Scoping Review with Global Implications for Population Health Equity. International Journal for Equity in Health 19, no. 1, 2020. Web.

Introduction

If at the beginning of this year, people were told that later they would be allowed to leave their apartments only for shopping or walking a dog, no one would have believed in such forecasts. However, the global coronavirus epidemic has radically changed the lives of people all around the world. In March, April, and May, we had a chance to work from home and communicate more closely than usual with our family members. Although the usual order of things will be gradually restored epidemiologists warn about the possibility of a second wave of COVID-19. The experience of staying at home during the pandemic is psychologically traumatic for everybody. It has become impossible for the majority of us to lead our usual lifestyle; many adults have lost jobs and faced financial problems (Luthar, 2003). Besides, no one can tell exactly when the epidemic would be stopped and what consequences the situation will have. Nevertheless, during isolation, some people feel better than others. The purpose of this paper is to describe which individual characteristics might pose a risk and which ones serve as protective factors during social isolation.

Individual Characteristics that Pose a Risk

The lack of financial resources and fears about the future contribute to the psychological discomfort all people experience because of being within the confines of four walls. However, the psychological consequences will depend on the individual characteristics of a particular person. Extraverts for whom socialization is a key element for personal well-being might feel depressed and devastated while staying at home all the time (Frison & Eggermont, 2017). Moreover, it should be taken into consideration that for many people, self-organization is based on external factors. For example, children and adolescents have to come to schools and other educational institutions by a certain time; adults have to be at work in the morning. Because of COVID-19 and the resulting necessity of decreasing social contacts, this organizational principle has become weaker or even vanished for certain groups of the population. Hence, those who have poor skills in self-organization and planning without appropriate external factors are at risk of developing depression. They do not know how to allocate time or what to do while being in isolation.

The necessity of staying at home and minimizing the number of contacts is hard itself; at the same time, it can aggravate the problems that already exist. For example, before the quarantine, people with an alcohol or food addiction had to exercise self-denial at times to go to work or meet with friends. During the isolation, such individuals have no restricting factors; on the contrary, there is much time and a variety of good reasons for consuming food or alcoholic beverages in large quantities. Men and women who suffer from inferiority complex or other psychological issues also belong to the group of most affected people. Like drinkers or food addicts, when being isolated, they have more time to dwell on their problems while there are no distractions.

Those who cannot get on well with their family members also fall under the category described. Usually, people do not have to stay with their mothers, fathers, husbands, wives, or children all the time. In isolation, which means less personal space they do; thus, the quarantine can make relations with family members more strained. For example, children and teenagers from affluent families might find it difficult to spend much time with their parents. Usually, wealthy mothers and fathers are busy with work while their sons and daughters feel neglected and insulted by their parents (Luthar, 2003). According to the appropriate statistics, 72% of girls and 59% of boys from rich families use alcohol and drugs respectively (Luthar, 2003). These indicators are much higher in comparison to the numbers reported by children from middle-class families (Luthar, 2003). All in all, individuals who have serious problems in their life which are usually concealed also might feel depressed and devastated while being isolated because the quarantine makes existing difficulties worse.

Protective Factors

The situation that the world is now dealing with is new to the majority of countries. However, isolation-related experiments were conducted; during such studies, test persons stayed on a desert island, in a lighthouse, or other remote places with a minimal number of contacts. The experiments show that those who are used to receiving basic emotions and impressions from some events outside bear isolation heavily. At the same time, practicing a hobby that does not require other peoples involvement helps to feel better and stay in a good mood while being at home due to COVID-19.

Increasing self-control and self-organization might also help to cope with the difficulties posed by the pandemic. People have to get used to planning their days and weeks for following a particular schedule is important for struggling with depression. Furthermore, to maintain a positive emotional state, one can think not about what they are deprived of but about the new opportunities. The isolation might be regarded as the time for finishing different projects and implementing the ideas that people have had to postpone before due to a tight schedule.

Influence of Isolation on Teenagers

Speaking about teenagers drawn to risky behavior, in my opinion, it is hard for them to endure staying at home all the time. Adolescents tend to put themselves in dangerous situations because they want to explore their limits and express individuality (Steinberg, 2010). For such young adults, following imposed rules is unbearable; hence, the teens perceive the quarantine as a restriction of their freedom (Steinberg, 2010). Unlike the group described above, adolescents who are not inclined to risky behavior are wiser and find less dangerous ways of coping with the difficulties of their age (Steinberg, 2010). Such teens might endure the isolation better than their risky peers.

Conclusion

A significant risk factor for all adolescence is the usage of social networks. During the isolation, teenage boys and girls spend much more time browsing Instagram and posting photos and videos. This might intensify negative feelings generated by staying at home (Frison & Eggermont, 2017). Researchers note that there is a direct connection between the usage of social networks and depressive symptoms in young people of 18-29 years old (Frison & Eggermont, 2017). The ground is that seeing bright pictures posted by others on Instagram might negatively affect ones self-esteem (Frison & Eggermont, 2017). To get rid of depression and other negative feelings, young adults might use the protective factors described above. Besides, they can talk to parents, relatives, or older friends who might help them to feel better. In conclusion, the quarantine enforced due to COVID-19 is a hard time for all people. However, introverts, people with poor planning skills or serious problems, and teenagers are drawn to risky behavior are most affected by the situation.

References

Frison, E. & Eggermont, S. (2017). Browsing, posting, and liking on Instagram: The reciprocal relationships between different types of Instagram use and adolescents depressed mood. Cyberpscyhology, Behavior, and Social Networking, 20, 603-609.

Luthar, S. S. (2003). The culture of affluence: Psychological costs of material wealth. Child development, 74(6), 1581-1593.

Steinberg, L. (2010). A dual systems model of adolescent risktaking. Developmental Psychobiology: The Journal of the International Society for Developmental Psychobiology, 52(3), 216-224.

Introduction

Homeless people can be described as that group of people who lack adequate, fixed or regular night-time shelter. This includes a considerable number of people who live in deplorable conditions such as abandoned buildings, public spaces, parks, and bus or train stations as well as in cars. Since the last quarter of the 20^th Century, homelessness has become one of the most serious problems affecting many urban centers in both developed and developing nations. In the U.S, homelessness has become so rampant that about 3.5 million people experience homelessness in the course of one year with 70% of them living in urban areas. Homeless people include single men and women, young families as well as runaway adolescents. Although lack of affordable housing and poverty has been blamed for increased homelessness especially among families, poor health greatly impacts on their disadvantaged status, and has been blamed for derailing any efforts to alleviate the plight of the homeless. Their vulnerability to various health problems makes life even harder for them because poor health makes it even harder for them to overcome homelessness (Galea & Vhahov 19-20; National Coalition for the Homeless).

