Reducing Tobacco Use by Adults

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Introduction

People have a responsibility of taking care of their own health. However, to accomplish this noble task, which can help in the creation of a healthier nation, dissemination of health information is of great importance. Expressed as a concept, health promotion addresses various health challenges such as non-communicable and communicable ailments that affect people in the US. It also helps in reducing engagements in behaviors and lifestyles that constitute risk factors to contracting chronic ailments. In this sense, health promotion aims at enabling people in different states to take action towards protecting their own health at an individual or communal level. Health promotion programs constitute one of the alternatives that are deployed by different states to address the challenges of drug and substance abuse such as alcohol and tobacco products.

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The goal of the programs entails enabling people live economically, personally, and socially productive lives. For the purposes of discussion of this proposal, health promotion refers to the course of allowing citizens amplify the control in terms of their wellbeing and any factor that influences their physical condition (World Health Organization, 2005). Reducing tobacco use helps in fostering heath promotion since it minimizes health risks and diseases that are associated with tobacco smoking. Any program for reducing tobacco use can take reactive or passive approaches.

This paper proposes a passive intervention, ‘You Can Quit Tobacco Use Program,’ through a hypothetical organization called LA Tobacco Use Rehabilitation Center. The organization is located in San Francisco. The intervention aims at reducing tobacco use among young adults (18-28 years old). The US Department of Health and Human Services (2012) data indicate that this group of adults is at an elevated risk of initiating tobacco use, and hence the focus of the program on this target group.

Health Promotion/Disease Prevention Problem and Specific Population

Description of the Health Promotion to a Target Population

A program for addressing tobacco use among young adults aged between 18 to 25 years is particularly important since this cohort has a higher prevalence rate of addiction. The US Department of Health and Human Services (2012) informs that 3,800 people (below 18 years) smoke their first cigarette on a daily basis with more than 1000 of such people becoming addicted to nicotine at young adulthood (18-25 years). Hence, developing a tobacco use cessation program for this group of people is of paramount significance as a strategy for health promotion in the US.

Many of the nicotine addicts in the 18-25 age group start smoking without adequate awareness of the impacts of tobacco on their health. To provide awareness, sharing life experiences between people who are in acute condition of ailments that are associated with tobacco and starters or addicts is important. This plan can help in the development of cognition and fear of tobacco abuse. Such an awareness program can encourage cessation. Through developing fear, young adults can embrace tobacco adverts with suspicion and interpret them as deceitful. This observation is important for 18-25-year old young adults since media profiling and advertisements influence their consumption patterns.

Analysis and the Significance of the Specific Prevention Problem

Tobacco smoking is associated with lung cancer. Reduction of tobacco use implies that the contribution of lung cancer in deaths that relate to all types of cancers in the US can be minimized. Data from the US Department of Health and Human Services (2010) ranks cancer in the second position in the list of fatal ailments within the US since it kills about 0.5 million people annually. Tobacco-associated health challenges such as lung cancer kill about 443,000 people in the US annually (US Department of Health and Human Services, 2012). Apart from causing death, it also impairs the nation’s productivity. It increases expenditure on treatments. The US Department of Health and Human Services (2012) estimates that tobacco costs the US about US$96 billion through direct expenditure on treatment and an additional US $97billion through a reduction of productivity of its addicts.

The US government and individual states discourage tobacco consumption through several programs. Farrelly, Pechacek, Thomas, and Nelson (2008) assert that increased expenditure on such programs has more effect on reducing smoking among adults in the age of 25 years and above compared to those between 18-25 years (p.304). Hence, an alternative way of reducing tobacco consumption among 18-25-year old young adults is significant.

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Relationship to Individual Advanced Roles

As a nursing student, I have an individual advanced role in ensuring quality and efficiency in the provision of healthcare. Nurses work with various communities, individuals, and diverse groups of people to provide care based on the fundamental principle of evidence-based healthcare. Degrease and Nicklin (2001) posit nurses have advanced individual roles of integrating and intertwining their knowledge that is anchored in nursing theory with practice to ensure effective health management, enhance health promotion, and participate in injuries and/or disease control. Engagement in the development of a program for reduction of tobacco use aligns well with these individual advanced roles of nurses as it helps in fostering health promotion. It is also a passive approach to disease prevention through mitigation of ailments risk factors.

