1. Running head: APPLICATIONS OF THE PRECEDE-PROCEED
MODEL 1
APPLICATIONS OF THE PRECEDE-PROCEED MODEL 4
Applications of the PRECEDE-PROCEED Model
Joseph Toole
Health Promotion and Disease Prevention
3 Jan 2016
Unprotected sexual intercourse among teens is one of the major
negative health behaviors in the current society. The sexual
intercourse among teens has predisposed teenagers to sexually
transmitted diseases and early pregnancy. The rate of
intercourse among the teenagers has been on the rise and this
raises eyebrows on the intervention strategies that need to be
adopted in reducing the behavior among the teenagers. The
major reason why the health behavior has been on the increase
is due to influence by the media and lack of information among
the teenagers. It is therefore important to address the problem
before it becomes a major disaster in the society.
The behavior of intercourse is problematic to the society. One
of the factors that make it problematic is how the teenagers are

2. predisposed to sexually transmitted diseases. Most of the
teenagers are not informed on the health dangers of their
behaviors and end up risking their lives. Some of the sexually
transmitted diseases are very dangerous and could lead to death
such as HIV/AIDs, which means that if the health behavior is
not taken care of, then more teenagers are expected to die. It is
therefore important that the behavior is paid the attention that it
deserves before the mortality rate resulting from the behavior
increases (Li, 2009).
There are a number of predisposing, reinforcing, and enabling
factors that influence unprotected sexual intercourse among the
teenagers. One of these factors is the media. The media has
played a major role in influencing sexual intercourse among
teenagers. Nowadays, the media brings programs that even show
the people having sexual intercourse. Since teenagers always
want to experiment what they see, they will want to try it out,
leading to unprotected sexual intercourse. With the introduction
of internet and smart phones, teenagers nowadays can watch
anything and since it is difficult to filter the content from the
internet, it becomes impossible to control what the teenagers are
watching. The other PRE factor considered to increase the
prevalence of unprotected sexual intercourse among the
teenagers is lack of information about sex by the teenagers.
Even though many teenagers are exposed to the internet and
other sources of information, they do not have information on
how to practice safe sex. The parents are also shying away from
educating their children, an aspect that makes the teenagers
oblivious of the dangers involved in practicing unprotected sex.
Most of the teenagers practice unsafe sex since they do not
know the health dangers involved. Some of them think that
pregnancy is the only thing that should be avoided during sex
not knowing that there are other many health dangers that can
be avoided by having safe sex (Li, 2009).
One the major interventions that need to be made is encouraging
the parents to educate their children. Parents need to teach their
children of the dangers that are involved in unprotected sexual

3. behaviors and the risks that are involved. Additionally, the
parents need to know the sites that their children are visiting
and the influence that they have on their perceptions about
sexual behaviors. By keeping an eye on what the children are
watching, it becomes possible to be able to learn what the
children are doing and control their decisions based on what
they see over the internet. Through such interventions, it will be
possible to reduce the rates of unprotected sexual behaviors
among the teenagers.
References
Li, Y., Cao, J., Lin, H., Li, D., Wang, Y., & He, J. (2009).
Community health needs assessment with precede-proceed
model: a mixed methods study. BMC health services
research, 9(1), 1.
Running Headlines: RESPONSE
1
Response
Needs Assessment
Joseph Toole

4. Health Promotion and Disease Prevention
10 Jan 2017
Health needs assessment can be defined as the systematic
approach to ensure that health service uses the available
resources in improving the health of the population in the most
reliable and efficient way. This is a discussion about health
needs assessment and how it can be used in addressing a health
issue. Further, the discussion will identify and analyze two
needs assessment.
Health needs assessment involves qualitative, epidemiological
and comparative techniques to identify inequalities in health
care and the access to service, determination of priorities on the
most effective use of the resources and description of health
problems of the population. It should be noted that health needs
are those that can fully benefit from health or alternatively from
wider environmental and social changes. For health needs
assessment to be a success it must have a practical
understanding of the time, what is involved and the resources
that will be used in the assessment. More importantly, requires
sufficient integration of the results into commissioning and
planning of local services.
Traditionally, health needs assessment has always been
undertaken by the public health professional. However; this
should not be the case as all the professionals in the healthcare
sectors need to participate in this imperative exercise. In this
case, primary care teams and hospitals must be able to rise to
the occasion and provide health care that meet the needs of the
local population. A combination of the personal knowledge of
patients with health needs assessment is sufficient to meet the

