Health Promotion Intervention: Risks Associated with Tobacco Smoking - Term Paper Example

Name Lecturer Task: Report on Health Promotion Intervention for undergraduate students at London Metropolitan University to promote awareness of the risks associated with Tobacco Smoking. Date Table of Contents Table of Contents 2 1.0 Introduction and Rationale 3 1.1 Introduction 3 1.2 Rationale 3 1.3 Specific Aim of this Initiative 4 2.0 Literature Review 5 2.1 International, National, and local health promoting policies. 7 2.2 Health Promotion Theories and Models 8 2.2.1 Theory of Reasoned Action 8 2.2.2 Theory Planned Behavior 9 2.2.3 Social Cognitive Theory 9 2.2.4 Health Belief Model 9 2.2.5 Transtheoretical Model 10 3.0 Intervention Method 10 3.1 Explanation for Methods used Before and after the Activity 11 4.0 Results of Observations 12 5.0 Conclusion and Recommendations for Future Health Promotion Initiatives 14 6.0 Works Cited 16 7.0 Appendix 1 18 1.0 Introduction and Rationale 1.1 Introduction Tobacco smoking is posing a major threat to the health of many youths globally. Despite the unrelenting effort by various governments to curb this menace which has seen the prevalence rates of smoking decrease, the percentage of intermittent smokers in the United States for example has increased immensely (Halperin et al., 2010: 96). This has not only affected the United States but also other nations globally. Students are the most affected and are categorized to the group of intermittent smokers. This is due to the fact that they are at a risk of addiction and health related risks that accompany addiction. Tobacco is currently among the leading causal agent of preventable death in most of the high-income nations (Sychareun et al., 2013). Health promotions as an integral part of the entire health process are therefore crucial in sensitizing these learners on the risks involved. This research report is about the London metropolitan students' quit smoking program, a health promotion initiative aimed at raising the awareness on the risks associated with smoking of tobacco amongst London metropolitan students aged between 18 and 30 years. 1.2 Rationale Tobacco smoking is posing a major threat to many students and if the situation goes on without intervention, tobacco related illnesses may soon be an issue of concern. Focus on tobacco smoking is supported by a research study done by Larsen J. & Cohen, L (2009). Findings from this study indicated how smoking related illnesses such as lung cancer, emphysema and chronic bronchitis kill more than 430, 000 Americans yearly making smoking the leading cause of preventable death. According to the CDC data (2006) 24.4% of young adults aged between 18 and 24 years reported being current smokers and this represents a high prevalence rate for age group. Notably, university students fall into this age group which calls for an immediate intervention program to curb this rising problem. According to Rodgers (2012), of the 19.8% of the adults who use tobacco, only 3% of them have undergraduate and graduate degrees. This clearly indicates how tobacco smoking is proving to be a major problem in colleges. Additionally, a number of studies that have been conducted related to smoking have shown that young adults aged between 18 and 24 have fallen victims of smoking consequences owing to their unawareness of health consequences that come along this habit (Murphy-Hoefer et al., 2004). Similarly, according to Solvic (2001), a research study conducted in the United States showed that individuals aged between 14 and 22 years have fallen victims of overestimation of risks of lung cancer, underestimation of loss of lives per year and failure to recognize the risks of smoking relative to other health risks. From this, there is no doubt that action needs to be taken to reduce death rates as a result of smoking related illnesses owing to the fact that a higher percentage of those adults who die from smoking related illnesses are college students. A health intervention for raising awareness on the risks of tobacco smoking is necessary. Institutions offer potential places for tobacco reduction interventions and can help in promoting surcease and prevention (Murphy-Hoefer et al., 2005). 1.3 Specific Aim of this Initiative The main aim of this initiative is to raise awareness on the risks associated with tobacco smoking and reduce the number of London Metropolitan Students aged between 18 and 30 years who are currently engaging in this habit. Specific Objectives The main objectives to be achieved by this initiative were; Student should feel empowered by being made aware of the options that are open to them in order to live a healthy life. Student should be able to make informed decisions about relinquishing this bad habit Student should identify five side effects of smoking, three services that can help them quit and three related illnesses caused by tobacco smoking. 