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307CPD Health Promotion Question: Scenario A study conducted by the National Network of Smoking Prevention and Poverty found that cigarettes served as a tool for those of low socioeconomic status to cope with boredom, relieve stress and as a companion to alcohol and caffeine. Cigarettes served as a loyal friend a theme recognizable from cigarette advertising. Other results of the studies conducted on this population included:  Store promotions served as major incentives, and there is high brand loyalty among this population. · Individuals did not relate smoking to deadly illnesses, or connect smoking to health risks. Many cited secondhand smoke as more harmful than smoking. . Raising cigarette costs do not serve as a deterrent, instead forcing individuals in this segment to merely buy down by buying generic brands or rolling their own cigarettes. .Unsuccessful quitting attempts and relapses are caused by stress, friends and family and environmental cues. .Lack of inquiry by providers and little advice or support by doctors to quit was reported. Some did not admit to smoking for fear of being scolded. ·Lack of self-efficacy individuals did not have a belief in their own power to quit. There are other factors unique to this community that prohibit prevention. Education materials may not be culturally or linguistically appropriate for this segment, and often members of this population live in communities where tobacco advertising is more prominent. Those who work in manufacturing, construction, or transportation are more likely to be exposed to second hand smoke at work. Also, quitting occurs less often in this segment, and when individuals do quit they are more likely to relapse, a fact not helped by the fact that smoking may be considered the norm among family and peers. And, for many members of this population, smoking simply meets a need that cannot  be met with something else. As many as 700,000 people are homeless on any given night. The homeless population is heavily represented by the mentally ill, over half have drug or alcohol dependency, and a disproportionate amount of homeless are ethnic minorities. Homelessness makes people exceedingly susceptible to smoking. Studies suggest that between 70 99% of homeless adults smoke. The homeless experience high stress, and feel vulnerable, overwhelmed and helpless. Also, mental illness and chemical dependency can increase susceptibility to marketing efforts that suggest that tobacco can help them cope. Hand-rolled cigarettes without filters, using recycled tobacco from butts, and group smoking can increase the dangers of each cigarette smoked, further endangering the health of this vulnerable population. The hazardous consequences of these behaviours can be seen in the dramatic increase in throat and mouth cancer of homeless people. In this task, you will demonstrate your understanding of LO1 and explain each of the point below, paying a specific attention to the link between homelessness and smoking and the effect on individual health. Task Explain the effects of socioeconomic influences on health stated in the above scenario. Assess the relevance of government sources in reporting on inequalities in health. Discuss reasons for barriers to accessing Healthcare The essay needs to be based on baseline information in order to identify needs, socioeconomic factors influencing health, inequalities, and barriers to accessing health as discussed above. Answer: Introduction This paper presents arguments and findings based on the scenario provided in our case study in conjunction with the report by The National Network of Smoking Prevention and Poverty (NNSPP). The study  and  findings will help us get more insights as to why smoking of cigarettes has been related to lead to the conclusion that smoking cigarettes acted as a mechanism for people of low socioeconomic backgrounds and status cope with boredom and relieve stress among the population and as a companion to alcohol and users of caffeine. Smoking of cigarettes is regarded in most societies as one of the greatest vices (Ruthefurd 2017, p. 150). Although some individuals find no harm is associated with tobacco use and therefore in my analysis, I am going to examine the causes or why do people smoke, the effects or the health risks related to tobacco use and the solutions available or quitting smoking. Understanding Of The Scenario It can be argued that no individual was born and just found themselves smoking tobacco; this leads us to the deduction of the fact one can either learn how to smoke or be influenced by the environment surrounding that particular individual. For instance, individuals who either have friends or parents who abuse cigarettes have a greater likelihood of finding themselves smoking than the individuals who may have not. Others are driven by the curiosity of just wanting to try. Research conducted by the (American Cancer Society 2014) found that 90% of tobacco users start smoking cigarettes or tobacco before they are 18 years of age (Lucyk 2016, p. 56). In the scenario provided in this scenario, NNSPP found out that cigarettes were used by individuals of low socio-economic status as a way of coping with behaviors such as boredom, stress release, and as a suitable companion to both users of caffeine and alcohol. And