Do Health Psychology Theories Help Smokers Overcome Their Addiction to Cigarette Smoking - Essay Example

" Do Health Psychology Theories Help Smokers Overcome Their Addiction to Cigarette Smoking”. Introduction: About 106,000 people in the UK die each year due to smoking. Smoking-related deaths are mainly due to cancers, COPD (chronic obstructive pulmonary disease) and heart disease. About half of all smokers die from smoking-related diseases. The risk to health does not end there, as cigarette smoking is the also the single leading cause of cancer. Persons who indulge in smoking are also found to be quite often at risk because of other bad health habits including, consumption of high fat diet, and use of alcohol and lack of exercise. Thus cigarette smoking is a health hazard to any individual indulging in it. Health behaviour change interventions could be a way out of addiction to smoking and in that is the relevance of exploring the possible use of health psychology theories to help smokers get over their addiction to smoking. (Multibehavioural changes for disease prevention among smokers). The Affect of Smoking on the Brain: Inhaling of tobacco smoke causes the nicotine present in it to reach the brain almost immediately. The brain as a result of the stimulation of nicotine releases dopamine. Dopamine provides smokers with a feeling of pleasure and this leads to the craving to smoke among cigarette smokers. Gradually the frequency of smoking increases to maintain sufficient nicotine levels and addiction to smoking is the result. (Smoking and mental health). Health Psychology: Health psychology refers to a recent development in the field of applied psychology. Health psychology utilises psychological theories to intervene and prevent damaging behaviours, which includes smoking. Health psychology also encourages behaviours that aid in the maintenance of good health, like exercising. Health psychology is also associated with health related cognitions, processes that have an impact on healthcare delivery systems and the psychological aspects of illness. (Health Psychology). Health psychology is an emerging branch of applied psychology and as such may have its limitations. There is a suggestion that health psychology may be lacking in standardized terminology and a unified theoretical framework that is necessary for the prediction and explanation of health behaviour. (Smedslund, G. (2000). Health Belief Model Overview: The health belief model explains and predicts health behaviour of individuals on the basis of attitudes and beliefs with regard to disease, especially with perceptions on barriers, benefits and susceptibility. This model suggests the use of messages that are focused on perceptions on barriers to stopping of smoking and the improved health and other benefits that are derived by cessation of smoking. The health benefit model can are made up of four constructs that make up the perceived threats and net benefits. These are perceived susceptibility, perceived severity, perceived barriers and perceived benefits. These elements constitute what makes people ready to act. Cues to action have been an added concept and is what would activate the readiness in an individual and cause overt behaviour. A more recent addition to the health benefit model has been the concept of self-efficacy of the confidence in the ability of the individual to successfully perform the required action. (Health Belief Model). Evaluation: To evaluate the role of the health belief model in helping smokers to give up smoking we need to look at its implications in attitudes and beliefs of smokers, as this is the area that it targets. The model suggests that there are barriers to giving up smoking and it is not an easy thing for a smoker to cease smoking and there is the need to motivate such a behaviour in the individual. The adoption of healthy behaviour in an individual has a relation to the currently held beliefs in the individual on the risk of injury or disease that such behaviour constitutes. From this emanates the perceived seriousness of this threat and the necessary action that needs to be taken to avoid this threat. For example a smoker would not attempt to quit smoking from a perceived threat of lung cancer or heart disease if everyone in the family lived to the age of ninety, as the perceived threat would be ignored in the susceptibility is low due to smoking. The smoker would also evaluate whether the benefits that accrue from the preventive action taken perceived threat outweigh the barriers that have prevented the cessation of smoking. The issue of non-smokers getting lung cancer or heart diseases becomes an issue here. The smoker would tend to ignore the other causes that have led to the diseases and assume that lung cancer and heart diseases are threat even with the cessation of smoking. This is the predictive behaviour of a smoker to cessation of smoking in the health belief model. The critical elements is making the smoker aware of the susceptibility to the ill effects of smoking and the severity of these ill effects and then identifying of the barriers to the cessation of smoking and presenting the benefits that accrue from the changed behavioural pattern as motivation to overcome the barriers of smoking. The health benefit model suggests that this could lead to the individual taking action to cease smoking. It would also be necessary to provide the smoker with enough confidence in their abilities to take the necessary measures to stop smoking and seeing it through, and providing support when attempts to stop smoking happen and encouraging action to stop again. The use of the perceived susceptibility of the health belief model requires the clear definition of the population at risk, the levels of risk and the personalized risks. These