5. desired goals.
The two needs assessment that has been selected in this case are
intensive and extensive. The main difference that exists between
intensive and extensive needs assessment is the fact that
intensively uses few cases or even one case detail in an effort to
understand the cause and effect whereas the extensive needs
assessment uses relatively many cases in the determination of
population. Extensive needs assessment uses population-based
indicators and has many strengths. Some of the strength
includes the availability of data for broad geographical areas,
availability of a large number of individuals and the description
of entire populations. Moreover, it is relatively easy to access,
inexpensive to use and it is perceived as unbiased. Survey is
also used in the extensive needs assessment. Survey has its
advantages that make it be preferred. It usually has the direct
feedback from the public; it creates public awareness on certain
issues, and it can also be customized to meet the specific needs
of the client. Service and database programs are also used in the
extensive needs assessment. SWOT is also part of the extensive
needs assessment. The intensive needs assessment normally
requires the ranking of priorities. It is always important for
criteria which can be used in ranking to be developed. In this
case, feasibility is always used as one of the criteria for
ranking.
Health needs assessment provides the opportunity for describing
the patterns of diseases in the existing population and the
distinction from regional, district and national disease patterns.
Moreover, health needs assessment also involves highlighting of
the area of the unmet need and provision of a clear set
objectives. During health needs assessment, the rationale for
improvement of the health services is also decided upon. More
so, health need assessment also ensures that patient’s
professionals in the healthcare can learn new skills in meeting
the demands of patients.
One of the major epidemiological accomplishments in the health
sector is the introduction of team-based approach in handling

6. patients with chronic diseases like a diabetic foot. Team-based
care can be defined as the provision of the comprehensive
health services to families and individuals by at least two health
professionals who have collaborated with family caregivers,
patients, and other community service providers (USDHHS,
2016). The paper is going to discuss how team-based approach
is used to take care of patients with chronic disease.
Team based approach ensures that physicians can connect well
with their patients in handling questions and calls from patients.
Even though team-based has been identified as the future for
delivering care to chronic patients, there is a need for
continuous research to be done in an effort to improve the
output. There are many diseases that require team-based
approach in ensuring that the patient gets the right treatment.
In this context, we present diabetic foot as the case that requires
team-based care which is rooted in the primary care setting. It
should be noted that high functioning team based approach work
effectively and efficiently to provide quality care to diabetic
foot. Patients with diabetes continue to increase as the day's
progress, and this calls for a joint effort in patient care.
Statistics indicate that one out of four patients with diabetes are
likely to experience foot ulcers and more than half of them get
infected and are hospitalized. Further, approximately 20 percent
of individual that are hospitalized will undergo amputation. It
has been reported that there is higher mortality rate in patients
with diabetic foot than those with malignant cancer. Therefore,
there is a need for a team-based approach to help in providing
care for the patients (Kenney, 2010).
Reference
United States Department of Health and Human Services,

7. (2016), Creating Patient Centered Team-based Primary Care,
Rockville, MD 20857,
Kenney, C. (2010) Transforming Health care: Virginia Mason
Medical Center’s Pursuit of the perfect patient Experience. New
York, NY: Productivity Press
Running head: BEHAVIORAL RISK FACTORS FOR LUNG
CANCER 1
BEHAVIORAL RISK FACTORS FOR LUNG CANCER
6
Behavioral risk factors for lung cancer
Joseph Toole
Health Promotion and Disease Prevention
17 January 2017
Behavioral and environmental risk factors for lung cancer
Lung cancer is highly dangerous. It is the leading cause of
cancer deaths in women and men in the United States. Therefore
it is such a delicate health issue that requires extensive
discussion on how to reduce and mitigate it. One of the ways of
mitigating the consequences of lung cancer is educating the
public on behavioral risk factors, since they can be controlled or
avoided all together (Ezzati, & Riboli, 2013). Behavioral risk

