Health promotion is of great importance to nursing because it has long been acknowledged in nursing literature as fundamental to health care. A dramatic increase in chronic lifestyle diseases has prompted an emphasis on health promotion (Egger et al, 1990). Health promotion can be defined as the process of enabling people to increase control over their health and to improve their health WHO (1986) cited in (Bright, 1997).

However, health promotion is commonly confused with health education and yet health education, is an instrument in health promotion together with health protection and illness prevention. Without knowledge people cannot make healthy choices about their lifestyles therefore health education is very much a part of health promotion (Tannahill, 1985) cited in (Bright, 1997).

This assignment is going to be based on a health initiative towards a group of young adult smokers within age range of seventeen and twenty five years. The author has chosen smoking because more young people continue to take up cigarette smoking and yet smoking has been identified as the biggest single cause of preventable ill health and premature deaths in the United Kingdom (DOH, 1999). The paper is going to support the choice of the topic with statistics and what the government is saying. The needs of the young adult smokers are going to be identified and these needs are going to be addressed through interactive lecture approach. It is essential to consider a health promotion model as a tool to meet the assessed needs.

There are many health promotion models but for purposes of this assignment, Ewles and Simnett (1999) model of health promotion is going to be used. The use of this model will help the author to focus and maintain delivery of health promotion to meet the complex needs of young adult smokers. The assignment will then discuss factors that may enhance or hinder the learning process of the young adult smokers and finally look into evaluation of the health promotion initiative.

According to research, eighty two percent of smokers take up the habit in their teenage years and the high rate of young smokers eventually filters through into adult smoking rates. In the United Kingdom, 120 000 deaths occur every year due to smoking related illnesses and that accounts for one fifth of all deaths per year (Richardson and Sowden, 2000). Smoking has been identified as a major risk for coronary heart disease, the leading cause of lung cancer and some respiratory complications such as chronic obstructive pulmonary disease (Richardson and Sowden, 2000).

The government produced a white paper, Smoking Kills, which targets to reduce the prevalence of smoking among young people (DOH, 1998). The government currently spends seventeen million pounds on anti-smoking campaigns and a further twenty million pounds on measures to help people stop smoking. On the other hand, smoking contributes more than ten billion pounds to government revenue each year (Naidoo and Wills, 2001). Perhaps most significant of all are the sums smoking contributes to government revenue. Therefore, it can be said that preventing and reducing smoking among young people presents a great challenge to health promotion. This is supported by ( Percival and Gough,2001) who say there have been intense efforts in the past three decades to reduce the prevalence of cigarette smoking but, smoking continues to be a critical public health problem

That said, in order to clearly identify the health promotion needs, it is important to consider that smoking is a personal behaviour and complex issue in which many different psychological, social, physiological and economic factors interact. This is supported by Webb (1997) who says peer pressure, parental attitudes and poor discrimination of media images can affect decisions in negative ways. In another perspective, research suggests that self-esteem, self-confidence and personal autonomy are important factors which influence conformity to peer pressure (van-Teijlingen et al, 1995). It is also understood that young adults say that they know very well that smoking is dangerous but they smoke because it resolves immediate social and psychological problems (MacDonald, 1998). However, they may only have superficial knowledge of the dangers of smoking therefore it is important for health promotion to come in with accurate information.

The identified needs of the young adult smokers are knowledge about the effects of smoking on health, empowerment, support for behaviour change and supportive social environment. These identified needs fall in the category of normative needs because they have been defined by the health promoter (Perkins et al, 1999).

The challenge for health promotion is to address the identified needs and factors surrounding smoking in the target group. This is supported by (Naidoo and Wills, 2002) who say understanding and addressing the needs and those factors which are beyond the control of individual influence is a major focus of health promotion. The importance of using a health promotion model as a tool to meet the assessed needs of a target group cannot be over emphasised. Ewles and Simnett (1999) identified a framework of five approaches to health promotion. However, the author will specifically use educational, client-centred, behaviour change and societal approaches. This health promotion model is appropriate because it will provide the health promoter with relevant approaches to the identified needs.

The priority is to give health education to the young adult smokers so they can have an understanding of the effects of smoking as well as passive smoking. Ewles and Simnett (1999) educational approach is appropriate for providing health education because it aims to deliver information and help clients come to decisions which they can act upon. Therefore, the health promoter will provide information on the effects of smoking and services available for smoking cessation so that if clients decide to stop smoking they can access smoking cessation facilities. Support such as provision of nicotine replacement therapy should be available to help the young adult smokers stop smoking (Owens, 2003).
The emphasis of most health education is on informed decision making. It is of paramount importance to provide health education without being judgemental so that the clients may feel free to make informed choices. It is believed that effective health education may produce changes in knowledge and understanding or ways of thinking (Katz et al, 2000). Therefore, it can be said that health education may help bring about some changes in the young smokers beliefs and attitudes. However, it is important to consider individual right of free choice.

According to Ewles and Simnett (1999), client-centred approach aims to work with clients on their own terms thus facilitating empowerment. The health promoter should empower the clients by treating them as equals. That means it should be a partnership and clients should be given the right to set agendas during the health promotion process. Smoking cessation issues will only be considered if the young adult smokers consider them as a concern. This is supported by Rollnick et al, (2001), who say, in health promotion, people should be empowered so they can take responsibility of their own health and if they decide to change the health promoter should help them take effective action based on their choice.