2.0 Literature Review Much has been done with regards to tobacco smoking and the interventions measures that have been used in a bid to reduce this habit. To provide concrete evidence to the initiative, a literature review was conducted on several research studies on tobacco smoking and control measures. Reviewing literature helps in building up on the strategies that have been used before so as to achieve the set objectives of this intervention. A number of scholars have provided their research findings and the corresponding intervention measures on various issues surrounding tobacco smoking such as the reasons why college students smoke and the control measures that have been used to control it. A search on the databases revealed a range of articles on intervention measures towards tobacco control. The articles obtained were more general and could not meet the required criteria; based at the colleges and involved the empirical analysis of intervention measures. Those which qualified and met the criteria were only three and they were categorized into individual intervention measures such as the cessation programs and institutional intervention measures e.g. the smoke free policies (Murphy-Hoefer et al., 2005). Quite common to these intervention measures, sample sizes were used in all those involving direct implementation of a pilot intervention program and all the programs were aimed at quitting smoking rather than preventing smoking (Murphy-Hoefer et al., 2005). In particular, one study involved a review of multi-component interventions that have been documented. For those intervention measures implemented directly on a cohort, different impacts were noted on each of the intervention programs. Most of these findings suggest that future interventions aimed at reducing tobacco use ought to focus on the attitudes of students towards smoking. Smoking intervention programs that alter the attitude through educating people on the negative effects of smoking. One scholar suggests that it is the presence of positivity rather than the absence of negativity that leads an individual to smoking habit (Larsen & Cohen, 2009). The first activity in review of past literature works involved a review of multi-component interventions to prevent and control tobacco use among the college students. MED-LINE, ERIC and pubMed databases were used to search literature related to tobacco control and prevention programs that were used in college campuses. The publications which were of major concern were those published between 2000 and 2009. A greater percentage of these publications indicated that while tobacco control programs containing policy and prevention education were used the most, promotion of tobacco-free environments and sales ban were minimally used. Prevention education was noted to be the most commonly used strategy with six out of eight colleges in study using it (Rodgers, 2012). Another study which was reviewed was that done by Larsen and Cohen and it involved the use of 181 smokers who completed a mass survey and questionnaires (Larsen & Cohen, 2009). The findings of this research study indicated that despite that they were smoking, a greater percentage of the respondents reported a negative feeling towards smoking (Larsen & Cohen, 2009). This was an indication that smoking prevention campaigns that alter the attitudes by informing people of the negative aspects of smoking. A review of quasi-experimental study of community intervention during the years 2005-2008 which was conducted by Martin et al. revealed that smoking reduced upon intervention. The study was conducted on a total 290 health science students on intervention campus and 256 on the control campus (Martin et al., 2012). The 290 participants were subjected to an intervention consisting of tobacco prevention and control course. The findings of this study indicated a decrease of -1.1% in the intervention group while the percentage of those in the control group increased by 1.5% (Martin et al., 2012). This was a clear indication of the risk college students are exposed to if they were not educated on smoking risks. Therefore, students should be provided with smoking related education lessons before joining colleges. A summary of literature works review is presented as Appendix 1. 2.1 International, National, and local health promoting policies. Smoking has been recognized as a major health threat by different nations. As a result various health policies to promote smoking cessation have been put in place especially in institutions. The national policies include embedding health information into the institutional curriculum and enhancement of anti-smoking campaigns. For example, in Australia talking posters on tobacco-related harms have been set up in schools, smoking related DVD's have been produced in local languages, smoking related education sessions has been embedded in schools and quit smoking campaign information and resources (Northern Territory Government Department of Health, 2014). The United Kingdom government has also come up with national policies to help in smoking habit cessation. For example, the 2003's comprehensive ban on advertising of tobacco products and the development of an official tobacco control policy in 1998 (WHO, 2004). Raising taxes on tobacco products has also been a major international policy measure that has been put in place by many nations of the world in a bid to reduce smoking. According to the World Bank report, an increase of 10% in every packet of cigarettes will lead to a corresponding 4% decrease in demand for cigarettes in developed nations and 8% reduction in developing nations (WHO, 2004). Currently, the prices of cigarettes have been increasing at very high rate globally. The local governments have also put up strong policy programs such as community campaign programs to promote smoking cessation. Smoking is posing a major health concern and therefore, nations have agreed to fight smoking at the local, national and international level. 