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Public health as a whole is focused on ensuring a population stays healthy and is protected from any potential threats to their health (National Health Service (NHS), 2015). This was summarised by Acheson (1988) when he defined public health as the ‘art and science of preventing disease, prolonging life and promoting health through the organized efforts of society’. The importance of this is highlighted by the World Health Organisation (WHO) who explain that public health helps increase the effectiveness of public health services through sustainably promoting health and well-being and reducing any inequalities that are associated with them.
Health promotion is one of the three strands that public health consists of, alongside prevention and protection which are used to reduce avoidable disease, shown by the Royal College of Nursing (2019). It is described as ‘the process of enabling people to increase control over and improve their health’ by WHO (1986) giving the idea that it is about individuals having the knowledge and skills needed to look after their own health. A nurse’s role is important in encouraging health promotion, in the Nurses 4 Public Health Report (2016) it is suggested that the skills nurses have and the places in which they work, such as hospitals, schools and in the community, makes them the ideal people to act upon and promote any health challenges that may be in the public. This is highlighted in the All our Health Framework (2018) which helps nurses and other medical professionals make as much of a difference as they can using health promotion. There are 5 different approaches that nurses can use to support patients with health promotion. This includes medical, behavioural change, educational, social change and empowerment (Naidoo and Wills 2016)
The main aims of public health and health promotion are shown in the Public Health Outcomes Framework 2016-2019, this essay will be focused on one indicator in particular under the framework’s second objective; ‘2.09 Smoking prevalence – 15-year olds’ (Department of Health, 2016). An intervention will be discussed as to how this indicator may be promoted through the skills of a student nurse. This will be done to a target audience of students in a specific year 10 class. One of the reasons in which the framework explains that smoking in 15-year olds is an issue is because it is one of the largest reasons for avoidable and premature morbidity (Department of Health, 2016). There is a lot of evidence to support this claim and underline the fact that this issue needs addressing. For example, it has been found that the younger the age you start smoking the greater risk you are at for developing diseases that are related to this (Seddon, 2007) These include diseases such as lung cancer, heart disease and chronic obstructive pulmonary disease (Action on Smoking and Health (ASH), 2015). It is not only physical problems that smoking can lead to, but also mental health issues. Arday (1995) found that students who were regular smokers ‘were more likely to have seen a doctor or other healthcare professional for an emotional or psychological complaint. This suggests smoking is doing a great deal of harm to teenagers, as this is the time when important psychological changes are taking place in the transition from childhood to adulthood (Kipke, 1999). Poorer grades have also been found to be associated with smoking (Dappen, 1996), demonstrating how smoking can have long term negative effects on the lives of teenagers who smoke if they are unable to get appropriate grades to get jobs etc in the future. By addressing this indicator, it may also have some economic benefits, smoking costs England around £12.6billion a year according to ASH (2018) with money being spent in many areas such as healthcare, social care and housefires. By stopping smoking before it is about to begin, as 9 out of 10 smokers start before the age of 18 (U.S Department of Health and Human Services, 2014), it would save England huge amounts of money that could be put towards other important causes.
There are reasons as to why these students would make the decision to smoke, for instance, if they are brought up in a household where smoking is a common practice then they are going to be more likely to carry out this action themselves. Otten (2007) found that weather or not parents smoke is predictive of the smoking status of adolescents, giving an understanding as to how much of an influence parents can have on their children. This can also be related to the economic backgrounds of the clients. Those who come from more deprived areas are four times more likely to smoke than those in least deprived areas (Office for National Statistics, 2016), this will have to be kept in mind when thinking about why the students are making the choices they do about their health. If the school is in a more deprived area or some students are less well-off then it may be more challenging to get them to change their outlooks on their health where smoking is concerned. Another factor that could impact these choices is the presence of peer pressure. This is an extremely powerful force, especially on teenagers as Evens (1978) discovered that the social pressure of peers can have more of an effect on adolescence to smoke than the deterrence of knowing how smoking engagers their health.
