The health belief model and smoking cessation interventions

Smoking Cessation

Health Belief Model

According to the Centers for Disease Control and Prevention (CDC) (2012) smoking harms nearly every organ of the body. It is estimated that there are more than 43 million adults who currently smoke in the United States. Of these 53% are men and 47% are women. Tobacco use is responsible for causing many diseases and reducing the health of smokers in general. The adverse effects of smoking cigarettes account for approximately 443,000, or nearly one in five deaths in the United States annually. Tobacco use causes more deaths each year than all of the deaths caused by human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, and murders combined. An estimated 90% of all lung cancer deaths in men and 80% of all lung cancer deaths in women are the result of smoking as are 90% of all deaths from chronic obstructive lung disease (COPD).

Compared to nonsmokers smoking is estimated to increase the risk of coronary heart disease and stroke by 2 to 4 times, developing lung cancer by 23 times in men and 13 times in women, and dying of COPD by 12 to 13 times. Smoking causes coronary heart disease (the leading cause of death in the United States), reduces circulation by narrowing the arteries, and puts users at risk of developing an abdominal aortic aneurysm. The cancers associated with tobacco use include lung, acute myeloid leukemia, bladder, cervical, esophageal, kidney, larynx, mouth, pancreatic, pharynx, and stomach. Smoking is also linked to infertility, preterm delivery, stillbirth, low birth weight, and sudden infant death syndrome (SIDS). Furthermore, postmenopausal women who smoke have a lower bone density and an increased risk for hip fracture than woman who never smoked (CDC, 2012).

Evidence shows that the harmful effects of smoking do not end with the smoker. An estimated 88 million nonsmoking Americans, including 54% of children aged 3 -- 11 years, are exposed to secondhand smoke. Even brief exposure can be dangerous because nonsmokers inhale many of the same poisons in cigarette smoke as smokers (CDC, 2011).

Secondhand smoke exposure causes serious diseases and even death. The effects of secondhand smoke have been traced to heart disease and lung cancer in nonsmoking adults and sudden infant death syndrome, acute respiratory infections, ear problems and more frequent and severe asthma attacks in children. Each year, primarily because of exposure to secondhand smoke, an estimated 3,000 nonsmoking Americans die of lung cancer, more than 46,000 die of heart disease, and about 150,000 to 300,000 children younger than 18 months have lower respiratory tract infections. Coupled with this enormous health toll is the significant economic burden of tobacco use, more than $96 billion a year in medical costs and another $97 billion a year from lost productivity (CDC, 2011). Quitting smoking greatly reduces the chances for developing these serious health complications or placing others at risk.

The Importance of Health Promotion

The U.S. Department of Health and Human Services recently announced $1.01 billion in grant-funding opportunities for health promotion. These grant programs emerged directly from the Affordable Care Act (PPACA).

According to Michael O'Donnell (2012) in 2010 Medicaid spending by the federal government totaled $273 billion or 7.3% of the total federal budget. State governments spent $127 billion on Medicaid in 2009. This figure represents 9.9% of all state budgets. This level of spending not to mention the inevitable annual increases will be difficult, if not impossible, for states and the federal government to maintain in the future.

It is estimated that tobacco use, inactivity, and poor nutrition cause 70% of all chronic diseases. These diseases account for approximately 75% of all medical costs in the United States, furthermore they account for 83% of all Medicaid costs and 96% of all Medicare costs. Rates of smoking, obesity and chronic diseases are significantly greater in the low-income populations eligible for Medicaid.

Definition of Heath and Health Promotion

According to Charles B. Corbin ("Dimensions of Wellness," NDI) health and wellness may be defined as "a multidimensional state of being describing the existence of positive health in an individual as exemplified by quality of life and a sense of well-being." These dimensions of wellness include: social wellness, occupational wellness, spiritual wellness, physical wellness, intellectual wellness, emotional wellness, environmental wellness, financial wellness, mental wellness, and medical wellness.

