Nowadays, despite the different limitations and bans, the number of smokers worldwide is very high. Moreover, while some of them are quitting smoking others start doing it influenced by the powerful advertising campaign of the tobacco corporations. Furthermore, there is a problem when pregnant women are smoking causing a negative impact on their health and health of their unborn babies. The only way to solve these problems is Health promotion and providing relevant health related information to the public. In this work, the Health Belief Model will be described with respect to the particular case of Jane and Peter, who are trying to quit smoking. In addition, the negative impact of smoking on pregnancy, a conflict between the tobacco industry and Health Promotion, and importance of providing the health-related information to public will be observed.
Pregnancy and Smoking
Every woman is advised to quit smoking before pregnancy or at least during it. However, it is not enough to secure their health and health of their future children. The second-hand smoking is equally dangerous. Among the sources of the second-hand smoking may be the following: second-hand smoke from family members, friends, colleagues and even from unknown people on the street. Furthermore, while it is very hard to avoid all sources of the second-hand smoking, such indirect contact may cause a lot of damage to the health of a woman in general and the health of her baby in particular. So, how exactly smoking influences the health during pregnancy and what is the difference between second-hand smoking and direct smoking negative effects?
How Smoking Affects Pregnancy?
When a woman smokes during pregnancy, her baby is affected by the toxic brew that gets into the bloodstream, the only source of nutrients and oxygen for a baby. It means that baby is influenced by the chemicals in the smoke. There are more than 4,000 chemicals in it including cyanide, carbon monoxide, and nicotine.
So, smoking woman is more likely will have the following problems in comparison with non-smoking woman:
- Preterm labor, that may start before 37 weeks of pregnancy and may cause the premature birth.
- Smoking during pregnancy may lead to bleeding from a vagina.
- Smoking while pregnant may be the reason for various problems with placenta, for instance, placenta previa or placental abruption. It is obvious that it is quite harmful situations for the baby because it gets oxygen and food due to the placenta.
- Consequently, smoking during the pregnancy may lead to ectopic pregnancy. It is the situation when the fertilized egg implants and starts to grow outside of the womb.
However, smoking affects not only the womans health during the pregnancy, it also makes a negative impact on the babys health before and after its birth.
Second-hand or passive smoking is a process of releasing the smoke into the environment by the smoker and breathing it by the non-smoker. Such second-hand smoke may include more than 4,000 chemicals. Moreover, a lot of these chemicals are closely related to cancer. In fact. If a woman is exposed to passive smoking she and her baby, both are put at risk.
According to the latest researches, second-hand smoke may be the reason for the ectopic pregnancy, miscarriage, early birth, low birth weight, stillbirth or deficiency in childs behaviour and learning. Moreover, the child that was affected by the second-hand smoke is exposed to the Sudden Infant Death Syndrome (SIDS), the disorder, when a child may die unexpectedly while sleeping. Furthermore, children and babies who are the subject of the passive smoking are put at risk of the development of allergies, ear and lung infections, and asthma.
Talking about negative effects on pregnancy and babys health, it could not be but mentioned the third-hand smoking. While it is not so obvious as second-hand smoking or direct one, it also may cause a lot of problems to the womans and babys health. Moreover, the danger is that pregnant woman may be exposed to the third-hand smoking without realizing it. The reason is that the toxins left after the cigarettes may collect everywhere in a room, for instance, in pain, on furniture, in rugs. The easiest way to determine whether the room is affected by the cigarettes toxins is a smell in it. If it smells like smoke without recent smoking in it the toxins are already collected there, and it is unsafe for the pregnant to be in this room. According to some studies, the third-hand smoke may badly influence on prenatal lungs and as a matter of fact cause respiratory problems in future.
