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4

Focused Health Promotion: Initiative to Lower Smoking in Older Adults

Ernesto Cisnero

Florida National University

Health Promotion & Role Development in Adv. Nursing Practice-DBX-DL01

Dr Nora Hernandez-Pupo

March 21, 2024

The issue of smoking in excess among older adults is a significant health problem that requires urgent action. Although tobacco control measures have been improved, older adults are still the vulnerable group that faces negative effects on health due to smoking. Data from the 2012 National Health Interview Survey showed that 18.1% of American adults, or 42.1 million people, were current smokers. This group of respondents attested having smoked more than 100 cigarettes in their whole life to date, and they currently smoke either daily or on some occasions. The popularity of smoking among young people aged 18–24 was higher, with 17.5% of that age group listed as current smokers, compared to 8.9% among those aged 65 and above, 21.6% among those aged 25–44, and 19.5% among those aged 45–64 (Chen & Wu, 2015). This statistic emphasizes the importance of those endeavors that are intended for smoking cessation among elders who have a high risk of cardiovascular disease, respiratory illnesses, and cancer. The proposed health promotion program will mainly focus on implementing evidence-based strategies, which will be aimed at quitting smoking and preventing relapses among the elderly. The program will focus on education regarding the health risks of smoking, connect people to the resources for smoking cessation, and motivate older adults to take up healthier lifestyle practices. The result that is expected from the program is to make possible a substantial drop in smoking prevalence among older adults within the aim community by no less than 20% during one year.

Description of the vulnerable population

The target population of this health promotion program is older adults aged 65 and above who are present smokers or have a chance of relapse. This particular group of people faces very own specific problems and hazard factors which lead them to be among smokers-related health issues. Another important risk factor is the interaction between the presence of tobacco in the body and the prolonged use of tobacco. Several older people have been smoking for many years and so have been regularly exposed to dangerous ingredients in tobacco smoke. Smokers who smoke for a long time have a higher risk of developing serious medical conditions like cardiovascular diseases, breathing problems, and cancers of different organs (Dahdad et al., 2022). Smoking both short term and long term puts the elderly at higher risk of these problems, which is one of the reasons why we should help our older population to quit smoking.

Another point is that socioeconomic status is associated with smoking diseases among the elderly because they are more likely to develop such diseases than others. Nowadays, studies have focused on the fact that smokers with low income or educational levels were found to be more likely to smoke while quitting this habit was rare among these categories (Kastaun et al., 2020). One of the most common problems seen in the smoking cessation aid services amongst poor elderly adults is that they may get discouraged by the lack of counseling, medicine, and even nicotine replacement therapy. However, the decision of smoking cessation for elderly persons from low socio-economic backgrounds is far more complex because they are more susceptible to the social - economic distress characterized by higher stress, lack of social support, and more smoking triggers.

In addition to this, comorbidities and aging health issues like old age, also contribute a great deal to the risk of development of these smoking-related diseases among older smokers. One of the adverse effects is that smoking can lead to a higher incidence of underlying health conditions such as heart disease, COPD, and diabetes among patients aged 65 and above, which only aggravate their situation (Soumagne et al. 2020). People aged 65+ who are suffering from other diseases can be affected very seriously by smoking and as a result, they may become even worse, their health may be reduced, and quality of life will be decreased. This is the underlying cause why it is not plausible for seniors to quit smoking and consequently, they are more likely to develop disease and death related to tobacco use. Thus, smoking cessation for elderly people as well as those with comorbidities and age-related health problems is a crucial strategy in health.

Review of articles

Henley et al. (2019) present the pivotal issue of smoking cessation among older adults in the United States, focusing on the life-saving role that quitting plays in cancer prevention among the elderly. The objective of this research initiative is to ascertain the prevalence of smoking and the behaviors associated with abandoning among the elderly population in the United States. This will be achieved by analyzing data from the Cancer Control Supplement and the 2015 National Health Interview Survey.These results have reaffirmed the high rates of those who would like to quit smoking among older people, including more than half of the current smokers. On the contrary, this study identifies significant shortcomings in quitting smoking, which was only experienced by a few seniors who managed to stop smoking in the past 12 months. Besides, although they have to consult doctors for smoking cessation, the utilization of evidence-based cessation treatments is low among older people. Such discoveries stress the improved clinical and community strategies that are destined to assist older adults in successful smoking cessation. For example, these may include the supply of evidence-based cessation care and various population-based interventions.

