An Analysis of the Impact of Smoking Jami Logan & Incidence on a Community’s Health Garrison Bruce

Ghent, Belgium Objective Jami: Exploring the college town of Ghent, Belgium was such an eye-opening experience. We learned so much about the community and the habits nurses and all members of the community participate in. Due to the observation of increased smoking while in Ghent, Belgium, my goal was to further see how the issue of tobacco impacts the health of the community.

Garrison: Ghent, Belgium is an incredibly beautiful city that we were fortunate enough to visit for a couple weeks. However, citizens of all ages and ethnicities participate in smoking behaviors at almost every turn because the practice is so normalized and widely accepted. Because of the sheer number of smokers in the area, we decided to investigate what shapes this behavior and what can be done in order to augment change. Belgium Background Information

● Geographic location: Western end of the Northern part of Europe. Neighboring countries include France, Luxembourg, Germany & the ● Educational level: A high percent of young people Netherlands enter higher education (307,000 student in higher ● Capital city: Brussels education) ● Total population: 11.35 million people (World ● Major sources of employment: Agriculture, industry Data Atlas) and services ● Age: 2.3 million people younger than 18 & 2.1 ● Political structure: Federal, representative million people over the age of 65 (World Data democratic, constitutional monarchy. Dr. Maggie De Atlas) Block, Minister of Health (Countries and Their ● Gender ratio: 96.68 males per 100 females Cultures) (World Data Atlas) ● Cultural health beliefs/behaviors: The inclusion of ● Income: Average household income legal euthanasia under palliative care services. Health $29,968/year (OECD) insurance is mandatory and is paid for by employers. ● Poverty level: 15% of the population lives in ● Notable health disparities: Smoking prevalence is poverty with only 3% of the population falls into doubled among low education groups (OCDE) the lowest 10 percent of Belgian’s income levels (The Borgen Project) Ghent, Belgium

● Total population: 260, 341 (City Population) ● Age: 40,169 people aged 0-14, 166,677 people aged 15-64 & 41,512 people aged 65+ (City Population) ● Gender ratio: 49.8% females and 50.2% males (City Population) ● Income: Average household income of $83,867 (City Population) ● Poverty level: 15% of the population lives in poverty (OECD) ● Educational level: 47% of 25-34 year-olds have attained tertiary education in Ghent (OECD) ● Cultural health beliefs: Because it is a college town, smoking and alcohol consumption incidence is increased without concern to health effects ● Specific health disparities: There are several “night shops” which are convenience stores located in close proximity to places students are known to frequent making tobacco very easily accessible to them at all times Health Issue ● According to The World Health Organization, in 2014, nearly one in five adults in Belgium smoked tobacco every day. ● Despite the knowledge that smoking tobacco negatively affects your health and increases chances of developing secondary disease, the percentage of smokers in Belgium remains almost constant. ● Recent health promotion campaigns were designed to promote further reduction in tobacco smoking. Belgium implemented comprehensive smoking cessation services and smoke-free policies were implemented when the country joined the WHO Framework Convention on Tobacco Control on January 30, 2006 (WHO, 2015). ● The Healthy People 2020 objective that targets this epidemic and its comorbidities is that of Tobacco Use, while the Sustainable Development Goal of Good Health and Well-Being works to ensure a healthy lifestyle across all ages. ○ Our chosen objective is to reduce tobacco use by adults, TU-1, in order to facilitate this connection Health Promotion Model We used Rogers diffusion of innovations model to guide the health promotion plan of CTQ smoking cessation programs. This model emphasizes dissemination of health behavior interventions. It identifies the four steps of diffusion: the innovation, communication channels, time and social systems.

● At the innovation stage the team will implement the CTQ program ● At the communication stage those who utilize this program will spread the word to friends and family. ● At the timing stage the team will assess participants at each week of the 6 week program ● This program targets all of the population and was even utilized in a underserved, minority, low-income population. This proves its effectiveness is not dependent upon a high-class social system and it can be effective in many different populations. Conclusions

● Tobacco is the risk factor that drives the most death or disability in Ghent, Belgium which is why it is the most important to address within this population (IHME, 2017). ● Smoking can lead to several negative health issues that are prevalent in Ghent, Belgium such as: ischemic heart disease, lung cancer and COPD (IHME, 2017). ● CTQ programs and Tabakstop hotline could be extremely successful evidence-based interventions to help aid this population in smoking cessation. ○ We could address likelihood of attendance and participation by conducting an analysis of readiness to quit and furthering our research with increased literature on the topic Professional Highlights ● Immersing ourselves in a culture that is different from our own and allowing ourselves to act as public health nurses, analyzing community health issues in an unfamiliar environment ● Comparing our healthcare system to that of Belgium’s was very interesting because of the reimbursement system and its role in providing quality care ● Observing what behaviors (ie. smoking) lead to chronic conditions that ultimately result in increased mortality ● Participating in palliative care site visits in a number of different institutions which allowed us to experience end-of-life care practices that are implemented in Belgium. These focus on more than just treating the symptoms of suffering or dying by ensuring the patient is cared for on a spiritual and mental level as well Personal Highlights ● Immersing ourselves in student life in Ghent, Belgium by visiting local restaurants, colleges, coffee houses, etc. ● Developing meaningful relationships with student nurses from several different countries who were also a part of the program ● Exploring historical buildings and sites and learning about their relevance to Belgian culture today References Gent (Oost-Vlaanderen). (n.d.). Retrieved February 19, 2019, from https://www.citypopulation.de/php/belgium-oostvlaanderen.php?cityid=44021

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Belgium Male to female ratio, 1950-2018. (n.d.). Retrieved from https://borgenproject.org/facts-about-poverty-in-belgium/

https://knoema.com/atlas/Belgium/topics/Demographics/Population/Male-to-female-ratio Waarom zou je stoppen met roken? (2014, December 29). Retrieved February 20, 2019, from

https://www.tabakstop.be/info-voor-rokers/waarom-zou-je-stoppen-met-roken