Smoking Intervention Models


SmokingIntervention Models

Cigarettesmoking contributes to the high cost of health on the Americanwelfare system. Changing the related behaviour of individual smokersis a prime target for improving national well-being and lowering thehealth cost burden on the national budget. There are three approachesto improving the personal behaviour of smokers, which are upstream,midstream and downstream intervention plans (Knickman &amp Kovner,2015).

Thefirst upstream approach entails enhancing the access to attractive,convenient and safe places for physical activity. The approachprovides information about the benefits and the opportunities forphysical health as a strategy to change smokers’ knowledge andattitudes. The implementation of upstream factors requirescollaboration between advocates, public health researchers,strategists, communicators and healthcare providers. Suchcollaboration creates room to guarantee the provision of high-qualityevidence that reaches the decision makers at the right time (Backeret al., 2005).

Thesecond upstream intervention entails the use of federal payments toenhance the community’s access to more health improvement options.The provision of funds promotes healthy living by enhancing othermultiple factors such as education, childcare, and housing. Theapproach improves the community’s access to behavioural healthservices, diminishes and controls behavioural risk factors. Afterproviding federal payments, the government should institutesystematic surveillance to monitor the prevalence of cigarettesmoking among adults and adolescents and the impact of second-handsmoke to children of 6 years and below (Hancock &amp Cooper, 2001).

Thefirst midlevel intervention entails applying skilled-basededucational forces and adult learning as stipulated in the sociallearning theory. The theory advocates for the use of the continuousquality improvement technique (CQI) in enhancing behavioural change.CQI is a chronic care model that provides a unifying approach toimprove the quality of smoker’s health. It addresses multipleinterpersonal and environmental barriers to smokers’ adherence. Forexample, the method uses office support to prompt, facilitate andreward the delivery of preventive interventions to smoking. The keyadvantage of the method is its ability to cut across the varioustypes of health behaviours and chronic conditions. The interactiveapproach of the CQI program makes it more efficient, cost-effectiveand sustainable at improving the quality of health care (Tengland,2010)

Downstream interventions entail the use of health habit counsellingand consultancy to change the smoker’s individual practices. Forexample, the STEP-UP trial is a downstream intervention programpioneered by individual practice consultation methods. The model usesan efficient practice tailored approach to improve preventive healthservice delivery. It requires initiating behaviour change througheffective community-based programs. Since, specially trained nursesare used to deliver the interventions of the approach, it emphasizeson improving the rates paid to health habit counsellors. Improvingthe salaries of the nurses increases their motivation to provideeffective follow up and ensure change on smokers’ behaviour(Knickman &amp Kovner, 2015).

The method calls for effective training of the specialized nurses.Training improves the effectiveness of the nurse in identifyinglikely changes and tools for implementing the changes. Suchintervention tools may include creating reminder systems, flowsheets, patient education materials and clinical information systems(Knickman &amp Kovner, 2015).

The key advantage of the model is its ability to establish changewithin a short period of six to twelve months. Besides, the change issustainable with constant follow up. The methods effectiveness ininstitutionalizing change is because it is tailored to the uniquecharacteristics of each practice (Schwartz et al., 2010).


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Hancock,C. &amp Cooper, K. (2001). A global initiative to tackle chronicdiseases by changing lifestyles. Primary health care,21(4), 24-6

Knickman,J.R., &amp Kovner, A.R (Eds). (2015). Healthcare delivery in the United States (11thed.). New York, NY: Springer Publishing.

Schwartz,S., Ireland, C., Stretcher, V., Nakao, D., Wang, C., &ampJuarez, D.(2010). The economic value of a wellness and disease preventionprogram. Populationhealth management,13(6),309-317.

Tengland,P. (2010).Health promotion and disease prevention: Logicallydifferent perceptions? Healthcare analysis,18(4),323-341