8. factors are often associated with peoples’ lifestyles and way of
living. These lifestyles can be dangerous or expose people to
lung cancer, while some lifestyles are considered healthy and
hence appropriate for living without the fear of lung cancer.
Two important behavioral risk factors for lung cancer include:
risky alcohol consumption and cigarette smoking (Filaire,
Dupuis, Galvaing, Aubreton, Laurent, Richard, & Filaire, 2013).
These factors are directly related to the causes of lung cancer.
Heavy alcohol consumption is the first behavioral risk factor.
Heavy drinking has several harmful impacts, including
increased risk for lung cancer and cardiovascular complications.
In 1984, McMichael and Potter proposed heavy alcohol intake
to increase chances of lung cancer in multiple studies (Ezzati, &
Riboli, 2013). Since then, many publications and periodicals
have warned about the need for men to control their alcohol
intake, as the two are closely related.
Cigarette smoking, according to health care professionals is the
number one behavioral risk factor for cancer. For instance, in
the American population, cigarette smoking has been linked to
approximately 80 percent to 90 percent of lung cancer (Filaire,
Dupuis, Galvaing, Aubreton, Laurent, Richard, & Filaire, 2013).
Using other products from tobacco such as pipes or cigars also
increases the risk for lung cancer. Persons who smoke cigarettes
almost on a daily basis are 15 to 30 times more likely to get the
deadly cancer of the lungs or die from the same than non-
smokers.
Predisposing, reinforcing and enabling factors for the selected
behavioral risk factors and examples.
Predisposing factors are conditions, characteristics, events or
substances that contribute to the onset of cancer (Filaire,
Dupuis, Galvaing, Aubreton, Laurent, Richard, & Filaire, 2013).
From this definition or description, the predisposing factors

9. also include lifestyle and hereditary conditions as early
mentioned. Heavy alcohol consumption is connected to
predisposing factors such as gender and hereditary factors or
family history. Males are more likely to abuse alcohol than
females and hence are at high risk of developing lung cancer
(Kim, Kim, Kang, Lee, Lim, Lee, & Ha, 2013). Family history
can also be at the center of heavy alcohol consumption.
Cigarette smoking is the other behavioral factor associated with
lung cancer. Several predisposing factors can contribute to
smoking.
Two of these factors include gender and family history. Males
are known to be use cigarettes more than females. Therefore,
the smoking factor is common in males than in females, and this
is why more males die of lung cancer than females (Kim, Kim,
Kang, Lee, Lim, Lee, & Ha, 2013). Family history is another
predisposing factor associated with lung cancer and smoking as
a behavioral risk factor. Some families have been known to
smoke from the grandparents to the grandchildren.
Reinforcing factors for smoking and heavy alcohol consumption
include external and internal rewards. Usually, those who abuse
drugs and alcohol mention that they get internal and external
rewards. For instance, for a heavy alcohol drinker, the external
reward fulfilment that comes after taking it. On the other hand,
the internal reward is associated with the quenching their thirst.
Smoking too, has internal and external rewards as reinforcing
factors. Additionally, there are people who provide negative
reinforcement for people who use these substances (Kim, Kim,
Kang, Lee, Lim, Lee, & Ha, 2013). For instance, amongst the
youth, peer pressure is a negative reinforcing factor which leads
to alcohol addiction and heavy smoking. Being in the wrong
company of friends is another factor. Pride in achieving some
level of life is an internal reward for most people caught up in
these situations. Some people would want to drink to
demonstrate how proud they are of their jobs and positions in

10. the society. Unfortunately, the pride can land them into
addictions, causing lung cancer.
Enabling factors make it easier for victims to smoke and be
involved in heavy consumption of alcohol. Such factors include
conditions of living and resources. People with money are likely
to attract lung cancer because they can smoke and be heavy
drinkers (Wenthe, 2007). On the other hand, poor conditions of
living are associated with smoking and heavy drinking since
people often ignore the idea of healthy living. For instance,
people who live on their own are likely to be involved in heavy
consumption of alcohol and cigarette smoking.
Careless living is another example of an enabling factor for
smoking and heavy consumption of alcohol. Some people are
never mindful of their lifestyles. In fact, these situations are
worsened by conditions such as stress or depression. For
instance, when a couple gets divorced or separated, one of them
could resort to alcohol consumption as a way of dealing with
the stress (Wenthe, 2007). Continued use of alcohol, and in
some cases tobacco smoking can lead into addiction, which if
not checked can precipitate lung cancer. Availability of
resources is another enabling factor which plunges people into
binge drinking and overusing tobacco.
Young people coming from wealthy backgrounds, especially
those in college or universities can sometimes overuse alcohol
or smoke because they have the money. Most college or
university students have found themselves in this position
because they have a lot of money that they may not exactly
know how to spend (Wenthe, 2007). The resulting behavior is
constant and daily clubbing, which is often associated with
heavy drinking and smoking hence leading to lung complication
which eventually cause death.
Advantages and Disadvantages of two different settings that can