Advanced individual roles of nurses also entail participation in healthcare leadership. Working in this capacity, nurses have the responsibility of developing and implementing various evidence-based health care programs while at the same time participating in resolving sophisticated healthcare related issues. DiCenso, Auffrey, Bryant-Lukosius, Donald, Martin-Misener, Matthews, and Opsteen (2007) add that advanced roles of nurses also involve providing directions for policies, developing standards, and evaluating and assessing the outcomes of initiatives for health promotion and care management. However, the development of health promotion program or any other mechanism of addressing the challenging health risk factors precedes the improvement of the strategies and procedures of evaluating and assessing its effectiveness in terms of resolving the health challenges that it seeks to address. Thus, the development of a program for reducing tobacco use aligns well with individual roles of nurses in terms of leading the process of developing strategies of mitigating risk factors, which have negative impacts on public health. The principal purpose of programs that promote health involves availing information, which when synthesized by public, will enable people make choices that influence their health and productivity positively.

Critical Analysis of Relevant Literature

Smoking tobacco is harmful to the health of people of all ages. The smoke has an excess of 7000 chemical substances with 70% of them posing risks of contracting cancer (CDC 2014). People who quit using tobacco experience reduced risks of contracting many ailments that are associated with it. More importantly, they escape premature death. CDC (2014) confirms that stopping smoking is highly beneficial to people who make such decisions early enough, although even those who stop at late ages also benefit. These benefits include a reduction of the risk of lung malignancy, coronary heart infection, COPD, stroke, sterility amongst women, and reduced birth rate among others. The benefits compel the US government and different states to seek different ways of creating awareness of tobacco use and reducing its prevalence rates among the US citizens.

One of the earliest attempts to reduce tobacco use was enacting ‘Family Smoking Prevention and Tobacco Act’, which aimed at regulating the use of tobacco products in the US through the authority in charge of foods and drug administration. The Act requires tobacco-manufacturing companies to indicate graphically the danger of smoking. It also bans the selling of single sticks of cigarettes and any marketing effort that targets people below 18 years (US Department of Health and Human Services, 2012). Although the Act regulates tobacco use, it fails to incorporate mechanisms of creating awareness of possible health consequences of smoking. It only relies on tobacco-manufacturing organizations to do it.

In an effort to overcome the challenges of ‘Family Smoking Prevention and Tobacco Act’, the Department of Health and Human Services established a kitty of US$225 million with the intention of using it in preventing and controlling tobacco use across various states (US Department of Health and Human Services, 2012). This marked the hallmark of the widespread community-based tobacco use prevention programs across all states in the U.S. The money was only allocated to community-based programs, which deployed evidence-based approaches in reducing tobacco use.

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Many states utilize comprehensive programs to encourage addicts to quit smoking among the US citizens. Such programs involve campaigns that are launched through mass media, increasing exercise duties that are levied on cigarettes, introducing free telephone cessation lines, subsidizing cessation treatments, assisting persons who seek smoking cessation, and restricting smoking in public settings in a bid to mitigate the effects of secondhand smoking (US Department of Health and Human Services, 2012). Some states also adopt policies that seek to discourage the manufacturing of cigarette products. For instance, MSA, which is an agreement made between 46 states, the US government, and 4 major tobacco product-manufacturing organizations, prohibits the promotion of tobacco products to people below 18 years old (Schroeder, 2004). Through the agreement, the tobacco-manufacturing organizations are also required to pay the states US$246 billion over a period of 25 years (Farrelly et al., 2008). MSA also establishes the American legacy foundation, which focuses on conducting a nationwide campaign against smoking that targets young adults.

Although the above efforts to curtail cigarette smoking are important, they produce different impacts on the reduction of tobacco use. For instance, according to the US Department of Health and Human Services (2012) and Tauras, Chaloupka, Farrelly (2005), through the programs, smoking amongst high school students reduced by 14.5% between 1997 and 2003. However, there is inadequacy of research on state-enacted programs for reducing the prevalence rate of tobacco use among adult smokers. This situation is perhaps unfortunate upon considering that cessation programs deliver incredible health benefits among adults (Peto, Darby, Deo, Silcocks, Whitley, & Doll, 2008). Research on such programs in the state of California confirms the ability of tobacco use programs to yield positive results. Between 1988 and1999, tobacco use among adults declined by 5.6% in California (Farrelly et al., 2008). Despite the positive results of the programs in this region, the findings have a limitation since they cannot be generalized to apply across all states.

Theoretical/Conceptual Framework

Conceptual Framework Selection

You Can Quit Tobacco Use Program’ follows tobacco use discounting theoretical or conceptual framework. Although, cessation may be realized through self-help approaches, in this program, a healthcare professional aid is mandatory. The conceptual framework constitutes three main stages, namely groundwork, intercession, and preservation (Scwartz, 2002). The objective of the preparation stage is to provoke impetus of tobacco users to embrace termination through acquiring confidence that they can quit successfully. The intercession phase deploys various evidence-based methodologies for achieving abstinence.