Homelessness and Poor Health

Contrary to popular belief that homelessness is a situation confined to single men and women, thousands of families also experience homelessness each year. In reality, 41% of the homeless population is made up of families and homelessness can be especially devastating for them. Virtually every aspect of their daily lives is disrupted, and their emotional and physical lives are extensively damaged. It is bad enough for families to lack shelter but even more devastating if they are suffering health-wise. This can lead to a state of helplessness so severe that the affected persons may succumb to mental depression. The rate at which homeless people succumb to health problems is so high that, illness and injury among the homeless ranges from two to six times higher than recorded rates among the housed people. Homelessness also makes delivery of essential health services to the affected population very difficult. Due to poor access to appropriate healthcare services, chronic and acute health conditions among the homeless may receive very little or no attention; leading to very serious medical complications and reducing the homeless persons ability to overcome homelessness (McMurray-Avila 6).

Homeless people are extremely burdened by illness and disease. But the patterns of illness differ extensively between mothers, youth, and single men and women. Diseases and illnesses most common among homeless people include but are not limited to pregnancy and related problems, sexually transmitted diseases ad high rates of suicide. Female mothers however tend to enjoy better health than the single homeless women although the later are highly prone to suffering from serious mental illness. Homeless children suffer from poor health at a rate twice as high as other children. They are more prone to stomach problems, asthma, ear infections and speech problems. Mental illnesses such as withdrawal, anxiety and depression are also more common among homeless children than children from housed families. If early treatment is not readily accessible, such health conditions are likely to delay their development (National Coalition for the Homeless).

Infectious diseases such as tuberculosis, viral hepatitis, sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) infections are also very common causes of health problems among the homeless people. Tuberculosis outbreaks among them have been very common especially among those co-infected with HIV. A common chronic illness such as diabetes, seizures, hypertension and chronic pulmonary disease (COPD) are however scarcely diagnosed in homeless adults; and therefore treatment is rarely accorded such illnesses. Other sicknesses which also receive very little attention among homeless people include cancer, mental illness and depression. Dental problems and pregnancies are also quite common. Contraceptives are unpopular with most of the homeless women and lack of prenatal care together with the hardships of homeless life; often lead to low birth weight (Galea & Vhahov 21-22).

Homeless people also display extremely high rates of smoking, a habit that makes COPD very common among the older adults. Smoking also exposes them to respiratory diseases such bronchial asthma, pneumonia and upper tract infections. Life on the streets is also characterized by a lot of trauma and injuries resulting from physical or sexual assaults. Young women are especially prone to such assault. Street youth abuse a wide range of drugs such as cocaine, opiates, hallucinogens, sedatives, inhalants and amphetamines. These drugs destroy the youth in such a way that their ability to get rid of homelessness is greatly reduced (Galea & Vhahov 22-23).

Conclusion

Any attempt either by the government or other organizations to end homelessness in any individual or group of people, must seriously address the issue of healthcare provision among the homeless. Disease or ill health can derail the process of overcoming homelessness because those affected may be spending the little resources they have on provision of healthcare; or they maybe too ill to participate in any efforts geared towards removing them from their homeless condition. A healthy person has every opportunity to make money and get out of poverty and homelessness but a sick person must take care of his sickness first before engaging in any project that is meant to help alleviate the problem of homelessness (McMurray-Avila 7).

Works Cited

Galea, Sandro and Vhahov David. Handbook of Urban Health: Populations, Methods, and Practice. Warren, MI: Springer, 2005. 19-20, 21-22, 25.

McMurray-Avila, Marsha. Healthcare for the Homeless Council, Inc. 2001. Web.

National Coalition for the Homeless. Homeless Families with Children. 2009. Web.

Problem statement

Smoking has been a health problem all over the world due to its negative health effects. The allure of smoking is great particularly for teenagers but the resultant addiction makes smoking a dangerous health risk. In this light, several alternatives have been advanced to assist addicts quit smoking.

Background

According to modern research, obtaining the numbers of dead people is the initial step in improving the health of the people of that nation. A recent study conducted in India indicated that there were a million deaths caused by tobacco related diseases. This had alarming reactions from people all over the world. However, these results were not new. According to statistics, smoking can be attributed of the more than 438,000 annual deaths in the US. This leads to a loss of more than 92 million dollars due to deceased human resources (Homish et al 2011). Such statistics qualify smoking as critical risk factor for numerous diseases. Initially it was perceived as an analgesic and used to treat disorders such as intestinal complications and rheumatism. Presently, cigarette smoking is known to be responsible for more than 30% cancer deaths (lung cancer) in the US. Other diseases caused by smoking include chronic bronchitis, aneurysms, neonatal death, heart attack and stroke. Moreover, further studies have shown that more eighty thousand children worldwide begin the habit of smoking every year. This implies the number of addicts is also growing at the same rate.

Originally, it was assumed that the effects of smoking were less in India than in the USA. The smoking of bidis, a cigarette with a lesser content of tobacco than the ordinary cigarette was taken as the main reason. In addition, the uptake age of the smoking habit in India was much more advanced compared to that of the US citizens. In the US, there were more teenagers getting trapped into the smoking addiction mainly due to peer pressure. The number of cigarettes consumed by each smoker was more for the US citizens than it was for the Indians. Despite this statistics, the risk factor in smoking remains relatively the same for the two countries. Bidis is said to reduce the lifespan of a man by five years and that of women by three extra years. The ordinary cigarette, on other hand, cuts down a mans life span by more than ten years. How tobacco smoke manages to achieve such alarming results becomes the vital question.

Cigarette smoke is made up of over four thousand varied chemicals. Of these, four hundred are known carcinogens. Other vital components of cigarette smoke are oxidants such as oxygen-less radicals and volatile aldeydes. Several researchers have found cigarette smoke to contain different amounts of toxic-ants. Hoffiman and Hecht identified forty-six toxicants while the US Environmental Protection Agency (EPA) came up with a list of 82 toxicants. Moreover, numerous randomized epidemiological studies attribute cigarette smoke to numerous heart complications and chronic pulmonary disorders.

Tobacco companies have come up with ways to reduce the toxic levels in cigarettes. However, complete cessation is the only sure way to reduce the risk of exposure to different diseases by helping the smokers to quit. Many smokers are more than willing to quit and a study on the effectiveness of the quitting options available would come in handy. It will help them evaluate the easiest and most effective option available. Taking actions that prevent the teenagers from starting may be important but it will only curb the number of deaths by the year 2050.

