Smoking Is Bad for Our Health Essay Example for Free

Smoking Is Bad for Our Health Essay Almost 50 years ago, evidence began to accumulate that cigarette smoking poses an enormous threat to human health. More than 30 years ago, initial reports was made began meticulous documentation of the biologic, epidemiologic, behavioral, pharmacologic, and cultural aspects of tobacco use. The present report, an examination of the methods and tools available to reduce tobacco use, is being issued at a time of considerable foment. The past several years have witnessed major initiatives in the legislative, regulatory, and legal arenas, with a complex set of results still not entirely resolved. This report shows that a variety of efforts aimed at reducing tobacco use, particularly by children, would have a heightened impact in the absence of countervailing pressures to smoke. Besides providing extensive background and detail on historical, social, economic, clinical, educational, and regulatory efforts to reduce tobacco use, the report indicates some clear avenues for future research and implementation. It is of special concern to derive a greater understanding of cultural differences in response to tobacco control measures. Since racial and ethnic groups are differentially affected by tobacco, elimination of disparities among these groups is a major priority. Perhaps the most pressing need for future research is to evaluate multifocal, multichannel programs that bring a variety of modalities together. For example, school-based education programs are more effective when coupled with community-based initiatives that involve mass media and other techniques. As pointed out in our report, a combination of behavioral and pharmacologic methods improves the success rate when managing nicotine addiction. Synergy among economic, regulatory, and social approaches has not been fully explored, but may offer some of the most fruitful efforts for the future. It also provides the preliminary data on new statewide, comprehensive tobacco control programs, which offer great promise as new models for tobacco control and combine multiple intervention modalities. Although all aspects—social, economic, educational, and regulatory—have not been combined into a fully comprehensive effort, it is exciting to contemplate the potential impact of such an undertaking to eventually ensure that children are protected from the social and cultural influences that lead to tobacco addiction, that all smokers are encouraged to quit as soon as possible, and that nonsmokers are protected from environmental tobacco. ACKNOWLEDGEMENT It is our great privilege to express our gratitude to our creator Allah (SWT) for such great opportunity to be in touch with this report and came to know the present condition of smoking in these following days. We also have to put our heartened feelings and gratitude for the kindness and assistance that was provided to us to complete our assigned report as on the topic and such way you assigned us.In preparing the proposed report we have taken great assistance support and guidance from the persons of our group, the information you gave as our faculty and website. Table of Content 1. Introduction 2. Real situation 3. Real situation of Bangladesh 4. Tobacco Smoking Prevalence, Total and by Gender Bangladesh, 1995-2010 5. Given statistics 6. Show a table 7. A chart 8. Tobacco Production in Bangladesh 9. Smoking Damage 10. Quitting statistics 11. Economic and Opportunity cost 12. Social cost 13. Recommendations 14. Conclusion Introduction: Smoking is the inhalation of the smoke of burning tobacco encased in cigarettes, pipes, and cigars. Casual smoking is the act of smoking only occasionally, usually in a social situation or to relieve stress. A smoking habit is a physical addiction to tobacco products. Many health experts now regard habitual smoking as a psychological addiction, too, and one with serious health consequences. Real Situation in all over the world: About 2.0 billion people smoke all around the world. The World Health Organization states that global prevalence is 48% for adult males and 12% for adult females, about 1/3 of the adults worldwide, making about 2.0 billion smokers around the world including child smokers. Percent of Population that Smokes by Gender: 22.3 percent are male smokers. 