Chen and Wu (2015) performed a systematic review and meta-analysis to assess smoking cessation interventions that were tailored for people who had a minimum age of 50. The study conducted a pharmacological, non-pharmacological, and multimodal intervention analysis, including the treatment efficacy of these modalities in addressing this group. In light of that, the outcomes indicate that the pharmacological, non-pharmacological, and multimodal approaches result in a greater effect than the control group, and the cessation rates differ for some trials and samples based on their distinctive elements. The meta-analysis highlights the role of different cessation strategies in promoting smoking cessation among older adults and it also illustrates the need for conducted studies to figure out the effectiveness of smoking cessation among various older population groups such as ethnic minorities. Such findings have strong evidential power that can be harnessed and used for the development of prevention and cessation interventions that are specific to the needs of older people (50 years and above). This, in turn, will lead to expected better health outcomes among the elderly who are quite vulnerable.

Henley et al.. (2019) and Chen and Wu (2015) have very well-founded ideas about smoking cessation attitudes and approaches of older adults. One of the main strengths exhibited by the study by Henley et al. is their contribution to the data collected nationally from the National Health Interview Survey . They were tough enough to furnish smoking prevalence and cessation trends among elderly people in the United States. The study results, which bring out the crucial role of smoking cessation in cancer prevention, are a strong point in the study and a clear message that this population needs to be targeted. On the other hand, the study has a limitation, which is that it uses self-reported data, which may cause some people to react to the questions in a biased manner and, thus, affect the accuracy of smoking prevalence estimates.

While the study by Chen and Wu is the sole systematic review and meta-analysis that directly evaluates smoking cessation interventions aimed at adults aged 50 and above, it provides a thorough review with a pooled effect size to assess the overall effectiveness of these smoking cessation interventions. A multilevel and integrated approach to intervention types, together with cessation rates analysis across different trials and samples, increases the overall applicability and generalizability of the results. Nonetheless, the study's use of consolidated data from the previous studies may not capture individual differences in smoking cessation outcomes and intervention effectiveness because they could not observe each person's condition. Moreover, the recommendation of additional research oriented on the efficacy of smoking cessation amongst the diverse older population groups shows a space in the current literature and calls for interventions that are focused on reducing smoking disparities among older adults. Overall, both studies supply essential information about smoking cessation among the elderly; however, additional investigations are required to stimulate the design of culture-specific and effective interventions.

Appropriate conceptual or theoretical framework for disease prevention and health promotion

The Transtheoretical Model (TTM) would be an effective model that comprises six stages of change: The following stages are involved in the process: pre-contemplation, contemplation, preparation, action, maintenance, and termination (Del Rio Szupszynski & de Ávila, 2021). Each of these phases is representative of a different transition level and willingness to undertake behavior change. During the pre-contemplation stage, people have not yet realized the necessity to change their habits and, therefore, might also be unaware of such a need. Contemplation focuses on the necessity of the action but has not yet been implemented. The preparation phase is where people are actively involved in planning out their behavioral change for the near future. Action, in this case, involves putting in place the actual plans that are required to change behavior, while maintenance, on the other hand, is committed to maintaining the behavior modification over time. The stage of termination differs from the rest of the model in that the behavior change becomes an ingrained part of the individual's routine, and they are no longer tempted or at risk of relapse.

It means that this model is based on the phases, and it is very comprehensive, with much information used for the change of behavior and adjustment of the interventions. The Transtheoretical Model is the one we are planning to use in this smoking cessation health promotion program among older adults, which will help us to identify individuals with different levels of readiness to quit smoking. Therefore, interventions can be accordingly made to tackle each stage of change, and the program is likely to help older adults quit smoking by adopting the TTM approach. Meanwhile, the TTM offers a platform for designing interventions that may correspond with the traits and preferences of older individuals. Taking into account the variety of factors, such as socio-economic, mental, and health aspects, that can impact the smoking behavior of older adults, the stage-based approach is suitable for finding tailored solutions for the change of behavior. Based on the TTM, the interventions can contain evidence-based methods, including motivational interviewing, cognitive-behavioral therapy, and social support networks to help the individual progress through the stages of change and then sustain the smoking cessation. Through the application of the TTM that serves as a reference point, the proposed health promotion program would be capable of maximizing its effectiveness in assisting older adults in their path to smoking cessation and health improvements.

