Question

Changing behavior-Cigarette Smoking It was not going to easy for Steve to stop smoking. He had been at it for 30 years- ever since he took it up on a dare at age 16 and found that it was a good way to socialize. In his 20s, it seemed to make dealing with the work pressure easier, and in those days, you could smoke in your office and did not even need to shut the door-much less deal with those dirty looks he was getting now.

Steve was always confident that he could take cigarettes or leave them. He would quit when he was good and ready, and a few cigarettes could no hurt. But then he talked to some friends who had quit a decade or more ago and said they would go back in a minute if they thought cigarettes were safe. Maybe for some people, those cravings just never go away, he worried to himself. However, there was that bout of walking pneumonia, and then the cough that just did not seem to go away. The could was so bad that he had trouble smoking more than a few cigarettes a day. The physician assistant let him know that these symptoms were early signs of things to come; however, Steve just was not ready to stop. So the physician assistant gave him a fact sheet and let Steve know there was help available when he was ready. It might have been his fears about his 10-year-old son that finally tipped the scales. "Daddy, those cigarettes are bad for you," he said. Or maybe it was when he found cigarette butts in the backyard after his 16-year-old daughter's birthday party. Steve knew enough to believe that a father who smokes has a child who smokes. So this time, he would do it right. Steve's physician assistant recognized that Steve was finally ready to quit. He let him know in no uncetain terms that it was important to quit totally, completely, and forever. He also informed Steve that he could rely on help-that he was not alone. With the encouragement of his physician assistant, Steve joined a support group, set a quit date, and announced the date to his friends and family. The new medication he was prescribed seemed to relieve the worst cravings and the feeling he called "crawling the walls." His wife, Dorothy, was supportive. She cleared the cigarette butts and ashtrays out of the house and dealth with the smell by having all the drapes cleaned. She also helped by getting him up after dinner and taking a walk, which kept him from his old habit of having a cigarette with dessert and coffee. It also helped keep him form gaining too much weight, which she confided was her greatest fear. Dorothy's quiet encouragement and sublte reinforcement without nagging worked wonders. Saving a five to ten of dollars a day did not hurt. Steve collected those dollars and put them in a special hiding place. On his first anniversary of quitting, he wrapped up the dollar bills in a box and gave them to Dorothy as a present. The note inside said: "A trip for us for as long as the money lasts." Dorothy was delighted, but feared the worst when Steve began to open up his present to himself. As he unwrapped a box of cigars, he smiled a big smile and said, "I am congratulating myself on quitting smoking."

1. Which effective public health (or population) approaches are illustrated in this case? Explain 2. What is the impact of combining individual clinical approaches with public health (or population) approaches?

Answer 1

1. In this case, the smoking cessation technique that has been used is that of self help strategy, where, the individual had quit abruptly,, after he was encouraged by his physician. He had also been involved in a support group, and quit after he had decided a particular date.

2. Population level interventions include mass media campaigns, bans on advertising, policies that are smoke free and hike in taxes for the cigarettes. If there occurs a combination of such public interventions along with approaches that an individual would be carrying out such as self help strategy, or strategies that are assisted, the individual would be motivated more. Population level interventions would at in the form of reinforcement techniques, where, the taxes would be acting in the form of reinforcement, such that increased prices ould lead them to not buy the product, along with their will to quit smoking.