University DNP-825: Population Health Management and Smoking Cessation

This DNP report focuses on population health management, specifically addressing smoking cessation among middle and high school students. It discusses the public health concerns related to tobacco use, including the rise of e-cigarettes, and emphasizes the need for health promotion activities. The report utilizes the Social Cognitive Theory and Transtheoretical Model to develop and implement smoking cessation programs. It outlines the rationale for these theories, detailing the cognitive, environmental, and behavioral factors influencing smoking habits. The report then describes the promotion and implementation of activities, including behavioral counseling, nicotine replacement therapy, and physical exercise interventions. The evaluation section assesses the program's efficacy, aligning with public health components essential to nursing science, and analyzes the impact on population health. The conclusion highlights the potential benefits of the discussed health promotion activities, not only for the adolescent population but also for their families and communities, promoting smoke-free environments and discouraging smoking behaviors.

Running Head: DNP POPULATION MANAGEMENT
DNP Population Management
Name of the Student:
Name of the University:
Author Note:

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Abstract
The population health is a critical factor that is affecting the global urbanisation and other
developments and is of utmost concern. This global development promotes unhealthy habits
and sedentary lifestyle. Hence, this negatively impacts the health of the population
contributing to the increased rate of morbidity and mortality. This makes promotion of health
and prevention of disease management a crucial factor that needs to be practiced. There are
several health promotion activities but, in this article, tobacco cessation is elaborately
discussed. This is because the increased usage of e-cigarettes especially at the adolescent age
hampers the health of the youngsters. Hence, awareness activities should be initiated to help
them abstain from tobacco and smoking.
Table of Content

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s
Introduction...........................................................................................................................3
Discussion.............................................................................................................................4
A Public Health Theory used to develop health promotion activities- Smoking Cessation 4
Rationale for the Public Health Theory.............................................................................5
Promotion and implementation of activities for the selected population..........................6
Evaluation to determine the efficacy of the program........................................................8
Aligns with public health components essential to nursing science..............................8
Impact of the components essential to the population health........................................8
Conclusion.............................................................................................................................9
References...........................................................................................................................10

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Introduction
The public health problems are a concern and the road to a better-quality life is health
promotion. The world is confronting a ‘triple burden of diseases’ which constitutes of an
incomplete agenda of contagious diseases and the rapid rise in the chronic non-contagious
diseases. The progress and development of the present world that includes globalization of
trade, advanced technologies and rapid urbanisation, acts as the double-edged sword as it
impacts the health positively on one side but negatively promotes sedentary lifestyle and
unhealthy diets. The significant increase in the tobacco is a prime concern in the unhealthy
diet pattern and also the reduced physical activities overall promotes the increase in the health
risks which in turn impacts the increase the occurrence non contagious diseases (Laschober,
Muilenburg, & Eby, 2015). The figure 1 illustrates the impact of the globalisation and other
developments that impact the population health. The financial crisis, natural calamity and the
security threats add to the factors.
Fig 1: Environmental factors are the main contributors of increased prevalence of Non-
communicable diseases (Kumar & Preetha, 2012).
The acceptance of and social well-being worldwide are assessed by multiple factors like
socioeconomic factors, political factors, economic factors. The diet of an individual, family
pattern and the learning environments also plays a role. In order to combat such issues health

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promotion plays a critical role (Stanton & Grimshaw, 2013). This article deals with the health
promotion activities that aid for the at-risk population. The population considered for this
report is middle school and high school students who have an unhealthy habit of smoking.
Discussion
A Public Health Theory used to develop health promotion activities- Smoking
Cessation
The emblem for health promotion which was adopted at the first international
conference which was held in Ottawa has a circle with three wings which includes five key
action areas in the health promotion and three strategies involved in health promotion. The
outer circle aims at “Building Healthy Public policies” and the essentiality to bind the
policies together. This circle has three wings that has the five action plans which are
establishing healthy public policies, maintain supportive environment for health,
development of the personal skills and reorient health services. The inner circle promotes the
three strategies involved that is enabling, meditation and advocate.
Fig 2: Health Promotion Emblem

