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Tobacco Control in Ireland – the Current Situation

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Tobacco Control in Ireland – the Current Situation 32 Tobacco Control Tobacco control in Ireland – the current situation Written by Professor Des Cox. Professor Cox is a consultant in paediatric respiratory medicine and the chair of the RCPI policy group on tobacco. Des is the Head of the Respiratory Department at Children’s Health Ireland, Crumlin and was appointed a Clinical Professor with the School of Medicine, University College Dublin in 2019. pandemic there were suggestions Although the relationship between budget has increased the excise that tobacco smoking may have a smoking, nicotine and SARS- duty on manufactured cigarettes protective effect from developing CoV-2 remains complex and more by 50c. Over the past 10 years, severe COVID-19 infection. This research is needed on the topic, the amount of excise duty has hypothesis was largely based on the current evidence confirms that almost doubled and the price reports of a lower prevalence of tobacco smoking is one of the few of a pack of 20 cigarettes now smokers in hospitalised patients modifiable risk factors for severe stands at ¤14. There has also with COVID-19 than would COVID-19 infection. Therefore been welcome a pro-rata increase have been expected based healthcare professionals should in recent years on roll your own Introduction on the countries smoking emphasise the dangers of tobacco (RYO) tobacco products. The price The SARS CoV-2 pandemic prevalence.5, 6 The pathological smoking during this pandemic and of these cheaper RYO tobacco has dominated the pages of basis for this conflicting evidence to strongly encourage smokers to products need to be aligned with newspaper articles and medical is that nicotine, through its quit. Additional resources manufactured cigarettes in order journals over the past twelve cholinergic response pathway, should be made available for to discourage young people from months and is the biggest public has anti-inflammatory properties smoking cessation services starting smoking. health crisis the world has seen which may inhibit the cytokine across Ireland to increase the in modern times. Given the storm which leads to severe likelihood of smokers successfully Although increasing excise duty international emergency created COVID-19 infection. A clinical quitting tobacco. on tobacco products is seen as by COVID-19, the focus has trial has begun in France to an old reliable on budget day, Tobacco free Ireland shifted away from other public ascertain whether or not nicotine there is solid evidence that price hikes work to decrease tobacco health issues such as tobacco, patches are an effective treatment Back in 2013, the Department of prevalence in countries where alcohol and obesity. Tobacco option in patients with severe Health launched the Tobacco Free 7 aggressive taxation measures smoking remains the leading COVID-19 infection. Ireland programme. This ambitious have been introduced.16, 17 cause of preventable death in strategy set a target for Ireland to However, there is now an Importantly countries where Ireland with almost 6,000 smokers become tobacco free (or less than accumulating body of evidence high tobacco taxes have been dying each year from tobacco 5% of the population smoking) demonstrating that smokers introduced have not witnessed a related diseases. According to by 2025. Now that we are more are more prone to developing significant increase in illicit trade. the World Health Organisation than halfway along this journey, COVID-19 infection and its severe The government should increase (WHO), tobacco smoking kills six we should review where tobacco complications. The spike protein the excise duty by ¤1 on each million people a year worldwide. control policy in Ireland of the SARS-CoV-2 virus binds to successive budget along with The Healthy Ireland Survey 2019 the angiotensin-converting enzyme currently stands. reported that 17% of the Irish pro-rata increase on RYO tobacco 2 (ACE2) receptors to gain entry The Healthy Ireland survey in order to make some ground population are current smokers. to the respiratory tract and cause Although the proportion of current provides us with the most towards a tobacco free Ireland. infection. This ACE2 receptor has comprehensive national survey smokers has declined from 23% in Regarding tobacco control been demonstrated in a number about health behaviours in 2015 to 17% in 2019, smoking is legislation, we have an excellent of experimental studies to be Ireland.15 In 2015, 23% of the clearly the biggest chronic public track record dating back to upregulated in the airway cells of Irish population were smokers, health issue in Ireland. As we the workplace ban on tobacco current smokers and patients with 19% daily and 4% occasional. emerge from the pandemic and the 8, 9 smoking in 2004. In the past few COPD. Overexpression of ACE-2 As of the last Healthy Ireland attention moves back to chronic years, Ireland has introduced a in smokers is likely activating a survey published in 2019, 