For an Action Research Class:
A prevention program that focuses on promoting mental health and addresses a specific
issue, problem, or concern prior to widespread occurrence:
TOPIC IS TEEN SMOKING in the USA.
a. MUST have a minimum of 10 references and at least 10 pages NOT including references.
b. Must justify the issue, problem and concern.
c. Provide an analysis of the evidence based research related to the intervention[s] or
treatment that is used.
d. A description of the target population (teenagers), stakeholders, and participants.
e. A description of the data collection and analysis methods that will be used for the needs
f. An explanation of the project goals and how they will be assessed.
g. An action plan, including the tasks to be implemented.
h. An analysis of possible challenges to implementation and how they may be addressed.
i. A description of how your project will influence social change.
THIS PAPER MUST BE IN APA FORMATTING. THIS MEANS IN TEXT CITATIONS
AND HEADERS SEPERATING PARAGRAPHS AS NEEDED. References must be
scholarly and must be American meaning the sources cannot be from other countries
which are not feasibly accessed here in the US.
Smoking is linked to a wide array of mental disorders including depression, anxiety
disorders, and schizophrenia. Individuals suffering from mental illnesses have high mortality and
morbidity rates as a result of smoking-related illnesses for instance cancer, respiratory diseases,
and cardiovascular diseases (Kazdin, 1993). One of the reasons for the solid association between
current smoking and mental illness is that smoking initiation is influenced by mental illness.
Anxiety and depression in teenagers are strong predictors of daily smoking transition and
experimentation. However, smoking is also linked to the onset of teenagers’ psychiatric
symptoms. This suggests that anxiety and depressive symptoms and smoking begin at the same
Justification of the concern, problem, and issue
Every day, approximately four thousand people aged less than eighteen years in the US
smoke their 1st cigarette. An estimated one thousand youths in this age group become novel
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daily cigarette smoker. In essence, nearly four hundred thousand youths adopt the habit of
smoking on a daily basis each year. About 80 to 90 percent of adult smokers begin the smoking
habit during adolescence. Presently, ten percent of middle school students as well as 23 to 26
percent of students in high school are smokers (Luke, Stamatakis & Brownson, 2000). If there is
persistence of the present tobacco use patterns, approximately 6.4 million youth smokers will
eventually succumb to premature death as a result of smoking-related diseases and mental
illnesses. In Virginia, around 15.5% of students in high school smoke. It is projected that
152,000 children who are less than 18 years of age in Virginia will die prematurely due to
smoking (DiClemente & Prochaska, 1982).
People suffering from schizophrenia have odds of smoking 5.3 times. There has been an
extensive description of excess mortality among individuals suffering from mental illness as a
result of common conditions that have smoking as a risk factor in community-based and service-
based samples. These include cancers, respiratory diseases, and cardiovascular diseases. Smokers
suffering from mental illnesses consider smoking as the easiest and most readily accessible
strategy through which mental illness symptoms can be relieved (Pierce, et al 1991). This is
particularly the case with people who are not enrolled with any prescribed treatment form for
mental health conditions. Many people meet the mental disorders’ diagnostic criteria but fail to
seek treatment for the conditions. The efforts of reducing the prevalence of smoking are a key
concern among psychologists (Kazdin, 1993).
An analysis of the evidence
Treating US teenage smokers using medication or counseling has been extremely vital at
promoting higher abstinence rates. However, using medication and counseling at the same time
has more benefits, as opposed to using either on its own. Usually, medication is not advisable in
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special conditions or populations where efficacy or safety evidence is insufficient; light smokers
smokeless tobacco users, adolescents, and during pregnancy (Kassel, Stroud & Paronis, 2003).
There are a number of psychosocial and behavioral interventions that psychologists can
use to promote smoke cessation and address mental illness issues among smoking teenagers in
the United States. The most effective interventions usually rely on established human behavior
The TTM (Transtheoretical Model) of Behaviour Change
The TTM model of behaviour change was developed by DiClemente and Prochaska and
individuals undergoes through five stages so as to transform an established behavior efficiently.
