Health education and the smoking habit

Abstract

THE effects on health of smoking are generally known in Britain. This knowledge is based on a great number of research projects carried out during the past few decades and needs no further elabora tion. Cigarette smoking is associated with an increased risk from a number of diseases, most of which are serious and even lethal. At tempts are constantly being made to eliminate this habit and stop people from smoking, which have so far met with very little success. This fact has attracted the attention of researchers. In trying to find out why these attempts have in most cases failed, the researchers have examined several factors: some believed that the answer lies in finding the difference between smokers and non- smokers ; some have looked at the reasons for starting to smoke; others have looked at the physiological aspects of smoking, and so on.

In general, one can say that most research so far has con centrated on smoking, that is on the problem, whereas very little has been done to study the solution, or attempts to solve the problem, and why they have so often been failures. This paper is con cerned mainly with the various aspects of the solutions to the problem of smoking, and outlines several new ap proaches which, if followed up, could provide us with a better insight into some more successful solutions.

In the first place a dis tinction is drawn between the prevention of an illness and of a behavioural habit. Ciga rette smoking is considered to be a habit, with most of the smokers in need of behavioural treatment. Pre vention, by means of health education, however, needs to concentrate on the non- smokers in the first place, and only secondly on smokers. Consequently the target population for health educa tion in smoking consists of the healthy population who as yet have not acquired this habit.

The methods to be used are based on a Social Interven tion Model (SIM) which I have been developing, design ed to emphasise preventive aspects and concentrate on a positive approach, stressing the rights of the non-smoker instead of the duties of smokers. This new concep tualisation of the smoking problem will require health education of two kinds: those skilled in influencing social norms and using the societal approach; and those who have a recognised profes sional status and have the skills of helping individuals to give up this habit and who will be involved in behav ioural treatment on an indi vidual basis, under approp riate contractual arrange ments. In some cases the two categories may overlap.

In summary, the paper stresses the consequences of such an approach for the health education services as well as the need for changes in research policy with greater emphasis on studies con cerned with various solutions instead of the problem of smoking; changes will be required in the conceptua lisation of the whole problem area, and in the evaluation of new methods and the training of a new type of health educator, be it a health educa tion officer or any other pro fessional active in this field.