Smoking? You Must Be Joking Multilevel Model of Health
- jc645587
- Dec 6, 2022
- 8 min read
In recent years, Canada has witnessed a general decrease in smoking prevalence among all age groups. However, despite large numbers of campaigns and interventions, thousands of young Canadians continue to initiate cigarette smoking every year (Woodgate & Busolo, 2015). This increasing popularity of alternative tobacco products and e-cigarettes is also creating new health challenges. Research has shown that deleterious effects of nicotine and cigarette smoke are significant and long-lasting (Woodgate & Busolo, 2015). Cigarette smoking remains the number one preventable cause of death worldwide, killing almost six million people each year (Harvey & Chadi, 2016). In 2013, 14.6% of Canadians >15 years of age (about 4.2 million people) were active smokers (Harvey & Chadi, 2016). Likewise, about 15% of Canadian children are exposed to second-hand smoke in their homes (Harvey & Chadi, 2016).
Health care professionals have key responsibilities in preventing tobacco use among youth and their families and need to know more about effective smoking prevention and cessation strategies (Woodgate & Busolo, 2015). Clinicians need to integrate tobacco counseling into health assessments of teenagers and be aware of the roles that families, communities and governments play in promoting tobacco-free environments (Harvey & Chadi, 2016).
For this assignment, I have used the social ecological model of health and related this to the topic of smoking cessation in youth. This is a relevant topic for my profession, as I am a Respiratory Therapist (RT) and order nicotine replacement pharmacotherapy and perform smoking cessation counseling to patients daily.
Image: (Philadelphia Department of Public Health, 2022)
When exploring the first step in the social ecological model, the individual choice: decision making capability, behaviors, socio demographics and personal choices examined. For example: at the individual level, youth may feel a sense of pleasure and the addictive nature of cigarettes/nicotine which motivates smokers to continue (Sorenson et al., 2004). Likewise, some individuals may feel immune to the negative effects of smoking due to age and being relative healthy prior to starting smoking (Woodgate & Busolo, 2015). Also due to the nature of rebellion, youth may be more likely to start smoking or continue to do so (Harvey & Chadi, 2016).
The two strongest factors associated with smoking initiation in children and adolescents are parental smoking and parental nicotine dependence (Harvey & Chadi, 2016). Certain attitudes and beliefs related to cigarette smoking are also important predictors of smoking initiation. As seen in Table 2, there are assorted reasons why youth would start smoking and many factors that increase risk of smoking initiation (Harvey & Chadi, 2016).
TABLE 2
Factors that increase risk of smoking initiation
Older age at time of parental smoking cessation (if parents are ex-smokers)
Low socio-economic status
Peer and family influence, including lack of parental support
Misinformation about the health consequences of smoking
Easy access to tobacco products
Influence of marketing, exposure to tobacco promotions
Previous experimentation
Depression and mental health conditions
Poor school performance
Adverse experiences such as:
emotional, and physical or sexual abuse,
parental separation or divorce,
a household member who is substance abusing, mentally ill or incarcerated
Substance abuse (smoking often precedes the use of illicit drugs)
Table from: (Harvey & Chadi, 2016)
Secondly, interpersonal and household environments can impact youth smoking initiation including family dynamics, social supports, and social interactions within families, households and peer groups (Woodgate & Busolo, 2015). Examples include exposure to family members’ (especially parents) smoking may encourage children to adopt the same behaviour. Exposure to second hand smoke and may also encourage children to smoke if seen as an acceptable behavior (Stuber et al., 2008). As children, close friends that develop a smoking habit may contribute via peer pressure and contribute to smoking habits.
Smoking and exposure to second-hand smoke are harmful at all stages of life, starting before birth. Some health effects can last a lifetime, and parents and caregivers should be made aware of health risks and ways to reduce or avoid them (Harvey & Chadi, 2016). Guidance for parents and families must be personalized to age and context and provide messaging that is specifically meaningful for them (Woodgate & Busolo, 2015). For prevention to be successful, the health care provider’s focus should be family-centred. It is important to emphasize the immediate negative effects of smoking when counselling children and adolescents, because long-term consequences tend to be less meaningful for younger age groups (Harvey & Chadi, 2016).
There is evidence of moderate quality that family-based interventions have a positive impact on preventing smoking in children and adolescents (Woodgate & Busolo, 2015). Authoritative parenting, where parents show a strong interest in caring for their adolescent combined with rule-setting, is a key feature of effective interventions with this age group (Harvey & Chadi, 2016).