therefore the lower the population’s socio-economic position in the society or in an individual, the greater is their unhealthy behaviors and more difficult it is also to practice healthy ones. These social-economic determinants such as employment level, education level, family and social support, income, and the community safety levels (CSL). According to Dreyfuss (2010), it was found that among adults with less than US dollar 25000 in household income, 30% smoke compared to 15% with incomes over US dollar 50000. It was also found that of those with high school education, 31% smoke as compared to 10% with college degrees. However, the effects of smoking cannot be ignored to both the users and the non-users of the substance (tobacco).From the scenario, it was found that Individuals who abused tobacco were adamant of the fact that smoking could cause deadly diseases, or even relate smoking to health risks (National Cancer Institute 2011). Whereby, many supported the idea that secondhand smoke was more harmful than smoking. It is notably that smoking has health effects or risks to both active and passive smokers and the so-called secondhand smoke (Matt 2011, p. 34). According to Rose (2016), it was found that passive smoke from cigarettes is a mixture of two forms of smoke. These included side stream smoke from lighted end of a cigarette and mainstream smoke usually exhaled while someone is smoking. Stream smoke is known to possess a higher concentration of agents that cause cancer or carcinogens and hence more toxic as compared to mainstream smoke. This is because it as well posses very minutes particles than mainstream smoking, which when inhaled finds their way into the body cells and the lungs of the receiver easily. The secondhand smoke has been attributed to causing lung cancer even in individuals who have never tried smoking. Evidence has also been given suggesting it as well contributes to causing cancer of the bladder, larynx, nasal blood vessels, rectum, stomach, pharynx, breast, brain, and to young children lymphoma, leukemia, brain tumors, and liver cancer. According to Darker (2016), research has shown that the use of tobacco to be linked with causing reduced fertility and a higher chance of miscarriage among pregnant women, early delivery and a high chance of experiencing stillbirth. It can also lead to low birth-weight in infants. It is as well linked to a higher risk of congenital disabilities in both young and adults and syndrome of sudden infant death. The question of finding the solution or quitting smoking will entirely revolve around the particular individuals abusing or smoking the cigarette. Under the scenario provided, it has been concluded that there were some increased unsuccessful attempts and relapses caused by stress, friends and other environmental cues (Moon 2014, p. 67). Therefore, self -efficacy is important in the process of quitting smoking. It is defined as the capability for purposive and intentional human action which is rooted in cognitive activity as cited by Albert Bandura a psychologist. In his view, when people commit themselves to specific standards or goals there is always some perceived negative discrepancies. These come between what they are seeking to achieve and creating self – dissatisfactions saving as motivational inducements for enhanced efforts. According to the American Cancer Society (AMS), research has shown that for those who want to quit, there is a vaccine which has been tested and presented a better chance, which can make living less complicated. The type of treatment was advised to be used in a program, along with counseling and bupropion to reduce withdrawal symptoms significantly. A drug called cytosine was also recently tested in Poland and found to contribute greatly to reducing smoking. Hospitalization, due to the reported lack of provider inquiries as well as limited doctors’ advice or support to quit also provides unique chances for medical practitioners such as nurses and physicians to deliver smoking cessation counseling services. Therefore hospitals, community organizations, government funding agencies, and nursing organizations are urged to work together in ensuring that nurse –counselors are involved in networking the process of tobacco control. Barriers To Accessing Health Care According to Darker (2016) it is important to note that people need to access primary or basic health care as it enables them to get medical attention before their conditions become severe. If an individual delays to seek medical help, his condition can worsen leaving the individual with no other option than to go to the hospital. In a bid to access healthcare many individuals are faced with certain barriers and are unable to meet some basic health care. These obstacles can occur for some reasons. For instance, a patient may not be able to get an appointment at the right time for medical help or counseling or may have insufficient financial resources or support to facilitate or even may not have the transport or means to get there. According to New Zealand Health Survey, it was found that a large number of elderly people are reported to may have experienced the unmet needs of accessing for primary health care in the past 12 months. Rose (2016) in her report outlined that these people might have experienced one or more of the following within the year. That majority of individuals were unable to get appointments at their usual medical center within 24 hours, while others experienced an unmet need for general practice services due to lack of transport or lack of finance.  