2.2 Health Promotion Theories and Models Scholars have always emphasized on the necessity to link health promotion theories to health education. Whitehead (2001a) highlighted the fact that if confusion prevails between health promotion theories and education, it will pose a challenge of not knowing when to implement health promotion programs. Theories act as a guide to on how to design, implement and evaluate a health promotion program. Theories help in explaining the necessity of an intervention, the right way of intervening and a way of analyzing its success (Glanz & Rimer, 2005). There are several health promotion theories and models underpinning health promotion. However there are the most commonly used theories and they include; 2.2.1 Theory of Reasoned Action This theory was proposed and introduced in 1980 by Fishbein in a bid to explain the correlation that exists between attitudes, beliefs, intentions and behavior (Tlou, 2009). According to him, the attitude towards doing something determines the behavioral intention of an individual. This theory uniquely proposes that individuals tend to behave according to how they intended when there is opportunity presented (Simons-Morton, McLeroy & Wendel, 2011). An individual action is influenced by his or her attitude towards a certain behavior and the inferred social pressure. For example, there a likelihood that an individual will smoke if he or she has a favorable attitude towards smoking. 2.2.2 Theory Planned Behavior It is an extension of theory of reasoned action. The theory was proposed by Fishben and Ajzen and it being an extension of theory of reasoned action (Tlou, 2009), it has a third key component; perceived behavioral control (Simons-Morton, McLeroy & Wendel, 2011). According to this theory, behavior is the end result of attitudes towards the behavior, subjective norms (person's perception of the social pressures) (Tlou, 2009) and the inferred behavioral control. This theory basically, tries to give an understanding of one's behavior when he or she cannot control both the internal and external factors. 2.2.3 Social Cognitive Theory Social cognitive theory grew from social learning theory proposed by Albert Bandura in 1960. This theory posits that human behavior is a product of interaction of three factors; personal factors, environmental influences and behavior (Society for Public Health Education, 2010). It is most commonly used in designing health promotion intervention programs. According to Bandura; the proponent of this theory, personal factors, environmental factors and behavioral factors are the key determinants of how a person behaves. The basic principle of this theory is that besides their own experiences, individuals also learn by observing what others do. Therefore, a person's behavior can be easily changed by altering the environment through features such as role models and rewards that promote good behavior. 2.2.4 Health Belief Model This model which was proposed in the 1950's argues that an individual's action to alter his or her behavior originates from personal evaluation of a range of constructs (Society for Public Health Education, 2010). The decision to change a behavior will depend on his or her perceived susceptibility. Susceptibility is therefore a motivating factor towards change. One has to weigh the perceived benefits and perceived barriers of the action (Society for Public Health Education, 2010; Simons-Morton, McLeroy & Wendel, 2011). If the benefits are more than the barriers, the person will be motivated to change that behavior. 2.2.5 Transtheoretical Model This theory proposes that people's change of behavior is stepwise. There are five key stages that people undergo when changing their behaviors. They are; pre-contemplation, contemplation, preparation, action and maintenance ( Dixey, 2013; Society for Public Health Education, 2010). Different factors therefore influence the behavior of an individual at different stages. People who have no intention of changing their behavior (pre-contemplators) are unlikely to change their behavior. Those people at the preparation stage and contemplators on the hand are more likely to change (Street, Gold, & Manning, 2013). 3.0 Intervention Method Educational approach was adopted for this health promotion program with an aim of helping the participants to know the options that are open to them. Educational approach is an approach whose objective is providing knowledge and information to individuals that enables them make informed choices about a behavior (Noble, 2012). 'Quit kits' accompanied by leaflets were distributed to all participants. Each 'quit kits' had a small straw, rubber band, coffee stirrers, toothpicks, mints, sunflower seeds and cinnamon. One could chew a gum, toothpick, cinnamon or straw when he or she had an urge of smoking. Smoking related activities such as holding a cigarette were to be replaced by twisting objects such as straws or twisting a rubber band. 