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Design and Health Promotion Program for Someone to Quit Smoking


Smoking is one of the main targets of health promotion programs since it damages body organs (Tait et al. 2006) leading to many deaths and health complications (Miller et al. 2005). However, persuading a person to quit smoking can be quite a challenge (Drevonhorn et al. 2007) due to a number of reasons. For example, variations in smoking needs across sexes and age groups mean that each segment of smokers will have its own program (Meken et al. 2010, Ory et al. 2002). Studies show that the intervention programs must be able to address the motivations and personal characteristics of the targeted group to be successful (Cummings et al 2010, Williams et al. 2002). As a result, every intervention for smoking must be holistic and correspond to the psychological, physiological, social, and behavioral changes of the groups as research has shown that smoking addiction is caused by bio-psychosocial aspects (Cummings et al. 2010, Rosen et al. 2000, Balmford et al. 2010).

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In light of these findings, the paper will present a smoking intervention program that combines medical and psychological solutions that address all the aspects of smoking addiction with respect to each smoker’s needs. This intervention is based on the stage of change model, which is the most commonly used model in health promotion programs. The model asserts that any behavioral change occurs in a five-stage process: pre-contemplation stage (the individual is reluctant in changing his/her behaviour); contemplation stage (the individual is considering the change but is torn between the pros and cons of change); preparation stage (the person is willing to change and is only trying to find a way of doing it); action stage (the change happens); and the maintenance stage (the challenge for the individual is to maintain the earlier lifestyle) (Rosen et al. 2000, Smit et al. 2010, O’Hea et al. 2003). The model will incorporate useful concepts from other theories such as client center psychotherapy and motivation (Cummings et al. 2010,Williams et al. 2002).

Stage of Change Intervention Model

This model dictates that when health personnel meets an individual who smokes, he will evaluate the level of his/her addiction (e.g. Cooke et al. 2001, Miller et al. 2005) and his attitude towards quitting the habit (e.g. Steptoe et al. 2001). He will persuade the smoker to quit the habit by focussing on the advantages of quitting rather than on harmful consequences (O’Hea et al. 2003, Romand et al. 2005, King et al. 2002). The counsellor will pay special attention to factors that are deemed important for the specific category (Cooke et al. 2000, Smit et al. 2009). For example, a parent will be informed of the advantages of a smoke-free house to the children (Gupta et al. 2001) while adolescence will be informed that smoking cessation leads to better appearance and better sport performances (Horneffer-Ginter et al. 2008). In the latter stages, the counsellor will discuss possible solutions for smoking cessation suggesting psychological counselling (e.g. Steptoe et al. 2001, Bailey et al. 2010), nicotine replacement therapy (e.g Marks and Sykes, 2002, Moller et al. 2002, Miller et al. 2005), or, where applicable, bupropion antidepressant drug (Romand et al. 2005, Bailey et al. 2010). He will highlight the number of people that successfully quit smoking (Jordan and Bazzarre 2002, Tait et al. 2006) using a combination of these solutions (Marks and Sykes 2002, Romand et al. 2005, Tait et al. 2006).

Next, the counsellor will give time to the client to ask any question(s) (Cummings et al. 2008). Finally, the professional will encourage the client to reflect on the discussion and seek more information. The counsellor will guide the client to reliable sources of information on quitting the behaviour such as the internet (Etter and Perneger, 2004) and help-lines (Miller et al. 2005, Bailey et al. 2010). Ending up, he will state his willingness to offer telephone counseling and answer any further questions (Tait et al. 2006). By the end of the session, the counsellor will invite his client for further discussions whenever the need arises (Horneffer-Ginter 2008, Cummings et al. 2008). He can choose to come with a friend (Marks and Sykes 2002).

This first session of the intervention aims at pushing the smoker from the pre-contemplation to contemplation stage (Xiao et al. 2004, Rosen 2000, Steptoe et al. 2001). Additionally, it aims at instilling the advantages of smoking cessation to help the individual to start readying for the change (O’Hea et al. 2003, Rosen 2000, Drevenhorn et al. 2007). Giving him/her the option of appearing or not for the second session is an act of respect to the client and that is essential to gain his cooperation (Cummings et al. 2008, Gupta et al. 2001).

If the client fails to contact the counselor within the following week, the professional will give him/her a call (Etter et al 2004) to enquire whether he/she is planning to attend the session and ask if he/she has made any research on smoking-related issues. If the client has withdrawn from the process, the professional will accept his/her decision and state that he/she will always be available should the client change his mind (***). Alternatively, if the client has carried out research or at least he/she is willing to continue the process, he will organize another session (Marks and Sykes 2002, Romand et al. 2005, Stepoe et al. 2001).

