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Social Determinants of Health

Cigarette smoking is one of the most addictive bad health behavior that is common in the people having chronic disorders (Strulik, 2019). These are the people who are mostly encouraged by the health care professionals to work towards smoking cessation because it is harmful for their health. Still there are some people who continue to smoke despite having a chronic disease. This essay focuses on finding the reasons on why some people continue to smoke despite having a chronic respiratory disease.

Chronic respiratory disease is a serious chronic disorder of lungs that hampers the normal respiratory function of the lungs thereby causing shortness of breath and difficulty in normal breathing in the affected individuals (Nogee&Trapnell, 2019). This essay serves the purpose of identifying the social determinants of health that are affected by these decisions of following cigarette smoking despite having chronic respiratory disease. This essay is based on the theoretical perspective related to the above mentioned question.

The chronic respiratory diseases are the most widespread lung disorders that have growing cause of suffering and mortality across the globe. These respiratory diseases are the underdiagnosed disease and once the people are diagnosed with these diseases, they are recommended to stop smoking. The statistics reveals that about 50% of the smokers develop COPD (Cruickshank- Quinn et al., 2018). The smoking cessation is extremely difficult to achieve because the smokers have higher nicotine dependence. These people are not able to quit smoking even after receiving the smoking cessation support because they believe their disease as self- inflicted (Mooren et al., 2018). According to a study conducted on the same topic, the reason that the smokers do not quit smoking despite being diagnosed with chronic respiratory disease is that smoking cessation requires substantial behavior modification that demands for huge efforts thus they do not stop smoking.

The theoretical perspective of health that can be best applied here is the social cognitive theory. This theory is an extension of the social learning theory that states an individual learns from other people through observation, instruction and modelling (Jenkins et al., 2018). The smoking cessation is a behavior change and the social cognitive theory states that self- efficacy is fundamental to any behavior change. As mentioned above, smoking cessation requires huge effort for behavior modification thus this theory can be related to this effort. There are many studies that show a positive relationship between self- efficacy and the changes in smoking behaviors. The people with chronic respiratory diseases are well aware of the consequences of smoking and its impact on worsening the condition of their lungs (Valiulis et al., 2019).

The social cognitive theory forms the basis of cognitive behavioural therapy that aims to break the situational and emotional connections that the people have developed with smoking. The studies suggest that it is the inability of the smokers that they are not able to quit smoking. They are not competent in self- efficacy to quit smoking thus this social cognitive theory states that this behavior is explained as a product of interactions between environmental, cognitive and behavioral influences. These people with chronic respiratory disorder lacks this self- efficacy that is strongly associated with the behavior change of smoking (Thai et al., 2018). This theoretical perspective is strongly associated with the people’s attached emotional and situational cues that they have attached with smoking.

The reason of them having this respiratory chronic condition is not sufficient motivator for them to stop them from smoking because nicotine dependence outweighs this health issue. The people with such respiratory diseases do not have self- efficacy because they state that breaking this lifelong pattern of smoking is very difficult thus do not put much efforts (DiClemente, 2018). They believe that there is a association between smoking and their life patterns. There are many reasons that restricts them from developing this self- efficacy that are hectic life style that makes them smoke every day, they also believe that it is never the right time in life to stop and so on.

Smoking cessation is one of the most important methods to improve the prognosis in the patients with chronic respiratory diseases (Kelly, 2016). The second main reason identified for them not able to quit smoking despite of being diagnosed with chronic respiratory disease is that there are some environmental and genetic influences that do not allow them to quit smoking. These act along the psychological factors and do not allow the people with chronic illness to stop smoking. These environmental factors such as stress and depression due to many reasons like family issues, work related stress and so on keeps them engaged with this nicotine product (Pang et al., 2019).

These people often justify their continuous smoking as a stress buster which helps them to cope up with various stressors relate to their poor health and associated repercussions. They can be under stress for many reasons and one of these reasons is this chronic illness that they blame to not allow them to stop smoking. The theoretical perspective here is the behavioural theory that states that the smokers have learned to associate smoking with other feelings and unusual events like they being in the stressful condition. This has an impact such that these conditions then automatically induce their craving and cue the person’s smoking behavior.

The social determinant of health that will be affecting these decisions is first the low level of education received by these people. The people who are less educated are not very well aware of the consequences of cigarette smoking on their chronic illness (Stenberg et al., 2018). There are some people who are well aware of these consequences but still do not wish to quit smoking. The social determinant, education plays a very important role over here as it dictates their behavior of smoking. These are the people who think that their chronic illness is out of the control and control over smoking would not make a significant change.

The less educated people are not well aware of the repercussions of prolonged smoking tobacco on their health and especially on their respiratory system (Chhabra et al., 2019). They live in a disbelief that these conditions are explicit and can never be controlled. This social determinant leads to the creation of health disparities thus these people needs to be educated on the importance of education in learning the dangers of smoking on the respiratory system. Educated people make behavioral changes more readily than the people who have received lower levels of education. Education is that social determinant of health that does not allow these people to change their behavior of cigarette smoking. The low education levels are strongly associated with the higher prevalence in the people who does not quit smoking (Pleasants et al., 2016). There are many studies that have proved that low education is associated with the lower rate of people quitting tobacco smoking despite having chronic respiratory disease.

