• Subject Name : Nursing

Tobacco and Smoking

Introduction to Barriers to Smoking Cessation

Smoking is one of the main factors behind increment in diseases throughout the world, especially chronic and non-communicable diseases like cardiac arrest, cardiovascular diseases, respiratory disease and cancer. According to World Health Organisation, tobaccos kill half of its user. More than 8 million people die every year by smoking tobacco. 7 million deaths are the result of direct tobacco smoking while 1.2 million deaths are caused by the second-hand smoke (WHO, 2020). There are over 1.2 billion tobacco users out of which 80% lives in low and middle-income family (WHO, 2020). Tobacco not just degrades health but also causes poverty. The spending which should be used for household purpose is diverted toward buying tobacco. There are many campaigns, launched by various Governments and organisation to spread awareness about the harms caused by smoking tobacco and help people to quit smoking. With all these efforts, smokers still find it difficult to cease smoking.

The biological understanding of the adverse effect of nicotine and its impact and smoking behaviour well known but the biopsychosocial understanding of smoking tobacco is still under study. The biopsychosocial framework includes biological, psychological and social-environmental aspects. A framework that analyses the biological impact which life experience effects on smoking tobacco and health outcomes would explore the biopsychosocial interaction (Fernander et.al., 2007).

Applying Health Psychology

There are many models which are used to evaluate health within the framework of psychology. One such model is the Health Belief Model is widely used to investigate within the framework and identify key health benefits. It succeeded up to some extent in predicting a range of health behaviour (Norman & Conner, 2017). This model theorises that health-related behaviour depends upon sic factors, namely; perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. 

Perceived susceptibility is the person’s judgement of chances of getting infected with a disease. Perceived severity is the consciousness about seriousness of the diseases in an individual. Perceived benefits are the belief of an individual about the effectiveness of the recommended health behaviour in lowering the risk caused by the disease. Perceived barriers are the insight about the price related with obeying recommended health behaviour, whether it can able enough to prevent or reduce the apparent threat. Self-efficacy is the confidence status in a person’s capability to perform health behaviour question. Those who have low self-efficacy will have low self-confidence therefore this will affect their chances of behaviour being performed to avoid or reduce the threat (Kagee & Freeman, 2017).

Using the health belief framework in analysing the tobacco smokers and their health threat:

  • Perceived susceptibility- Most of the smokers belongs to low-income to middle-income families, which implies that they are not much subjected to health awareness. Although, there are many health awareness programs run by the governments, NGOs and the WHO for individual belonging to that category.
  • Perceived severity- Around 76% of the smokers quit smoking due to self-awareness (Usman et. al., 2014). If the smokers are made self-aware about the harms caused by smoking tobacco, it becomes easier for them to quit smoking. The awareness about the severity of smoking can be created by regular spreading the knowledge about health damage caused by the tobacco. A research was carried out on nurses in hospital in New South Wale, which concluded that knowledge about the damage caused by the smoking significantly reduced the habit of smoking in employees (Nagle et. al, 1999).
  • Perceived benefits- Once the individual is positive about the health behaviour which could help them in reducing smoking threat, it becomes easy for them to adopt it. Therefore, it becomes important for them to find out benefits of health behaviour to achieve the successful outcome.
  • Perceived barriers- Some of the barriers in quitting smoking are (Chean, 2019):
  • Due to personal lifestyle, not able to resist smoking
  • Nicotine is addictive and withdrawal symptoms are very difficult to overcome.
  • Peer pressure from friends or colleagues who offers them cigarettes.
  • Smokers think that smoking can be quitted only by the power of mind and strong will and quitting cigarettes will make their body weak. This makes the withdrawal overpowering.
  • Those who wants to quit often imply poor assisted, non-friendly and poorly understood smoking cessation which makes them believe that quitting is impossible for them.
  • Self-efficacy- The perceived barriers create lower self-efficacy in smoker to quit tobacco. Most of the university student consider smoking as a way to relax and gain more friends or thinks to quit after graduation. But, they fail resulting in 36.2% cessation in tobacco smoking quitting (Pardavila-Belio et. al., 2019).

Understanding Well-Being

The Full Frame Initiative presented the five domain of well-being. Regardless of a person’s background, race, gender or culture, everyone shares some common needs. Everyone’s need is driven within five domains or well-being namely, social connectedness, stability, safety, mastery and meaningful access to relevant resources (The Five Domain of Well-Being, 2015). The experience of each domain may unique for each individual. A smoker who wants to quit smoking also requires the accomplishment of these five domains to successfully cease smoking. A brief review of each domain is as below (The Five Domain of Well-Being, 2015):

  • Social connectedness- It is the feeling of belongings and relationship which allows a person to give or receive information, emotional support and other help, nourishes growth. A person on the path of quitting tobacco smoking needs such support from their family and friend in order to stay motivated and freely ask for help whenever they need.
  • Stability- It is the extent to which the person can predict the stability of their situation in near future. The smokers are very unstable in cessation due to nicotine addiction and other reasons mentioned above. Therefore, they must keep a keen eye on their regular stability of growth toward quitting.
  • Safety- It is important for a smoker to avoid any physical and emotional harm to oneself or others for a healthy well-being.
  • Mastery- The smokers need to master and control their urge to smoke tobacco. They must careful about the correlation between effort and outcomes and avoid such places or people who remind them of smoking.
  • Meaningful access to relevant source- All the sources which helps the smoker in quitting must be easily available, like medication, social support and counselling. It is important for their situation that their needs are fulfilled in not degrading or dangerous fashion.