11. be used to address lung cancer.
Quitting smoking and heavy consumption of alcohol are two
ways of addressing the behavioral concerns of lung cancer
(Wenthe, 2007). There are several advantages of quitting using
substances. Apart from reducing the risk of contracting lung
cancer, there are several other benefits associated with
behavioral factors associated with lung cancer. One of the
settings of addressing the health behavior is quitting smoking
and heavy consumption of alcohol. Those who quit smoking as
early as possible reduce the possibility of reducing the risk of
getting lung cancer by more than 50 percent.
Additionally, quitting smoking has several other health
problems such as impotence, tooth loss, fertility problems and
gum disease. Saving money or resources is another benefit of
quitting smoking. The financial rewards should motivate people
to quit smoking and heavy consumption of alcohol (Hecht, &
Szabo, 2014). Chances are high that people can save more when
they are not smoking or drinking alcohol than the reverse.
Weight gain is another benefit. People who drink and smoke a
lot often lose weight. However, the challenges of quitting
smoking and drinking include relapse and a lot of money used
in rehabilitation centers.
Nutrition and better dieting is another strategy that can be used
in reducing the behavioral risk factors of lung cancer (Hecht, &
Szabo, 2014). Better dieting and nutrition has two advantages:
Combating lung cancer risk factors and improving the body’s
defense to outside infections. However better eating and
nutrition is usually associated with high finances and a lot of
time put in choosing the right food.
References
Ezzati, M., & Riboli, E. (2013). Behavioral and dietary risk

12. factors for noncommunicable diseases. New England Journal of
Medicine, 369(10), 954-964.
Filaire, E., Dupuis, C., Galvaing, G., Aubreton, S., Laurent, H.,
Richard, R., & Filaire, M. (2013). Lung cancer: what are the
links with oxidative stress, physical activity and nutrition?
Lung Cancer, 82(3), 383-389.
Hecht, S. S., & Szabo, E. (2014). Fifty years of tobacco
carcinogenesis research: from mechanisms to early detection
and prevention of lung cancer. Cancer Prevention Research,
7(1), 1-8.
Kim, H. R., Kim, D. J., Kang, D. R., Lee, J. G., Lim, S. M.,
Lee, C. Y., ... & Ha, S. J. (2013). Fibroblast growth factor
receptor 1 gene amplification is associated with poor survival
and cigarette smoking dosage in patients with resected
squamous cell lung cancer. Journal of Clinical Oncology, 31(6),
731-737.
Wenthe, P. J. (2007). The predisposing, reinforcing, and
enabling factors associated with physical activity and sedentary
behavior in males and females during early adolescence.
Social Marketing Campaigns
Joseph Toole
Health Promotion and Disease Prevention
24 January 2017

13. Social Marketing Campaign in Public Health
Social marketing is the use of proven concepts and methods
derived from the commercial sector to promote changes in
different social significant behaviors. It involves the use of
health communication strategies like promotion, community
outreach and also mass media (Andreasen, 1995). We will
discuss two social marketing campaigns, the ‘smoke-free
Alexandria’ and ‘PackHead’ done by the World Lung
Foundation.
‘smoke-free Alexandria’ is a campaign that has two phases
starting with smoke-free legislation enforcement. It sought to
get public support for the law. The campaign used creative
measures which attracted other media services. They used a
small budget, and the campaign was successful as it was the
first campaign on Egypt’s Facebook. By the end of it, the
advertisement gained many impressions within ten days at a
cheaper cost. The campaign is resource intensive as it requires a
lot of human resource and ongoing communication among the
users. Also, message generation should be continuous for it to
be effective.
The ‘Packhead’ campaign involved an application that was used
by Facebook users to attach photos on the effects of tobacco and
made them as profile pictures. The pictures were put on a
generic pack of cigarettes and later shared. Therefore, the
primary objective raise awareness, give warning on tobacco
smoking and passage a message on effects of tobacco. The
smoke-free Alexandria campaign used products like ashtrays
shaped like lungs as a marketing strategy. The tobacco users
were prepared psychologically as awareness on legislation was
first done to the people, and they gave support to it, and this
helped in emotional cost. The lungs like ashtrays got put in