Landscape Identification

In studying the smoking problem, several stakeholders and factors must be put into consideration. The stakeholders in the smoking problem can be divided into two major categories: smokers and tobacco companies. The smokers are the divided into two categories: active smokers and passive smokers. Active smokers are the smokers who actually smoke while the passive smokers are those who inhale the cigarettes smoke by being situated next to smoker. These include the smokers friends, co-workers and relatives. The different factors that affect smoking are:

Social factors

Social facts play the greatest of role in determining the level of tobacco consumption. First, the smoking habit of the smoker was most probably initiated by social habits. The social theory identifies smoking as one of the habits acquired by example. Parents, siblings or successful actors and musicians play a vital role in influences young peoples actions (Kong et al 2011). Smokers may have adopted the smoking habit since a close relative to whom they look up to was a smoker. Moreover, music videos and movies portray smoking as a prestigious habit which greatly influences the potential smokers to start smoking. In other instances, smoking can be used to initiate and perpetuate friendships. Requesting a stranger for a match box can at time act as an icebreaker in a conversation. The smoking zones in the working areas and in streets in certain countries also create opportunities for bonding for the smokers. These social factors may act as hindrances to the quitting process particularly if the friendship bond has its roots in the smoking habit. Attempts to quit may be viewed as criticism of the habit which may eventually break up the friendship bond.

Tobacco companies are aware of the potential of the social habits and continue to sponsor sporting activities that are appealing to the young generation. This makes the smoking appealing and therefore increasing the likelihood of future smoking by these youngsters (Fichera & Sutton 2011). For instance, tobacco companies pump in millions into the motor industry. According to recent studies, young people that are great fans of the motor sport exhibit a greater likelihood of smoking than those who are not. However, these companies ensure they do not portray the negative aspects of smoking such as the discolored fingers, bad mouth odor and increased risk of disease contraction. In addition, critical health complications may result in the death of the smoker. This becomes a loss to all the beneficiaries of the smoker particularly the nuclear family. Emotional suffering due to parental loss could lead the children to develop a smoking habit as a way to relieving themselves off the stress (Laura 2011).

Political

Tobacco companies ensure their products reach their customers through sales by middlemen. In any given country, there are rules that govern the sales and smoking of tobacco products. Such legislations include the government imposition of exorbitant taxes on the numerous tobacco products in an attempt to limit the number of smokers. The government is concerned with the health of its citizens and is well aware of the negative effects of tobacco smoking. The tobacco companies are well aware of this and go as far as bribing the law makers for them to formulate laws in their favor. Tobacco lobbies spend up to $100000 daily on politicians to prevent deregulation of tobacco. Lawsuits filed against tobacco companies end up closed through punitive damages to the plaintiffs or rulings in favor of tobacco companies. In other instances, politicians use smoking as an image of identification. It portrays them as care-free thus endearing them to the people (Anonymous 2011). Promises to amend laws related to smoking could also be used to woo voters into voting in favor of the politician.

Economics

The economics of tobacco industry can be analyzed on the basis of elasticity of its demand and prices and the implications on the market under reference. Economic forces can be modeled in such a way that they contribute to the reduction of the death toll due to consumption of tobacco. Since excise tax makes up a section of the price of a commodity, numerous countries including the United States of America (USA) use taxation as a key strategy to cut down the rate of tobacco consumption. Tobaccos response to demand is similar to that of other commodities. Economists definition of price is not only monetary but it also includes other factors such as time and cost relating to the product. The restrictions and setting aside of smoking zones imposes additional costs on the smokers. Fines imposed on those who break this law also serve as additional costs. In addition, limiting youths accessibility to tobacco may help determine the first age of tobacco consumption as well as evade the additional costs. Other factors that influence the demand of cigarettes are income of the smokers, advertising and other promotional activities by the tobacco companies and taste differences.

In industrialized nations, the relationship between the smokers income and the rate of cigarettes smoking is reversed. Unlike earlier, cigarettes are now classified as inferior goods. This implies an increase in the income of the smokers is followed by a subsequent decline in the rate of cigarette smoking. Wealthy people have a greater access to information on the negative effects of smoking and therefore tend to abstain from smoking. In developing countries, the increase in the price of cigarettes results in a subsequent decrease in the rate of tobacco consumption by the smokers. Despite the legal restrictions on the advertisement of tobacco, tobacco companies spend millions on the adverts to ensure they reach as many potential customers as possible. They do these based on studying the economics of tobacco products.

Legal factors

There are numerous laws that govern the sales of tobacco products in all countries. For instance, there is an age limit below which minors should not smoke. Parents and law enforcers ensure minors do not smoke tobacco before their right age. This helps limit the number of smokers in the country (Frank 2011). Moreover, there are laws that limit public smoking to certain zones provided by the municipalities. This is intended to reduce the level of pollution. Laws have also been put in place to determine the time during which the smoking advertisements are aired. This is intended to reduce the number of minors with accessibility to the television from starting the smoking habit. Lastly, some countries demand that every cigarette packet be accompanied by a warning on the negative health effects of cigarette smoking. All the laws are backed by penalties should they not be followed or broken.

Tobacco companies are affected negatively by these laws as they are bent on decreasing their sales. However, the health of the people comes before the monetary returns. Therefore, tobacco companies have no choice but to comply. The age limit law is the most observed as the minors have parents who limit their freedom and thus control the age at which they begin to smoke. The health warnings on the cigarette packets are mostly ignored by the smokers. A majority of them are addicted and quitting is not an easy option.

Alternative options

Majority of the smokers depend on a combination of counseling, medications and family support in order to quit smoking. The interventions that help one quit smoking are referred to as smoking cessation. There are health insurance policies that cover smoking cessation particularly counseling and medication. Under counseling, all the plan participants are entitled to telephone-based counseling. The health plan should cover all medical alternatives below. While some of the medications need a prescription, others are sold over the counter. Doctors are usually in the best position to advise their clients on the best method or combination of methods to help treat their cigarette addiction. Nicotine in the cigarette is not responsible for the cancer in a smokers body. Therefore, nicotine replacements are in certain cases used in medication. The quitting process requires persistence as a single attempt may not work the magic. Successful attempts require up to eight or ten times according to current statistics (Malarcher et al 2011). The alternative treatment options are as below.

Self-Help

This refers to a smoking cessation method in which experienced or educated groups or individuals write out materials such as pamphlets, booklets, mailings accompanied by videotapes and audiotapes to help the smoker in the quitting process. These methods become necessary since physicians and therapist-facilitated interventions can only reach a small group of people. The main intention of this method is to avail behavioral interventions and alleviate the need for treatment attendance. The self -help materials can be disseminated and applied as smoking cessation interventions on a wider scale than other therapist-delivered interventions. The self- help methods are either tailored for an individual or non-tailored.

Advantages

This method can reach a greater number of people at the same time since the information can be shared. A single self-help material can be used by different people at different times with no need for additional costs to be incurred. Moreover, its documentation allows future reference with no additional costs where necessary. The information in the material remains unchanged for long periods of time making it more reliable. It does not depend on the physicians ability to communicate the intended message effectively. In addition, the cost of purchasing the self-help materials is relatively low. Pamphlets can go for less than $100 while videos and audio tapes cost much less. This makes them affordable to the smokers. Lastly, the smoker can easily determine the schedule for the quitting process depending on the supposed treatment process.