17.4 percent are female smokers. Smoking Statistics by Age: Ages 18 to 24 years 22 percent, ages 25 to 44 years 22.8 percent, ages 45 to 64 years 21 percent, ages 65 and over 8 percent. Smoking Statistics by Race: Blacks are 19.8 percent, American Indians are 36.4 percent, Asians are 9.6 percent, Hispanics are13.3 percent and Whites are 21.4 percent. Smoking Statistics by Education Level: 44 percent of adults with a GED diploma, 33 percent of adults with 9 to 11 years of education, 11 percent of adults with an undergraduate college degree, 6 percent of adults with a graduate college degree Smoking Statistics by Poverty Status: 28.8 percent of adults who smoke live below the poverty level and 20.3 percent of adults who smoke live at or above the poverty level. Number of People Who Start Smoking Each Day: Even with what we know today about the health effects of smoking and the dangers associated with it people continue to start smoking. There are many reasons people start smoking and none of them are good. Each day, nearly 1,000 kids under the age of 18 will start smoking on a daily basis. Eighteen hundred adults, 18 and over, will also start smoking on a daily basis. Smoking situation in Bangladesh: Smoking is an increasingly prevalent habit in Bangladesh, particularly among men. In the past 10-15 years cigarette consumption has more than doubled. In Bangladesh 43.3% of adults (41.3 million) currently use tobacco in smoking and 44.7% of men, 1.5% of women, and 23.0% overall (21.9 million adults) currently smoke tobacco. 26.4% of men, 27.9% of women, and 27.2% overall (25.9 million adults) currently use smokeless tobacco. BDHS 2007 found 60 percent of Bangladeshi men smoke cigarettes and 20 percent consume other forms of tobacco. Although rural men are more likely (62 percent) to smoke cigarette than urban men (54 percent), urban smokers tend to smoke more cigarette per day (42 percent)smoke 10+ cigarette in the past 24 hours) than their rural counterparts (21 percent smoke 10+ cigarette in the past 24 hours). Population (Million) Population(Age Limit)| 1975| 2000| 2025| 2050| All adults, ages 15+ Female adults| 73.115 35.210| 84.249 40.127| 151.428 74.103| 207.054 100934| All youth, ages 0-14 Female youth| 50.457 24.523| 53.190 25.855| 59.344 28.965| 58.368 28.561| Tobacco Smoking Prevalence, Total and by Gender Bangladesh, 1995-2010 Tobacco Production in Bangladesh: Cigarette production and consumption patterns in Bangladesh were examined and the health, nutritional, and economic consequences of these patterns was assessed. Consumption of cigarettes and biri, hand-made tobacco rolls, is increasing. Annual per capita consumption of cigarettes, taking into account all males and females over the age of 15, is 350 cigarettes. Previously conducted surveys of 2 villages indicated that 67% of the males and 1% of the females, over the age of 15, smoked 1 or more cigarettes or biri each day. Cigarette, bidi, chewing, hookah, cigar, cheroot, snuff, natu, burley etc. are the various types of tobacco grown in different parts of the country. Each month approximately 1500 million cigarettes and 3000 million biri are produced. 57% of all commercially produced cigarettes are manufactured by 1 company, which is affilated with the British American Tobacco interest group. Biri are generally produced in cottage industries. Cigarette production is expected to increase by 40%. The cigarette industry is not labor intensive and it provides only a small number of jobs for the population. 123,000 acres of land are currently devoted to the production of tobacco. This constitutes a serious loss of land which might otherwise be used to raise needed rice. It is estimated that the annual rice production loss attributable to the use of land to raise tobacco is equal to 1/2 of the countrys yearly food grain deficit. Regional variation is also notable in men’s cigarette smoking: 73 percent in Sylhet division to 45 percent in Barisal division; 66 percent in Dhaka, 62 percent in Chittagong, 57 percent in Rajshahi and 52 percent in Khulna. Cigarette smoking in men found to have an inverse co-relation with education attainment: 73 percent with no education to 39 percent with secondary complete and higher; 63 percent in primary incomplete and 53 percent in secondary in complete. Similarly wealth quintile reversely influences men’s cigarette smoking: 71 percent in lowest quintile and 46 percent in highest quintile; 65 percent in second, 62 percent in middle and 60 percent in fourth quintiles. Area | Number of Company Card holders | Number of other growers in tobacco cultivation| Total number of growers in tobacco cultivation | Kushtia (Daulatpur upazila) | 11689 (90%) | 1266 | 12955 | Kushtia (Mirpur Upazilla | 8437 (91%) | 796 | 9233 | Bandarban (Lama upazila) | 5754 (98%) | 79 | 5833 | Bandarban (Ali Kadam upazila) | 1149 (97%) | 37 | 1186 | Cox’sbazar (Chakaria Upazilla) | 3008 98%) | 65 | 3073 | Market Share by Cigarette Manufacturer, 1999-2010: BAT Bangladesh 60% Other domestic 32% Imports 8% Health Effects of Smoking Statistics: Smoking is the leading cause of many different health issues within our society. Many types of cancers, heart disease, and lung diseases have been directly linked to smoking. For every person who dies from a smoking related disease, 20 more suffer from at least one serious illness related to smoking. 