Health Belief Model
While everyone in the modern world has heard at least once about the negative effect of smoking a lot of people still doing it without any thoughts about changing their behaviour. Same situation we can observe with Jane and Peter. They are both smokers and although they might hear that cigarettes may lead to the several complications such as bladder cancer or lung cancer they do not feel any risk and continue to smoke. So, at that moment Jane and Peter are influenced by their individual perceptions and according to the Health Belief model it is the first factor, perceived susceptibility. According to it even if they know about the negative effects of smoking they are not ready to do any changes in their behaviour. Moreover, they may be uninformed or under informed about all the risks of smoking. On the other hand, according to the Stages of Change, Jane and Peter even are not ready to talk, read or think about their high-risk behaviours, as they are on the first stage called Precontemplation. Furthermore, they are unmotivated, resistant and unready for help. However, the situation has changed considerably. They got to know that Jane was pregnant, and it may help to do the first steps for quitting smoking. The major goal of the health promotion specialist, in this case, is to inform them about a negative effect of smoke not only for their health but moreover for the health of their unborn child. However, the focus should not be made only on Jane. Both of them should be informed that both, the smoking and the second-hand or passive smoking affect the health of their child equally, and moreover, not only during the pregnancy but also after this child will be born. So, the key goal during this Precontemplation period is to make Jane and Peter think about smoking as a negative and high-risk behaviour.
The next step will be to point Jane and Peter how exactly their smoking may influence on them and their unborn child. In Health Belief model this factor called perceived severity. The reason for it is that even while they already heard that smoking is a negative behaviour, they may not even imagine how dangerous it is. The explanation should be made from two points, how smoke affect their health, including fatal examples of cancer disease and at the same time how smoking may influence on pregnancy, discussing such problems as miscarriage, preterm labor, and even stillbirth. These examples should be supported by statistics to achieve a better effect. This period may be described as Contemplation stage or period when Jane and Peter are getting ready to do some actions. However, they still will be weighting for some time and it is quite important to help them make a right decision. But it should be mentioned that they are not ready for active actions or programs during this period, so everything should be done very careful.
The next factor, according to the Health Belief Model (HBM), is called Perceived Benefits. While the main benefit of the HBM is better health and quality of individuals life, it is very important to find some individual benefiting factors. In respect to Jane and Peter in addition to their health it may be avoiding different complicated situations during labor or the stronger health of their unborn baby and as the matter of fact its better health in future. Moreover, as an additional factor may be used the cost benefit because nowadays cigarettes are not so cheap and instead of buying them Jane and Peter will be able to buy, for example, some food in a supermarket, for instance, vegetables and fruits that are needed for Jane during the pregnancy.
However, Perceived Benefits factor is closely connected with one called Perceived Barriers. These barriers are the reasons why the particular person cannot change its behaviour. There is a huge variety of these reasons, and it is hard to examine what are these reasons for Jane and Peter in this particular case. It can be assumed that Jane and Peter have a group of smoking friends, and they are afraid that due to quitting smoking they will lose them. On the other hand, maybe due to smoking Peter and Jane feel senior or more confident. Moreover, talking about Peter, he may have more barriers because his parents have a history of substance abuse, so he has an example when individuals have pernicious habits and do not experience any problems with their health. Furthermore, in such age, as Peter is, the parents example is crucial for the individuals behaviour and views formation. However, it is very important to show Jane and Peter that the benefits they may achieve are much stronger than the barriers.
It could not be but mentioned that the period of evaluating benefits and barriers is quite complicated. However, at the beginning of this period Jane and Peter are more likely to be in a stage of Preparation, according to the Stages of Change. It means that they are ready for some actions. Among these actions, there are the following: participation in some health educating classes, self-education via reading self-help books or other printed or web sources, participating in more action-oriented programs. Furthermore, if everything was done right soon Jane and Peter will be able to proceed to the following stage that is called Action stage. It means that Jane and Peter can make some specific changes in their behaviour and lifestyle. However, it should be noticed, that reducing the number of cigarettes smoked per one day does not count as any action.
Cues to action are one more important factor in HBM. In general, it is everything that fosters the decision of the individual to change its behaviour. Cues to action may be divided into two groups: signs that give an impetus for quitting smoking and cues that help to maintain the period of non-smoking. These factors both have a great importance for Jane and Peter in attempt of changing their behaviour. However, it is obvious, that cues to action are related to the different stages of the Stage of Changes model.