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The health promotion activity in this article is based on the Social Cognitive Theory.
According to this theory it discusses about the way by which the individual should initiate
and maintain a particular behaviour which is smoking cessation in this article. It enforces on
the role played by the cognitive, environmental and behavioural factors. Cognition in this
aspect involves the behavioural capability, responses with respect to emotional coping,
promoting self-efficacy and outcome expectancies (Audrain et al., 2013). The behaviour
considered in this aspect is the manner in which the individual reacts to various social and
physical environmental factors. The factors that are physically external to the individual that
plays a role in the individual’s behaviour. This is referred to as the environment in this
theory. It consists of the social and physical factors like family, friends, weather and
availability of tobacco products (Ali, Amialchuk & Heller, 2014). The theory that guides
cessation of smoking is the transtheoretical model. It is also known as the stages of change
theory which defines the stages that a tobacco addicted individual goes through in the process
to quit smoking. The stages involved are precontemplation, contemplation, preparation,
action and maintenance (Haasova et al., 2013).
Rationale for the Public Health Theory
Smoking cessation improves the health condition specifically for individuals before the
age of 35 years. This impacts the mortality rates and it is similar to those of the non-smokers.
Health programs that initiates smoking cessation has played a significant role in decreasing
the rate of smoking especially in United States. In this article the selected population is the
middle school and the high school students that is mainly the adolescent individuals in a
population.
Smoking cigarette and tobacco usage is a critical public health concern worldwide. In
2012, 21% of the world population smoked tobacco above 15 years of age according to
World health Organisation (WHO). The percentage of people addicted to smoking has

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reduced from 42.4% to 17.8% in the year 2010 but still it remains a health concern. But the
use of e-cigarette has increased greatly of late and according to the data obtained from
National Youth Tobacco Survey (NYTS) estimated that 3.6 million high and middle school
students were current users of e-cigarette and there was a dramatic increase of approximately
1.5 million students involved in smoking when compared with the results of 2017. According
to the ASE model the attitude, social influence and self-efficacy among the students play an
important role and influences them to experiment with cigarettes (Haug, Schaub & Schmid,
2014). This is clearly depicted in the figure below.
Fig 3: The ASE model that shows smoking among school students.
Adolescent individuals who are inclined to smoking of cigarette has a lot of physiological
effect like reduced lung growth rate, maximum functioning of the lungs and also negatively
impacts the physical fitness of the individual leading to onset of respiratory issues. They are
more nicotine dependant compared to those who start at a later age which promotes as a
barrier in the process of abstinence. All this leads to delay in smoking cessation that
negatively impacts the health conditions.

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Promotion and implementation of activities for the selected population
The activity proposed had two groups the first involved standard smoking termination
with intervening physical activity and the second was smoking cessation with frequency
matched wellness contacts. The time limit for this project was six to twelve months. The
secondary outcome involved changes in dietary intake, physical activity and symptoms of
nicotine withdrawal that impacted the waist circumference, body mass index, body fat
percent. The aim of this activity was to educate the school going children along with their
parents about the advantages of smoke free houses that reduces non-smokers to passive
smoking and to normalize the idea of a smoke free environment not only among the school
going children but also in general among normal citizens (Vander et al., 2018). The main
objectives of this project are to educate the school kids, it encourages the students to promote
the concept to their family members as well as their friends by educating them to quit
smoking and not to smoke at home. This enhances the knowledge publicly about active and
passive smoking as well as the consequences that follows and their gradual commitment to
smoke free homes. It would also exploit the five strategies to tobacco cessation that is ask,
advice, assess, assist and arrange (Murdaugh, Parsons & Pender, 2018).
It was ensured that before the onset of the physical activity the participants should undergo
a medical screening test to ensure they are eligible to go for physical exercises. The two
groups received behavioural counselling on smoking termination in combination with
nicotine replacement therapy. The sessions were administered by health and fitness
instructors who has achieved cross trainings in exercise science and health promotion based
on their backgrounds and were also trained with respect to cognitive behavioural counselling
strategies (Camenga et al., 2015). The participants who volunteered for physical activity
received a combination of smoking cessation with physical exercise intervention had 15 face
to face counselling sessions to promote physical activity and 15 added telephonic and