means need to be employed to create and increase perceived susceptibility in encouraging cessation of smoking through changed behaviour. The use of these techniques to enhance perception of susceptibility can be seen in most programs in place to stop smoking. The risk to every segment of population young or old, off and on smokers to heavy smokers, pregnant mothers, and so the list goes on making it clear that the every segment of society is at risk. Has this caused any changes and the answer to that is yes. The awareness of the risk of smoking to each and every individual is high and so are the risk levels. The heightened perceived susceptibility can be witnessed in the fact that smoking in public places has come into effect and smokers have accepted it due to the establishment of the fact of the risk in smoking and that too the high risk to each and everyone, even the non-smoker exposed to the smoke in the air in an environment of smokers. The next step is the perceived consequences of the risk and this calls for clarifying the risk and the extent of the risk. In the case of smoking it means creating awareness of the high rate of fatal diseases like lung and mouth cancer, and heart ailments due to smoking. The consequences of risk is high with smoking and so too the extent as it often leads to death. Awareness of this among smokers has been created and the use of this can be seen in the employment of health warnings on every cigarette pack that is sold in most countries. This is the most potent aspect of the health benefit model in its use to get smokers to stop smoking. The next step is to make clear the action that the smoker needs to take to derive benefits of the action and the positive effects that are the result. The action that the smoker needs to take is to smoke smoking as reducing does not have any benefit. The benefit is a healthy life or even life itself. So the perceived benefits in the health benefit model are strong enough to overcome the barriers to smoking. (Health Belief Model). The identification of the barriers and the reduction of these barriers through reassurances incentives and suggestions are the means according to the health belief model. Anti-smoking programs do make use of counselling as a means to provide these aspects. These programs also do look after the need to provide information on how to stop smoking and reminders to initiate this action. Training and guidance is also provided in performing the required action to stop smoking. These steps are for the last two parts of the health belief model consisting of the cues to action and self- efficacy. Does the health belief model help in cessation of smoking through the use of these steps is easily answered with a yes. This is the most used health psychology theory in the smoking cessation programs. Most of the initial success that has been seen in the cessation can be attributed to the health benefit model and its strengths of perceived susceptibility, perceived severity, and perceived benefits. This is because smoking is an extremely unhealthy addiction that has severe consequences on the health of the individual. The success of the health benefit model in the cessation of smoking has caused its use in other areas like HIV/AIDS and the use of condoms. Does the health belief model offer a total solution to the cessation of the smoking is also easily answered and that is in the negative. In case it provided a total solution, the vexing problem of smoking would no longer exist. There are limitations to the use of this model in the cessation of smoking and these limitations in the use of this model include the lack of taking into consideration of environmental and economic factors and the consequences of the influence of social norms and peer pressure. These weaknesses of the health benefit model have given rise to the use of other health psychology theories to assist in the cessation of smoking. (Smucker, R.D. and Hasse, L. Changing Health Behaviours in a Family Practice). Protection Motivation Theory:   Overview: Protection Motivation Theory proposes that the intention of an individual for protection is subject to four factors. These factors re perceived severity of a possible event, perceived probability of the occurrence or vulnerability, the efficacy of the recommended preventive behaviour and the perceived self-efficacy. On the basis of this theory it would be possible to cause reduction in the addiction of smoking by highlighting the health hazards and its possibility of occurrence on one side and the benefits as a result of cessation of smoking. (Protection Motivation Theory). Perceived vulnerability is the personal perception of individuals of the risk of as negative incident happening to them. Applying this in the case of smoking it means the personal perception of succumbing to an undesirable disease like lung cancer or heart disease. The higher the perception of the risk of these diseases the higher will be the intent to stop smoking. Perceived severity is again the personal feelings concerning the seriousness of the negative incident. In its application to the cessation of smoking this means the concern that contracting a serious illness like lung cancer or heart disease. The evaluation dimensions are both medical consequences of death, disability and pain, and social consequences of effect of the conditions of lung cancer or heart disease on work, family life and social relations. Perceived severity varies with the individual and as can be expected the higher the perceived severity of lung cancer or heart disease the higher the incentive to follow the recommendations to stop smoking. Perceived response efficacy takes into consideration the individual’s belief that the behaviours recommended would lead to elimination or reduction of the