References

Chen, D., & Wu, L. T. (2015). Smoking cessation interventions for adults aged 50 or older: a systematic review and meta-analysis. Drug and alcohol dependence, 154, 14-24. https://doi.org/10.1016/j.drugalcdep.2015.06.004

Dahdah, A., Jaggers, R. M., Sreejit, G., Johnson, J., Kanuri, B., Murphy, A. J., & Nagareddy, P. R. (2022). Immunological insights into cigarette smoking-induced cardiovascular disease risk. Cells, 11(20), 3190. https://doi.org/10.3390/cells11203190

Del Rio Szupszynski, K. P., & de Ávila, A. C. (2021). The Transtheoretical Model of Behavior Change: Prochaska and DiClemente’s Model. Psychology of Substance Abuse: Psychotherapy, Clinical Management and Social Intervention, 205-216.

Henley, S. J., Asman, K., Momin, B., Gallaway, M. S., Culp, M. B., Ragan, K. R., ... & Babb, S. (2019). Smoking cessation behaviors among older U.S. adults. Preventive Medicine Reports, 16, 100978.https://doi.org/10.1016/j.pmedr.2019.100978

Kastaun, S., Brown, J., & Kotz, D. (2020). Association between income and education with quit attempts, use of cessation aids, and short-term success in tobacco smokers: A social gradient analysis from a population-based cross-sectional household survey in Germany (DEBRA study). Addictive behaviors, 111, 106553. https://doi.org/10.1016/j.addbeh.2020.106553

Soumagne, T., Guillien, A., Roche, N., Annesi-Maesano, I., Andujar, P., Laurent, L., ... & Degano, B. (2020). In patients with mild-to-moderate COPD, tobacco smoking, and not COPD, is associated with a higher risk of cardiovascular comorbidity. International Journal of Chronic Obstructive Pulmonary Disease, 1545-1555. https://www.tandfonline.com/doi/full/10.2147/COPD.S253417

4

Focused Health Promotion: Initiative to Lower Smoking in Older Adults

Ernesto Cisnero

Florida National University

Health Promotion & Role Development in Adv. Nursing Practice-DBX-DL01

Dr Nora Hernandez-Pupo

March 21, 2024

The issue of smoking in excess among older adults is a significant health problem that requires urgent action. Although tobacco control measures have been improved, older adults are still the vulnerable group that faces negative effects on health due to smoking. Data from the 2012 National Health Interview Survey showed that 18.1% of American adults, or 42.1 million people, were current smokers. This group of respondents attested having smoked more than 100 cigarettes in their whole life to date, and they currently smoke either daily or on some occasions. The popularity of smoking among young people aged 18–24 was higher, with 17.5% of that age group listed as current smokers, compared to 8.9% among those aged 65 and above, 21.6% among those aged 25–44, and 19.5% among those aged 45–64 (Chen & Wu, 2015). This statistic emphasizes the importance of those endeavors that are intended for smoking cessation among elders who have a high risk of cardiovascular disease, respiratory illnesses, and cancer. The proposed health promotion program will mainly focus on implementing evidence-based strategies, which will be aimed at quitting smoking and preventing relapses among the elderly. The program will focus on education regarding the health risks of smoking, connect people to the resources for smoking cessation, and motivate older adults to take up healthier lifestyle practices. The result that is expected from the program is to make possible a substantial drop in smoking prevalence among older adults within the aim community by no less than 20% during one year.

Description of the vulnerable population

The target population of this health promotion program is older adults aged 65 and above who are present smokers or have a chance of relapse. This particular group of people faces very own specific problems and hazard factors which lead them to be among smokers-related health issues. Another important risk factor is the interaction between the presence of tobacco in the body and the prolonged use of tobacco. Several older people have been smoking for many years and so have been regularly exposed to dangerous ingredients in tobacco smoke. Smokers who smoke for a long time have a higher risk of developing serious medical conditions like cardiovascular diseases, breathing problems, and cancers of different organs (Dahdad et al., 2022). Smoking both short term and long term puts the elderly at higher risk of these problems, which is one of the reasons why we should help our older population to quit smoking.