'Quit kits' had wide variety of materials which provided alternatives to the participants to choose from. 'Quit kits' were offered to individuals on condition that they were agreeing to think seriously about quitting tobacco use and also agreed to be contacted after four weeks to ascertain if 'quit kit' was of great help. In addition to being issued with 'quit kits' and leaflets, participants were also issued with questionnaires to fill. 3.1 Explanation for Methods used Before and after the Activity Questionnaires were filled before and after the intervention by thirty participants. Their feedbacks before and after intervention were compared. Each participant was issued with a pre-intervention questionnaire to fill and this aided in providing personal information of each participant such as the age, name, year of study, their smoking habit details including how long have one been smoking and academic background. Before a participant was issued with a questionnaire, he or she was required to fill a consent form as a confirmation of agreement to participate in the program. A pre-intervention questionnaire was issued to a participant upon the return of a fully completed and signed consent form. The question of whether one was a smoker or non-smoker in the pre-intervention questionnaire was used to evaluate the present status of each individual. To evaluate the willingness to quit this habit, a question of whether one was willing to quit smoking or not was provided. In addition to this, a participant was also required to state whether he or she had a negative or positive feeling about smoking. Each participant was also required to estimate the number of cigarette sticks he or she smoked in a day. To assess the participant's awareness of the dangers associated with smoking, the question of whether one was a aware was provided. If one was aware, he or she was required to list five health dangers associated with smoking. Besides this, each participant was also required to list five health benefits of quitting smoking. This was to ascertain the extent of awareness of benefits of quitting smoking. To assess the participant's effort in quitting smoking, each of them was required to state three resources in the community that could provide facts on stopping smoking. With such a question, a participant who had initially tried to quit smoking was expected to state different resources. The post-intervention questionnaire on the other hand was filled after four weeks of intervention and it was a bit different from the pre-intervention questionnaire. Besides the personal details, post-intervention questionnaire had questions related to how helpful was the program. Notably, some questions in the pre-intervention questionnaire were repeated in the post-intervention questionnaire. The main objective of repeating some questions in the post-intervention questionnaire was to ascertain the level of awareness of the participant after being subjected to the intervention program. For example, each participant was required to list the dangers of smoking which was a repetition of what was in the pre-intervention questionnaire. It was expected that a participant who had little knowledge of the imminent dangers before intervention ought to list more dangers after the intervention. The one who had no idea of the dangers was expected to list some of the dangers of smoking after the intervention program. To assess how helpful the program was, each participant was required to estimate the number of sticks smoked in one day after the intervention and record it. In addition to this, there was the question of how one managed to overcome smoking urge whenever there was that feeling. A participant was expected to highlight those items according to the instructions of 'quit kits'. 4.0 Results of Observations After the intervention program, the results of pre-intervention questionnaire and post-intervention questionnaire were compared. Notably, thirteen participants out of twenty two who were accessible after the intervention gave positive results. Many of them who were daily smokers with each of them having reported that on average they smoked twenty sticks per day had reduced the number of sticks. The results of the remaining nine were showing no change from the pre-intervention analysis. Of those who reported positive results, One impressive case was that of a participant in the group of an average of twenty sticks per day and had managed to reduce that to smoking twice a day. They reported how they managed the habit of smoking by using various components of 'quit kits'. Many of them reported to have tamed the habit by use of mints and cinnamon. A comparison of their positivity and negativity towards smoking habit indicated that the thirteen participants who gave positive results had reported a negative attitude towards smoking. This can be explained by Fishbein's theory of reasoned action which contends that an individual's action is influenced by his or her attitude towards a certain behavior and the inferred social pressure (Simons-Morton, McLeroy & Wendel, 2011). Their negativity towards smoking was therefore helpful in this regard. Use of intervention methods that influence attitudes of smokers may deem helpful as an intervention measure towards smoking. One notable question in