In Focus: Reflecting on Smoking Cessation among Adolescents
Despite efforts to reduce smoking, there are still 12 million adult cigarette smokers in Great Britain and another 2.3 million who smoke pipes and/or cigars. Smoking is still one of the leading causes of death in the UK, resulting in 114,000 deaths per year, accounting for at least one-fifth of all deaths in UK (Peto R. et al., 2004).
Working further on the vision of assisting young adults quit smoking in UK, this paper would first present the key issues and relevant social factors luring young adults into smoking at a very early age. The paper would then discuss the need to address and to respond to the call of helping young adults cope tobacco addiction and assisting them maintains a smoke-free lifestyle.
According to the published report of Action on Smoking and Health (ASH) last March 2006, the 20-24 age bracket has the highest number of men and women smokers, thereafter older age group tend to progressively have fewer smokers (Action on Smoking and Health, 2006). The reason is that older age groups are more likely to have stopped smoking (Table 1).
Table 1. Prevalence of cigarette smoking by age – percentage of adult population (Adapted from Smoking statistics: Who smokes and how much (Action on Smoking and Health, 2006).
Table 1. Prevalence of cigarette smoking by age – percentage of adult population (Adapted from Smoking statistics: Who smokes and how much (Action on Smoking and Health, 2006))
age 60 +
In addition, the report also includes children who smoke entering secondary school in UK. The report shows that very few students smoke when they start secondary school; however, the likelihood of smoking increases with age. By age 15, 21 percent of the students are regular smokers.
In a news article published by BBC World in September 11, 2000, smoking can be more addictive than what was originally thought. The researcher’s findings show that people can be addicted to nicotine early on. A survey of 700 children was conducted and the researchers have found out that children are more prone to nicotine addiction than in any other age group. In fact, many exhibited signs of nicotine addiction and dependence in their survey. While diseases such as lung cancer may not set-in at their early age, the bigger risk is that the likelihood for these teens to quit when they are in their 30s or in their later years is much lower.
The increase in smoking prevalence among the young adults can be attributed to the marketing strategy of tobacco companies (Blach, 2000). To further explain this strategy, the marketing approach in general divides the potential audience into various segments in order to choose which segment to target. Companies then develop offerings that will appeal to their target market. Commercials and various marketing communication is also developed to entice and persuade the target market to try the product. This is also the case for smoking and the youths.
The marketing strategy of tobacco companies is to entice young adults to try smoking. While tobacco companies publicly maintain that they do not target the young adults, the marketing logic of selling to teenagers is overpowering (Bates and Doyle, 2006). That is, teenagers are the key battleground for tobacco companies and for the industry as a whole. Tobacco companies that targeting the young adults is a more profitable market in the long run – i.e. if a company can “hook” a teenager early on they could well smoke the brand for life. In fact, commercials are aimed to elicit emotional response that is very true during adolescent – a time of great aspiration and insecurity. And, smoking is often identified with adulthood and has become a badge or signifier of positive values such as rebellion, independence, and self-expression.
Nevertheless, Government has stepped up policies to reduce smoking prevalence on different age groups (Blair 1998). Periodically, Government sets targets to reduce and to measure rates smoking rates among adults. Moreover, Government has also passed legislation to phase out and ban traditional advertisement on cigarette smoking as well as increasing excise taxes on cigarettes. Moreover, different sectors and organizations have also step-up the informational campaign to curb the carnage caused by tobacco especially targeted at young adults.
While different sectors have pushed towards eliminating smoking prevalence, recent studies published in Nursing Research show that nurses are in a unique position to address this growing concern. Nurses who advice patients to give up smoking may have a higher success rate than anyone else in helping patients kick the habit. In fact, “Health care professionals and particularly the nurses have tremendous access to patients and families affected by tobacco use. Nurses are in the unique position to act as agents of change when it comes to preventing and treating tobacco dependence,” said Dr. Molly C. Dougherty, Nursing Research editor and professor of nursing at the University of North Carolina at Chapel Hill (Dougherty, 2006).
Nurses, as the largest group of health care professionals, can have an expanded impact in eliminating nicotine addiction and dependence. Similarly, the research articles also recommend a widespread training of nurses to deliver interventions to patients to treat nicotine addiction and dependence (Sarna et al., 2006). Moreover, there is a need to promote the role of nurses in tobacco control and in response to the recognition of potential contribution to the field (Bialous, 2006). More importantly, it is a call towards taking a leadership role towards tobacco cessation.
Following the NHS Leadership framework, there is a need for a transformational leadership to undertake this challenging task (NHS Modernization Agency and Leadership Centre, 2003). While managers engage in very little change and manages only what is present and leaves things as much as they found them, transformational leadership focuses on change and innovation (Tichy & Devanna, 1986). More importantly, transformational leadership begins with the social fabric – the social condition and the needs of the patients. Starting with the very needs of the young adults as patients and engaging in the healing process for them is the key in disrupting the environment that promote smoking prevalence among adults. This provides school nurses in health care the opportunity to recreate the social fabric and respond to the challenge to better reflect and improve the quality of life for their patients, i.e. young adults.
Nonetheless, this challenging task does not happen overnight. As a school nurse, I envisioned to conduct sessions with young adults to assist and to help them quit smoking. While similar sessions are being conducted, I can differentiate my sessions in the quality and the manner with which it is conducted. By focusing on the varying needs of students, listening to them and learning from them, and motivating them to participate in the whole process, I aim to generate interest as well as awareness on the benefits from the health promotion sessions. In effect, the ultimate goal is to make a real dent in the lives of the students by effectively helping them quit smoking.