1 out of 5 people die each year from smoking. Over 400,000 people die each year from smoking related illnesses. Nearly 50,000 nonsmokers die annually from secondhand smoke exposure. Cigarette smoke contains about 4,000 different chemicals which can damage the cells and systems of the human body. These include at least 80 chemicals that can cause cancer (including tar, arsenic, benzene, cadmium and formaldehyde) nicotine (a highly addictive chemical which hooks a smoker into their habit) and hundreds of other poisons such as cyanide, carbon monoxide and ammonia. Every time a smoker inhales, these chemicals are drawn into the body where they interfere with cell function and cause problems ranging from cell death to genetic changes which lead to cancer. Risk factors of smoking: People take up smoking for a variety of reasons. Young people are especially vulnerable because of pressure from their peers and the image that smoking is clever, cool or grown-up. Just trying a few cigarettes can be enough to become addicted. Many people say that smoking helps them to feel more relaxed or cope with stress but nicotine is a stimulant not a relaxant, so it doesn’t help stress. What people are describing is more likely to be relief from their craving or withdrawal symptoms. Smoking Damage: There are hundreds of examples and volumes of research showing how cigarette smoking damages the body. For example, UK studies show that smokers in their 30s and 40s are five times more likely to have a heart attack than non-smokers. Smoking contributes to coronary artery disease (atherosclerosis or hardening of the arteries) where the heart’s blood supply becomes narrowed or blocked, starving the heart muscle of vital nutrients and oxygen, resulting in a heart attack. As a result smokers have a greatly increased risk of needing complex and risky heart bypass surgery. Smoking also increases the risk of having a stroke, because of damage to the heart and arteries to the brain. If someone smokes for a lifetime, there is a 50 per cent chance that your eventual death will be smoking-related half of all these deaths will be in middle age. Smoking and Lung problem: Smoking does enormous damage to the lungs, especially because these tissues are in the direct firing line for the poisons in smoke. As a result there is a huge increase in the risk of lung cancer, which kills more than 20,000 people in the UK every year. US studies have shown that men who smoke increase their chances of dying from the disease by more than 22 times. Women who smoke increase this risk by nearly 12 times.Lung cancer is a difficult cancer to treat long term survival rates are poor. Smoking also increases the risk of the following cancers: * Oral * Uterine * Liver * Kidney * Bladder * Stomach * Cervical * Leukemia Even more common among smokers is a group of lung conditions called chronic obstructive pulmonary disease or COPD which encompasses chronic bronchitis and emphysema. These conditions cause progressive and irreversible lung damage, and make it increasingly difficult for a person to breathe. Harm to children from Smoking: Smoking in pregnancy greatly increases the risk of miscarriage, is associated with lower birth weight babies, and inhibits child development. Smoking by parents following the birth is linked to sudden infant death syndrome, or cot death, and higher rates of infant respiratory illness, such as bronchitis, colds, and pneumonia. Smoking and young people: Smoking is particularly damaging in young people. Evidence shows people who start smoking in their youth aged 11 to 15 are three times more likely to die a premature death than someone who takes up smoking at the age of 20. They are also more likely to be hooked for life. Nicotine, an ingredient of tobacco, is highly addictive – it takes on average on about six cigarettes before nicotine receptors in the brain are switched on, generating a craving for nicotine which may continue for the rest of the person’s life. In less than one packet of cigarettes, a person’s brain can be changed forever from that of a non-smoker to a nicotine addicted smoker. Although the health risks of smoking are cumulative, giving up can yield health benefits, regardless of the age of the patient, or the length of time they have been smoking. Quitting Smoking Statistics: Nearly 70 percent of smokers want to quit smoking altogether. Approximately 40 percent of smokers will try to quit this year. About 7 percent will succeed at quitting smoking their first try. That may sound like a small number but it is over 3 million people. 