To promote this indicator to the target audience, with permission from the school and in co-ordination with the school nurse a workshop would be set up for a specific year 10 class, with students who consent to taking part. This may also be correlated with non-smoking day if the school is doing anything around this, as it will mean some issues surrounding smoking may already have been brought to light for the students. A volunteer who suffers from chronic obstructive pulmonary disease (COPD) could be brought in to talk to the students. Bringing in a volunteer rather than just giving the students information should have more of an impact on them. This is because the brain makes its strongest connections through concrete experiences (Wolfe, 2010), so in this situation it will be more effective seeing the volunteer rather than them just being an abstract thought. They could speak about the struggles that a disease like COPD brings, such as loss of social activity resulting in loosing important relationships and breathlessness creating anxiety and panic attacks (Barnett, 2005). This would give them a first-hand look at what smoking can lead to. Ideally the volunteer would be another teenager or young adult, this will allow the students to relate to them more, as adolescence are more likely to be influenced by peers (Watson and Skinner, 2004). In addition to this an email could be sent out to the parents of the students taking part, this would give them an insight of what their child is learning and also raise their awareness too.
This intervention takes an educational approach towards smoking prevalence in 15-year olds. The workshop will empower the students to make their own decisions based on the information they are given (Naidoo and Wills). This seems like the best approach for this indicator, as with the target audience being so young it has the ability to stop the issue before medical intervention is needed due to its consequences. In turn this will lead to lower costs for the NHS, with money being saved on treatments. For those in the class who already are smokers, it may also be seen as a behavioural-change approach as it may start the cycle of change needed for them to give up the habit. It may lead them to the contemplation or preparation stage of Prochaska and DiClemente’s (1982) cycle, meaning they are aware of the problem and potentially intend on taking some sort of action to help it.
Although these approaches seem like the most appropriate method there are still some factors that may stop the students from making a change to their health. For instance, even though they will know and be able to see the effects smoking can have it still might not deter them from smoking. Research has shown that 95% of smokers do have the knowledge of the health risks associated with smoking but in 70% of these people it is little concern (Dappen,1996) this could easily be the case for this target audience as well. A different way in which the approach may be hindered is by the parents. The email sent to them is designed to prompt family involvement of the issue as its been found that adding family-based components to school interventions is more effective than just using the school (Thomas, 2015). It is not guaranteed that the email will be read, or brought up to the students by the parents, especially if they are smokers themselves. As a result, the intervention may be less effective and not have the desired effects. In contrast, seeing and hearing about the volunteer’s experiences might be shocking to the students which could help in motivating them to change their views. This is because the brain pays more attention to information that causes an emotional response (Wolfe, 2010). Similar to this, Tyler and Cook (1984) established that media influence is ‘largely impersonal’ when trying to change the opinions of people. With this in mind speaking to the students face to face from a person who is around the same age, more of a personal connection can be made in contrast to a media campaign stating facts. As a result, it is more likely to motivate and help them make positive changes needed for their health.
Being a health care professional, it is important that the workshop is as effective as possible. Evaluating the impact of this intervention may be hard as there will be no easy way to know of the long-term effects it has on the students. A simple questionnaire could be given to them when the workshop finished to get an idea of how much they enjoyed the session and to see if they found it useful, giving an insight of how effective it was. These questionnaires could be anonymous, as this will give a greater chance of the answers being honest (Guerra-Lopez, 2007). The questions would be quantitative so data can be be easily interpreted and allow for changes to be made if similar interventions occur in the future.
To conclude, using the opportunities and resources available as a student nurse an intervention in the form of a workshop will be organised with the help from a school nurse to a group of year 10 students. This will involve hearing about the experiences from a volunteer with COPD and information being sent to the parents of those involved. This should be an effective form of health promotion for smoking prevalence in 15-year olds, and will be evaluated through a questionnaire at the end of the session.
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