Disadvantages

Self-help methods depend on the smokers ability to comprehend the instructions given in the pamphlet, audio tape or video. The smoker may wrongly interpret them and in the process fail to achieve the intended purpose. Use of written pamphlets may not effectively convey the message intended and therefore complicate the whole quitting process. Making the process difficult has the effect of discouraging the smoker as the process is not particularly easy. Moreover, the process is demanding and may require a lot of follow up by a second party. Having self-help materials does not avail the appropriate follow up pressure required and could cause the smoker to quit midway. The method may therefore demand the services of a third party which may not be available. In addition, certain self-help materials may be expensive for the smokers making the quitting process expensive. Efficiency of this method is therefore not reliable.

Counseling

Successful quitting results from two forms of counseling and behavioral therapies. First is ensuring the smokers acquire practical counseling in which they acquire problem solving skills. Secondly, making sure the smokers get the support and encouragement in the process of treatment (Steinberg et al 2011). These are sometimes incorporated within other smoking cessation interventions. The telephone quit lines such as the American 1-800-QUIT-NOW ensure call-back counseling is available for all those who are willing. The cost of this method can be analyzed based on the organization offering it and on the smoker intending to quit. A recent study shows that the wages of the counselors handling about 1440 smokers could go up to $27.3 million but would result in a gain of over thirsty thousand lives. A normal counseling program can cost the smokers averagely $540 when only the intervention costs are considered. The organization from which the smoker seeks help must be registered within the laws of the country concerned.

Advantages

Smokers receive counseling from professional physicians or therapists. Such professionals are properly trained on the most appropriate ways to successfully help the smokers quit the smoking habit. They administer the required amount of follow up and are available should anything be difficult or beyond the patients understanding. The telephone quit lines are operational twenty four hours in a day thus making them convenient for the smokers to reach.

Disadvantages

Counseling requires set up of particular schedules with the counselor which could conflict with the smokers working schedule and therefore complicate the quitting process. This method can be expensive particularly for the group or organization offering it. Compared to the self-help materials, the intervention is more expensive particularly if follow up telephone calls are provided. In addition, the attitude and personality of the therapist can determine the effectiveness and the time taken before the intended goals are met.

Bupropion SR

Following approval by FDA in 1997, Bupropion SR became the first non-nicotine medication identified to give successful smoking cessation results. It achieves these results by acting on the chemicals associated with nicotine craving. Usage can be done alone or in conjunction with nicotine replacements. Patients with seizure disorders, any previous or present identification of bulimia or anorexia nervosa, a two week period usage of Monoamine oxidase (MAO) inhibitor, or present intake of any form of medicated drug containing bupropion should use this method. Prescription is mandatory for this form of medication. According to studies conducted by the British National Coordination Center, the application of bupropion is relatively affordable as compared to the NRT method discussed below. The cost is approximated to be $700 for the complete intervention process. In the application of this method, the motivational support should be accompanied by the prescription (Planer et al 2011).

Advantages

This method is considered much cheaper than all the other the NRT options. The period required for the quitting process is relatively reduced and therefore chances of the smoker being persistent are very high. Cigarette smoking introduces nicotine into the body system of the smoker and causes an unending craving for nicotine. It is a non-nicotine method and therefore does not cause any harm to the smokers body. Studies have indicated that nicotine based methods could cause effects of nicotine similar to those caused by smoking-related nicotine.

Disadvantages

Unlike the other forms of medication, it requires prescription. Bupropion SR demands seeking services in certain locations that might involve additional travel costs. Absence of the designated personnel could cause the delays in the medication process as the drugs cannot be purchased over the counter. It has side effects such as rash, insomnia, headache and tremor. These may result from withdrawal from application of the treatment. Its most distinguished side effect is seizure (Andrea 2011).

Nicotine Replacement Therapy

This refers to the application of Nicotine Replacement Therapy (NRT) bent on replacing the nicotine from cigarettes and subsequently curbing symptoms of nicotine withdrawal. Application of different types of NRTs, for instance, gum and patch and combination with Bupropion SR is possible under this form of medication. However, pregnant women who smoke are usually advised against using NRT. Nicotine gum has been proved as a reliable smoking cessation treatment option. Usually, the recommended dosage for the highly dependent smokers is 4mg compared to the 2mg for lighter smokers. The smoker is required to chew the gum thus quickly delivering nicotine to the brain and the blood. If done for two or more weeks, likelihood of the smoker quitting is doubled. Another effective smoking cessation treatment is the nicotine inhaler. This refers to a plastic tube containing a nicotine cartridge. A nicotine vapor is released when the inhaler is puffed on. The quit rate with this method is relatively higher as it closely resembles that of smoking a cigarette. It is about twenty five percent. Nicotine lozenge is a tablet that emits nicotine into the smokers body by dissolving in the mouth. It requires o prescription and is available over the counter. It demonstrates a quit rate of about twenty four percent. The working of the Nicotine nasal spray is similar to that of the inhalers but has a higher quit rate of about twenty seven percent. Lastly, there is the Nicotine patch that delivers successful results by being smeared on the smokers skin. The dosage is reduced gradually in the course of a few weeks. The usual dosage is 25ml but can be increased with the anticipation of a higher likelihood of quitting. Patches can be prescribed by a medical professional or purchased over the counter.

According to studies conducted recently, the success of the NRT intervention is not dependent on the form of NRT used. All the forms lead to relatively similar results. Moreover, provision of additional support to the individual does not necessarily increase the chances of quitting. The recommended time period is eight weeks and any extension does not necessarily guarantee different results.

Advantages

This method reduces the urge to smoke and down cuts the symptoms associated with attempts to quit smoking. The different forms of NRT allow the smoker to identify the most appropriate form for their condition. Its ability to deliver excellent results without the need for counseling or any motivational support makes the process cost-effective. Moreover, the period of use of the NRT is rather short (Vidrine & Vidrine 2011).

Disadvantages

All forms of NRT have certain side effects associated with them. For instance, gums and tablets can cause irritation to the mouth. Patches also cause irritation to the skin. Since, they only replace the smoking-related nicotine with another form of nicotine; the initial effects of the nicotine may still be experienced. However, studies into this matter have shown that NRT do not cause heart attack as initially believed. Moreover, the method is limited to certain smokers only; it is not universal. Its costs are relatively higher as compared to the other forms of medication already discussed.