In the maintenance phase, the focus is on enhancing retention of the acquired positive mechanism of quitting and abstinence. This stage requires the development of support, various coping mechanisms, and/or substitution of smoking behavior in an effort to foster permanent tobacco use abstinence (Scwartz, 2002). In spite of people making decisions for quitting the use tobacco on their own, smoking cessation self-help kits may help compel people to make the decisions. Counseling and behavioral programs may also compel people to break from the smoking habit successfully. The conceptual framework for ‘You Can Quit Tobacco Use Program’ relies on the contribution of healthcare professionals, through counseling and enhancing the experience sharing, to solicit tobacco users to make quitting decisions.

Incorporation of the Theoretical Model into the Design of an Intervention Plan

Using the conceptual model of discounting tobacco use, in designing an intervention plan, the first stage is preparation. Mass media campaigns against tobacco smoking create the awareness that smoking is related to many health challenges. However, some people may undervalue them since they may not have a shared experience on such implications in real life. While preparing people, the program uses mass media to draw people’s attention ‘You Can Quit Tobacco Use Program’. Emphasis is placed that those wishing to prove without doubt that smoking tobacco can cause death should visit LA Tobacco Use Rehabilitation Center. Through the ‘You Can Quit Tobacco Use Program’, all visiting adults are taken to various wards for people who are suffering from acute lung cancer under the guidance of a health professional who explains to them the cause of hospitalization of the patients.

Potential candidates for cessation later undergo a workshop. In the workshop, people who have had complications that are associated with tobacco use are brought to share their experiences with smokers who now have constructed disturbing images of people lying on hospital beds and placed on some breathing aids. The purpose of this workshop is to create awareness that quitting is possible through live proclamation of the possibility of addicts who have already quitted. After the workshop, potential candidates are allowed to go home and re-evaluate their decision to quit. Those who still consider quitting after the re-evaluation are required to report after one month, but with two more other smokers who upon sharing their experience at the workshop are convinced that they need to seek cessation help. Newcomers go through the preparation procedure while people who are now fully decided to engage in cessation proceed to the next phase, the intervention, as discussed in the next section.

Intervention Plan: The ‘You Can Quit Tobacco Use Program’

Designing the Intervention Plan

Intervention programs are developed in accordance with the appropriate epidemiological, social, and environmental assessments. Epidemiological assessment refers to “the study of the distribution and determinants of health-related states or events in specific populations and the application of this study to control health problems” (Williams, 1998, p.1379). It takes analytical and descriptive forms. ‘You Can Quit Tobacco Use Program’ uses a descriptive approach. Descriptive epidemiology entails the assessment of the occurrence of health challenges in the context of time, place, and a specific group of people. ‘You Can Quit Tobacco Use Program’ focus is on 18-25-year old people in San Francisco, LA. Through social and environmental assessments, it becomes possible to develop health-related problem intervention program to solve specific social and environmental problems. In the context of ‘You Can Quit Tobacco Use Program’, the issue is on the quality of life among the target populations (18-25 years old people).

The ‘You Can Quit Tobacco Use Program’

This program uses psychological support and medication to reduce tobacco use. It applies the health belief model. Therefore, for this plan to work effectively, aspects such as motivation and decisions by the users to quit are mandatory. The plan forms a strong foundation for enhancing the effectiveness of psychological support in helping patients deal with smoking behavior. Medical interventions enable patients reduce their dependency on nicotine in phases. These two approaches are administered simultaneously under ‘You Can Quit Tobacco Use Program’.

The first option involves administering NRT (Nicotine Replacement Therapy), which involves the delivery of nicotine in less risky forms compared to tobacco smoking. Depending on patients’ dependency levels, NRT administration initiates with a dosage that meets individual patient’s nicotine dependency level before narrowing down to a level where stopping becomes possible. In this process, five NRT medications are administered. They include gum, inhalers, sprays, TP (Transdermal Patches), and Lozenges.

Over-the-counter NRT medication is not recommended. Evidence indicates that NRT that is administered this way translates into relapse for more than 93% of cases within a period of 6 months (West, 2006). This observation reveals why people who successfully complete the workshops and make decisions to quit must report to LA Tobacco use Rehabilitation Center for cessation professional help. Alternative medication encompasses ‘Nicotine Receptor Partial Agonists’, antidepressants, and Moclobemide. Psychological help through counseling is delivered through workshops and engagement forums with past smokers who have not relapsed. To keep their motivation for abstinence, those who have recently stopped are called upon to preside over forthcoming workshops by engaging other people who wish to quit smoking.

Alternative Interventions

The above intervention plan only focuses on 18-25-year old cohort of the LA population living in San Francisco. Although addiction occurs mostly at these ages, many people adopt tobacco-smoking behavior at the adolescent age (US Department of Health and Human Services, 2012). People who are older than 25 years also engage in smoking. Alternative programs can address cessation needs among people who are not considered in the ‘You Can Quit Tobacco Use Program’. One of the most cost-effective ways of addressing the needs of both people below 18 years and those older than 25 years entails shifting their attitudes towards smoking.