3 to 4 percent of people who quit smoking will do it cold turkey. If we join a proper smoking-cessation service, using all available help including medication and counseling, your chances of quitting may be as high as one in three (compared to just three per cent if you go it alone). Many smokers are lead to believe that quitting smoking is impossible. That is ridiculous! We have it in our right now to quit smoking we just need to believe. Yes, it is going to be tough and we will face challenges but thats true for anything worth obtaining in life. No one starts smoking to become addicted to nicotine. It isnt known how much nicotine may be consumed before the body becomes addicted. However, once smoking becomes a habit, the smoker faces a lifetime of health risks associated with one of the strongest addictions known to man. About 70% of smokers in the United States would like to quit; in any given year, however, only about 3.6% of the countrys 47 million smokers quit successfully. Although specific genes have not yet been identified as of 2003, researchers think that genetic factors contribute substantially to developing a smoking habit. Several twin studies have led to estimates of 46-84% heritability for smoking. It is thought that some genetic variations affect the speed of nicotine metabolism in the body and the activity level of nicotinic receptors in the brain. Causes and Consequences of smoking: Tobacco usage accounted for 4.1% of the global burden of ill-health in 2000. Much of this burden was due to an increase over the previous decade of tobacco-related illnesses in developing countries. Almost 4.9 million deaths in 2000 were attributed to tobacco usage (Ezzati et al., 2002). According to a recent study on smokers, the average loss of life expectancy per tobacco related illness in India was estimated at 20 years, with middle-aged smokers having twice the death rates than non-smokers (Gajalakshmi et al., 2003). Thus, tobacco usage results in loss of life – and in turn productivity – during the active years of experienced workers. Economic and Opportunity cost: The study in Bangladesh identifies and compares the economic costs and opportunity cost of tobacco consumption with a view to providing economic data to frame tobacco control policy. More specifically it provides an estimation of opportunity costs (costs necessitated by tobacco usage that could otherwise have yielded greater benefit) incurred because of ill-health attributable to tobacco usage. Accounting includes the costs borne by the health system to treat tobacco-related illnesses, and out-of-pocket costs borne by the household of the person afflicted by these illnesses. These two items make up the direct costs. To this is added the cost to the economy due to premature death and disabilities, or the indirect costs. The initial task was to identify the types of illnesses that can be attributed to tobacco usage, although the etiology of the illnesses is not exclusive to tobacco. The list of illnesses varies from country to country due to different habits for tobacco usage (Peto et al., 1992). In this study, eight illnesses were selected as they are consistent with tobacco usage in all regions of the world. These are given below: * lung cancer, cancers of the mouth and larynx * stroke and ischemic heart diseases (IHD) * chronic obstructive pulmonary disease (COPD) (Murray and Lopez, 1996). Studies in the People’s Republic of China and India have shown that tobacco contributes to the incidence of pulmonary tuberculosis. Buerger’s Disease occurring primarily among heavy smokers. Here, tobacco-related illnesses are all those that have been associated with tobacco usage. A portion of the prevalence of the illnesses can be attributed to tobacco usage. Thus the main interest of this study is to estimate the opportunity costs imposed by occurrence of illnesses directly caused by tobacco usage are poor and work bare feet in wet soil condition, has been shown to be a source of disease burden in Bangladesh and other developing countries. Having identified the illnesses, the study compared the total cost of tobacco usage to zero usage. The difference between these costs would represent the magnitude of the problem. The calculation of annual costs followed the cross-sectional, or prevalence-based, approach for cost of illness studies. This estimates actual costs as a function of all illnesses related to current and past smoking. Costs were calculated using standard guidelines on economic â€Å"cost benefit† analysis. All costs attributable to tobacco-related illnesses were deemed excess medical costs Consumption of tobacco is addictive and can therefore be seen as an unwarranted cost. The opportunity costs of tobacco-related illnesses included: * private expenditures (out-of-pocket or insurance) of patients on medical care, e.g., drugs, medical examination, hospitalization, and