Counselling around the health effects of smoking in different age groups
Age group
Most compelling information
Parents
Risks associated with second-hand smoke on children and other household members
Prematurity
Stillbirth
Sudden infant death syndrome (SIDS)
Effects on fetal brain development
Asthma, colds, pneumonia and ear infections (even when parents do not smoke indoors)
Acquired heart disease
Becoming smokers (even when parents tell children not to start)
Long-term health risks:
Heart disease, chronic obstructive pulmonary disease, lung and other cancers
Infertility
School age (5 to 11 years)
Negative effects and consequences of smoking:
Bad breath
Yellow teeth
Harder to keep up during active games or sports
Smoking just a few times can get your body hooked so that it is harder to stop
Cigarettes are expensive. Smokers spend money on cigarettes that they could use for more fun things
Tobacco companies use ads to trick you into thinking that smoking is cool and safe
Smoking has long-term effects on health, including several types of cancer and heart attacks
It is illegal to buy cigarettes when you are underage
Adolescents
Immediate effects of smoking
Cosmetic effects (smell, bad breath, yellow teeth, early wrinkles)
Poorer endurance and athletic performance
Hacking coughs, more colds and pneumonias
You can get addicted to tobacco after smoking as few as 100 cigarettes
Cigarette smoking is expensive. The cost of buying one pack a day for a year could buy a used car (between $1500 and $3500)
When you smoke you might be ‘under the influence’ of marketing from tobacco companies
Long-term health consequences:
Selected long-term health risks listed for parents (above)
Alternative forms of tobacco (eg, snuff, e-cigarettes) may not be safer than cigarettes
Smoking exposes friends and family (including babies) to harm from second-hand smoke
Table From: (Harvey & Chadi, 2016)
Additionally, the next step of the social ecological model talks about how organizations (school and work environments), policies, education, staffing, work culture, and a team-based approach effect smoking in youth. In todays society, smoke free environment policies are in place at most workplaces, schools, and public places. The province of Prince Edward Island (PEI) has the Smoke Free Act which prohibits smoking in a public place or workplace and no smoking in a motor vehicle in which a person under 19 is present (Smoke-free Places Act, 2018).
Health care encounters in pediatric offices should include a screen for sources of tobacco exposure for every child seen (Harvey & Chadi, 2016). There is adequate evidence to recommend that primary care clinicians provide interventions, including education and brief counselling, to prevent initiation of tobacco use in school-age children and adolescents. Counselling can help counter or address an adolescent’s attitudes, beliefs and knowledge about smoking and its consequences, especially when they are mistaken or influenced by social or environmental factors, such as tobacco marketing (Harvey & Chadi, 2016). Counselling can also strengthen the development of social competence and social skills, thus helping youth to decline cigarettes (Woodgate & Busolo, 2015).
When looking at community, physical and social environments, external organizations, commercial or retail establishments, parks, streets, and the social exchanges that occur in these settings. Smoke free places such as public parks, streets, playgrounds continue to fall under the smoke free act (Smoke-free Places Act, 2018). Advertising the negative health effects of smoking in these places such as hospitals, community centers etc could be one way to prevent youth from smoking or to help them quit.
The primary purpose of the Smoke-Free Places Act and Regulations is to protect citizens from the harmful effects of second-hand smoke and the unknown effects of vapors from an electronic smoking device (Smoke-free Places Act, 2018). Secondarily, it is meant to reduce consumption of tobacco products in the province. The legislation prohibits the use of tobacco products and electronic (vapor) smoking devices in any public or work place in the province including hospitals, school grounds, community or church halls, restaurants, bars, shopping malls, movie theatres, rinks and office buildings (Smoke-free Places Act, 2018).
Lastly with the social ecological model, the final layer looks at society. Within this layer of the model, policy inputs, population, government programs, taxes and laws come into effect. For example, the government increases tax rates on tobacco to increase costs which makes cigarettes less accessible to lower income people. In PEI the tax is 29.5 cents per cigarette purchased (Tobacco Tax Rates, Government of Prince Edward Island, n.d.).
Laws in PEI changed in March 2020 to prohibit the purchase of tobacco products and electronic smoking devices under the age of 21 (Tobacco Tax Rates, Government of Prince Edward Island, n.d.). Additionally, in the province of PEI, electronic smoking or vape products can only be sold in "tobacconist shops," described as an "age-restricted location" where, "at least 50 per cent of the retailer's product display space is devoted to the sale of tobacco, electronic smoking devices, or a combination of both” (Tobacco Tax Rates, Government of Prince Edward Island, n.d.). At this time P.E.I. was one of the first provinces in Canada to increase the age to access tobacco and vaping products to 21, a move supported by both the Canadian Lung Association and the Canadian Cancer Society (Smoke-free Places Act, 2018).
In PEI the sale of flavored tobacco is illegal which will help prevent youth starting to smoke or vape. This legislation prohibits the sale of any flavoring agent "added to tobacco or an electronic smoking device to produce an aroma or taste other than the aroma or taste of tobacco, including the aroma or taste of candy, chocolate, fruit, a spice, an herb, an alcoholic beverage, vanilla or menthol” (Tobacco Tax Rates, Government of Prince Edward Island, n.d.). Youth are less likely to start smoking or vaping if the flavor they are ingesting is strictly nicotine and tastes bad.
In terms of government programs, PEI has the provincial smoking cessation which helps PEI residents who wish to stop smoking or using other tobacco products by: covering 100% of the cost of nicotine replacement therapy (NRT) products (i.e., nicotine gum, lozenges, patches, and inhaler) and specific smoking cessation prescription medications (Quit Smoking, Government of Prince Edward Island, n.d.). Once per year, PEI residents can receive a single continuous course (12 weeks) of one product or smoking cessation medication. This provincial program helps people of low-income access nicotine replacement therapy and help them quit smoking with no cost to the patient (Quit Smoking, Government of Prince Edward Island, n.d.). There is also the Smokers Help Line that is used as a resource for long term follow up with patients.
As talked about, when using the social economic model regarding smoking cessation in youth, there are numerous layers that should be looked at. Starting with the individual and personal choices and behaviors. Next interpersonal and household environments, including exposure to second-hand smoke or parents that smoke can influence youth and their health habits. School and work environments play an important role in contributing to smoking cessation in youth. Many provinces have taken the smoke-free approach in public places which contributes to helping people quit. Lastly, government laws and policies in place to prevent access to nicotine products in youth can drastically prevent initiating smoking in this age group.
References
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