Using Health Promotion to Change Health Behaviour

The Australian Government launched ‘National Tobacco Campaign’ in 1997 aimed to reduce smoking in Australia. This campaign successfully reduced smoking by 3.7% within 5 years (Department of Health, Australian Government, 2020). The goal of this campaign was to demotivate people from smoking, implement stronger tobacco control policy, help people to quit smoking and change public attitude towards smoking.

The campaign was conducted through TV ads, social media, prisoner’s resource kit, mobile phone apps, advertising in different languages and partnership with health organizations and dedicated programs for aboriginal people and pregnant women.

Currently, this campaign is targeting aboriginal and Torres Strait Islander people. This campaign is hosted by an aboriginal person who talks about his smoking experience and how he quitted and its benefits.

This campaign is using perceived benefit framework of Health Belief Model. The person who talks with aboriginal people actually explains them the benefits of the health behaviour. Also, the people self-efficacy is uplifted to quit smoking.

Centre for Disease Control and Prevention (CDC), in the USA, initiated a campaign- Tips From Former Smokers (Tips) in March, 2012. This campaign helped people with illness caused by the long term smoke exposure and second-hand smoke exposure. From 2012-2018, approximately 16.4 million people attempted quitting, while 1 million people became successful.

The goal of this campaign was to build awareness about the long-term smoking and second-hand smoke exposure, help people quit smoking and encourage people for avoiding second-hand smoke especially from a family member. The target audience were smokers of age 18-54 years and their families, and healthcare provider.

The campaign successfully helped smoker to cross perceived barriers by providing proper support and motivation. The campaign included many doctors, nurses, pharmacists and health care provider who helped their patients to quit smoking. They were motivated to not smoke while around their families or non-smoker so that the risk of second-hand smoke exposure may be reduced.

Conclusion on Barriers to Smoking Cessation

The tobacco smoking had taken millions of lives every year. This problem is prevalent in every corner of society, mostly in lower-income and middle-income family. The psychology of health behaviour tells the reason why smokers find the cessation very difficult. For the well-being of those individuals it is really important to help them out as a society and provide them such environment which helps them in quit smoking. The withdrawal phase is crucial and smokers is most vulnerable at this stage. Many campaigns are using biopsychology to promote harms of smoking and help them to quit smoking. Not just smokers, their families and other people in their vicinity are affected.

Referensces for Barriers to Smoking Cessation

About the Campaign. (2020). Centre for Disease Control and Prevention. Retrieved on 19 August, 2020 from https://www.cdc.gov/tobacco/campaign/tips/about/index.html

Chean, K. Y., Goh, L. G., Liew, K. W., Tan, C. C., Choi, X. L., Tan, K. C., & Ooi, S. T. (2019). Barriers to smoking cessation: a qualitative study from the perspective of primary care in Malaysia. BMJ open, 9(7), e025491.

Fernander, A. F., Shavers, V. L., & Hammons, G. J. (2007). A biopsychosocial approach to examining tobacco‐related health disparities among racially classified social groups. Addiction, 102, 43-57

Kagee, A., & Freeman, M. (2017). Mental Health and Physical Health (Including HIV/AIDS). International Encyclopaedia of Public Health, 35–44. doi:10.1016/b978-0-12-803678-5.00282-4 

Nagle, A., Schofield, M., & Redman, S. (1999). Australian nurses' smoking behaviour, knowledge and attitude towards providing smoking cessation care to their patients. Health Promotion International, 14(2), 133-144.

National Tobacco Campaign. (2020). Department of Health, Australian Government. Retrieved on 22 July, 2020 from https://www.health.gov.au/initiatives-and-programs/national-tobacco-campaign

Norman, P., & Conner, M. (2017). Health Behaviour. Reference Module in Neuroscience and Biobehavioral Psychology. Doi:10.1016/b978-0-12-809324-5.05143-9 

Pardavila-Belio, M. I., Canga-Armayor, A., Duaso, M. J., Pueyo-Garrigues, S., Pueyo-Garrigues, M., & Canga-Armayor, N. (2019). Understanding how a smoking cessation intervention changes beliefs, self-efficacy, and intention to quit: a secondary analysis of a pragmatic randomized controlled trial. Translational Behavioral Medicine, 9(1), 58-66.

The Five Domain of Well-Being. 2015. Full Frame Initiative. Retrieved from https://dmh.mo.gov/sites/dmh/files/media/file/2019/01/mhc-meeting-five-domains-of-wellbeing-10132016.pdf

Tobacco. 2020. World Health Organisation. Retrieved on 27 May, 2020 from https://www.who.int/news-room/fact-sheets/detail/tobacco

Usman, S., Notoadmodjo, S., Rochadi, K., & Zuska, F. (2014). Changing Smoking Behaviour of Staff at Dr. Zainoel Abidin Provincial General Hospital, Banda Aceh. Advances in Public Health, 12. Doi: https://doi.org/10.1155/2014/316274

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