of the behavior of many people on multiple levels, and a broad systems approach to understanding both the individual ' s and the population ' s behavior is critical to achieving health promotion for all. Investigators cannot ignore the behavior of politicians who enact legislative policies that infl uence public health research, the behavior of medical care providers and insurers, and the behavior of industries (e.g., pharmaceuticals, tobacco) that may profi t from behavior that prevents disease or that harms the public. The confl uence of these many agencies defi nes complex behavioral ecological subcultures that determine health-related behavior and morbidity outcomes. We have used a Behavioral Ecological Model (BEM), where social ecological systems are emphasized and integrated with individual factors (e.g., genetic and personal learning histories) to understand and engineer change in the populations ' behavior ( Hovell, Wahlgren, & Adams, 2009 ;Hovell, Wahlgren, & Gehrman, 2002 ). In this context, we discuss the role of secondhand smoke exposure (SHSe) in the overarching process of tobacco control.This article describes the BEM, how it applies to SHSe research, and how elevating SHSe as the key target within the overarching tobacco control science may be a means of preventing tobacco addiction in whole populations.
Need for a new modelThe tobacco industry creates more smokers and disease than clinicians can prevent by clinical services alone. The focus on clinical care is understandable, as it helps seriously damaged members of society, but it only indirectly contributes to prevention. Alternatively, smoke-free policies and increased taxation hold promise for complete tobacco control, where no one uses tobacco products. Such policies are consistent with the BEM and illustrate a more comprehensive prevention model. Popular theories offer " rational " or cognitive models of decision making that depend on understanding the health
AbstractIntroduction: This article outlines a theoretical framework for research concerning secondhand smoke exposure (SHSe) prevention as a means to curtail the tobacco industry.
Methods:The Behavioral Ecological Model (BEM) assumes interlocking social contingencies of reinforcement (i.e., rewards or punishments) from the highest level of society (e.g., taxing cigarette sales) to physiological reactions to nicotine that infl uence smoking and SHSe. We review selected research concerning both policy and clinical efforts to restrict smoking and/or SHSe.
Results:Research to date has focused on smoking cessation with modest to weak effects. The BEM and empirical evidence suggest that cultural contingencies of reinforcement should be emphasized to protect people from SHSe, especially vulnerable children, pregnant women, the ill, the elderly, and low-income adults who have not " elected " to smoke. Doing so will protect vulnerable populations from industry-produced SHSe and may yield more and longer-lasting cessation.
Conclusions:Interventions that reduce SHSe may serve as a Trojan horse to...