Sustainable growth supports an economic development that take into consideration social and environmental welfare as well. Economic development and excessive use of resources are a major cause for many life style diseases. Fast food culture, lack of physical activity, smoking, pollution, pesticides, stress and production practices have increased the occurrences of obesity, cancer, cardiovascular and autoimmune diseases. Unlike the past, when majority of the deaths were associated with infectious diseases; life style diseases are the major cause of deaths in today. The primary step to reducing these diseases, is by introducing a change in human behavior.
Health behavior theories help in identifying targets, whose behavior needs to changed, and also provides methods, that will help in accomplishing the change (Glanz, Rimer & Lewis, 2002). They also provide methods to evaluate intervention efforts and measure outcomes (Glanz, Rimer & Lewis, 2002). These approaches are often different from intuition driven traditional methods. Such scientific approaches are essential to prevent unhealthy eating habits and lifestyle. In a global survey, use of tobacco was identified as an unhealthy habit, and was responsible for the maximum number of premature deaths in a year. In this assignment I choose to bring about a change in the smoking habits of young men and women studying in colleges/high schools.
Almost 99% cigarette smoker started the habit before the age of 26. More than 5 million Americans, less than 18 years of age, die from smoking related diseases. Nearly half of the high school students use some form of tobacco products (Smoking and Tobacco Use, 2015). According to the 2014 CDC statistics, 9% of high school children are cigarette smokers. Each day, in US, more than 2000 adolescents, less than 18 years of age, become daily cigarette smokers (Smoking and Tobacco Use, 2015). If this is to continue unrectified, smoking related health problems will become one of the major health concerns in the future. Further, cigarette butts, are the most common item that litter the environment. (Grimshaw & Stanton, 1996)
Smoking not only harms the smoker, but does more harm, to people who are passively exposed to the tobacco smoke, by being near a smoker. Smokers pollute the environment, in which we all live and increase the risk to lifestyle diseases, for all who live in the polluted environment. Smokers who started at an early age, have increased risk to lung cancer, than those who started late. Apart from this, young teenage smokers have poor respiratory health. Smoking is also linked to high level of absentees and poor performance in school.
Health workers are entrusted, with the responsibility of providing health education to susceptible population, along with providing measures that bring about social and behavioral changes. The first step in preparing for a “youth smoking cessation intervention program”, would be to form an intervention committee, review the relevant context, approaches and factors such as accessibility, cost effectiveness and impact. Many intervention programs to stop smoking, are based on cognitive-behavioral interview or by using motivation strategies. Counselling, talks, interviews, school presentations, competitions, cell or internet based approaches can be used for this purpose. Introducing smokers to physical activity and regular exercise, was also found to bring about a habit change. Motivation from family, friends and overall social connectedness can help the target to quit smoking.
Dalum, Schaalma & Kok, 2011, used an Interventional Mapping approach to reduce smoking among adolescents. As a first step in this approach, a planning group consisting of researchers and interventionists were established. Intervention was then carried out in four phases to detect the best methods, and finally a potpourri of all methods was used to promote behavioral change among adolescent smokers in a particular school. These intervention were targeted on both the students and faculties of a school. A non-confronting approach was used in which; during the first phase of intervention, trans-theoretical model and self-regulatory model were used to introduce behavior change (Dalum, Schaalma & Kok, 2011). According to this theory: knowledge, self-efficiency, attitudes, coping skill, academic skills, social determinants and smoking history will determine the success of behavioral change (in this case smoking cessation) intervention.
Peer pressure is an important motivator to adolescent smoking behavior. Though many adolescents are aware of the harms associated with smoking, they lack the necessary skill needed to resist this behavior. Therefore a continuous and persistent interventions might be necessary, to bring about a behavioral change. These interventions must aim to provide, essential decision making skills that will help to resist pressure to smoke from friends, family, peers and media. In certain countries, cigarette packet or smoking clips in media, show the warning signs: “smoking is injurious to health”. This is one way to promote correct decision making skill. Prevalence of smoking among fathers and low socio economic status, increases the likelihood of developing smoking habits among adolescents. Another factor that can influence the intervention, is the degree of dependence of the smoker, on tobacco. Students who smoke maximum number of time or those who smoke frequently, are likely to have greater dependency and thus need more help in bringing about a behavioral change. (Casallas, 2004)
Pharmacological intervention in the form of nicotine gum, nicotine patch, or bupropion are also used to bring about behavior changes. However reports about their success is limited. Though these pharmacological interventions can decrease the frequency of smoking, they failed to produce significant numbers of quitters. For adolescents, who want to give up smoking, but could not because of high dependency on nicotine, a resident program may be necessary. In this program, the addicted student is taken as inpatient and provided a comprehensive treatment for 12 to 18 months. Most of the adolescent who are admitted for resident treatment, are found to have other psychiatric or behavioral disorders, which motivates them to smoke. (Casallas, 2004)
Prochaska & DiClemente, 1984 proposed five stages in a person undergoing behavioral change. The first stage is the pre contemplation stage, in which the smoker is either unwilling or willing to give up smoking. In this stage the intervention program will aim to counsel students into giving up smoking, by introducing them to harmful effect of smoking and the benefits associated with smoking cessation. This stage is also suitable for interviewing and collecting facts, about factors that prevent smokers from quitting. Stage two is the contemplation stage, when smokers explore their personal goals and contemplate on reasons that prevent them from quitting the habit. This stage involves identifying reasons that motivate change, and contemplating on the actions needed to bring about the change. Smokers weighs the benefit of smoking against its harms. Third is the Action stage, the smoker takes small mental or behavioral action to quit smoking. Physical activity, group discussions, competitions, can be arranged during this period. In stage four, individuals are committed to quit smoking. Active behavioral intervention strategies are adopted during this stage. Reminding, reaffirming, person to person interview is done during this stage. The last stage is the maintenance stage, when the individuals agrees to stop smoking forever. Intermittent phone calls and parental support can help during this period. The overall success rate in each step, could be measured, by estimating the level of decrease in smoking behavior. Measuring CO levels, and using urine nicotine dipstick test can help determine, whether the student has reduced or stopped smoking.
Conclusion: Smoking is an injurious behavior, both for adolescents and adult. However, the ill effects of smoking are more for early smokers. Introducing behavioral changes are more successful at an early stage, than in adult age. Socio economic factors along with inherent nature of an individual, predisposes him/her to smoking. Behavioral changes are most effective, in preventing this vice and ensuring health among adolescents. They also provides immense benefit to environment and the nation by reducing diseases and other anti-social behaviors. It also reduces environmental pollution and littering.
References:
Casallas, F. (2004). A Feasibility Study of a Cognitive Behavioral Smoking Cessation Intervention for Adolescent Males in Residential Treatment (Doctor of Psychology). Philadelphia College of Osteopathic Medicine.
Dalum, P., Schaalma, H., & Kok, G. (2011). The development of an adolescent smoking cessation intervention--an Intervention Mapping approach to planning. Health Education Research, 27(1), 172-181. doi:10.1093/her/cyr044
Glanz, K., Rimer, B., & Lewis, F. (2002). Health behavior and health education. San Francisco: Jossey-Bass.
Grimshaw, G., & Stanton, A. (1996). Tobacco cessation interventions for young people. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd003289.pub4
Prochaska, J., & DiClemente, C. (1984). The transtheoretical approach. Homewood, Ill.: Dow Jones-Irwin.
Smoking and Tobacco Use,. (2015). CDC - Fact Sheet - Youth and Tobacco Use - Smoking & Tobacco Use. Retrieved 24 July 2015, from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/