negative incident. In the case of smoking this refers to the belief in the person that stopping of smoking would either eliminate or reduce the chances of becoming a victim to diseases like lung cancer or heart diseases. The more the chances of not falling victim to these fatal diseases by the cessation of smoking the greater are the chances of following the recommendations to stop smoking. The positive response that is expected here includes several variables including attitude, intention and the actual cessation of smoking. Personal self-efficiency concerns the individual’s belief in the personal capability to undertake the recommended course of action. Applied to cessation of smoking this means that the person needs have self-belief in the ability to stop smoking at any cost. The greater the self-belief in the ability to quit smoking the greater will be the inclination to stop smoking. Evaluation: The personal motivation theory is thus a mix of threat appraisal and coping appraisal in the predicting the behaviour of an individual. Initially it was believed that both elements had an equal role to play but there is growing belief in the increased tendency on individuals to lean on coping appraisal in their intention towards the recommended changes of behaviour. In cessation of smoking according to the personal motivation theory this means that the threats instil in individuals fear. This fear causes the individual to process a coping response and information on the ability to overcome the barriers to cessation of smoking. The feeling of a high level of ability to overcome the barriers to smoking encourages the following the recommendations to stop smoking. Individuals motivate themselves to have a higher belief in coping with barriers to stop smoking when the incentive is on the higher side. This has caused the personal motivation theory to be used successfully in reducing smoking in certain vulnerable sections of society. It would be useful here to examine the role of the personal motivation theory in reducing smoking in the pregnant women. A developing strategy in the use of personal motivation theory to assist in smoking cessation is the use of biomarker feedback to promote motivation. This has become necessary because while many smokers are aware and acknowledge the health risks related to smoking there is a tendency to minimize this risk when it comes to them. The use of information that has a more personal meaning becomes relevant in the use of this theory to overcome the reduced perceived personal risk. The successful use of heightened information on the risk to the foetus in pregnant women is example of the use of more personalized information to make the personal motivation theory more successful. Pregnant women who do not believe that smoking affects the foetus in a negative manner show lesser tendency to give up smoking, while women who believe that the foetus is at risk due to smoking have a greater tendency to give up smoking. (McClure, B.J. 2004. Motivating prepartum smoking cessation: A consideration of biomarker feedback). The Transtheoretical Model: Overview: The transtheoritical model provides a model of behaviour with intentional change. The transtheoritical model takes into consideration the emotions, cognitions, and behaviour of an individual. This requires involvement of reliance on self-report. In smoking cessation in individuals self-report has proved to very accurate. For self-report accurate measurement steps are required and these need to be unambiguous to enable the individual to respond accurately with as little scope for error as possible. The issue of measurement is extremely significant as it is a critical step as the model is founded on the development of several short, reliable and valid measures of the key constructs of the theory. The transtheoritical model looks at change as a process that makes progress by a series of five steps. (Velicer et al (1998). Pre-contemplation: This stage is where individuals do not intend taking an action in the near future and this is usually measure as within the ensuing six months. Individuals remain in this stage because of two reasons and these are the lack of information or sufficient information and the lack of success in earlier attempts to change, which have demoralized them. Contemplation: In this stage people intend changing within the next six months. There is more awareness of the benefits of changing, but the acute awareness of the constraints to change is also there and this causes them to be ambivalent. This is the stage where individuals can remain stuck without change for long periods of time. Preparation: In this stage individuals intend taking action in the immediate future, which is usually taken to be a month. The individuals have taken significant action in the past one year towards the change. The theory suggests that it is at this stage that individuals are ripe for targeting of smoking cessation programs. Action: In this stage people have made definite moves to modify life styles in the previous six months. There are several actions that are possible in the cessation of smoking like switching to lighter cigarettes, or the reduction in smoking, but the model only accepts total cessation as action. This is also the stage where extreme vigilance is required as relapse is possible. Maintenance: In this stage individuals are conscious of the possibility of relapse and work against it. They display better confidence in their ability to maintain their changed life styles. The transtheoritical model has been successfully used to promote better health behaviour and as such holds promise for the cessation of smoking. (Sullivan, K. T. 2000. Promoting Health Behaviour Change). Evaluation: The relevance of this theoretical model lies in the findings