In addition, I followed the model reflection of Driscoll (2000) in facilitating on the sessions with the young adults. According to the ‘What?’ stage in Driscoll’s reflective model, I will go on about the describing the planning and training sessions with my students. In planning for the sessions with our students, I have adopted a constructivist approach to teaching young adults on the common concerns and problems in their lives. Duffy and Cunningham (1996) differentiates between the cognitive constructivism and social constructivism. Cognitive constructivism focuses on individual learner while social constructivism reinforces learning within the context of dialogue and social interaction (Duffy and Cunningham, 1996).
The sessions with the students were anchored on their own experiences, which helped me gain a better understanding and insight for their reasons for smoking at a very early age. In listening and communicating with my individual patients, I began to relate and to understand their anxieties and insecurities particular to their age. As a school nurse, I treated each person as unique and empathize on his own experience. As I learn more about my students, the more I gain rapport and more importantly their trust. In closing of the tobacco cessation sessions, I have ensured that individual goals had been set to increase the chances of success of quitting. I believe the participation of the individual in goal setting should increase commitment and acceptance among students.
Next, the ‘So What?’ stage of Driscoll (2000) focuses on the analysis of events to discover what learning arises from the process of reflection. I realized that there is a need for a continuum after the sessions with our students. To sustain our continuing dialogue and communication, I followed through with a one-on-one sessions with the students. I tracked their progress and encourage them to carry on. I believe as their school nurse I have unique position to influence their thinking and start the healing process amongst them at root from overcoming insecurities and anxieties.
To deliver results, I ensured that the benefits of the quitting is clearly emphasized to the students and I aligned the rewards which the students would find appealing. The reward helped me overcome the inertia of quitting. Giving the students the motivation and the reason to quit provided me with leverage to deliver the desired results.
‘Now What?’. Driscoll (2000) focuses proposed action following the event. Realizing the need for a continuum even after the sessions with the students, there would be a need to establish and to define a process of follow-up consultations and dialogue to ensure continuous progress and improvement towards quitting among the students. This means there is a need in developing and training my colleagues for the task. I hope to establish a strong mentoring relationship with an apprentice school nurse. I believes enabling my colleagues for the tasks ensures continuity of the project as well as developing my leadership skills. I believe as the project would grow in scope, what I learn from this training endeavor will ultimately guide me in future decisions and training session design to effectively nurture and educate our students on the hazards of smoking.
Action on Smoking and Health (2006). Smoking Statistics: Who smokes and how much. Retrieved August 16, 2006 from http://www.ash.org.uk/html/factsheets/html/fact01.html
Balch, G. (2000). Communicating with teens: some lessons from commercial marketing Tob Control 2000; 9 (Suppl 1): i52 (Spring)
Bass, B. (1990). Bass & Stogdill’s handbook of leadership: theory, research and managerial applications. New York: The Free Press.
Bates, C. and Doyle, P. (Eds.) (2006). Tobacco Explained. Action on Smoking and Health. Retrieved August 16, 2006 from http://www.ash.org.uk/html/conduct/html/tobexpld3.html
— (2000, September 11). Smoking addiction ‘sets in early’. BBC Health. Retrieved August 16, 2006 from http://news.bbc.co.uk/2/hi/health/916370.stm
Bialous, S.A. (2006). Tobacco Use Cessation Within the Context of Tobacco Control Policy: Opportunities for Nursing Research. Nursing Research. 55(4) Supplement 1:S1-S9
Blair, T. (1998). Smoking Kills – A white paper on Tobacco. Retrieved on August 16, 2006 from http://www.archive.official-documents.co.uk/document/cm41/4177/contents.htm
Carnall, C. (1990). Managing change in organizations. Prentice-Hall.
Dougherty, M. (2006). Evolution of Tobacco Use and Tobacco Use Policy. Nursing Research. 55(4) Supplement 1:S58-S63
Girvin, J. (1998). Leadership in nursing. McMillan Press.
Hartog, D., House, R., Hanges, P. Dorfman, P., Ruiz-Quintanilla, A. (1999). Emics and etics of culturally endorsed implicit leadership theories: are attributes of charismatic/transformational leadership universally endorsed? Retrieved June 3, 2005 from http://jonescenter.wharton.upenn.edu/papers/1999/wp99-02.pdf
Marquis, B. ; Huston, C. (2005). Leadership roles and management functions in nursing: Theory and application. Lippincott Williams ; Wilkins.
Martin, V. (2003). Leading change in health and social care. Routledge: London
National Centre for Social Research/National Foundation for Educational Research (2005). Smoking, drinking, and drug use among young people in England in 2004.
NHS Modernization Agency and Leadership Centre. (2003). NHS leadership qualities framework. Department of Health.
Peto, R. et al., (2006). Mortality from smoking in developed countries 1950-2000 (2nd edition) Oxford University Press, Oxford.
Sarna, L. and Bialous, S.A. (2006). Strategic Directions for Nursing Research in Tobacco Dependence. Nursing Research. 55(4) Supplement 1:S1-S9
Tichy, N. M. and Devanna, M. A. (1990). The transformational leader. (2nd ed.). New York: Wiley.