Varenicline

This is usually sold as Chantix in the US and as Champix in foreign nations. It was recently approved for the smoking cessation treatment. It is an agonist of nicotinic acetylcholine receptors and utilizes its lower binding affinity with other alpha-seven receptors to alter the reinforcing effect of nicotine in the smokers body. The rewarding and reinforcing effects of smoking are achieved by inhibiting the binding of nicotine to alpha-four-beta-two receptors. Usually, it is available in packs of fifty six 0.5mg or 1mg tablets. This pack costs $54.60 while a twelve-week course treatment costs three times the same amount. When its effects are accessed retrospectively or prospectively, varenicline is used to lower the smoking urge. However, these results are particularly limited to men as women take longer to respond. The results are also dependent on the smokers interest to quit. The higher the interest of the smokers causes faster effects of varenicline. It is normally prescribed as a part of behavioral support (Yeomans et al 2011). Smokers intending to quit are required to set the date of quitting and start application of varenicline about fourteen days before. Just as the bupropion SR and NRT, use of varenicline causes nausea and gastrointestinal disorders (Kathleen 2011).

Advantages

Varenicline is cheap and affordable to many smokers. It is requires a short period of use before the supposed quitting date. Moreover, since tablets are taken, it does not interfere with the working schedule of the smoker and is therefore is more flexible to apply (Erin 2011).

Disadvantages

Usage of varenicline results in side effects such as vomiting that may discourage the smoker. In critical cases, this form of medication works better when combined with motivational support. This in turn increases its cost.

Comparison table

Recommendation

Among the five smoking cessation treatment alternatives, the most efficient is varenicline. This method is better than self-help material and counseling as it works to limit the smoking rewards of nicotine which forms the root of the addiction. It allows a flexible quitting process as the tablet can be taken at ones convenience. In comparison to the other medications it is relatively cheaper with a short duration of use. Recent studies indicate varenicline demonstrates significantly greater quit rate than bupropion SR: odds ratio 1.93(ninety five percent confidence interval of 1.40-2.68). The study further proves varenicline to be superior to bupropion SR and NRT, both in the short-term and long-term. According to a study in the manufacturers submission, varenicline sustained its domination over bupropion and NRT- both in cost and efficiency- for twenty years and over. Moreover, varenicline achieves continuous abstinence better than other forms of medication (Karam-Hage et al 2011). The documented success rate (70%) distinguishes it from all the other smoking cessation intervention especially because multiple quit attempts are required by many smokers. According to the extrapolated results, varenicline can save up to more than eighty thousand lives in a period of less than three months. Smokers willing to quit can apply this medication combined with a little motivational support for better and more satisfactory results. However, it is important to note that the quitting process demands persistence and perseverance before any results can be observed. The smoker should also maintain a positive mental attitude throughout the whole process.

References

Andrea L. (2011). W.Va.s Smoking Problems Can Be Solved With the Right Programs. The State Journal, 27(37), 16.

Anonymous. (2011). Smoking Cessation Resources for Patients. The Journal of Cardiovascular Nursing, 26(6), 431.

Erin, J. (2011). Tool kits join the war on smoking. The Centralian Advocate, 17.

Fichera, E., & Sutton, M.. (2011). State and self-investments in health. Journal of Health Economics, 30(6), 1164.

Frank, B. (2011). Roundup: Tobacco giant launches High Court challenge to Australias plain cigarette law. Xinhua News Agency  CEIS.

Homish, G., Eiden, R., Leonard, K., & Kozlowski, L. (2011). Social-environmental factors related to prenatal smoking. Addictive Behaviors, 37(1), 73.

Karam-Hage, M., Strobbe, S., Robinson, J., & Brower, K. (2011). Bupropion-SR for Smoking Cessation in Early Recovery from Alcohol Dependence: A Placebo-Controlled, Double-Blind Pilot Study. The American Journal of Drug and Alcohol Abuse, 37(6), 487.

Kathleen S. (2011). Snuffing out youth smoking. The Washington Post, p. A.17.

Kong, G., Camenga, D., & Krishnan-Sarin, S. (2011). Parental influence on adolescent smoking cessation: Is there a gender difference? Addictive Behaviors, 37(2), 211.

Laura, B. (2011). Smoking rate at all-time low; Teen smokers slide to 12%. The Ottawa Citizen, C.11. Retrieved December 24, 2011, from ProQuest Newsstand.

Malarcher, A., Dube, S., Shaw, L., Babb, S., & Kaufmann, R. (2011). Quitting Smoking Among Adults  United States, 2001-2010. MMWR. Morbidity and Mortality Weekly Report, 60(44), 1513-1519.

Planer, D., Lev, I., Elitzur, Y., Sharon, N., Ouzan, E., Pugatsch, T., Chasid, M., Rom, M., & Lotan, C. (2011). Bupropion for Smoking Cessation in Patients With Acute Coronary Syndrome. Archives of Internal Medicine, 171(12), 1055.

Steinberg, M., Randall, J., Greenhaus, S., Schmelzer, A., Richardson, D., & Carson, J. (2011). Tobacco dependence treatment for hospitalized smokers: A randomized, controlled, pilot trial using varenicline. Addictive Behaviors, 36(12), 1127.

Vidrine, D., & Vidrine, J. (2011). Active vs. Passive Recruitment to Quitline Studies: Public Health Implications. Journal of the National Cancer Institute, 103(12), 909.

Yeomans, K., Payne, K., Marton, J., Merikle, E., Proskorovsky, I., Zou, K., Li, Q., & Willke, R.. (2011). Smoking, smoking cessation and smoking relapse patterns: a web-based survey of current and former smokers in the US. International Journal of Clinical Practice, 65(10), 1043-1054.

One of the most important trends is the continuous use of digital technologies in healthcare. Digital technologies are laying the foundation for increasing the efficiency of healthcare systems, increasing the ability to track health indicators. Thus, they improve the quality and safety of treatment through the use of artificial intelligence and personalized medicine. Subsequently, another important trend is that the active digitalization of medicine has led to the availability of huge data on patients, specific cases of diseases and treatment histories. Big Data will allow healthcare professionals to make informed decisions about choosing the most effective methods for diagnosing and treating patients, making medical predictions and organizing care in general.

In my opinion, Millennium Development Goals truly reflect the need to resolve the most acute needs of global society. At the same time Health and Healthcare in 2032 provides more active strategic planning. Specifically, I think the goal of combatting HIV/AIDS is the most promising, as the evidence from Berliner and London patients treatment shows very good perspectives of treating AIDS. However, I want to set my main goal as a professional nurse reducing maternal and child mortality, as these two issues are still acute everywhere in the world.

Today in medicine, developments related to artificial intelligence are most in demand, and I think that is one of the crucial concepts of future healthcare that requires the most interest. AI is already actively used in diagnostics, drawing up a personal treatment plan and selecting the optimal formulation of drugs. We need to develop this technology further to provide healthcare up to the high standards of the XXI century. Pereno and Eriksson (2020) add that innovative policy instruments are crucial to promote radically sustainable innovations in the healthcare sector (p. 1). Additionally, telemedicine also belongs to digitalization, and needs active development. There are still many areas where medical care remains difficult to access. Video and audio chats with doctors can become the only accessible healthcare for some people, thus, it is quite important to enhance this technology.