According to TTM, smoking cessation progresses via five stages; the first step is
precontemplation and the teenager may be unwilling to quit. Second, the teenager moves into
contemplation and plans on the period on which to start quitting. Third, there is active
preparation and planning to quit. Fourth, there is action and active quitting, and finally, the
abstinence has to be maintained after six months. Research denotes that smoking is a chronic
disorder where patients normally find themselves in remission and relapse. Therefore, a
psychologist using the TTM strategy should include relapse and termination so as to promote
effective cessation. When using TTM, motivation is a key ingredient throughout the progression,
and it influences a person’s readiness to change. As a result, a person perceives the seriousness
of the problem and has confidence in positive behavior change (Goodman & Capitman, 2000).
The 5 A’s Approach
Psychologists working in the clinical setup can use this approach that entails asking about
smoking, advising on quitting, assessing a teenager’s willingness to attempt quitting, assisting in
the quitting attempt, and arranging for follow-ups (Gruber & Zinman, 2001). All the five
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components should be implemented with follow-up actions and assistance that are based on the
smoking status, abstinence length, and readiness to change.
Nicotine Replacement Therapy (NRT)
According to Patton et al (1996), nicotine is identified as the addictive ingredient that is
contained in cigarettes. When teenagers quit smoking, there is an experience of nicotine
withdrawal, and it involves difficulty concentrating weight gain, hunger, sleep disturbance,
depression, irritability and craving. On resuming smoking, these symptoms subside and
therefore, withdrawal symptoms are an indication that there is a risk of relapsing to smoking
(Luke, Stamatakis, & Brownson, 2000). NRT aims at preventing or reducing withdrawal
symptoms through ensuring a steady nicotine dose to individuals trying to quit. However, the
toxic carbon monoxide and carcinogens are eliminated. This is associated with long-term
abstinence, and five forms of nicotine that can be used are nicotine patch, nicotine nasal spray,
nicotine lozenge, nicotine inhaler, and nicotine gum. Combining gum and the patch is highly
effective in adults (Pierce, et al 1991).
The target population
Teenagers are the target population, and there are approximately 4.5 million smoking
adolescents in the US. Teenagers who have smoke are more likely to use other drugs including
marijuana, bhang, alcohol, and engage in risky sexual behavior (Luke Stamatakis, & Brownson,
2000). This predisposes them to numerous health challenges. Smoking related illnesses account
for many death. Moreover, since smoking is closely linked to the use of other drugs, teenagers
end up in crimes such as risky sexual behavior, assault, and theft (Kazdin, 1993).
Stakeholders include cigarette manufacturing companies, the health and public health
ministers, government, learning institutions, various counseling and psychology programs, and
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the media. These and other stakeholders should coordinate and lay down strategies aimed at
preoccupying teenagers with productive activities and preventing them from engaging in
smoking (Gruber & Zinman, 2001). Efforts from all the concerned bodies promotes more
Participants include parents and relatives, neighbors, peers, and shopping facilities.
Parents are relatives play a great role in determining whether teenagers smoke or not. Parents and
relatives who smoke make teenagers assume that smoking is acceptable. Neighbors should report
teenagers who are smoking to their teachers and parents so that the habit is terminated early.
Teenagers should associate with well-behaved peers, to avoid bad habits. Shopping facilities
should not trade in cigarettes so that they are not readily accessible to teenagers (Mrazek &
Data collection and analysis methods- needs assessment
So as to assess the needs of smoking teenagers efficiently, both qualitative and
quantitative data should be gathered. Self- administered questionnaires are essential in gathering
qualitative and quantitative date (Eccles & Gootman, 2002). Likert-scale questions can help in
gathering quantitative data regarding attitudes and awareness about anti-smoking messages,
reasons for smoking, smoking behavior, and demographic information that includes gender, age,
and level of education. Focus groups can also be used to assess the needs of smoking teenagers.
Finally, conducting targeted interviews is particularly crucial in needs assessment as the
interviewer gathers facial expressions and poses questions in different ways so as to collect data
on different aspects. Since the interviewer and the participants interact face-to-face, the
interviewee can assess the extent of mental illness (Gruber & Zinman, 2001).
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The data collected can be analyzed through various ways (Patton et al., 1998). Bivariate
analysis identifies the statistically significant linkages between demographic characteristics and
method of data collection. Bivariate relationships should also be examined so as to enable an
exhaustive description of the sample and avoid the inclusion of collinear variables in smoking-
related attitudes’ and behaviors’ multivariate models. Multivariate logistic regression analysis
examines the association between smoking-related respondents’ behavior and attitudes of people
close to the teenager, and data collection methodology while demographic characteristics are
being controlled. Cox proportional hazard analysis assesses the link between time-dependent
variables and the interview modality (Kazdin, 1993).
