The largest preventable cause of death and disease is tobacco consumption in the United States of America, which kills 480, 000 people annually, and unfortunately about 41, 000 of these deaths are from secondhand smoking. In addition loss in productivity and health costs incur around $300 billion a year in the country (CDC, 2018).
Stated by the California Department of Public Health (CDPH), about 9.4 % adults in the state use tobacco products (cigarillos, cigars, chew, snuff, pipe, hookah pipe, e-cigarettes, and snus) of these 2.7% are dual users. The loss in momentum of decline suggests a tobacco use may increase in future thus reversing the gains made through the program (CDPH, 2016). Since the beginning of Comprehensive Tobacco Control Programme in 1989, smoking prevalence in the state of California declined from 23.7% to 11.6% by 2014, decreasing 51.1%. This decrease in the trend was most profound during the initial years which declined with time (Roeseler & Burns, 2010).
At present, 2.3 million men and 1.3 million women in the state are smokers, with the highest prevalence in African American men and women at 20% and 14.7% respectively (Lightwood & Glantz, 2013). In students from grade 9 to 12th, the smoking prevalence decreased from 24.8% in 2000’s to 14.2% in 2014 (CDPH, 2016).
According to CDPH (2016), over half (52.8%) of Californian adults in the age group 18-64 reported being exposed to secondhand smoke recently. Data indicates 11.4% and 15.5% Californian adults allow smoking or vaping in homes respectively. Home is the main place of secondhand tobacco exposure to children, who are more vulnerable to health effects of secondhand smoking.
As a result of the prevalence of tobacco smoking, the state of California incurs health care cost of additional $13.29 billion annually, with $ 10.35 billion loss in productivity every year due to the menace (Truth Initiative, 2017).
Authors on pp. 132-137 of “Health Care Delivery in the US” argue that several factors led to a shift from individual to population-based intervention models; such as success in interventions stemming from social learning theory, development of social marketing models for population-scale interventions, minimal reach and low effectiveness of cognitive behavioral treatments.
The effectiveness of the individual-based intervention was dwarfed by ecological and policy level interventions in the field of health, which gave a stable foundation for ecological models of health behavior in the early 90’s. This model encompassed the social institution, organizations, and environments in addition to an individual as target of interventions. The ecological model recommends multilevel strategies to address the health risk factors, such as smoking, and bring about an effective and permanent change in an individual’s health behavior by addressing challenges at individual, population and state levels.
Authors have cited McKinlay (1995), who was first to propose an ecological approach to health risk prevention for a successful population-based health behavior change. He forwarded a model for potent population health promotion strategies interlinking personal behavior change strategies with community-level health promotion activities which also included upstream policy changes and environmental interventions. Encompassing a wide range of factors linking downstream (individual level) with midstream (workplace, school, and community) and upstream interventions (policy level and environmental) with the capability to challenge the existing social, economic and industrial forces. More effective interventions are those that focus on changing rather than preventing risk behavior in individuals and mediation through suitable environmental or organizational channels for populations with the aim to strengthen and alter the social norms that are more helpful in discouraging unhealthy behavior.
The conspicuous reduction in tobacco use in the Californian population is one of the best examples of ecological approach for health intervention. Free counseling and medication was a downstream approach that helped reduce the number of individuals consuming tobacco, bringing under the umbrella the marginalized, low-income, and minority population. Yet it would not have been much effective without midstream and upstream approaches like, elevated tobacco prices, higher tax, legislation that banned workplace and public place smoking, mass-media campaigns that discouraged smoking. This multilevel intervention made possible halving the smoking population in just two decades.
References
CDC. (2018, 02 15). The burden of Tobacco Use in the U.S. Retrieved 03 27, 2018, from Centre for Disease Control and Prevention: https://www.cdc.gov/tobacco/campaign/tips/resources/data
Health, C. D. (2016). California Tobacco Facts and Figures 2016. California Tobacco Control Program. Sacramento: California Department of Public Health.
Lightwood, J., & Glantz, S. (2013). The effect of the California Tobacco Control Program on smoking prevalence, cigarette consumption, and healthcare costs: 1989–2008. PLoS One, 8(2). doi:doi: 10.1371/journal.pone.0047145
McKinlay, J. B. (1995). The public health approach to improving physical activity and autonomy in older populations. In E. Heikkinen, J. Kuusinen, & I. Ruoppila (Eds.), Preparation for aging (pp. 87-102). Boston, MA: Springer.
Roeseler, A., & Burns, D. (2010). The quarter that changed the world. Tob Control., i3–i15. doi:doi: 10.1136/tc.2009.030809
Truth Initiative. (2017, May). Tobacco use in California. Retrieved 27 3, 2018, from Truth Initiative: https://truthinitiative.org/tobacco-use-california