Reference

Pereno, A., & Eriksson, D. (2020). A multi-stakeholder perspective on Sustainable Healthcare: From 2030 onwards. Futures, 122, 102605. Web.

Ten million illegal immigrants live in the US, according to estimates by academic and government agencies, although Bear-Stearns investment firm analysts claim that the US illegal immigrant population may be as high as 20 million people. (Illegal Immigration, 2 May 2009).

Every year millions of people sneak illegally into another country by crossing the border line, this is very common in United States of America. This is called illegal Immigration, in other words, people who do not have work permit or any kind of permission from the government to come and stay in that particular country. The same affects the health facilities in the country and negatively impacts the overall healthcare facilities in the USA.

Research has found that illegal immigration affects the citizens of that particular country, especially the poor people and the legal immigrants. It is also found that the taxes paid by these illegal immigrants are far less than the services received by them. Countries like United States of America are trying their level best to counter this by increased border patrol but this is not only reason for illegal immigration, most of the cases occur because of people who overstay even after their visa is expired.

United States of America provides Medicaid facilities to the legal and illegal immigrants but this results in a very big loss for the economy of the country because the people take undue advantage of the same by overstaying in the hospitals even after recovery. The Medicaid policies depend on state to state but there are some states in America which provide the young children and elders requiring medical attention with great facilities like free drugs, free nursing and proper medical attention.

Off late the federal law has brought in many restrictions to keep a check on the illegal immigrants, this also ensures a strict check on the money spent on the public welfare. Some of the services provided by Medicaid to the people are Vaccine for the children, rural health care services, transportation services and these are just a handful of many services provided by the Medicaid in America.

The funding of these services provided by the states comes from a partnership between the federal and the state government and this was established in the year 1965, this comes under the social security act. States with lower per capita income get more government money, those with higher get less. This Federal Medical Assistance Percentage (FMAP) in 2000 paid 76.8% of all Medicaid in Mississippi, 70 % in the District of Columbia, and 59.8% in Alaska. Alaskas FMAP increased markedly in 2005. The federal government also reimburses states for Medicaid administration and for Indian Health Service facilities. (Medicaid, 2 May 2009)

Medi-Cal is Californias Medicaid program. This is a public health insurance program which provides needed health care services for low-income individuals including families with children, seniors, persons with disabilities, foster care, pregnant women, and low income people with specific diseases such as tuberculosis, breast cancer or HIV/AIDS. Medi-Cal is financed equally by the State and federal government. (Health care services, 2 May 2009).

There are various programs under Medi-Cal, some of the most noticeable ones are, Access for infants and mothers which provides pregnant women with a very low cost quality attention. American Indian infant Health Initiative, this provides the Indian families with home management services to the families at high risk. According to a study it was found that the largest expenditure made on illegal immigrants was on their childrens education. There are many other facilities given to the illegal immigrants and there is so much spent day in and day out in providing these services to these people.

Major Problems and solutions

There are many people in the US who are uninsured with regard to the health care; the young children especially become very vulnerable because of the same, an example will prove the point better young children who are uninsured have very less or no chance of being operated if they are diagnosed with a deadly disease like cancer or for that matter any other disease. The cost of health insurance has been constantly on the rise in the country and it is becoming very difficult for the people in the country to afford insuring themselves against the possible occurrence of any health related problems.

The uninsured people in the US owe a lot of money to the hospitals, the collection agencies are trying to collect the money from them. The children who have not been insured are very less likely to receive treatment even if they suffer from serious injuries. Even those who have been affected by lung cancer or other serious diseases that require a surgery to be done will not be operated if they are not insured. Patients suffering from diseases like heart-attack will not receive angioplasty if they are not insured. Patients suffering from Pneumonia are very less likely to receive facilities like X-Ray and other medication. (Health Care in America, 2 May 2009).

Racism in the US also affects the health of the people who are a minority in the country; the blacks are very vulnerable to developing chronic diseases and this is because their homes are located in poor localities in the US, the same has a bearing on their health and makes them extremely vulnerable to developing diseases like cancer, HIV/AIDS etc. The blacks are treated differently than the whites in the US, for instance the treatment or the medical prescription given to a white would be very different than that of a black who visits the same hospital. This not only affects the health care system in the country but it also affects the overall balance of a country.

The government has to take initiative to improve the overall quality of health care in the country. First of all the government should make sure that no discrimination of any kind takes place in the country, by doing this the US would make sure that the blacks or the minority do not suffer from what they are suffering now, this would enable them to prosper inevitably resulting the growth and development of the country.

Another thing which has to be done is that the government must take initiative to establish more hospitals in the country because there have been numerous cases when the shortage of hospitals in the country has resulted in the death of many people so to make sure that this is not repeated in the future, the government should establish more hospitals in the country. If these two steps are initiated than the overall health care system in the country is sure to develop by leaps and bounds.

Solutions to Prevent Illegal Immigration in the US

The US government had been ineffective in dealing with the problem of immigration, there are many ways by which the people violate the rules set by the US government for instance people who have got expired Visas still stay in the country, this is illegal and the US government has to deal with this problem sooner rather than later. The same has devastating impacts on the economy of the US.

The example of the Medicaid policies was just a small example to prove that the government of the US incurs hefty losses due to immigration of people. It is high time for the US government to make stricter rules and to follow those rules at any cost if they are to stand any chance of protecting their country from this serious problem. The security at the border has to be tightened to make sure that no person is given the liberty to sneak in the US. There are lapses in the security which is why the illegal immigration is constantly on the rise and the most worrying factor is that the government in spite of knowing this has been unable to take appropriate steps.

Companies like Wal-Mart recruit immigrants, whether they are recruited knowingly or unknowingly is a different question altogether, in the year 2005 the company had to pay a whopping $11 million to the US government when it was found that hundreds of thousands of employee working in Wal-Mart were illegal Immigrants. This goes to show the failure of the US government to deal with this long standing problem. Some possible solutions can be fines, Arrests, Military service etc (How Should the US deal with illegal Immigration, 2 May 2009). The country has already suffered a lot of loss because of this problem; they cannot afford to ignore it. If they do so then the future of the US citizens is certainly not looking bright.

References

Health care services. In Dhcs.ca. Web.

Health Care in America. In Kottke. Web.

Illegal Immigration. In US Liberal Politics. Web.

Medicaid. In News with views. Web.

Precipitating Factors

Institutional violence includes various institutionalized acts of aggression committed by societal agents (James & Gilliland, 2012). Healthcare workers, as people who play a frontline role during emergencies or crises, are more prone to victim aggression than other professionals are.

In recent years, a number of factors, namely, substance abuse, gender stereotypes, mental illness, and deinstitutionalization (James & Gilliland, 2012) have precipitated violence in various institutions, including schools. With regard to substance abuse, aggressive behavior has been attributed to intoxication and the use of illicit drugs.