Second Session

In the second session, the counsellor will combine cognitive, behavioral, and client center techniques to develop a co-operational relationship with the client through which they will address smoking on an individualized basis (Cummings et al. 2010, Bailey et al 2010). Specifically, the professional will explore the benefits of smoking to the client and help him/her to discover alternative (Cummings et al. 2010, Horneffer-Ginter et al. 2008) ways to realize similar benefits (e.g. relaxation, social acceptance). The counsellor will explore the clients’ personal goals and make him/her realize how smoking prevents him/her from achieving these goals (Williams et al. 2002). Moreover, the counsellor will enhance the client’s self-efficacy (Brendryen and Kraft 2008, O’Hea et al. 2003). The counselor should listen carefully to the client’s concerns and fears towards smoking cessation, then help him to resolve them (Drevenhorn et al 2007, Ginch et al. 2008). At this stage, the professional will remind the client of his/her personal goals; this ensures the patient focuses on the process (King et al. 2002). The counsellor may opt to discuss with the client the possibility of receiving nicotine replacement pharmacotherapy (e.g. Miller et al. 2005, Romand et al. 2005, Marks and Sykes 2002) or antidepressant drugs to face the biological aspects of smoking or encourage him/her to seek cancelation from a G.P (Romand et al. 2005, Bailey et al. 2010).

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Finally, the counsellor will advise the client to participate in group sessions (Romand et al 2005, King et al. 2002, Ory et al. 2002) where the smoker will meet people who quit smoking and therefore their experience will strengthen the client’s resolve to quit (King et al. 2002, Ory et al. 2002, Rosen 2000, Smit et al. 2010). At the end of the second session, the individual is expected to have progressed from the contemplation to the preparation stage (Horneffer-Ginter et al. 2008, Rosen 2000).

The Third Session

The third session targets a group of smokers who are in different stages of the cessation process. This has two advantages: costs in time and money are reduced (Romand et al 2005, King et al. 2002, Ory et al. 2002, Smit et al 2009); and individuals who have progressed more in the cessation process can help others with their experience (Romand et al 2005, Smit et al 2009). The client can choose to come to the session alone or with his friend. In this session, the client will further discuss the issues that were addressed in earlier sessions, utilizing the experience of members who are in advanced stages. People who have progressed further will teach useful behavioral techniques such as stimulus control, reinforcement and relaxation, and control of intrusive thoughts together with the counselor (Rosen et al 2000, Ory et al 2002, Smit et al 2010). The group will also address issues relevant to other health behaviors such as weight control, alcohol consumption, and exercise. This aids in two areas: smoking can lead to weight gain or other unhealthy behaviors (Williams et al 2002, Hea et al 2003); and, studies show that the adaptation of a healthy lifestyle is easier when someone is willing to change his/her behavior, may aid in smoking cessation (Vries et al.2008). Furthermore, the group will discuss the benefits of suitable pharmacotherapy for smoking cessation (Tait et al 2006, Romand et al 2005, Miller et al 2005).

At the end of the session, the client is expected to have an appropriate supportive social network as well as a variety of helpful ways to face all aspects of his addiction (Romand et al 2005). The client should be ready to quit and the counselor can set a day within the next two subsequent weeks in which to start giving suitable pharmacotherapy with the assistance of a doctor (Romand et al 2005, Mller et all 2005,Tail et al 2006). Within those two weeks, older members of the group will be in contact with the client, offering him support (Romand et al 2005, Smit et al 2009). At the end of the quit day, the client will receive a health award in case of success (e.g. Marks and Sykes 2002, Romand et al. 2005, Stepoe et al. 2001). Otherwise, he/she will discuss with a member of the group the causes of the failure and explore ways to deal with these problems, and he/she is encouraged to set another quit day (Romand et al 2005).

Maintenance stage

The maintenance stage is the most difficult phase, for this reason, the intervention includes another session designed to help the client to remain focused (e.g Bailey et al 2010, King et al 2002). A week after quitting, the person should join the group again to discuss his experiences of the first few days of quitting (Romand et al. 2005, Rosen et al 2000, Mercen et al 2010). The group members reward his success (e.g. Marks and Sykes 2002, Romand et al. 2005, Stepoe et al. 2001) and support him to stick to the changes and in dealing with withdrawal symptoms (Romand et al. 2005 Marks et all 2002, Hea et al 2003). In the case of a relapse, the other members can share with him/her their experiences of relapse and encourage him to try again after exploring and finding solutions to the causes of the relapse (Ory et al 2002, Xiao et al 2004, Gnich at e 2008, Williams et al 2002). However, if the client is unwilling to join the group after relapse, he can have a meeting with the counselor or one member of the group to address the same issues (Williams et al 2002).

At the end of the intervention, the client should be given a questionnaire asking him to rank each part of the intervention and identify the sections that troubled him and those that were helpful. This questionnaire aims to point out the strengths and limitations of the intervention. Furthermore, the counselor should call the client regularly to check on his long-term progress and re-engage him in case of relapse (King et al. 2002).

A major benefit of this intervention is that it combines medical solutions with psychological counselling and social support addressing smoking as an addiction with bio-psychosocial aspects (Romand et al. 2005). Being a combination of intensive counseling and pharmacotherapy, it is considered highly effective (Tait et al. 2006). The process takes a shorter duration (roughly six weeks) and partly works on a group basis (Moller et al 2002), this lowers the cost while increasing its effectiveness. However, it needs a counselor to put it into practice as quitting requires flexibility and creativity that enables the counselor to adapt according to the needs of the clients and keep them engaged to the final step of smoking cessation.

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