Based on another survey conducted by the World Health Organization and information from the National Coordinating Centre for NHS Service Delivery and Organization, some other factors were outlined which has been a barrier to accessing healthcare (Wiseman 2016, p. 4). These include unwelcoming professional attitude or inadequate communication and interpersonal skills (centered on the personality and behavior of an individual) and complex systems for hospital billing. Low self- esteem and lack of assertiveness by users among the poor had also contributed to the difficulty of accessing health services. There were also restrictions on various health staff tasks such as policies that favor the adoption of the urban- based strategies. Hospital affiliated obstetricians can as well help in deliveries in case of inadequacy in the number of midwives. And an increasing rate was reported for the late referral or non-referral to more specialists care for patients who may report with a condition at lower level health facilities was also a possible barrier to accessing health. Government Source Relevance In Reporting On Health Inequalities To achieve a long-term beneficiary of reducing health disparities, it requires integrating different  comprehensive policies into the mainstream policy and planning. The inclusion of health inequalities in our perspective requires further governmental developments since it can involve the assessments of the likely impact of formulated policies to minimize the likelihood that policies may advertently broaden health inequalities as denoted by Luginaah (2015, p. 3). Therefore better progress measures by the government are required including incorporating the wider health determinants, supporting a government joined-up approach across, and not just being infection oriented according to Rose (2016, p. 5). Also, they should not be dominated by health care or the NHS. They should also combine process measures that focus on the long and short-term goals while giving opportunities for national policies to govern the local priorities. Conclusion From the scenario in our case study, smoking cigarettes has adverse effects or risks to both the smokers and to the passive smokers who are in more danger because of the secondhand smoke. Although many individuals did not relate smoking to deadly illness, it cannot be ignored that smoke from cigarettes is of the greatest contributors to increased cancer cases among the population. And that the most significant drawback to quitting smoking has been the lack of self – efficacy, in that the individuals did not have a belief in their power to stop smoking. The government should also be leading the fight and report on inequalities in health. Lastly, there was also a reported findings of the stigma associated with a disease or condition such as tuberculosis and also the effect of non- financial barriers such as lack awareness, clear unfelt need or lack of opportunity as also a major obstacle to accessing health care. References Darker, C 2016, ‘Healthcare seeking practices and barriers to accessing under-five child health services in urban slums in Malawi: a qualitative study’, BMC Health Services Research, 16, pp. 1-11, Academic Search Premier, EBSCOhost, viewed 23 March 2017. Dreyfuss H. Thirdhand smoke identified as potent, enduring carcinogen. CA Cancer J Clin. 2010; 60(4):203-204. Lucyk, K 2016, ‘They Are Not My Problem: A Content and Framing Analysis of References to the Social Determinants of Health within Canadian News Media, 1993-2014’, Canadian Journal Of Communication, 41, 4, pp. 631-654, Communication & Mass Media Complete, EBSCOhost, viewed 23 March 2017. Luginaah, I 2015, ‘Can she make it? Transportation barriers to accessing maternal and child health care services in rural Ghana’, BMC Health Services Research, 15, 1, pp. 1-10, Academic Search Premier, EBSCOhost, viewed 23 March 2017. Matt, G 2011, ‘Thirdhand tobacco smoke: Emerging evidence and arguments for a multidisciplinary research agenda’ Environ Health Perspect. 2011;119 (9):12-46. Viewed  on March 2017 Moon, K 2014, ‘Secondhand smoke in waterpipe tobacco venues in Istanbul, Moscow, and Cairo’ Environ Res. 2015;142:568-574.Viewed  on March 2017 National Cancer Institute. Secondhand Smoke and Cancer. January 12, 2011. Accessed on November 10, 2015, Retrieved from Rose, Z 2016, ‘Health Equity Assessment Toolkit (HEAT): software for exploring and comparing health inequalities in countries’, BMC Medical Research Methodology, 16, pp. 1-10, Academic Search Premier, EBSCOhost, viewed 23 March 2017. Rutherfurd, I 2017, ‘The Case for “Environment in All Policies”: Lessons from the “Health in All Policies” Approach in Public Health’, Environmental Health Perspectives, 125, 2, pp. 149-154, Academic Search Premier, EBSCOhost, viewed 23 March 2017. Wiseman, V 2016, ‘”I go I die, I stay I die, better to stay and die in my house”: understanding the barriers to accessing health care in Timor-Leste’, BMC Health Services Research, 16, pp. 1-15, Academic Search Premier, EBSCOhost, viewed 23 March 2017.

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