Modern social institutions, including day care centers, operate in deinstitutionalized (less restrictive) environments. This has increased the likelihood of clients falling back to their previous mental states during the course of treatment (James & Gilliland, 2012, p. 132). On the other hand, mental disorders, including hallucinations and delusions, also make victims more impulsive and violent. Masculine stereotypes that require men to be competitive and aggressive also precipitate violent dispositions in male clients.

Institutional Culpability

Social institutions, through their discriminatory policies and procedures, commit abuses against certain groups or individuals. In particular, human services institutions that require their personnel to follow strict procedure and protocols impede personal introspection and criticism of institutional activities (Allen & Sheen, 2005, p. 29).

The fact that everyone is following strict routines depicts the institutions activities as conventional and legitimate. They require their agents to adhere to standard operating procedures as prescribed by the organization (Allen & Sheen, 2005, p. 27). This results in institutionalization of violence.

Institutions also foster violence through their bureaucratic reporting procedures and protocols. Besides subverting moral restraint, bureaucratic routines create a situation where no single person takes full responsibility for violence against a client. Such institutions evoke blind loyalty and obedience to the people in authority, which makes the staff less critical of the institution or its activities.

Staff Culpability

The medical staff members are expected to exhibit empathy and concern for their clients, in the assumption that the recipients will reciprocate (Bass & Yep, 2002). However, social workers should watch for signs of a potential assault as their actions or institutional systems can provoke the client. Patients afraid of a treatment or an intervention may act aggressively towards the staff members.

Additionally, overbearing staff members can make the patient to feel powerless and turn violent (Bass & Yep, 2002). Conversely, clients may act aggressively if the intervention entails seclusion or physical restraints.

Staff members also define appropriate behavior within a facility. While doing so, they should be firm, fair, and non-dictatorial to motivate the client to be cooperative and obedient. Denying clients certain privileges will only breed more violence (Bass & Yep, 2002).

The staff members disposition and attitude towards his or her client also determines the likelihood that he or she becomes a victim of assault. In general, those who exhibit indifference towards clients are more assaulted than those who do not (Gadon, Johnstone & Cooke, 2006). Inexperienced staff members are also more likely to be assaulted than experts are.

Legal Liability

The medical staff, in some instances, may be held liable for their work-related actions. Criminal liability also includes the administrators of the institution. When a patient is injured, the staff and the directors are held legally liable for not performing their duty of providing care owed to clients (James & Gilliland, 2012, p. 127).

Lawsuits against medical staff usually involve misdiagnosis and incorrect procedures to control clients exhibiting aggressive behavior. On the other hand, directors are required to implement measures to prevent workplace violence, which is a serious health issue.

A medical staff member may also be legally liable for violence if he or she fails to inform others that the client is known to be aggressive (James & Gilliland, 2012).

A history of aggression is a strong predictor of future violence. In this regard, a medical worker should examine the clients medical records to find out if the patient has a history of aggression and advise the others to take precaution. This will absolve him or her from legal responsibility in case the client becomes violent.

Model of Intervention

Intervening during a crisis requires careful planning and coordination to help the client and his or her family to overcome the problem. The popular model of crisis intervention entails nine steps. The first step entails building a trust relationship with the client. It requires the healthcare worker to be respectful, a good listener, sincere, and sensitive to the victims needs (Allen & Sheen, 2005). Respect helps build a good rapport with the client.

The second step involves encouraging the client to express his or her emotions. Feelings of anger and frustration reflect the clients emotions towards the present crisis (Allen & Sheen, 2005, p. 41). Once a good rapport has been built, the client and the social worker discuss the crisis and how it happened. During this step, the client reveals the causes of the event and the measures his or her family undertook to mitigate the problem.

After the discussion, the healthcare worker assesses the family needs and strengths to deal with the crisis (Allen & Sheen, 2005, p. 42). In step five, the healthcare worker develops an explanation for the event or problem before working with the family to develop an appropriate solution to the problem.

After identifying the solution, he or she formulates an all-inclusive treatment plan that would ensure a holistic care for the client. The treatment plan terminates once the family is able to cope well, based on the healthcare workers assessment. However, regular follow-ups continue even after the intervention ends.

References

Allen, M. & Sheen, D. (2005). School-based Crisis Intervention: Preparing all Personnel to Assist. New York: Guilford Press.

Bass, D. & Yep, R. (2002). Terrorism, Trauma, and Tragedies: A counselors guide to preparing and responding. Alexandria, VA: American Counseling Association.

Gadon, L., Johnstone, L. & Cooke, D. (2006). Situational variables and institutional violence: A systematic review of the literature. Clinical Psychology Review, 26(5), 515-534.

James, R. & Gilliland, B. (2012). Crisis Intervention Strategies. Belmont, CA: Cengage Learning.

Status of women in Honduras ranks very low owing to gender inequality. In social, economic, and political aspects, women are in lower positions than men because cultural factors deny them the opportunity to participate actively in the society as their male counterparts. Culture, norms, and traditions have restricted roles that women play in the society. While men dominate in high positions in social, economic, and political aspects, women occupy the remaining low positions. According to United Nations Development Program (2014), Honduras ranks 100 in gender inequality index out of 146 countries. This means that gender inequality in Honduras is below the average as women experience significant discrimination in social, political, economic circles. Bautista (2004) argues that poverty makes women to play secondary roles in Honduras since they belong to low socioeconomic status. In this case, gender inequality appears to be a fundamental factor that defines the roles of women in Honduras as it relegates them to meager duties that do not empower them economically, politically, and socially. Therefore, this essay examines the impact of the social status of women in Honduras on their education, employment, and social rights in relation to health.

The status of women in Honduras reflects their education status and consequently indicates health status of women. Women with high levels of education usually have good health because they can afford and access healthcare services because they are informed, unlike women with low education, who cannot understand the nature of healthcare services that is imperative for their health. The illiteracy levels and school attendance rates among girls are lower than in boys because they are 19.8% and 5.9% respectively (Bautista, 2004). These statistics show women of Honduras need affirmative action or policies that would enhance their educational standards and empower them. Murphy-Graham (2008) asserts that since education empowers women, Honduras needs to provide special education, which focuses on awareness of gender equity, self-confidence, and knowledge, to empower women. For this reason, education provides a means of empowering women socially, politically, and economically so that they can play a central role in improving their health conditions.

Employment is also an issue that relates to the status of women because the labor sector discriminates against women. Since women are subject to cultural norms and traditions that restrict their roles in the society, Women of Honduras do not have an equal chance in the employment sector. The enactment of Equal Opportunities for Women Act has enhanced employment rates of women and property ownership. Bautista (2004) reports that women employees increased by 12%, 9%, and 8.5% in financial institutions, commerce and transport, and agriculture respectively. These statistics imply that significant numbers of women are gradually entering into the employment sector, unlike in the past where their numbers were negligible. From the health perspective, these statistics imply that women can now afford and access healthcare services because of the economic empowerment.