The second social determinant of health that impact the decision of not quitting smoking despite having chronic respiratory disease is low socio- economic status of people. The people having low income that is low economic status are more prone to take decision of not quitting smoking because they believe that cigarette smoking is their stress buster (Chalian et al., 2018). The people with low socio- economic status have stress of poor housing, fulfilling the needs of family members, have difficulty in accessing affordable medical health care services, may have problem in getting adequate amount of food and issues with receiving education. All these issues cause stress and depression and the reason in social determinant of health that is low socio- economic status of these people (Grigsby et al., 2016).

This does not allow them to quit smoking despite having chronic respiratory illness because they are stressed and believes that smoking is the way out. This social determinant also creates health inequality which does not allow these people to get education on smoking cessation because they are not able to access health care facilities. The medical health professionals educate the people diagnosed with chronic respiratory disease to quit smoking as the first most important health related behavior change because this has the most significant impact in worsening the condition of lungs. According to a study conducted on the similar topic, it was found out that the people with low economic status generally faces a lack of support and they are more associated with the poorer health status in terms of respiratory disease (Van Hecke et al., 2017).

The conclusion drawn is that the people having chronic respiratory disease are not ready for smoking cessation because of various psychological factors like they believe that smoking is the solution for eradicating stress due to environmental factors and the second most important reason is that they lack of self- efficacy because they believe that this chronic illness is out of their control. The theoretical perspective that is applied is social cognitive theory and behavioural theory that helps in learning this non- changing smoking behavior of the people despite being diagnosed with chronic respiratory disease. The social determinants of health that are education and low socio- economic status of people affects this decision of not quitting smoking. These two social determinants of health needs to be addressed for better results in terms of smoking cessation and also in terms of better respiratory health.

References for Social Determinants of Health

Chalian, H., Khoshpouri, P., &Assari, S. (2018). Demographic, social, and behavioral determinants of lung cancer perceived risk and worries in a national sample of American adults; does lung cancer risk matter?. Medicina, 54(6), 97.

Chhabra, A., Hussain, S., & Rashid, S. (2019). Recent trends of tobacco use in India. Journal of Public Health, 1-10.

Cruickshank-Quinn, C. I., Jacobson, S., Hughes, G., Powell, R. L., Petrache, I., Kechris, K., ... &Reisdorph, N. (2018). Metabolomics and transcriptomics pathway approach reveals outcome-specific perturbations in COPD. Scientific Reports, 8(1), 1-18.

DiClemente, C. C. (2018). Addiction and change: How addictions develop and addicted people recover. Guilford Publications.

Grigsby, M., Siddharthan, T., Chowdhury, M. A., Siddiquee, A., Rubinstein, A., Sobrino, E., ... & Checkley, W. (2016). Socioeconomic status and COPD among low-and middle-income countries. International Journal of Chronic Obstructive Pulmonary Disease, 11, 2497.

Jenkins, L., Hall, H., &Raeside, R. (2018). Applications and applicability of social cognitive theory in information science research. Manuscript of paper submitted to Journal Librarianship and Information Science.

Kelly, C. (2016). Pulmonary rehabilitation. The Management of COPD, 175.

Mooren, K., van der Linden, G. G. H., Pool, K., & Engels, Y. (2019). The attitudes of pulmonologists regarding smoking behavior of their patients with advanced COPD: A qualitative research. International Journal of Chronic Obstructive Pulmonary Disease, 14, 2673.

Nogee, L. M., &Trapnell, B. C. (2019). Lung diseases associated with disruption of pulmonary surfactant homeostasis. In Kendig's Disorders of the Respiratory Tract in Children (pp. 836-849). Content Repository Only!.

Pang, T. Y., Hannan, A. J., & Lawrence, A. J. (2019). Novel approaches to alcohol rehabilitation: Modification of stress-responsive brain regions through environmental enrichment. Neuropharmacology, 145, 25-36.

Pleasants, R. A., Riley, I. L., &Mannino, D. M. (2016). Defining and targeting health disparities in chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease, 11, 2475.

Stenberg, U., Vågan, A., Flink, M., Lynggaard, V., Fredriksen, K., Westermann, K. F., &Gallefoss, F. (2018). Health economic evaluations of patient education interventions a scoping review of the literature. Patient Education and Counseling, 101(6), 1006-1035.

Strulik, H. (2019). An economic theory of depression and its impact on health behavior and longevity. Journal of Economic Behavior& Organization, 158, 269-287.

Thai, C. L., Coa, K. I., & Kaufman, A. R. (2018). Implicit theories of smoking and association with current smoking status. Journal of Health Psychology, 23(9), 1234-1239.

Valiulis, A., Bousquet, J., Veryga, A., Suprun, U., Sergeenko, D., Cebotari, S., ... &Billo, N. E. (2019). Vilnius Declaration on chronic respiratory diseases: Multisectoral care pathways embedding guided self-management, mHealth and air pollution in chronic respiratory diseases. Clinical and Translational Allergy, 9(1), 7.

Van Hecke, A., Heinen, M., Fernández‐Ortega, P., Graue, M., Hendriks, J. M., Høy, B., ... & Van Gaal, B. G. (2017). Systematic literature review on effectiveness of self‐management support interventions in patients with chronic conditions and low socio‐economic status. Journal of Advanced Nursing, 73(4), 775-793.

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