the pre-intervention questionnaire was the question of awareness of the dangers of smoking. Quite impressive was the fact that all the thirty participants reported that they were aware of the dangers of engaging in smoking and seventy percent of them reported that they had negative feeling about smoking habit. The fact that many of them had a negative attitude towards smoking was in line with previous research studies such as that of Larsen & Cohen (2009) which indicated that many smokers had negative attitude towards smoking. On analysis of their smoking details in comparison to their answers to positivity or negativity, it was quite notable that many of those who had negative attitude towards this habit had actually been smoking for more than three years. All the thirty participants were able to list the five dangers and quite impressive was that all of them gave one common danger of lung cancer. This basically implied that many of them ignored these dangers only for immediate satisfaction. Loewenstein & Thaler (1989) highlighted the fact that may people ignore the future repercussions of their habits in favor of the current consequences. The health belief model proposes that a person's alteration to a certain behavior will depend on the perceived benefits and perceived barriers of that behavior. Perceived immediate benefits are more likely to outweigh perceived consequences. With smoking, the perceived benefits tend to be more immediate than perceived barriers which are the smoking related illnesses (Larsen & Cohen, 2009). This explains the high percentage of smokers being aware of smoking consequences yet they continue with that habit. One smoker admitted that he engaged in the smoking habit without considering the future health implications basically because smoking gave him immediate pleasure (Shervington, 1994). Despite the negative attitude towards smoking, some individuals will continue to smoke only to get immediate pleasure. This will imply that a focus to intensify negative attitudes towards may at times not work (Larsen & Cohen, 2009). However, it might deem helpful to design intervention programs that focus on intensification of negative attitudes of smoking and at the same time undermining the inferred positive values of smoking. 5.0 Conclusion and Recommendations for Future Health Promotion Initiatives In conclusion, the report findings have indicated that attitude play a key role in molding a certain behavior. The design of smoking intervention programs need to focus on the attitudes of smokers. Inculcating a negative attitude among the smokers may help. Findings have shown that seventy percent of the participants in the pilot study continued with the habit yet they had a negative feeling towards it. The idea of negativity has an effect on the willingness of smokers to be assisted. Indeed, findings have shown that a greater percentage of those who were showing positive results were those who had a negative attitude towards smoking. However, it might be necessary to consider a health promotion initiative that focuses on both the intensification of negative attitudes and at the same time undermine the positive attitude of those who perceived the smoking positively. 6.0 Works Cited Centers for Disease Control and Preventation (CDC). Sustaining State Programs for Tobacco Control: Data Highlights 2006. Centers for Disease Control and Preventation. (2006). Dixey, R. Health Promotion: Global Principles and Practice. New York: CABI. 2013. Print. Glanz, K., & Rimer, B. Theory at a glance: A guide for health promotion practice (2nd ed.). Bethesda, MD: U.S. Department of Health and Human Services, National Institute of Health. 2005.Print. Halperin, A. C., Smith, S. S., Heiligenstein, E. Brown, D. & Fleming, M. F. Cigarette Smoking and Associated Health Risks Among Students at Five Universities. Nicotine & Tobacco Research, 12(2010)2: 96-104. Larsen, J. T. & Cohen, l. M. ‘Smoking attitudes, intentions, and behavior among college student smokers: Positivity outweighs negativity’, Addiction Research and Theory. December; 17(2009)6: 637–649. Loewenstein, G. & Thaler, R. H. Intertemporal choice. Journal of Economic Perspectives 3(1989):181–193. Martin, v., Molinaa .j., Fernandez, D., Fernandez T. , Deabajos . & Martin V., Molina A. J., Fernandez D., Fernandez T., Deabajo S. & Delgado M . Effectiveness of a course on the prevention and control of the smoking habit on its prevalence and incidence among students of health sciences. Journal of Advanced Nursing, 67(2011)4: 747–755. Murphy-Hoefer, R., Alder, S., & Higbee, C. Perceptions about cigarette smoking and risks among college students. Nicotine & Tobacco Research, 6(2004)Suppl 3: S371-S374. Murphy-Hoefer, R., Griffith, R., Pederson, L. L., Crossett, L., Iyer, R. S. & Hiller, M. D. "A review of interventions to reduce tobacco use in colleges and universities." American journal of preventive medicine 28.2 (2005): 188-200. Noble, S. Clinical Textbook of Dental Hygiene and Therapy. New York: John Wiley & Sons. 2012. Print. Northern Territory Government Department of Health. Health Promotion Strategic Framework 2011-2015. Northern Territory Government Department of Health. 