14. public places where the tobacco smokers were usually available,
and this made the area accessible. Social networking adverts
were used in which it was very effective as many people became
supporters (Egypyt|Vital strategies, 2010).
The packhead campaign used a graphic pack warning as a
product in which the participants could easily access. The
participants could easily access it online, therefore, making it
cheap for them since they were not incurring costs. A YouTube
video was used to show some the effects of using tobacco which
was very effective as it went viral. It was done purely online in
which there was no real venue. The campaign intended to make
changes to tobacco control policies. Though the video went
viral, this was not the intended or objective of the campaign
(Becky Freeman, 2015).
For the smoke-free Alexandria campaign, there was a growing
community on Facebook. And for it to be continuous it needed
constant communication. The members had to encourage the
followers to build the society. This campaign gained favor in
Egypt as it was the first public health campaign in social media
as compared to the pack head marketing year.
For both campaigns, there are chances for wastage of resources
because in social media there will be untargeted audiences
which will be of no value and may bring about wrong
impressions on the success of the campaign. It is, therefore,
good for both campaigns to know their audience. In regards to
appeal to the audience, there should be added advantages like
some gifts for someone who promotes the campaign more than
others in the social media. It will encourage more people to
participate. The content for the campaign should be straight to
the point and engage for example the one for packhead in which
people were changing profile pictures with a certain message.
The message was unique and at the same time engaging peoples’
mind.
Both campaigns also have weaknesses in which the messages or
the content was general. As for the message, it should have been
divided into different age groups to make sure everyone was a

15. target in a special way. Secondly, another weakness for the
campaigns is that it encouraged more use of tobacco and thus
got enhanced by the social media. It is through the
encouragement of tobacco consumption due to resources found
on social media. Finally, it was observed to have spent more
time on it instead of regulating on its practicality period for the
campaign so that it does not last for so long and instead of
bearing results it destroys more.
Recommendation for both campaigns can be given that they
involve even mass media to make it effective though cost
intensive. Social media is small scale and cheap which is a good
thing. In order to make it more effective, there should be
effective planning and development of evaluation strategies for
the campaign. The integration of other techniques can be highly
effective as shown by the smoke-free Alexandria campaign in
Egypt. Mass media on its own or social media cannot reach
everyone, but the use of others like mediated techniques like
healthcare providers can bring about the achievement of set
objectives. The goals of the campaign should be behavioral a
change rather than awareness, embrace what your audience likes
most and focus more on evidence (Fenton, 2013).
When recruiting participants for the campaign, social media is
very effective. It, however, leaves you wondering the effective
way of measuring the success of the campaign. Between the two
campaigns, the smoke-free Alexandria campaign is the best. It
is because the results were very impressive. The use of both
social media and mass media seem to have worked very well for
this campaign also being the first of the kind in the country
could have favored it.
References
Egypyt|Vital strategies. (2010, June). Retrieved from Building
Health Systems Globally:
https://www.vitalstrategies.org/resource-center/media-
campaigns/country/egypt

16. Andreasen, A. (1995). Marketing Social Change: Changing
behavior to promote health, social development, and the
environment. San Francisco: CA: Jossey-Bass.
Becky Freeman, S. P. (2015, March 30). Public Health Research
and Practice. Retrieved from Social media campaigns that make
a difference: what can public health learn from the corporate
sector and other social change marketers?
http://www.phrp.com.au/issues/march-2015-volume-25-issue-
2/social-media-campaigns-make-difference-can-public-health-
learn-corporate-sector-social-change-marketers/
Fenton, K. (2013, September 18). Public health matters.
Retrieved from Public health issues:
https://publichealthmatters.blog.gov.uk/2013/09/18/social-
marketing-2-0/