Moving on, behaviour change is another identified need for the young adult smokers. Ewles and Simnett (1999) behaviour change approach aims to achieve individual behaviour conducive to freedom from disease. The health promoter will encourage attitude and behaviour change for the clients by providing information and persuade the young adults to be active decision makers by inviting their views. According to Rollnick et al (2001), young people can change their attitude towards smoking but may not necessarily change their behaviour. Therefore, good rapport, openness and autonomy are essential for an honest discussion on the young adult smokers behaviour change. Young adults are also said to be more likely to consider behaviour change if the health promoter avoids imposing assumptions of behaviour change (van-Teijlingen et al, 1995). Although health behaviour is commonly viewed as individually chosen, it is also known to be influenced by social and environmental factors.

According to Ewles and Simnett, (1999), societal change approach views a physical and social environment that enables a choice of healthier lifestyle. This approach is essential for the health promotion initiative to meet the young smokers’ identified need for societal and environment change. The aim is to make smoking socially unacceptable to the young adult smokers by advocating political and social measures for example making cigarette sales less accessible to the youth.

The health promoter can also advocate for tobacco advertising and sports sponsorship to be limited and challenged. This is supported by Ewles and Simnett (1999) who say a no-smoking policy in all public places and promotion of non-smoking as a social norm will create a social environment where it is easier for young adults to stop smoking. After appropriate implementation of the chosen health promotion approaches, the young adult smokers are expected to be confident and competent in terms of dealing with psychological and other environmental influences like peer pressure or parental smoking.

Moving on, the aim of this health promotion initiative is to increase chances of smoking cessation and reduce the prevalence of smoking among young adults. However, due to the complexity of factors surrounding smoking in young adults, it could be very hard to achieve the outcomes. Nevertheless, the assumption is that when people are informed about the link between their behaviour and health, they will act in a manner that benefits their health and make efforts to change behaviour (Webb, 1997). Awareness that people have different learning styles is important so that the health promoter could incorporate different teaching approaches. For example (Knowles, 1990) andragogical approach to the teaching and learning of adults encourages a pro active approach to learning in which enquiry and autonomy feature predominantly (Quinn, 2000).

The factors that may enhance the learning process of the client group are that they are people who have a general common habit so they can relate to each other during the interactive lecture. They also use the same language so there is common ground for communication. On the other hand, the complex range of individual, social and environmental factors influencing smoking in young people may be difficult to address through lecture approach because some young people are more vulnerable than others. In addition, the difference in age and maturity may impact on the discussions. The opinion is that if the message had been delivered on individual basis, better results may have been achieved because people have different needs and they do not always need the same kind of help (Rollnick et al 2001).

The effectiveness of the health promotion initiative is going to be determined by some form of evaluation. Evaluation is a critical analysis of the activity and identifies what was good and bad. It helps to assess the outcomes, whether the appropriate methods were used, and in the most effective way (Ewles and Simnett, 1999). In the client group, smoking cessation will indicate behavior change. This can be assessed through attendance to smoking cessation program mes. In addition, intentions to stop smoking will indicate changes in knowledge and attitude although individuals may vary in their states of readiness to change (Rollnick et al, 2001). Some literature suggests that once people become aware of a message, for example the effects of smoking, there are a number of stages which they go through prior to adopting new patterns of behavior (Jones and Sidell, 1997). Therefore, knowledge change is an indicator of the effectiveness of a health promotion initiative.

The effectiveness of methods used can be assessed by feedback from clients (Ewles and Simnett, 1999). However there is evidence to suggest that, in young people, respondents sometimes give answers they perceive the health promoter wants to hear, rather than what they actually believe (van-Teijlingen, 1995). Therefore, great uncertainty remains for evaluators to take young people’s answers at face value.

To summarize, smoking is a critical challenge for health promotion because young people continue to take up smoking although it has become the largest cause of deaths through preventable illnesses in the United Kingdom (DOH, 1999). However, research has demonstrated that smoking remains a popular habit despite the known health risks perhaps due to the addictive nature of nicotine. Therefore, health promotion needs should be identified and addressed appropriately (Naidoo and Wills, 2001).

The aim of the health promotion is to reduce the prevalence of smoking among young adults through smoking cessation. Strategies to support smoking cessation could range from policies such as bans in public places to individual support and advice on cessation (Owens, 2003). However, smoking cessation could be difficult to achieve because smoking is a personal behavior, and in young adults, is influenced by many complex issues. The clients’ needs could be better addressed individually because different people may not need the same kind of help (Rollnick et al, 2001).

Evaluation of the outcomes could involve assessing attendances to smoking cessation program mes and any voiced intentions to stop smoking. Evaluating the methods can involve getting feedback from clients. However much literature raises doubts about taking young people’s feedback religiously. Sometimes they give answers they perceive the health promoter wants to hear and not what they actually believe. Therefore relying on feedback from the target group remains a great challenge for health promotion (van-Teijlingen, 1995).

On a final note, smoking kills, but, it is an activity of individual choice. However raising awareness through health promotion can assist people in making decisions to change. Health promotion is obviously defendant on government policy, but perhaps there may be great concern if health promotion on smoking could really work when smoking contributes significant sums to government revenue.