Talking about the cues to action that push individuals to do some changes in their behaviour, these ones are related to the Contemplation and Preparation stages. For instance, among these signals may be reduced immunity, loss of appetite which are very unlikely for the pregnant women in general and Jane in this particular case. Moreover, bad breath, stained teeth that may cause a discomfort in communication with other people also may be considered as cues to action for smokers. On the other hand, the group of signs to action such as leaflets, reminding calls from physicians may be considered as ones that help during the stage of Maintenance. In addition, it can be concerned relative, in our particular case Jane and Peter may help each other with it by controlling one another.
The HBM also includes the following factors that influence individuals behaviour changes: self-efficacy (ability to successfully perform a behaviour) and modifying variables (race, sex, age, social class, education). All of these factors are different for every individual and it is quite difficult to evaluate their impact. However, Maintenance and Termination stages of the Stage of Changes model depend on these individual characteristics a lot. For instance, 43% of individuals returned to the regular smoking after 12 months of maintenance. It means that after Jane and Peter quit smoking there still be a risk of returning to it. So, everything will depend on their individual characteristics and willing to be non-smokers.
Local Industry and Health Promotion
Nowadays, a tobacco industry is quite influential and controls considerable assets. Moreover, the interests of the huge corporations involved in this industry are often guarded by the lobbyists and representatives in the governments of all levels. It is obvious, that the interests of the tobacco corporations are opposite to the Health promotion programs. For instance, there are 19% of smoking adults in England and two-third of them are willing to quit smoking. So, the main goal for the Health promotion is to help them. Talking about the tobacco industry, the major goal is to leave this number of smokers, recruit new ones and promote smoking.
With respect to Jane and Peter case, the main conflict between Health promotion and tobacco industry that may affect their behaviour change is advertising conflic. The reason is that there is a direct relation between consumption of tobacco products and advertising. While Tobacco Advertising and Promotion Act 2002 (TAPA) was prohibiting tobacco promotion and advertising in broadcast media it does not mean that advertising of tobacco products disappeared. It was simply refocused on below the line marketing. Among the examples of new tobacco industrys advertising strategy, there are the following: sales promotions, advertising to wholesalers and sellers, discounts for the promotion of particular brands, offering various competitions and prizes around specific products. Moreover, smoking on the big screen is still a source of the tobacco advertising. Nowadays, it is usual situation to see how the main actor of the movie is smoking. The biggest danger of it is that a lot of people often try to follow the model of the behaviour of their favorite actors.
In case of Jane and Peter, the advertising conflict will mainly affect their period of maintenance and termination. It is quite hard to quit smoking or not to start it again when you still can see a lot of different adverts that promote this pernicious habit. However, hopefully, in some time even these sources for the tobacco advertising will be banned.
Importance of Relevant Health Related Information
Providing health related information may be a powerful vehicle for health promotion and improving the health of the community in general and individuals in particular. Due to it a lot of existing health-related problems may be highlighted and furthermore, the solutions for them may be given. It also may become a reason for public incentives for changing current policy and modifying or developing new healthcare programs. It is obvious that such incentives may improve the effectiveness of healthcare considerably.
Nowadays, the easiest way to provide relevant health-related information is internet. There are a lot of different websites that provide various health related information, describe diseases and ways of medication, give information about negative effects of smoking, alcohol and other pernicious habits, provide information about the existing healthcare programs. Health and Care Information Centre (HSCIC) is an example of such sources. It provides a lot of various information covering different healthcare problems and promoting healthy behavior.
With respect to Jane and Peter, the providing of relevant health related information is crucial. First of all, if they knew all the negative impacts of smoking, how it can affect their health, the statistics of diseases and death among the smokers, it is possible that they would not start smoking at all. On the other hand, providing the relevant health-related information is also useful for them while they are trying to quit smoking. They can find almost everything they need, for instance, various quitting smoking related classes or programs, self-education articles or magazines. In addition, Jane may find any information related to her pregnancy.
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Health promotion is a powerful vehicle that can reduce the number of individuals with pernicious habits and increase the health of the society. With respect to the particular case of Jane and Peter, it helps them quit smoking using different tools, for instance, HBM or providing them with relevant health-related information. However, as it can be seen in Health Belief Model quite a lot depends on Jane and Peters individual characteristics. So, health promotion can only help them quitting smoking pointing the right direction and explaining its negative effects. However, it is still up to Jane and Peter to decide will they continue being non-smokers or will they return to this pernicious habit.