17% public health issues in 2021, number of legislative measures pro-inflammatory response which were smokers, 14% daily and 3% there are number of important including plain packaging with places them at increased risk occasional. If the current trend of issues which need to be health warnings on tobacco of developing severe COVID-19 decreasing smoking prevalence addressed in respect to tobacco infection. A number of recently products and a ban on smoking smoking in Ireland. continues at the same rate then we published meta-analyses provide can expect that 12% of the Irish in vehicles where children are Tobacco products and robust evidence that smoking is a population will be current smokers present. More recently, the last COVID-19 infection significant risk factor for disease in 2025. Unfortunately this is government approved to draft severity and poorer outcomes in far away from the figure of 5% a Public Health (Tobacco and 10-14 There is strong evidence that COVID-19 infection. Pooled tobacco smoking prevalence rate Nicotine Inhaling products) bill. the use of tobacco products results from thirteen studies in projected back in 2013. Further The proposed legislation will increases a person’s one meta-analysis showed that progress is needed to decrease introduce a licensing system for susceptibility to respiratory tract smokers (current OR 1.98:95% the sale of all tobacco products 1, 2 tobacco smoking rates in Ireland infections. For example, smokers CI, 1.16-339 and former OR especially in regards to taxation and nicotine inhaling products are more at risk of hospitalisation 3.46; 95% CF, 2.46-4.85) had and legislation. (e.g.: e-cigarettes), prohibit the from influenza3 and bacterial significantly higher odds of severe sale of tobacco products from pneumonia.4 Early on in the COVID-19 outcomes.14 Since 2016, each successive vending machines and the sale FEBRUARY - 2021 • HPN | HOSPITALPROFESSIONALNEWS.IE 33 of nicotine inhaling products to behavioural support have been hospital admissions among concentrations of compounds persons under 18 years. However, shown to significantly improve adults in Ireland. Hospital COPD and flavours which are being the bill has stalled since the quit outcomes. In 2017, a Health mortality across Ireland have not vaporized at different temperatures COVID-19 pandemic hit early Information and Quality Authority decreased in recent years and the via different devices with unknown last year and there is currently (HIQA) Health Technology reasons for this trend is most likely long-term effects. We do not no timeline for this bill to be Assessment (HTA) of smoking multifactorial. However, the best know how harmful they are if resurrected. Another legislative cessation interventions found way of treating COPD is inhaled regularly over many years. measure which has been mooted that Varenicline with nicotine getting patients to stop smoking As healthcare professionals, we is a ban on smoking in outdoor replacement therapy (NRT) was or preventing people from should be recommending tried and areas where food is served. Both the most effective pharmacological starting smoking. trusted therapies to our patients these legislative measures should intervention.20 Either Varenicline as a first line quitting tool until we E-cigarettes be progressed into law within the or NRT alone was more learn more about the long-term lifetime of our current government. effective in their meta-analysis. The use of electronic nicotine effects of e-cigarettes. Smoking cessation services delivery devices (ENDS) or But it’s not going to be enough A more worrying aspect of should seek to increase the e-cigarettes is a hot topic in if just introduce current planned the HRB report was that it also uptake of Varenicline (alone or in tobacco control currently. There legislation and keep cranking up concluded that adolescents who combination with NRT) among has been an explosion in the the price of cigarettes. If we are ever smoked an e-cigarette were smokers wishing to use a form of use of e-cigarettes over the going to get anywhere near to a between 3 and 5 times more pharmacological support to quit. past ten years and the scientific tobacco free Ireland in 2025 then likely to start smoking compared For groups where Varenicline is literature is now trying to answer we need more comprehensive to never e-cigarette users. contra-indicated, then Buspirone if e-cigarettes are safe and can methods of getting people to quit Following quickly of the footsteps should be considered. play a role in tobacco cessation. smoking. Certain US states have of this report, the results of the According to the Healthy Ireland banned the sale of tobacco to European Schools Project on If people do not wish to use Survey 2019, the current rate of people under the age of 21 years. Alcohol and other drugs (ESPAD) pharmacological interventions, e-cigarette use in Ireland is 5% A recent study found that this study was published by the then behavioural therapies should and a further 12% have tried intervention resulted in a reduction TobaccoFree Research Institute be recommended.
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