transportation to health centers * cost of the public health care system * loss of potential income and investment opportunities due to illness and consequent working disability or termination of working life by premature death. * The first two components are the direct costs to the patients and the health care system. * The third component constitutes the indirect cost of illness to individuals and society. The measurement of the total annual cost of tobacco-related illnesses to the economy involves the estimation of: * the relative risk of the eight selected diseases with respect to tobacco the proportion of tobacco users having any of the diseases; * the prevalence rates of the eight diseases attributable to tobacco usage–the probability that one of them would befall a tobacco consumer, derived from the ratio of tobacco users having any of the eight illnesses compared to the proportion of tobacco users in the economy; * the average cost of private treatment of individual patients; * the average hospital cost (inpatient and outpatient) of treatment of individual patients; * the average indirect cost from the loss of working days and income of both the patient and the attendant family members due to the treatment; * average indirect cost from the loss of income owing to disability or early demise caused by the illness. * Methods and analytical framework * Impact of Tobacco-related Illnesses in Bangladesh * The sum of the average costs , weighted by the rate of prevalence of tobacco-related illness, yields an estimate of the expected average cost of illnesses attributable to tobacco usage. To obtain the expected total cost of illness, the average cost needs to be multiplied by the total population. Thus the following basic economic cost structure for each illness will be calculated for each year. Objectives: The objective of the study was to obtain information on the economic costs of illnesses resulting from tobacco usage in Bangladesh. It entailed calculating the opportunity costs borne by the government attributable to tobacco related illnesses, and an analysis of the extent to which these may frame tobacco control policy. The specific objectives were to determine: * the prevalence of tobacco usage; * the prevalence of tobacco-related illnesses; * utilization of health services (in a partial way); * hospital costs borne by the health system due to tobacco-related illnesses; * out-of-pocket expenditure of households, either when(6) deaths and disabilities due to tobacco-related illnesses; * the impact of second-hand smoking; and * benefit of tobacco consumption for the economy. Using the above criteria we attempted to test the following hypotheses: * tobacco-related illnesses impose substantial costs to the society; * total expenditure (household out-of-pocket, health system and indirect costs) exceeds total income (public and private) earned from, domestic consumption of tobacco; and * the cost of tobacco usage is disproportionately high for the poor. The prevalence of tobacco-related diseases and the average private and public costs of treating them were estimated using data collected in 2004 from various sources, including a national household survey, hospital costs and patient surveys (from three public medical college hospitals and one private one), and an expert survey that determined the survival rate and quality of life after occurrence of the diseases attributable to tobacco. These data were supplemented by others from the institutes that provide specialized care for the diseases. On the other hand, a major reason that tobacco consumption has not been considered as a cost has been the concern of policy-makers in poorer countries of losing tax revenues from sales of tobacco products (including surpluses which are normally seen as benefits in welfare economics), as well as wages earned through the production of tobacco. The study therefore adopted a mixed approach while the tax and wages associated with tobacco consumption and production were seen as benefits the producer and consumer surpluses from domestic consumption were discounted as they stem solely from addictive consumption and cause damage to health. In the United States of America, the direct costs of treatment of illnesses directly attributed to tobacco usage accounted for 0.46% to 1.15% of gross domestic product (GDP). This is the actual expenditure in a given year. In the United Kingdom, these costs amounted to 0.13% of GDP, while those in Canada ranged from 0.12% to 0.56% of GDP. Similar ranges were found in Australia. The only comprehensive study from any developing country , carried out in China, showed that direct costs amounted to 0.43% of GDP. Social cost: Social costs included the indirect costs of morbidity and premature