Instead of believing on advertisement that profiles smoking as a good behavior in films, mass media campaigns can be deployed to instill the belief that it causes cancer. When accompanied by the appropriate community-based support programs, this approach can incredibly reduce tobacco use upon considering that 92% of the Americans strongly associated smoking with lung cancer in 1986 compared to 1950s, when about 50% of the US people believed that tobacco smoking could cause cancer (Scwartz, 2002). Banning the portrayal of characters who smoke in films that are meant to be viewed by young people below 18 years may also help in non-portrayal of smoking as a behavior that characterizes liberated people.

Another alternative for reducing tobacco use among people who are not served by the ‘You Can Quit Tobacco Use Program’ is a self-help program. People, especially those over 25 years old, can acquire instructions and motivation to stop from cessation kits that are developed by comprehensive statewide programs for tobacco smoking cessation. Nevertheless, for better outcomes, seeking professional help, especially among people who show strong psychological tobacco use addiction is important.

Evaluation Plan

Designing an Evaluation Plan

Intervention strategies for ‘You Can Quit Tobacco Use Program’ only apply to candidates who have gone through the preparation phase. The preparation phase builds fear among tobacco users who engage in the program that presents smoking as a risky behavior that can see them admitted to hospital in critical conditions. The fear is crucial in avoiding relapse since it may overpower addictive compulsion to engage in tobacco use. The number of people who return to seek more cessation help after the preparation phase can indicate the effectiveness of the ‘You Can Quit Tobacco Use Program’. Where the ratio of the total number of people who engage in the preparation phase to those who come for more help exceed 1, the program is effective and vice versa. In fact, the intervention plan is likely to be more effective to people who have made the solid decision to quit. Thus, the one-month break that is given after the preparation phase on condition that only serious people return acts as a subjective test on the solidness of the decision made by potential cessation candidates.

People who develop adequate fear after seeing critically ill people because of tobacco use are likely to initiate cessation while on the one-month break. Hence, biological feedbacks can be deployed to monitor the effectiveness of the preparation phase. For instance, CO monitor can help in evidencing recent tobacco use. Relapse rates can indicate the effectiveness of the overall program. Determining it requires a mechanism of showing recent tobacco smoking. Thus, indicators such as CO monitor and Cotinine are important. Determining of Cotinine quantities may be accomplished through checks that are done on the spit or urine. These indicators help in the determination of abstinence as an indicator for effectiveness of the intervention on non-use of tobacco.

Barriers in the Evaluation Process

The evaluation depends on the ability of potential candidates for tobacco use cessation to perceive and cognize the implications of engaging in tobacco smoking behavior. However, although some may understand that smoking is a major threat to their healthy lives, such cognition may not directly translate into the immediate reduction in tobacco use. Thus, using CO indicators after preparation phase to evaluate the effectiveness of the preparation phase may give wrong results. Additionally, CO monitor only finds application in detecting the recent use of tobacco through smoking, but not other ways of taking it. However, Cotinine resolves this barrier. Participants in the ‘You Can Quit Tobacco Use Program’ may perceive negatively the two procedures for evaluating the efficacy of the intervention. For instance, they can consider the intervention administrators not trusting their decision to quit. Thus, they may abstain only to please the healthcare professionals.

Reference List

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Farrelly, M., Pechacek, T., Thomas, K., & Nelson, D. (2008). The Impact of Tobacco Control Programs on Adult Smoking. American Journal of Public Health, 98(2), 304-309.

Peto, R., Darby, S., Deo, H., Silcocks, P., Whitley, E., & Doll, R. (2008). Smoking, Smoking Cessation, and Lung Cancer: Combination of National Statistics with Two Case–Control Studies. American Journal of Public Health, 3(21), 323–329.

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Tauras, J., Chaloupka, F., & Farrelly, C. (2005). State Tobacco Control Spending and Youth Smoking. American Journal of Public Health, 95(2), 338–344.

US Department of Health and Human Services. (2010). Healthy People 2010 Midcourse Review. Web.

US Department of Health and Human Services. (2012). Preventing Tobacco Use among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA: Center for Disease Control and Prevention.

West, R. (2006). Tobacco control: present and future. Br Med Bull, 77(1), 123–136.

Williams, R. (1998). Epidemiological Issues in Health Needs Assessment. BMJ, 316(7141), 1379-1382.

World Health Organization. (2005). Participants at the 6th Global Conference on Health Promotion: The Bangkok Charter for Health Promotion in a Globalised World. Geneva, Switzerland: World Health Organization.

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