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supportive counselling. The participants volunteered for wellness received smoking cessation
along with general wellness program which had 7 face to face sessions and 20 added
telephonic and supportive counselling. The face to face sessions lasted for an hour almost.
The telephonic counselling was for 15 minutes approximately on an average. Both the
sessions started simultaneously and the quit date for the participants started three weeks post
the onset of the health promotion activity to ensure the participants had acquired a
behavioural skill before the start of another skill. The purpose of the telephonic counselling
was a cost-effective follow-up that assured to review the smoking relapse, assess adherence
to nicotine patch and the side effects and enhance the behavioural coping skills and a
feedback about the physical activity and the wellness goals (Haug et al., 2013). The mailed
attachments included topics on smoking termination and physical activities or wellness
intervention.
Evaluation to determine the efficacy of the program
Aligns with public health components essential to nursing science
The unassisted rates of quitting of smoking among the adolescent population is
relatively low because of their dependence on nicotine hence, this becomes a prime health
promotion. School based, multi sessional group programs are the most common cessation
intervention observed but it has a limited reach. The smoking termination, physical exercise
and wellness are based on the Social Cognitive theory. This theory mainly focuses on the
self-efficacy. The self-efficacy for the physical activity and for termination of smoking are
related to each other and a change in one positively impacts the other (Horn et al., 2013). This
also helps individuals to overcome the barrier for behavioural goals. The behavioural
counselling session primarily had four session which involved preparation to quit, going
through the process of quitting, maintenance of short interval smoking abstinence, prevention
of relapse and prolonged maintenance. The Five A’s were emphasized along with self-

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monitoring of smoking cigarette. Wellness counselling ensures an individual to gain balance
in life.
Impact of the components essential to the population health
This program helped to evaluate the impact of physical exercise along with nicotine
replacement therapy and cognitive behavioural counselling in respect to smoking cessation.
Physical exercise has benefits in increasing nicotine withdrawal and reduces craving
symptoms in those undergoing abstinence (Walker & Loprinzi, 2014). Robust structured
group physical activity ensures effective prolonged cessation in women (Smits et al., 2016).
The selected sample was immensely sedentary. The aim was also to mitigate post cessation
effects that adversely promote weight and increases the body fat content as some of the
participants can be at a higher risk for some health issues due to the gained weight.
Conclusion
It can be inferred that the health promotion activity discussed in this article would not
only benefit the adolescent population but also positively impact their family and friends as
well. This would encourage the students to restrict themselves from smoking even at home
hence promoting a smoke-free homes. This health promotion activity also promotes a
message that smoking is an irksome behaviour that not only reduces the quality of life but
also has a damaging impact on the health and is against the social norms. Health promotion
activities for smoking cessation is a critical concern especially in the adolescent population.
These activities exploit the principles of promoting change in the individual level. It proves to
be socio-economic effort to promote the health of a population by incorporating a change in
the social norms in the community.

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References
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cigarette smoking among adolescents: evidence from Add Health. Nicotine & Tobacco
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Krishnan-Sarin, S. (2015). Adolescents’ and young adults’ perceptions of electronic
cigarettes for smoking cessation: A focus group study. Nicotine & Tobacco
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controlled trial. Journal of medical Internet research, 15(8), e171.

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Horn, K., Branstetter, S., Zhang, J., Jarrett, T., Tompkins, N. O. H., Anesetti-Rothermel,
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