mortality, as well as direct medical costs. While social costs averaged 1.4% to 1.6% of GDP in the USA and Canada, the China study showed a higher figure of 1.7% (In 2000) While directly not accounted in the cost calculations in any of the studies mentioned above, the effects of tobacco consumption on poor populations are significantly higher than for other income groups. Taking education as proxy for income levels, data from both developed and developing countries suggest that poor people consume more tobacco products than people in higher income groups in nearly all regions of the world. In the United Kingdom, the least educated people smoke three times more than the highest educated group, and this rate is up to seven times more in some developing countries. The risk of death from tobacco usage is also related to income. A study in Canada determined the risk of death attributable to smoking to be 5% for high-income earners, rising to 15% for the poorest population group. The effects of high consumption of tobacco in developing countries is compounded by the opportunity costs of consuming other essential items. Studies in several countries observed that up to 17% of household income was being spent on tobacco products (de Beyer et al., 2001). A study in Bangladesh estimated that 10 million people currently malnourished could have an adequate diet if money spent on tobacco were spent on food instead. In developed countries, considerable efforts have resulted in a lower number of smokers, often as a result of banning direct and indirect tobacco advertising, high taxes on tobacco products, the enforcement of laws requiring tobacco-free public and work places, and clear graphic health messages on tobacco packaging. Developing countries, on the other hand, are not only witnessing an increase in tobacco usage; they are also lacking effective legislation, often for the socioeconomic arguments stated above. Based on these arguments, some policy-makers conclude that amount gained as revenue from tobacco exceeds the cost to society due to tobacco use. This study seeks to assess the validity of this view in Bangladesh, a pioneer among countries considering legislation to control tobacco consumption. Household survey: The household survey allowed us to estimate the prevalence of tobacco usage, construct a population disease profile for the age group of 15 years and above, determine out-of-pocket costs incurred for tobacco-related illnesses, and diagnose associated health-seeking behavior. Sampling and cluster selection: The household survey took place from May to July 2004. A representative sample of 2467 households was drawn from six divisions. We made sure that the districts selected had different degrees of accessibility to tertiary health care Facilities: Districts within a 25 kilometer radius from a tertiary health-care facility were considered near and those 25 to 50 kilometers were considered far. Unions or Wards (clusters) were selected randomly from the districts. A total of 59 clusters were selected from 6 divisions that included 11985 young and adult individuals. Impact of Tobacco-related Illnesses in Bangladesh: The household sample is representative of the Bangladeshi population in terms of urban–rural composition, distribution of household expenditure, as well as age composition. For example, youth and infants (those aged below 30) accounted for 63% of the total sample, while the national figure is 64%. The distribution of sample population by age group is shown in. The present study focused on adults aged 30 years and above, who constituted 37% of the sample, because tobacco-related illnesses are observable primarily among people of this age group. Impact of Tobacco related Illnesses in Bangladesh are, * Ischemic heart disease (IHD), stroke or transient ischemic attack (TIA), oral cancer, lung cancer * laryngeal carcinoma, chronic obstructive pulmonary disease (COPD) * pulmonary tuberculosis * X-ray: A chest X-ray was performed on any suspected case of lung cancer, COPD or tuberculosis. * Carbon Monoxide Monitor (CO-monitor): In order to corroborate the use of tobacco, a CO monitor was used to measure the ambient air quality and individual CO level. A conversion table was used to determine the CO level in blood (hemoglobin). Recommendations: Despite dissemination and availability of the recommendations on smoking cessation, few countries had taken sufficient action. Therefore, in June 2002, the WHO Tobacco Free Initiative organized a meeting to develop ‘Policy Recommendations for Smoking Cessation for governments, non-governmental organizations and health professionals interested in making public health gains in the short and medium term. The policy recommendations were published in June 2003 and launched during the 12th World Conference on Tobacco or Health in Helsinki, Finland. The recommendation chart is given below: pressure| Companies| People| Government| 1.Adhunik2.Bangladesh 2nd Sub-National Smoke-Free Project organized a Workshop. 