Another point is that socioeconomic status is associated with smoking diseases among the elderly because they are more likely to develop such diseases than others. Nowadays, studies have focused on the fact that smokers with low income or educational levels were found to be more likely to smoke while quitting this habit was rare among these categories (Kastaun et al., 2020). One of the most common problems seen in the smoking cessation aid services amongst poor elderly adults is that they may get discouraged by the lack of counseling, medicine, and even nicotine replacement therapy. However, the decision of smoking cessation for elderly persons from low socio-economic backgrounds is far more complex because they are more susceptible to the social - economic distress characterized by higher stress, lack of social support, and more smoking triggers.

In addition to this, comorbidities and aging health issues like old age, also contribute a great deal to the risk of development of these smoking-related diseases among older smokers. One of the adverse effects is that smoking can lead to a higher incidence of underlying health conditions such as heart disease, COPD, and diabetes among patients aged 65 and above, which only aggravate their situation (Soumagne et al. 2020). People aged 65+ who are suffering from other diseases can be affected very seriously by smoking and as a result, they may become even worse, their health may be reduced, and quality of life will be decreased. This is the underlying cause why it is not plausible for seniors to quit smoking and consequently, they are more likely to develop disease and death related to tobacco use. Thus, smoking cessation for elderly people as well as those with comorbidities and age-related health problems is a crucial strategy in health.

Review of articles

Henley et al. (2019) present the pivotal issue of smoking cessation among older adults in the United States, focusing on the life-saving role that quitting plays in cancer prevention among the elderly. The objective of this research initiative is to ascertain the prevalence of smoking and the behaviors associated with abandoning among the elderly population in the United States. This will be achieved by analyzing data from the Cancer Control Supplement and the 2015 National Health Interview Survey.These results have reaffirmed the high rates of those who would like to quit smoking among older people, including more than half of the current smokers. On the contrary, this study identifies significant shortcomings in quitting smoking, which was only experienced by a few seniors who managed to stop smoking in the past 12 months. Besides, although they have to consult doctors for smoking cessation, the utilization of evidence-based cessation treatments is low among older people. Such discoveries stress the improved clinical and community strategies that are destined to assist older adults in successful smoking cessation. For example, these may include the supply of evidence-based cessation care and various population-based interventions.

Chen and Wu (2015) performed a systematic review and meta-analysis to assess smoking cessation interventions that were tailored for people who had a minimum age of 50. The study conducted a pharmacological, non-pharmacological, and multimodal intervention analysis, including the treatment efficacy of these modalities in addressing this group. In light of that, the outcomes indicate that the pharmacological, non-pharmacological, and multimodal approaches result in a greater effect than the control group, and the cessation rates differ for some trials and samples based on their distinctive elements. The meta-analysis highlights the role of different cessation strategies in promoting smoking cessation among older adults and it also illustrates the need for conducted studies to figure out the effectiveness of smoking cessation among various older population groups such as ethnic minorities. Such findings have strong evidential power that can be harnessed and used for the development of prevention and cessation interventions that are specific to the needs of older people (50 years and above). This, in turn, will lead to expected better health outcomes among the elderly who are quite vulnerable.

Henley et al.. (2019) and Chen and Wu (2015) have very well-founded ideas about smoking cessation attitudes and approaches of older adults. One of the main strengths exhibited by the study by Henley et al. is their contribution to the data collected nationally from the National Health Interview Survey . They were tough enough to furnish smoking prevalence and cessation trends among elderly people in the United States. The study results, which bring out the crucial role of smoking cessation in cancer prevention, are a strong point in the study and a clear message that this population needs to be targeted. On the other hand, the study has a limitation, which is that it uses self-reported data, which may cause some people to react to the questions in a biased manner and, thus, affect the accuracy of smoking prevalence estimates.

While the study by Chen and Wu is the sole systematic review and meta-analysis that directly evaluates smoking cessation interventions aimed at adults aged 50 and above, it provides a thorough review with a pooled effect size to assess the overall effectiveness of these smoking cessation interventions. A multilevel and integrated approach to intervention types, together with cessation rates analysis across different trials and samples, increases the overall applicability and generalizability of the results. Nonetheless, the study's use of consolidated data from the previous studies may not capture individual differences in smoking cessation outcomes and intervention effectiveness because they could not observe each person's condition. Moreover, the recommendation of additional research oriented on the efficacy of smoking cessation amongst the diverse older population groups shows a space in the current literature and calls for interventions that are focused on reducing smoking disparities among older adults. Overall, both studies supply essential information about smoking cessation among the elderly; however, additional investigations are required to stimulate the design of culture-specific and effective interventions.