Project goals and their assessment
The goals of this project are to research on the relationship between teen smoking and
mental health disorders and illnesses health among American youth (Mrazek & Haggerty, 1994).
The project is also aimed at identifying the specific mental that are linked to teen smoking in the
United States teen population. The project looks at how teenagers, stakeholders and participants
can work together in the fight against tobacco smoking and promoting mental health. The project
shows how the stakeholders the participants that could include the family, youth professionals,
non-Governmental organizations and the government can work together in dealing with the high
tobacco smoking rates among the U.S teenagers (Mrazek & Haggerty, 1994). Despite the fact
that tobacco smoking among the youth is on the decline, there is a need to facilitate this decline
by using anti-smoking campaigns that change the perception of smoking and other drugs among
the youth (Gruber & Zinman, 2001).
The project looks into the perceptions of smokers and non-smokers and how these
perceptions facilitate the use of tobacco among the youth. Finally, it focuses on the action plan
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that can be used to reduce and prevent teen smoking (Gruber & Zinman, 2001). These goals can
be achieved if there are adequate funds from governments and non-governmental organizations.
These goals can be assessed by means of questionnaires, surveys, interviews and other
qualitative studies that can determine whether there is any reduction in the use of tobacco among
teenagers and whether the treatment plans put in place for those having mental problems are
successful (Mrazek & Haggerty, 1994). The assessment will include analyzing the success of the
anti-smoke campaigns and treatment that is used on the affected teenagers. In addition, it will
determine how well the project is preventing the use of tobacco to nonsmokers. The use of
baseline measures is the best to method determine whether the programs put in place are working
or not (Mrazek & Haggerty, 1994).
An action plan
An action plan that can be applied in reducing tobacco smoking among the American
youth can be a 5-A method (Kazdin, 1993). This stands for ask, advice, assist, assess, and
arrange. This method is appropriate because it takes a psychological aspect of treatment. This
method is appropriate mostly to those who are already smokers. Although the teenagers rarely
visit physicians, the sports or school physicians can play a good role in assessing tobacco use
among the youth keeping in mind that encounters with the school or sports physicians is almost
unavoidable for the teens. The teenagers are not willing to volunteer and admit that they are
smokers and, therefore, asking them if they smoke can get them talking (Kazdin, 1993). When an
adolescent is asked if they smoke in the absence of their parents, this increases their chances of
telling the truth. This is because of the feeling that they are safe if their parents do not know this
truth. Offering confidentiality motivates the youth to share and also facilitates cooperative
treatments up to a point where the teen feels that parents can be involved. After the physician
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knows that the teenager is a smoker, he can work together with a therapist in helping the teenager
to quit (Kazdin, 1993). The therapist then advices the teenager accordingly, and an assessment
will be carried out to determine the level of tobacco dependence, by use of qualitative or
quantitative methods, and then determine the appropriate treatment plan (DiClemente &
Prochaska, 1982). The therapist assists the adolescent towards cessation and arranges for the
treatment and follow-ups even after the treatment is over (Kazdin, 1993).
In this 5-A method, the treatment plans mostly used include counseling, nicotine
replacement therapy, psychoactive medication, and combined therapy. The cessation of tobacco
smoking at an early age reduces the chances of developing mental health disorders as compared
to cessation at later ages, for example, in old age and adulthood (Kazdin, 1993). This strategy
provides the smokers with alternative ways of dealing with pressure and challenges without
having to smoke on a daily basis. Counseling also tackles the mental illnesses that could have
come up as a result of smoking, and they could include depression and anxiety. Community
intervention programs can be used to prevent the use of tobacco in adolescents who have not
started smoking (Eccles & Gootman, 2002).
Education programs in combination with strong anti-smoking policies work effectively at
preventing tobacco use among adolescents (Patton et al., 1998). Anti-tobacco counter-advertising
is another form of community intervention that can help in reducing tobacco smoking among the
youth. Tobacco advertising is said to contribute to adolescent smoking and, therefore, anti-
tobacco campaigns through the media can counter this effect (Eccles & Gootman, 2002).