Women of Honduras do not enjoy their social rights fully because of their status in society. The representation of women in the political arena is still low because women comprise 8.6% National Congress (Bautista, 2004). This shows that women have poor representation in leadership positions. Carlsen (2013) asserts that women have joined numerous social movements to agitate for their rights as they claim that they constantly experience sexual violence, femicides, poverty, marginalization, and inequality. Men violate social rights of women because of their status in the society and unfair norms and traditions that consign women to meager roles that do not empower them. Price and Asgary (2011) hold that the social conditions women in rural areas prevent them from achieving better health status like women in urban areas. In this view, restricted social rights of woman in Honduras create a society that supports male dominance and discriminates against women.

References

Bautista, L. (2004). Report of Honduras on Implementation of the Beijing Platform for Action (1995) and the Outcome of the Twenty-third Special Session of the General Assembly (2000). Web.

Carlsen, L. (2013). Women Raise Banner of Womens Rights in Honduran Popular Movement. Web.

Murphy-Graham, E. (2008). Opening the black box: Womens empowerment and innovative secondary education in Honduras. Gender and Education, 20(1), 31-50.

Price, J., & Asgary, R. (2011). Womens health disparities in Honduras: Indicators and determinants. Journal of Womens Health, 20(12), 1931-1937.

United Nations Development Programme (2014). Gender Inequality Index. Web.

Introduction

Smoking simply refers to a practice in which a known substance, usually cannabis or tobacco, is burnt and the smoke it produces is inhaled directly. The combustion releases active substances like tar and nicotine that are responsible for lung poisoning and infection. When inhaled, the smoke induces spiritual enlightenment and trances, it is also a major health hazard that indirectly claims the lives of many people by causing a variety of diseases including cervical cancer, lung cancer and other chronic obstructive pulmonary diseases (COPDs). Other risks caused by smoking include: the raising of an individuals blood pressure, the worsening of ones asthmatic conditions, the development of ulcers and the occurrences of erectile dysfunctions especially in males. The discussed below are some of the health-care policies and economic impacts of smoking.

Economic Impacts of Smoking

The most common method of smoking today is through cigarettes that contain tobacco, nicotine, tar, carcinogen, carbon monoxide and cannabis. These compounds are referred to as narcotics and have the following effects when ingested in the human body. Feldstein (2007, pg. 82) advices health medical officers to help in the reduction of the cost of treatment by lowering the number of high medical-cost subscribers such as, heavy drinkers, drug addicts and tobacco smokers through medical insurance.

The carcinogenic components of a cigarette are responsible for causing up to 60% of the cancerous diseases suffered by humans. The presence of carcinogen stimulates the growth of cancerous cells in the human body causing various types of cancers in the body namely: mouth cancer, lung cancer, throat cancer, bladder cancer, cervical cancer and cancer of the kidneys. This in turn raises the health-care cost of smokers since they always undergo very expensive medical treatment methods including surgery and radiology, as compared to the non-smokers who are less likely to be attacked by cancer.

Heavy smokers risk very high chances of contracting COPDs due to the blockage of their airflow systems by the cigarette smokes resulting into breathing difficulties. These chronic obstructive pulmonary diseases include emphysema and chronic bronchitis, which are characterized by severe coughing and chest pains. In fact, the research says that smoking is responsible for up to 80% of COPD cases in the recent years and that 94% of 20 smokers per day are suffering from emphysema while 90% of the non-smokers lack COPD attacks (Macnair, 2011).

Smoking is also accompanied by other risks including fertility problems and impotency where married couples experience hormonal imbalances with the males experiencing erectile dysfunction (ED). In fact, Feldstein (2007, pg. 32) argues that the worldwide smoking reduction program has lowered cost per life saved (from $1,000,000/40 to $50,000). He adds that the life expectancy and death rates are highly dependent on a number of factors including, drugs usage, smoking, diet, cultural values and many others. Nicotine narrows the blood capillaries within the penis and reduces the blood flow into the penis, hence, causing ED. Smoking raises the blood pressure levels of the smokers, thereby, exposing them to strokes and heart attacks; it also accelerates and worsens their asthmatic conditions. Tobacco smoking impairs muscular activities resulting into eyesight loss and development of cataracts due to the reduction of vitamin A levels in the human body.

Tobacco and cigarette production have been on the rise in the recent years. Therefore, the American Economics Group report in 1996 concluded that tobacco generated more than 1.8 million jobs producing over $53.4 billion wages and benefits. This sector has also generated taxes amounting to $36 billion (Warner at al, 1996). In their extensive research on Michigan incomes, Warner et al (1996) proposed that tobacco contributes to up to 1% of the regions employment opportunities, hence, raising the number of jobs within the region is up to 133,000 vacancies nation wide. However, in terms of impacts, cost efficiency and efficacy, tobacco-use infections are ranked amongst the top three expensively treated human infections (Maciosek et al, 2006).

Smoking Health Policies

Due to the rise of the health-care cost, certain policies were put in place to check the discriminative usage of cigarettes. According to McLaughlin (2008), the US laid policies to boost the relationship between health-care financing and employment. Policies were made to improve the autonomy, status and the compensation of health professionals who tirelessly fight to curb smoking. McLaughlin (2008, pg. 304) adds that the finances spent on smoking cessation campaigns by governments ultimately reduces the Medicaid programs cost. Other personal smoking policies were instituted to consider the non-smokers interests which included the bans from smoking in all public and work places, the introduction of smoke-free legislations and laying a ban on expectant mothers to stop smoking until they deliver. According to Feldstein (2007), these health policy issues offer economic perspectives of understanding the political and socio-economic effects of smoking on human beings. He emphasized on the negative effects of drugs and smoking on their medication costs, medical education and expenditures.

Conclusion

Due to these disastrous effects associated with smoking, it is advisable for a smoker to quit smoking; this is because it will benefit the individual by lowering his/her cost of health-care, improving health, lessening the heart strains and improving his/her sense of smell and taste.

References

Feldstein, J.P. (2007). Health policy issues: an economic perspective. Irvine, California: Health Administration Press.

Maciosek, M.V., Coffield, A.B., Edwards, N.M. (2006). Priorities among effective clinical preventive services: results of a systematic review and analysis. American Journal of Medicine 31(1):52-61.

Macnair, P. (2011). Smoking-health risks. Web.

McLaughlin, D. C., & McLaughlin, P. C. (2008). Health Policies Analysis: An Interdisciplinary Approach. Sudbury, MA: Jones and Bartlett Publishers.

Warner, K. E., Fulton, G. A., Nicolas, P., & Grimes D. R. (1996). Employment implications of declining tobacco product sales for the regional economies of the United States. JAMA: The Journal of the American Medical Association. 275 (16): 124146.