1. How are each of the phases in the stages of change model illustrated in Steve’s case? Precontemplation, contemplation, preparation, action, and maintenance are the five stages of change. Steve’s precontemplation stage was when he was positive that he could take the cigarettes or leave them. When he landed up getting walking pneumonia, and a cold that didn’t go away, that still didn’t motivate him to change when his doctor told him that those were early warning signs of things to come. His contemplation stage came when he thought about how smoking could affect his kids. This was evident when his 10-year-old son told him that cigarettes were bad for him as well as when he found cigarette butts in the backyard after his daughter’s sixteenth birthday party. Steve’s preparation stage started when he let his physician assistant know that he was ready to quit. With the encouragement from his physician assistant, Steve could establish a plan of action which included joining a support group and setting a quit date. The action stage is probably one of the most critical stages because it has the potential for relapse. In Steve’s case though it was the support of his wife, and her actions that prevented him from revisiting his old habits (she cleared the cigarette butts and ashtrays from the house, got him to take a walk after dinner to avoid him from his routine of normally having dessert and coffee with a cigarette which helped him from gaining weight, cleaned the drapes to get rid of the smell of smoke). Finally, the maintenance stage occurred when he and his wife celebrated his first year anniversary of quitting. This allowed Steve to focus on how far he had come and how hard he worked to get to that point. This should keep Steve motivated to stay smoke free.

2. What other theories or models can be applied to the public health issue described in this case? Explain. The theory or model that can be applied to the habit of cigarette smoking would be the Health Belief Model which incorporates the cues to action behavior (strategies/events that encourage one’s “readiness” to act). In Steve’s case, he had friends that had quit a decade or more ago and figured if they could quit then he could also quit. But, it is often easier said than done. Also, the self-efficacy behavior of the social cognitive theory is also exhibited. Self-efficacy describes the belief in one’s ability to take action. Since Steve was a smoker he sort of made himself believe (tricked his mind into thinking he can quit) that he was going to have the ability to stop smoking.

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3. What effective individual and group approaches are illustrated in this case? Explain. Steve’s effective individual approaches were that he took the initiative to go get the help he needed and developed a plan of action. By doing this it was a major step in the right direction to get him on track to quit smoking. Also, the group approaches included his wife’s effort and her actions that kept Steve from going back to smoking as well as what his son had said to him. This group approach influenced him to want to quit and then actually stick with it.

4. Which effective public health (or population) approaches are illustrated in this case? Explain. One of the effective population approaches that was illustrated would be the traditional public health approach which focuses on interventions that are aimed at preventing disease and promoting health (examples would include reduction of the risk factors for disease, communicable disease control, etc). In this case though I feel like if there were more people like Steve who are motivated to quit it can greatly reduce the risk factors associated with smoking. Also interventions such as the support group that Steve joined helped him to prevent his urge to go back to smoking. The improving-the-average approach just backs up what the traditional public health approach is all about. It basically focuses on the entire population and looks at reducing the risk for everyone.

5. What is the impact of combining individual clinical approaches with public health (or population) approaches? By combining individual clinical approaches with public health (or population) approaches people would be more motivated to get the help they need. For instance it was the encouragement and reassurance from Steve’s physician assistant that played a big role in helping Steve go in the right direction (clinical approach) and also the support from his wife and the realization from his son (population approach) that enabled him to have the will to quit smoking. The two approaches together give a person the support and acknowledgement that they are not alone and that they can quit.


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