2014. Print. Rodgers, K. C. A Review of Multicomponent Interventions to Prevent and Control Tobacco Use among College Students. Journal of American College Health, 60(2012)3:257-261. Shervington, D. O. Attitudes and practices of African-American women regarding cigarette smoking: Implications for interventions. Journal of the National Medical Association 86(1994):337–343. Simons-Morton, B., McLeroy, K. R., & Wendel, M. Behavior Theory in Health Promotion Practice and Research. New York: Jones & Bartlett Publishers. 2011.Print. Society for Public Health Education. Health Promotion Programs: From Theory to Practice. New York: John Wiley & Sons. 2010. Print. Solvic P. Smoking: Risk,perception and policy. Thousand Oaks, CA: Sage Publications. 2001. Print. Street, R. L., Gold, W. R., & Manning, T. R. Health Promotion and Interactive Technology: Theoretical Applications and Future Directions. New York: Routledge. 2013. Print. Sychareun, V. Hansana, V., Choummanivong, M., Nathavong, S., Chaleunvong, K. & Durham, J. Cross-sectional Survey: Smoking among Third Year Medical Pharmacy, Dentistry and Nursing Students. University of Health Sciences, Lao PDR. 2013. Print. Tlou, R. E. The Application of the Theories of Reasoned Action and Planned Behavior to a Workplace HIV/AIDS Health Promotion Programme. University of South Africa. 2009. Print. Whitehead, D. A stage planning programme model for health education/health promotion practice. Journal of Advanced Nursing, 36(2001a)2: 311–320. World Health Organization (WHO). WHO European Strategy for Smoking Cessation Policy. World Health Organization. 2004. Print. 7.0 Appendix 1 Thematic Chart Author Title Methodology Outcome/Result Summary Kirsten C. Rodgers 2012 A Review of Multicomponent Interventions to Prevent and Control Tobacco Use Among College Students MED- LINE, ERIC, and PubMed databases were used to search literature concerning tobacco prevention and control programs conducted on college campuses published between 2000 and 2009. No studies were found that implemented all 5 recommended components of a comprehensive program. Tobacco control programs containing policy and prevention education were used the most and promotion of tobacco-free environments and banning sales of tobacco products were used the least. The review suggests that despite the recommendation of comprehensive tobacco control programs to reduce tobacco use on college campuses, few institutions have implemented and evaluated programs consisting of multiple components. Jeff t. Larsen & lee m. Cohen 2009 Smoking attitudes, intentions, and behavior among college student smokers: Positivity outweighs negativity Mass survey and questionnaires were used to complete the research. Results suggest that weakening positive reactions toward smoking may deter smoking more than strengthening negative reactions does. Potential mechanisms are discussed, as well as the prospect of increasing negativity’s deterrent effect. If attitudes fall along a bipolar continuum, smoking prevention campaigns that change attitudes by informing people of the negative aspects of smoking make sense. Yet, smokers are already aware of the negative aspects of smoking, as evidenced by our finding that 89% of our participants report some amount of negativity toward smoking. Moreover, 66% felt both good and bad about smoking, which suggests that attitudes toward smoking are best conceptualized as falling within a bivariate space, rather than along a bipolar continuum. From this perspective, attitudinal negativity need not influence smoking behavior even though global attitudes do. Indeed, our findings suggest that it is the presence of positivity, rather than the absence of negativity, that leads to smoking. One implication is that dispelling people’s positive reactions toward smoking may be a more effective deterrent than intensifying their negative reactions. Alternatively, it may be effective to enhance the 648 J. T. Larsen & L. M. Cohen deterrent effect of negativity by making the immediate negative consequences of smoking more salient or by combating smokers’ illusions of invulnerability. Vicente Mart ́ın, Antonio J. Et al 2011 Effectiveness of a course on the prevention and control of the smoking habit on its prevalence and incidence among students of health sciences This study is a quasi-experimental study of community intervention. During the years 2005–2008, a total of 290 health science students on the intervention campus and 256 on the control campus took part in the study. In the former, the intervention consisted of a course on the prevention and control of tobacco use for students, which was not offered on the control campus. Data about tobacco use and socio-demographic variables were collected by means of a questionnaire before and 6 months after the intervention. Prevalence of tobacco use decreased in the intervention group (-1.1%) and increased in the control group (1.5%). The risk of acquiring the habit was almost three times higher in the control group than in the intervention group and the probability of cessation was 40% higher in the intervention group and correlated with nicotine dependence. The intervention suggests the effect on habit acquisition was slight but not so on cessation. Preventive interventions should be carried out before students go to university, while more specific cessation programmes are required to reduce tobacco use among students. Read More