Health psychology does recognise the importance of looking at behaviour change models and it also recognises that half of premature deaths in developed countries are caused by specific risk factors. These include; smoking/tobacco use, alcohol abuse, physical inactivity, unhealthy dietary habits, unsafe sexual practices, non adherence to effective medication regimes and to screening programs. The impact of these risk behaviours on health is of such magnitude that it has become a priority of the most important national and international health organisations, such as NHS, World Health Organisation etc. Many health behaviours have been indentified, this means ‘Behaviour performed by an individual, regardless of their health status, as a means of protecting, promoting or maintaining health, e.g. diet.’ (MORRISON, BENNETT. 2009).
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Although there are many health risk behaviours that could have been researched, due to restraints on the word count, the health risk behaviour that is going to be looked at in more detail is smoking. The reason for this is because smoking has become a big cause
This piece of work will be looking at different theories that are linked to smoking, and what the main points of each theory are. It will also be looking at a few different models which are linked to health psychology, and how each model can be linked to smoking. The assignment will include information on the risks which are brought on by smoking, and how a person can become addicted to smoking. The assignment will then be concluded by drawing the main points together and stating any future research which can be done.
According to The World Health Organisation, the biggest health threat the world has ever faced is the tobacco epidemic. Six million people a year are killed due to smoking related incidents. Five million of those are smokers or ex smokers, and more than 600 000 are non-smokers who are exposed to second-hand smoke. Approximately one person dies every six seconds due to smoking and this accounts for one in 10 adult deaths. Up to half of current users will eventually die of a smoke-related disease, such as lung cancer, unless people take urgent action, the amount of people who die a year could rise to more than eight million by 2030. (WHO. 2009)
Tobacco smoke does not just harm the person who is smoking, but it also harms those who are consistently breathing second hand smoke (or passive smoking). This means that those people also have a higher risk of cancer, heart disease, and respiratory disease. ‘The Surgeon General estimated that exposure to second hand smoke killed more than 3000 adult non-smokers from lung cancer each year, and approximately 46,000 from coronary heart disease.’ (MARKS ET AL. 2011).
There are lots of different reasons why people smoke. Some of these reasons could be linked to stress, as a support if things are going wrong, to look more confident and grown up, boredom or even addiction, because tobacco contains a very addictive substance called nicotine. ‘Nicotine is a stimulant that increases your heart rate and affects many different parts of your brain and body. Smokers get a high because nicotine triggers the release of dopamine in the brain – a chemical linked to feelings of pleasure.’ (CANCER RESEARCH UK. 2009)
Addiction is an explanation as to why giving up smoking can cause withdrawal symptoms. Withdrawal symptoms can include; anxiety, nicotine cravings, not being able to sleep, being irritable and not able to concentrate. There are many different campaigns and health websites for people to use in order to help them to quit smoking. These include; a local doctors surgery, smokefree.nhs.uk, and there are also many local health groups.
There are many different models and theories which are developed and used to encourage people to change their health behaviour such as:
‘The biopsychosocial model is the view that health and illness are produced by a combination of physical, psychological, and cultural factors’. (ENGEL, 1977).
The biopsychosocial model indicates that there are three influences on health which are shown in the theories of smoking. The 3 theoretical approaches related to the understanding of smoking are; the biological, the psychological, and the social. ‘The theories are complementary and slightly overlapping, hence the term ‘biopsychosocial’ is an apt one in this context.’ (MARKS ET AL. 2011)
The main elements of the biological theory are:
Tobacco contains nicotine, which is a very addictive substance.
Nicotine activates brain circuits which regulate feelings of pleasure; these are called the ‘reward pathways’ of the brain.
Smoking is an addiction which is repeatedly and immediately reinforced each time a person smokes a cigarette.
The main elements of the psychological theory are:
The habit of smoking is learned. And it becomes an automatic response to stimuli following repeated reinforcement – a conditioned response.
The smoker learns to distinguish between the situations which reward smoking, and those in which smokers are punished.
Smoking is a way to avoid or escape awkward situations. The smoker will light up a cigarette to escape or avoid an uncomfortable situation.
The main elements of the social theory are:
To begin with, smoking is physically unpleasant (smelly, looks awful) but this is over powered because of social and peer pressure.
The social identity of the smoker is changed once he/she forms the habit.
Smoking is a social activity in which the smoker becomes friends with, and hangs out with others that smoke. There is a rebellious feeling associated with the activity.