that nearly forty percent of the smokers are in the pre-contemplation stage, another forty percent are in the preparation stage and another twenty percent in the preparation stage ready for further treatment in the process of cessation of smoking in America. These figures change to seventy percent in the pre-contemplation stage, twenty percent in the contemplation stage and ten percent in the preparation stage in Europe. (Velicer et al (1998). The use of this model in the cessation of smoking clearly defines the kind of messages would be useful to individuals in the different stages and thus making it more effective. Heightening the risk and benefit factors messages would be useful in the first two stages promote action to the subsequent stages. The third stage would require more personal attention with programs like counselling not just to the individual, but to the family members too, to get the individual to actually cease smoking. The next stage calls for constant alertness and support to prevent relapse into smoking. It is here that the support of the family and social circles play an important role by not creating incentives to smoke and messages need to target these audiences too. In the last stage the alertness can be relaxed and the messages to the individual should stress the benefits that the individual currently enjoys, due to the ceasing of smoking, so that the changed behaviour persists. This theory suffers from limitations in that it does not take into account environmental factors, gives more of a descriptive instead of a causative nature of the behaviour, and the stages described may not be suitable to characterize the different segments of population. (Shimoda, T. A Theory Belief for Cognitive Agents). Discussion: The different health psychology theories do have a role to play in the cessation of smoking. The health behaviour theory with its stress on individual perceptions of risks, benefits and barriers prove to be useful in initiating smokers into action to cease smoking. The protection motivation theory displays better characteristics in addressing individual segments of society like pregnant mothers, or adolescents by heightened their perceptions of vulnerability and severity and thus getting them to change their behaviours. The transtheoritical model provides an insight to the stages through which the cessation process works and thereby the means to address the required motivation for change. The psychology theories work by themselves, but for them to be more effective it would be preferable for them to be used in conjunction with one another, so that the lacunae of one theory is made up by the supporting theory. This is better understood when we look at the use of the health behaviour model in conjunction with the transtheoritical theory, with the protection motivation theory reserved for certain segments of society like pregnant women and adolescents. The transtheoritical theory does not hold out much for the individuals who make up the first two stages in the theory, and are numerous. The health belief model provides the means to address this section, but is weaker in the remaining. By combining the health belief model in the first two stages of the and the transtheoretical theory a better solution for the cessation of smoking by the use of health psychology theories are arrived at. (Zimmerman et al. 2000. A Stages of Change Approach to Helping Patients Change Behaviour). Literary References Health Belief Model. Retrieved March 12, 2006, Web site: http://lamar.colostate.edu/~shimoda/Pages/hicss36/theory2.htm. Health Belief Model. Retrieved March 12, 2006, Web site: http://www.tcw.utwente.nl/theorieenoverzicht/Theory%20clusters/Health%20Communication/Health_Belief_Model.doc/ Health Psychology. Retrieved March 12, 2006, Web site: http://www.bps.org.uk/careers/areas/health.cfm. McClure, B.J. 2004. Motivating prepartum smoking cessation: A consideration of biomarker feedback. Retrieved March 12, 2006, from Nicotine & Tobacco Research, Vol 6, Suppl. 2 Web Site: http://www.ntrjournal.org/mcclure.pdf. Multibehavioural changes for disease prevention among smokers. (2002). Retrieved March 12, 2006, from Tobacco-Related Disease Research Program. Web site: http://www.trdrp.org/research/PageGrant.asp?grant_id=2470. Protection Motivation Theory. Retrieved March 12, 2006. Web Site: http://www.tcw.utwente.nl/theorieenoverzicht/Theory%20clusters/Health%20Communication/Protection_Motivation_Theory.doc/. Shimoda, T. A Theory Belief for Cognitive Agents. Retrieved March 12, 2006. Web Site: http://lamar.colostate.edu/~shimoda/Pages/TBM/TheoryBeliefModel.pdf. Smedslund, G. (2000). A Pragmatic Basis for Judging Models and Theories in Health Psychology: The Axiomatic Method). Journal of Health Psychology, Vol. 5, No. 2, PP. 133-149. Smoking and mental health. (2004). Retrieved March 12, 2006, from, action on smoking and health. Web site: http://www.ash.org.uk/html/factsheets/html/fact15.html. Smucker, R.D. and Hasse, L. Changing Health Behaviours in a Family Practice. Retrieved March 12, 2006. Web site: http://www.familymedicine.uc.edu/predoc/9-21%20PDF%20files/Chapter%202%20-%20Changing%20Health%20Behaviors.pdf. Sullivan, K. T. 2000. Promoting Health Behaviour Change. Retrieved March 12, 2006. Web site: http://www.ericdigests.org/1999-4/health.htm Velicer et al (1998). Smoking cessation and stress management: Applications of the Transtheoretical Model. Homeostasis. Vol. 38, Pp. 216-233. WHAT IS HEALTH EDUCATION? Retrieved March 12, 2006, from UNITE FOR SIGHT. Web site: http://www.uniteforsight.org/course/overview.php. Zimmerman et al. 2000. A Stages of Change Approach to Helping Patients Change Behaviour. Retrieved March 12, 2006, from American Family Physician. Web site: http://www.aafp.org/afp/20000301/1409.html Read More