Banning smoking at home and in school effectively works at reducing tobacco smoking among
the youth. If these bans are implemented strictly, they reduce tobacco smoking by up to 40
percent. These bans give the perception that smoking is bad, and that is why it is unacceptable
TEEN SMOKING 9
(Eccles & Gootman, 2002). This perception has a big effect on the behavior of the youth since
they will avoid situations that can introduce them to smoking. Through the implementation of
these community intervention programs, adolescents are made to know that there are better ways
of dealing with problems other than engaging in smoking. As a result, the occurrence of mental
health illnesses and disorders reduces because of the reduction of smoking. Through these
programs, other factors that contribute to mental illnesses and disorders are addresses especially
through counseling and, thus, reduce the number of mental illness occurrences (Eccles &
Possible challenges and how they can be addressed
One of the challenges in the fight against tobacco smoking is inadequate resources. The
campaigns and programs that are put in place for the treatment and prevention of smoking have
mostly failed due to inadequate funding and resources. The percentage of youth smokers in the
United States still remain high, and the funds and resources available do not adequately meet
their needs (Pierce, et al 1991). The programs for cessation of smoking require expensive
facilities and hiring professionals. If there are no funds to employ the professionals and purchase
the equipment necessary for treatment, them the intervention plans could fail. The parents also
cannot afford the treatment processes for their children, and as a result, these adolescents
continue with smoking. Most of the therapy plans are expensive; therefore, those who are already
dependent on tobacco may not get adequate treatment to clear the tobacco from their bodies. The
psychological help offered cannot work alone in such extreme situations (Pierce, et al 1991). The
government of the U. S needs to review its budget on the amount of money allocated towards the
fight against teen smoking. This should be taken as a major concern by the government because
the high numbers of youth smokers means more tobacco related health problems, more mental
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illnesses and eventually more deaths as a result of smoking. The stakeholders and participants
should ensure that they collect sufficient funds to promote the project. The stakeholders and
participants can also be increased so as to increase funds for the project (Pierce, et al 1991).
Another challenge is the use of advertisements by tobacco companies that are targeted
towards the youth. This counters the media campaigns that educate the youth on the real truth
about tobacco smoking. To address this challenge, strict policies should be put in place, to
restrict how advertisements on tobacco products should be designed. The other challenge is lack
of co-ordination between communities, the government and non-governmental organizations in
the fight against teen smoking (Pierce, et al 1991).
This project is expected to influence social change in a number of ways. One of them is
the belief of self-medication with tobacco smoking. Through this project, people will learn that
smoking is not a solution to any problem but is it rather an additional problem (Luke, Stamatakis,
& Brownson, 2000). Through educating the teenagers on better ways of coping with problems,
they will stop the use of tobacco as a solution to their problems. Through the use of
advertisements that teach the consequences, it is possible to reduce second hand smoke. This
project will help to counter the tobacco industry’s marketing efforts to deceive people so that
they can start smoking. It will also help in motivating teen tobacco users to quit smoking and
discourage the assumption that once a person starts smoking, they cannot quit. This program will
help in changing the social beliefs that discourage people from quitting smoking and these could
include religious reasons for smoking and impossibility to stop smoking (Luke, Stamatakis &
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The other social change that the project will bring in the society is the need to seek
therapy regularly especially for the young people so that they can be guided on the right path, to
take in their lives. There will be reduced peer influence to abuse tobacco among the teenagers.
Equipping the youth with knowledge about tobacco smoking helps them to avoid possible
negative peer influence from their peers (Luke, Stamatakis & Brownson, 2000). This project will
also educate the society that some of the mental illnesses and disorders found among the youth in
the American society are as a result of tobacco smoking and, therefore, smoking should be
discouraged and treated for those who are smokers. The society gets to know the importance of
seeking immediate help in a situation when one becomes a smoker.
From the foregoing discussion, it has been established that smoking among teenagers in
the US is linked to mental conditions such as depression, anxiety, and schizophrenia. Statistics
indicate that every year, there are many teenagers who start the habit of smoking daily.
Participants and stakeholders have a collaborative role in ending the habit among teenagers. The
5’A approach and education programs are cardinal action measures that can be used in
addressing the issue. The stakeholders can cooperate and provide the necessary resources.
Teenagers should be informed that smoking does not solve any challenge and whenever they are
experiencing problems, it is important to seek counseling and therapy.
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