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Can free nicotine patches help smoking cessation by utilizing diffusion
of innovations theory?
Tobacco use and smoking continue to be public health problems
in the United States and around the world. Effective treatments
for quitting smoking are available, but many tobacco users and
smokers do not utilize them. In the United States, all 50 states
have set up quitlines. One quitline, the Oregon Tobacco Quit Line
(OTQL), used the diffusion of innovations theory to promote the
use of free nicotine patches (Deprey et al., 2009). The innovation
that the project had was free nicotine patches, which were distrib-
uted by the Oregon Free Patch Initiative (FPI). The FPI provided a
2-week nicotine patch starter kit free of charge to callers for 2 and
half months (time). The program used various communication
channels, including radio programs, word of mouth, emails, and
letters to public- and private-sector partners. The social systems
the program tapped included health plans, local policymakers,
media sources, and referral sources, such as healthcare provid-
ers. An evaluation of the program found that over a 3-month
period the FPI was able to get free news media coverage, was
successful in generating a 12-fold increase in calls to the quit-
line, sustained a twofold increase in the calls 5 months after the
program ended, and reached 1.3% of all smokers in the state of
Oregon. The researchers concluded that the distribution of free
nicotine patches utilizing the diffusion of innovations theory was
an effective way for quitlines to promote smoking cessation.
Deprey, M., McAfee, T., Bush, T., McClure, J. B., Zbikowski,
S., & Mahoney, L. (2009). Using free patches to improve
reach of the Oregon Quit Line. Journal of Public Health
Management and Practice, 15(5), 401–408.
Questions for Discussion
1. Can free nicotine patches help smoking cessation by utilizing
diffusion of innovations theory? Why or why not?
2. Was the diffusion of innovations theory adequately opera-
tionalized in this case study? What else could have been

Can Freire’s model of adult education be used to design effective health
education digital games among adolescents?
Health education and health promotion programs are often
not very well received by adolescents, who perceive these to
be meaningless, thus making the task challenging. Monteiro
and colleagues (2018) experimented with the development of a
serious digital game (a game with an educational purpose) for
adolescents (aged 11 to 19 years) based on Freire’s model of
adult education. The game was called DECIDIX and focused on
imparting sexual and reproductive health education.
DECIDIX was developed by the Center for Studies and Research
on Vulnerability and Health in Childhood and Adolescence
(NEPVIAS) of the Federal University of Pernambuco (UFPE) in
Brazil. The game uses instant messaging around a storyline for a
teen to chat with another teen and make decisions about issues
such as sexuality, gender issues, liability for contraception, and
consequences and responsibilities in an unplanned pregnancy.
At the end of the game, participants reflect on their actions and
are debriefed by the instructor. The methodology was based on
Freire’s model of adult education.
For qualitative evaluation, data were collected through audio
recordings, focus group discussions, interviews, and observa-
tions by participants and nonparticipants. Collected data were
coded and categorized thematically. Four themes emerged: the
approach to daily life by adolescents, critical reflection, relation-
ship between educator and learner, and emancipatory (freeing)
learning and experience. The researchers concluded that
DECIDIX had a positive impact on the lives of adolescents and
engaged them in meaningful reflection.
Monteiro, R. J. S., Oliveira, M. P. C. A., Belian, R. B., Lima,
L. S., Santiago, M. E., & Gontijo, D. T. (2018). DECIDIX:
Meeting of the Paulo Freire pedagogy with the serious
games in the field of health education with adolescents.
Ciencia & Saude Coletiva, 23(9), 2951–2962.
Questions for Discussion
1. Do you think Freire’s model of adult education can help
develop interesting and effective health education programs
for adolescents? Why or why not?
2. Do you think the case study adequately operationalized all
the constructs of Freire’s model of adult education? Why or
why not?

Can the Binge Drinking Problem on Campuses Be Solved Through
the Multi-Theory Model (MTM) of Health Behavior Change?
Binge drinking is defined as drinking four or more drinks in one
sitting by women and five or more drinks by men. It is a common
problem on university campuses, with students reporting the
prevalence of binge drinking over the past month to be as high
as 40% to 60%. Thus, theoretical (evidence-based) approaches
are needed to reduce binge drinking on campuses. Sharma and
colleagues (2018) tested the multi-theory model (MTM) of health
behavior change in a case study to assess its predictive potential
for responsible drinking or abstinence among students who binge
drink. The study used a cross-sectional design. The researchers
developed a 39-item questionnaire based on demographic infor-
mation, six constructs of MTM (participatory dialogue, behavioral
confidence, changes in the physical environment, emotional
transformation, practice for change, and changes in the social
environment), and intention to initiate and sustain responsible
drinking or abstinence. A panel of six experts validated the
instrument for face and content. Construct validity of the MTM con-
structs was established through confirmatory factor analysis, and
internal consistency reliability was established with all subscales
having Cronbach’s alpha greater than 0.70. Regression modeling
revealed that behavioral confidence and changes in the physi-
cal environment constructs of MTM were statistically significantly
associated with intended initiation for drinking responsibly/
abstinence behavior change and added 20% predictability to
the model. Likewise, the constructs of emotional transforma-
tion, changes in the social environment, and practice for change
added 20% predictability to the intended sustenance for drink-
ing responsibly/abstinence behavior change. The researchers
concluded that the MTM was a robust model that could be used
to design responsible drinking/abstinence programs on college
Sharma, M., Anyimukwu, C., Kim, R. W., Nahar, V. K., & Ford,
M. A. (2018). Predictors of responsible drinking among
college students who binge drink: A multi-theory model
(MTM) approach. The Journal of the American Osteopathic
Association, 118(8), 519–530.
Questions for Discussion
1. Do you agree with the researchers’ conclusion? Why or
why not?
2. Can the binge drinking problem on campuses be solved using
the multi-theory model (MTM) of health behavior change?

discussion, nurse
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