3. PROGGA organized a workshop on 17th May,20124. YPSA(Young Power In Social Action) organized a program on May,20105. Bangladesh 2nd Sub-National Smoke-Free Project Workshop† held in Chittagong on 17th to 19th May, 20106. WHO(World Health Org.), BAT, BATA, other Non-governmental org.7. The Anti-tobacco advocacy and campaign. 8. The World No Tobacco Day has been celebrated throughout Bangladesh in befitting manner on 31 May| 1. Banglalink campaign on 15th June, 2012.2. Nokia-Banglalink joint campaign named ‘Ovijaan’ and Ovi internet against smoking.3.Grammenphone4. The Daily Star and Kaler kontho.5. Prothom Aloo organized Anti Tobacco campaign, Bandhushava with the help of DIU.6. Google and anti smoking campaign against tobacco.7. Samsung Electronics leads other companies in the campaign against smoking. 8. The Truth About Tobacco Times of India campaign and workshop against tobacco.9. Radio Today, Bangladesh Betar and other radio TV channel also working against Tobacco.| 1.We should avoid smoking for our own health and environment.2. We should stop smoking among nonresidential area and public places.3. We should avoid smoking before children and young generations.4. We should not smoke too much and encourage other for smoking.5. We should not smoke in school. Colleges and universities. 6. We should follow the tobacco control campaign and avoid smoking.7. We should encourage others to avoid smoking.8. We should follow the rules and regulations of Govt. and other organization against smoking.9. We should avoid smoking in offices and public places.10. We should try to avoid smoking with the help of health agencies and doctors.11. We should aware the local people.12. We can aware the urban and rural people about the consequences of smoking.| 1.Govt. should fund state tobacco control activities at the level recommended by the CDC.2. excise tax rates below the level imposed which states excise tax rates should be indexed to inflation.3. States and localities should enact complete bans on smoking in all nonresidential indoor locations. 4. All health care facilities should meet or exceed JCAHO standards in banning smoking in all indoor areas.5. Colleges and universities should ban smoking in indoor locations.6. State health agencies, health care professionals, and other interested organizations should undertake strong efforts to encourage parents to make their homes and vehicles smoke free.7. All states should license retail sales outlets that sell tobacco products.8. All states should ban the sale of tobacco products directly to consumers.9. Congress should ensure that stable funding is continuously provided to the national quit line network.10. Can increase the high level of prices for tobacco products is an important factor in preventing people.11. Govt. can aware the people about the effect of smoking. 12. Govt. can increase tax among the sales of tobacco.| Recent changes to legislation: In July 2009, further provisions of the Public Health (Tobacco) Acts 2002 and 2004 were commenced. These included * ban on all in-store/point-of-sale advertising of tobacco products. * ban on the display of tobacco products in retail premises. * introduction of a closed container / dispenser provision. * tighter controls on the location and operation of tobacco vending machines, introduction of a retail register. The recommendations propose a broad framework for addressing treatment of tobacco dependence. In this framework, Governments can progressively choose minimal, expanded and core recommendations as they strengthen their resources and capacities. The recommended framework includes a mix of three main strategies: * A public health approach that seeks to change the social climate and promote a supportive environment. * A health systems approach that focuses on promoting and integrating clinical best practices (behavioral and pharmacological) which help tobacco-dependent consumers increase their chance of quitting successfully. * A surveillance, research and information approach that promotes the exchange of information and knowledge so as to increase awareness of the need to change social norms. These are recommendations from WHO and social welfare organization for people and Government also working for prohibiting tobacco. Conclusion: As countries prepare to develop national policy guidelines for the treatment of tobacco dependence, the international community can help by providing a forum for sharing and distributing information, writing up guidelines, reviewing best practices, raising funds and establishing partnerships.