During the Oncology Nursing Society's 28th Annual Congress in 2003, I attended the symposium, "Global Perspectives on Nursing Involvement in Tobacco Control." Presenters included four nurses regarded among the world's most ardent tobacco-control advocates. While it's true that this session was competing with several others, fewer than 50 of the more than 5,000 nurses registered for the congress were present. Although tobacco use is the world's single largest cause of preventable death, nurses at the congress seemed more interested in topics relevant to their own day-to-day clinical practices, which often deal with outcomes of misapplied or failed preventive measures, rather than preventing illness in the first place. I had to wonder: Where's the passion?
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The lack of attendees at this session is indicative of a greater problem. Perhaps we've become numb to the horrific numbers. It's bad enough just considering data from the United States, where smoking costs about $150 billion each year in health care and lost productivity, in addition to the loss of nearly half a million lives. Globally, tobacco kills at least 4 million people annually, yet when I performed a thorough literature search of tobacco control in nursing journals, I found only eight papers published in the last six years. Among the thousands of articles appearing in hundreds of journals, only these eight directly addressed nurses' roles in tobacco-control efforts. At best, this represents misplaced priorities among our profession; at worst, it represents global professional apathy.
U.S. nurses have a recent history of being apolitical. The division of America's nearly 3 million nurses into more than 80 specialty groups (a trend reflected in other nations as well), each with a narrow spectrum of interests, renders us politically powerless. We don't speak with one voice. Our potentially powerful collective voice remains silent with regard to tobacco control, despite the fact that most nurses care for patients with tobacco-related problems.
The effects of tobacco are obvious during all phases of life and are seen by nurses in each specialty. Smoking during pregnancy increases the risk of fetal distress, preterm delivery, and infant mortality. Asthma occurs more frequently among children whose parents smoke; these children are also more likely to become tobacco users. Nearly 23% of U.S. high school students are currently smokers. Older smokers are affected by chronic vascular insufficiencies, chronic occlusive pulmonary diseases, and cancers. Tobacco use causes damage and disease in almost every major organ system and is the most serious risk factor for morbidity and death among adults worldwide.
Despite our different interests and areas of expertise, nurses share the responsibilities identified in the Code of Ethics for Nurses of the International Council of Nurses (ICN): "to promote health, to prevent illness, to restore health, and to alleviate suffering." Our professional nursing organizations must move beyond issuing passive position statements to setting an aggressive agenda of collaborative action for tobacco control. Either of the international nursing associations, the ICN or Sigma Theta Tau International, could assume a coordinating role. Each nation's major nursing organization, such as the ANA, could be accountable for nationally focused efforts. Specialty organizations could encourage initiatives that tap their members' interests and expertise. For example, neonatal nursing and women's health organizations might focus on reducing the incidence of maternal smoking. Rural and pediatric nurses might collaborate with community organizations to devise appropriate adolescent interventions. And nursing organizations must incorporate tobacco-control efforts into short-and long-range strategic plans.
Nurses represent the world's hope for health. We work to promote good health in so many ways-assuming an active and assertive role in global tobacco-control efforts is our responsibility. Let it also be our passion.