Appropriate conceptual or theoretical framework for disease prevention and health promotion

The Transtheoretical Model (TTM) would be an effective model that comprises six stages of change: The following stages are involved in the process: pre-contemplation, contemplation, preparation, action, maintenance, and termination (Del Rio Szupszynski & de Ávila, 2021). Each of these phases is representative of a different transition level and willingness to undertake behavior change. During the pre-contemplation stage, people have not yet realized the necessity to change their habits and, therefore, might also be unaware of such a need. Contemplation focuses on the necessity of the action but has not yet been implemented. The preparation phase is where people are actively involved in planning out their behavioral change for the near future. Action, in this case, involves putting in place the actual plans that are required to change behavior, while maintenance, on the other hand, is committed to maintaining the behavior modification over time. The stage of termination differs from the rest of the model in that the behavior change becomes an ingrained part of the individual's routine, and they are no longer tempted or at risk of relapse.

It means that this model is based on the phases, and it is very comprehensive, with much information used for the change of behavior and adjustment of the interventions. The Transtheoretical Model is the one we are planning to use in this smoking cessation health promotion program among older adults, which will help us to identify individuals with different levels of readiness to quit smoking. Therefore, interventions can be accordingly made to tackle each stage of change, and the program is likely to help older adults quit smoking by adopting the TTM approach. Meanwhile, the TTM offers a platform for designing interventions that may correspond with the traits and preferences of older individuals. Taking into account the variety of factors, such as socio-economic, mental, and health aspects, that can impact the smoking behavior of older adults, the stage-based approach is suitable for finding tailored solutions for the change of behavior. Based on the TTM, the interventions can contain evidence-based methods, including motivational interviewing, cognitive-behavioral therapy, and social support networks to help the individual progress through the stages of change and then sustain the smoking cessation. Through the application of the TTM that serves as a reference point, the proposed health promotion program would be capable of maximizing its effectiveness in assisting older adults in their path to smoking cessation and health improvements.

References

Chen, D., & Wu, L. T. (2015). Smoking cessation interventions for adults aged 50 or older: a systematic review and meta-analysis. Drug and alcohol dependence, 154, 14-24. https://doi.org/10.1016/j.drugalcdep.2015.06.004

Dahdah, A., Jaggers, R. M., Sreejit, G., Johnson, J., Kanuri, B., Murphy, A. J., & Nagareddy, P. R. (2022). Immunological insights into cigarette smoking-induced cardiovascular disease risk. Cells, 11(20), 3190. https://doi.org/10.3390/cells11203190

Del Rio Szupszynski, K. P., & de Ávila, A. C. (2021). The Transtheoretical Model of Behavior Change: Prochaska and DiClemente’s Model. Psychology of Substance Abuse: Psychotherapy, Clinical Management and Social Intervention, 205-216.

Henley, S. J., Asman, K., Momin, B., Gallaway, M. S., Culp, M. B., Ragan, K. R., ... & Babb, S. (2019). Smoking cessation behaviors among older U.S. adults. Preventive Medicine Reports, 16, 100978.https://doi.org/10.1016/j.pmedr.2019.100978

Kastaun, S., Brown, J., & Kotz, D. (2020). Association between income and education with quit attempts, use of cessation aids, and short-term success in tobacco smokers: A social gradient analysis from a population-based cross-sectional household survey in Germany (DEBRA study). Addictive behaviors, 111, 106553. https://doi.org/10.1016/j.addbeh.2020.106553

Soumagne, T., Guillien, A., Roche, N., Annesi-Maesano, I., Andujar, P., Laurent, L., ... & Degano, B. (2020). In patients with mild-to-moderate COPD, tobacco smoking, and not COPD, is associated with a higher risk of cardiovascular comorbidity. International Journal of Chronic Obstructive Pulmonary Disease, 1545-1555. https://www.tandfonline.com/doi/full/10.2147/COPD.S253417