Health promotion is the practice of making positive contributions to the health status of individuals, families, and communities by providing information and education that supports family unity community commitment and traditional spirituality. It is also the promotion of healthy ideas and concepts to motivate individuals to adopt healthy behaviors. The World Health Organization (WHO) says health promotion is the process of enabling people to increase control and improve their health. Health promotion is a social and political process encompassing actions directed at improving the skills and capabilities of individuals and actions directed at changing social, environmental, and economic conditions to enhance public and individual health ("Definition of Health Promotion," NDI).

Social Learning Theory

In Social Learning Theory people are "agentic operators in their life course, not just on-looking hosts of brain mechanisms orchestrated by environmental events." Environmental issues appear in three forms, imposed environment, selected environment and constructed environment. The theory subscribes to a model of emergent interactive agency. Bandura (1999) describes the human mind as generative, creative, proactive, and self-reflective. People's behavior and decisions are influenced by triadic reciprocal causation. This model factors in the form of cognitive, affective, and biological events and their influence on each other another bi-directionally. Thoughts serve as determinative functions. This theory also holds that human agency involves self-organization, along with proactive, self-reflective and self-regulative mechanisms. Human agency is implemented through direct personal agency, through proxy agency (relying on the efforts of others), and by collective agency. These influences cause individuals to assess thoughts about future courses of action to suit ever-changing situations, organize and deploy the selected options, evaluate the adequacy of their thinking based on the effects which their actions produce, and make whatever changes may be necessary to produce the optimal outcome.

Diffusion of Innovations Theory

Diffusion of Innovations Theory seeks to explain how and why new ideas and practices are adopted, with timelines potentially spread out over long periods. The way in which innovations are communicated to different parts of society and the subjective opinions associated with the innovations are important factors in how quickly diffusion, or spreading, occurs. Factors that affect the rate of innovation diffusion include the mix of rural to urban population within a society, the society's level of education and the extent of industrialization and development. Different societies are likely to have different adoption rates for different types of innovations (Rogers & Scott, 1997).

Conclusion

Changing life styles, habits, beliefs or self-image can be difficult undertaking and for many may seem impossible. However change is a process and there are steps that must be taken in order to make lasting changes. The Stages of Change model helps health care workers to understand destructive behaviors and assists in recognizing a client's place in the change process. This model involves six stages that take a person from the beginning, learning to indentify the problem, to the end, living without the problem (Prochaska & DiClemente, 1984).

In the first stage, pre-contemplation, an individual may not even recognize there is a problem. An individual is not yet thinking about changing behavior directly, and possibly believes that others are overreacting to them and their behaviors. Pre-contemplation can be broken down to four categories: Reluctant -- may not have enough information to identify the problem; Rebellious -- are so habituated to their behaviors that they become hostile or resistant; Resigned -- believe in the inability to change; and Rationalization -- think about their behaviors and justify their choices. The second stage, contemplation, involves the openness to consider that a problem exists and there may be a need to change behavior in order to correct the problem. At this point a commitment to change has yet to be made. The third stage, determination (sometimes referred to as preparation) occurs when a decision has been made to change behavior and an individual begins planning a course of action. The fourth stage, action, is the result of recognizing that a problem exists, developing a plan to make changes, and involves modifying behaviors relationships, environments, and experiences to overcome the problem. The fifth stage, maintenance, relapse, and recycling, occurs when change has been made and the individual recognizes the benefits, however, there is still a risk of returning to old behaviors. If this happens the person must re-enter an earlier stage. This does not equate with failure but is merely a part of the process of change. The sixth stage, termination, occurs when the threat of relapse is truly reduced and the individual has a support system in place and resources available in order to maintain the change.

As new and innovative policy and environmental interventions to support health and well-being are implemented it will be important to identify which are most effective. A deeper understanding of how to prevent unhealthy activities is also needed.