Behavioral Risk Factors
Behavioral Risk Factors
Tobacco Use
In comparison to other behavioral risk factors, tobacco use contributes the highest number of preventable diseases and deaths (Kovner & Knickman, 2011). Tobacco use includes direct cigarette smoking and exposure to secondary exposure to tobacco smoke. Data on smoking, from the centers for disease control and Prevention (CDC), reveals that it is responsible for 443,000 premature deaths from the various forms of cancer, lung, and heart disease. CDC estimates indicate that interventions for tobacco use cost the healthcare budget $ 96 billion annually. It is also responsible for $97 billion worth of productivity loss.
In pregnancy, it is the most modifiable cause of poor outcomes (Ibid). It accounts for 20% of low birth weight deliveries, 8% of preterm births, and 5% of perinatal deaths. It is responsible for respiratory illnesses, sudden death syndrome, decreased lung function, and middle ear infections. 30% of the 3000 children and teens, who become new smokers daily, ultimately become addicts. 22% of high school students are smokers. In the general population, 10 million people smokeless tobacco, linked to oral cancer, gum disease, and tooth loss. Environmental tobacco smoke affects 37% of adult non-smokers and 27% of children (<6 years). In the summary of baseline prevalence data, 24% of adults (>18 years) smoke against the 2010 goal of 12%. 35% of adolescents (grades 9 to 12) smoke against the 2010 target of 16 %. Environmental tobacco smoke affects 27% of children (<6years) against the 2010 target of 10%.
Population-Based Prevention Model
Implementation of health care interventions occurs at three levels: upstream, midstream, and downstream.
Downstream
Downstream interventions refer to interventions for behavior change targeted at the individual level of persons who possess behavioral risk factor, or suffer diseases related to the risk factor (Ibid). It comprises several actions such as counseling, health education, self help programs or tailored communication, and pharmacologic treatments.
Intervention for tobacco use: design and implementation of counseling programs for individual students in high schools. Access to counseling at an early stage relates to a high potential for smoking cessation (Novic, Morrow, $ Rays, 2008).
Midstream
Midstream interventions refer to population level interventions targeted at defined population groups in order to prevent or change behavioral risk factors (Kovner & Knickman, 2011). Implementation may follow natural channels or organizational channels. It may include interventions at worksite, schools, and other specified community settings. Midstream interventions include actions related to health care screening, promotion and prevention.
Intervention for tobacco use: Introduction of smoke-free zones in institutions such as schools in order to prevent secondary exposure to environmental tobacco smoke among nonsmokers. Secondary exposure affects a high proportion of the population, and, therefore, segmentation of living environment will highly protect people who do not smoke.
Upstream
Upstream interventions are environmental interventions targeted at national and state policy level (Kovner & Knickman, 2011). The aim is to strengthen social norms. Actions may include national public education or media campaigns, economic incentives for health behavior, policy preventing use of unhealthy products, or policy preventing advertisement and promotion of unhealthy products.
Intervention for tobacco use: Introduction of a state policy that ends advertising and promotion of cigarettes. Cigarette advertisement and promotional content contributes, significantly, to the incidence of smoking (York, 2012).
References
Kovner, A. & Knickman, J. (Eds.). (2011). “Health care delivery in the United States (10thEd.).
New York, NY: Springer Publishing.
Novic, L., Morrow, C. & Mays, G. (2008). “Public Health Administration”. Sudbury, MA:
Jones and Bartlett Publishers.
York, N. (2012). “Tobacco Control, an Issue of Nursing Clinics”. Oxford: Elsevier.
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