Looking at Tobacco Cessation and Control through the lens of a Socio-Ecological Model (SEM)
- Cynthia Yuen
- Nov 30, 2022
- 4 min read
Tobacco cessation and control is so complex that using multilevel models helps identify the factors and determinants. To understand the role of multilevel models of health, I have decided to explore how the socio-ecological model (SEM) applies to tobacco cessation. The SEM provides a framework for categorizing into ascending order of intraindividual, interpersonal, community/organizational, and societal/policy levels; these factors play a role in why individuals start smoking and continue to smoke. Interventions targeting each of these factors can help to reduce smoking prevalence (Kalkhoran S. et al., 2018).
On the individual (intrapersonal) level of the SEM, the determinants include age, race, genetics, sex, socioeconomic status, beliefs and attitudes (Kalkhoran S. et al., 2018). According to the Canadian Cancer Society (n.d.), smoking is the leading modifiable risk factor for disease and death in Canada. More than 45,000 Canadian deaths are due to smoking tobacco each year. The prevalence of cigarette smoking as of 2020 was 10% (3.2 million); a higher percentage of men (12% or 1.9 million) than women (7% or 1.1 million) reported smoking daily (The Government of Canada, n.d.a). Smoking prevalence is disproportionately higher among adults with less education, lower incomes, and comorbid psychiatric and other substance use disorders (Kalkhoran S. et al., 2018). Psychological factors are often associated with smoking. Many people smoke in response to stress or other negative emotional states, and quitting smoking is particularly difficult for such smokers (Kalkhoran S. et al., 2018). The physiological effect of inhaled nicotine can cause nicotine addiction; the pharmacological basis of nicotine addiction may affect mood and mental or physical functioning (Benowitz, N.L., 2010). Nicotine dependence is a significant reason for difficulty quitting smoking (Kalkhoran S. et al., 2018).
On the interpersonal level, the determinants include friends, family, physicians and coworkers (Kalkhoran S. et al., 2018). Tobacco use among the peer group is a significant risk factor for smoking initiation and a regular smoking habit (Irles et al., 2013). Both nicotine addiction and peer-influential smoking can be barriers to smoking cessation. However, physicians can make a positive impact to help smokers to quit smoking. Physician counselling and pharmacotherapeutic interventions for smoking cessation are among the most cost-effective interventions; also, recommending behavioural strategies to smokers can prevent them from collapsing (Cornuz, J. 2007).
The determinants of the level of community or organization in the SEM include workplaces, media, healthcare systems and schools (Kalkhoran S. et al., 2018). AlbertaQuits by Alberta Health Services offers information for quitting tobacco, including nicotine replacement therapy (NRT) and other medications, which can lessen nicotine cravings and effectively help smokers with withdrawal (AHS, n.d.). AlbertaQuits also offers various kinds of support, including phone, text, group and counselling; these services provide strategies to deal with cravings and avoid triggers (AHS, n.d.). Besides the healthcare system, workplaces can also facilitate smoking cessation. The government of Canada has developed a guideline for employers and workplace leaders to educate and encourage their employees to quit smoking (Government of Canada, n.d.c). Some reasons employers should support smoking cessation in the workplace include improved employee health, increased productivity and better corporate image (Government of Canada, n.d.c).
As for the level of society and policy of the SEM targeting tobacco control, the determinants include smoke-free laws, taxes, advertising and education. This level requires the governing agencies to achieve tobacco reduction goals by changing laws.
Canada's Tobacco Strategy (CTS) is the current federal strategy to address tobacco use in Canada; it is designed to help achieve the target of less than 5% tobacco use by 2035 (Government of Canada, n.d.b). All provinces and territories have legislation and comprehensive strategies to address tobacco use. In Alberta, tobacco or vaping products are prohibited from being advertised or displayed (Government of Alberta, 2021). Alberta's Tobacco, Smoking and Vaping Reduction Regulation sets out many requirements for selling and using tobacco and vaping products. Examples of matters addressed include signage requirements, identification requirements and characterizing tobacco flavours (Government of Alberta, 2021).
Applying the socio-ecological model to tobacco cessation and control helps me visualize the big picture and unfold the interconnected determinants and factors on different model levels. It shows how complex it could be when someone has decided to quit using tobacco, as so many factors could affect one's behaviour and decision. The study by Kothari et al. (2007) stated that while health promotion public health programs are increasingly responding to the complexities of health determinants, intervention research has lagged behind. Kothari et al. (2007) also stated that socio-ecological models offer ways to frame real-world complexities that can help inform intervention research, research that captures the complex system of influences between and among determinants. To succeed in tobacco control, health promotion practitioners and researchers must collaboratively build on their understanding of socio-ecological models to advance the field (Kothari et al., 2007).
The socio-ecological model shows different levels of factors that affect one's behaviour on tobacco cessation. To ensure that these levels function cohesively, the government, researchers and healthcare providers should work collaboratively to identify and break these barriers by 'connecting the dots' and tangibly assisting people in utilizing these tobacco cessation services.
References:
Alberta Health Services (AHS). (n.d.) Alberta Quits.
Benowitz, N. L. (2010). Nicotine Addiction. The New England journal of medicine, 362(24), 2295.
Canadian Cancer Society. (n.d.). Tobacco control.
Cornuz, J. (2007). Smoking Cessation Interventions in Clinical Practice. European Journal of Vascular and Endovascular Surgery, 34(4), 397-404.
Government of Alberta. (2021). Tobacco, Smoking and Vaping Reduction Regulation.
Government of Canada. (n.d.a). Canadian Tobacco and Nicotine Survey (CTNS): summary of results for 2020.
Government of Canada. (n.d.b). Canada's Tobacco Strategy.
Government of Canada (n.d.c.). Smoking Cessation in the Workplace: A Guide to Helping Your Employees Quit Smoking.
Irles, D., Pertusa, M., Guijarro, A., Carbonell, M. (2013). Parent and Peer Influence Models on the Onset of Adolescents Smoking. Health and Addictions, 13 (1) 59-66
Kalkhoran, S., Benowitz, N. L., & Rigotti, N. A. (2018). Prevention and Treatment of Tobacco Use. Journal of the American College of Cardiology, 72(9), 1030-1045. https://doi.org/10.1016/j.jacc.2018.06.036
Kothari, A., Edwards, N., Yaniki. S., Hansen-Ketchum, P., Kennedy, M. (2007). Socioecolocigal Models: Strengthening Intervention Research in Tobacco Control. Drogues, santé et société, 6(1), Supplemental III 1-21.
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