The Health Belief Model (HBM) (ROSENSTOCK. 1974) is suggesting that we don’t just need to make smokers realise that if they carry on smoking, it will result in a serious illness and/or death. But we also need to educate them of the benefits of stopping smoking (more money, better health), and also convince them that the benefits of stopping smoking outweigh the benefits of continually smoking.
Ogden (2004) says that the health belief model predicts that behaviour is a result of a set of core beliefs, which have been redefined over the years. The original core beliefs are the individual’s perception of:
Susceptibility to illness. For example ‘The chances that I might get lung cancer are high’.
The severity of the illness. E.G. ‘Lung cancer is a serious illness’.
The cost involved in carrying out the behaviour. E.G ‘I don’t have any money to spend on myself when I buy cigarettes’.
The benefits of carrying out the behaviour. E.G ‘If I stopped smoking, I will save money’.
The cues to take action. E.G ‘I’m feeling out of breath’ or reading information in a leaflet.
Rogers (1975, 1983, 1985.) developed the Protection Motivation Theory (PMT), which expands the HBM to include additional factors. Like the HBM, the PMT contains four components:
Severity. E.G ‘Lung cancer is a serious illness’.
Susceptibility E.G ‘My chances of getting lung cancer are high’.
Response effectiveness E.G ‘Stopping smoking will improve my health’.
Self-efficacy E.G ‘I am confident that I can stop smoking’.
‘There are many criticisms of the Health Belief Model and the Protection Motivation Theory for example, they assume that individuals are conscious information processors, it does not account for habitual behaviours, nor does it include a role for social and environmental factors.’ (OGDEN, 2004)
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The Theory of Planned Behaviour (TPB) further emphasises the role of attitudes and beliefs in behaviour change. It is similar to the HBM and PMT in the sense that they all have components. The components include:
Attitude towards a behaviour
Perceived behavioural control
‘Unlike the HBM and PMT, the TPB attempts to address the problem of social and environmental factors (in the form of normative beliefs). In addition, it includes a role for past behaviour within the measure of perceived behavioural control.’ (OGDEN, 2004)
Bandura’s (1986) Social Cognitive Theory examines the social origins of behaviour in addition to the cognitive thought process that influences human behaviour and functioning. The Social Cognition Theory is suggesting that before people are motivated to stop smoking and/or to continue to remain stopped they have to believe they have the ability to do so. The theory also suggests that although health may be a long term gain following smoking cessation, we are largely influenced by shorter term benefits. Smoking cessation programmes should accordingly highlight the short term benefits of stopping smoking as well as the long term health gains.
The transtheoretical model, otherwise known as the stages of change model, was developed by Prochaska and DiClemente (1983). It has been highly influential in the literature on health behaviour change. The transtheoretical model hypothesizes six different stages of change, which people are alleged to process through in making a change:
Precontemplation – A person is not intending to make any changes. ‘I am happy being a smoker and I intend to continue smoking’.
Contemplation – A person is considering. ‘I have had a cough recently, maybe I should think about stopping smoking’.
Preparation – A person is intending to take make small changes. ‘I will not buy as many cigarettes as usual’.
Action – A person is actively engaging in their new behaviour. ‘I have now stopped smoking’.
Maintenance – A person is trying to keep the change up. ‘I haven’t had a cigarette in over five months’.
Termination – A person has had zero temptation. ‘I have not been tempted to have a cigarette’.
Relapse- Going back to the original behaviour. ‘I had a cigarette yesterday’.
To conclude this assignment, a majority of the information shows that the public are educated on illnesses, and how to prevent common diseases, however it seems that some, don’t listen to or even abide by the information or advice given by professionals.
As per all the information collected, there is still room for improvement in the field of smoking, in other words there is still very limited understanding of cigarette smoking among young people. Although there has been an overabundance of smoking prevention programmes, the need for greater understanding of their effectiveness is still needed.
‘In smoking cessation research, proposed future directions are:
Conduct research on motivational and decision-making processes to encourage more smokers to make quit attempts or to participate in cessation programs.
Conduct more research on high-risk populations such as heavy smokers and pregnant women.
More research on the effects of public smoking policies.’ (GRUNBERGET AL. 1989).
‘More research on the influences of tobacco advertising the uptake of smoking in young people is necessary in those countries where advertising is permitted. This evidence will be significant in eventually gaining a worldwide advertising ban.’ (MARKS ET AL. (2011).
From the research shown, there is clear evidence that if people worldwide were educated on smoking, and if people took the information seriously there would be less people dying from illnesses that are caused by smoking, and therefore the assertion that less people would be dying from preventable illnesses if they changed their health behaviour, is true and very much supported.
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