Sociology

Background of Smoking Cessation System among Male Smokers
The social and health care smoking cessation system is a mechanism related to different measures and strategies, which helps to quit smoking among the males smokers of Saudi Arabia. The health and social care smoking cessation system in Saudi Arabia provides effective counseling to the male smokers in order to reduce or quit their smoking habit. The administration of health and social care smoking cessation system increases awareness about the health hazards that are generated from smoking among the males, which motivates them to quit smoking. This health care smoking cessation system also helps to enhance the social smoking cessation system among the male smokers in Saudi Arabia as people after counseling, are also inspired to provide appropriate smoking cessation counseling to the other people or the male smokers.

The previous studies and research explain that percentage of smoking is more among the males in Saudi Arabia in comparison of the female smokers. In order to reduce the smoking habit among the male smokers, various strategies are adopted by the health ministry, which also help to increase the effectiveness of the smoking cessation system. The ban on smoking and its advertisements are the some important strategies, which are adopted as the smoking cessation strategies to increase the effectiveness of the smoking cessation system in Saudi Arabia.

The smoking cessation program includes the advertising of negative impact of the smoking on the health of people, increase in the taxation, clinical counseling and the related legislation. The smoking cessation strategies in Saudi Arabia are quite effective in order to increase the effectiveness in preventing smoking habits among the male smokers. The smoking cessation program in Saudi Arabia also includes some recommendations for legislative changes in order to reduce the ratio of preventable deaths from smoking. In the current environment, cigarette smoking is causing a major health problem. The major problems due to smoking attract the attention of mental health professionals worldwide. The mental health professionals are looking towards the smoking as it leads to various psychiatric disorders such as depression, drug addiction, schizophrenia, anxiety disorders and several personality disorders. It also has some neuro-psychiatric implications on the smokers. The smoking is also associated with suicide among the psychiatric patients because of the mental disorders.

In the current competitive business environment, several forms of tobacco that are manufactured and produced by the multinational companies and used for smoking such as cigarette, cigar, water pipe etc. (Siddiqui Ogbeide  Khalifa 2001) The health hazards related to smoking affect a large number of people from different age groups and different sexes. Several studies show that smoking involves the risk of developing Coronary Artery Disease (CAD) in the smokers from the different age groups. These risks are mainly considered related to the density and duration of the smoking.

In Saudi Arabia, the smoking habit is increasing continuously among the students and the other males. The smoking habit in Saudi is causing dire health problem and increase in the smoking is also causing an augmentation in the volume of related diseases, which is putting extra pressure on the health system of the people. A research suggests that most of the smokers start smoking in their teenage age because of some psychological problems such as feeling of being unappreciated, low self esteem etc. (Shalhoub 2005). Cigarette smoking is the major health problem among the public of Saudi Arabia. The following table exhibits the prevalence of smoking among female versus male smokers from different age and profession groups -

(Source Bassiony 2009).
The smoking habit could be seen mostly in the young male students of Saudi Arabia, which is also causing the preventable cause of the death. It is because school and college age is the critical period, which plays a crucial role in the formation of smoking habit. The adolescent years of the males are the most appropriate time for the formulation of smoking habit among them. The study among the smokers and non-smokers suggest that smokers are thinner in comparison of the non-smokers. Smoking causes loss of weight among the people. In Saudi Arabia, people are also facing the problem of obesity due to lack of proper exercise and their eating habits (Alsaifa et al 2002). In order to reduce the problems of obesity, they use smoking as the prevention, which causes several other diseases.

Smoking in Saudi Arabia is the most preventable risk factor, which is causing an increase in the morbidity and mortality. A family heath survey was conducted in the year 1996 in Saudi Arabia, which exhibits that among the total population about 18 of men are smokers while this percentage was less than one percent for women. This research shows that males are more prone to smoking in comparison of the females. The prevalence of the smoking among the health care professionals and medical students are much higher in comparison of the other professional in Saudi Arabia even when they know its harmful effects and consequences (Vohra 2009). The other reason behind the increase in smoking is the peer influence.

There are several problems, which are associated with the smoking. Smoking increases the risk of contracting diseases in the proportion of duration that a person continues to smoke. It also makes people addicted as it includes nicotine, which is responsible for the psychological and physical dependency. According to a study, smoking is the most important reason for the premature deaths in the world. The dental problems, cancer are the other major problems or diseases, which appear due to smoking. There are various other problems, which are associated with smoking. The health and social care smoking cessation system is quite helpful to prevent smoking among the male smokers in Saudi Arabia.

Health and Social Care Smoking Cessation Systems among Male Smokers
In the existing environment, all the countries are more conscious about reducing the health problems or issues. Most of the countries are taking some preventive measures to reduce the health problems among the people of the country. The increase in the smoking is causing the problem of increase in the health diseases in the several countries. The increase in the health and social care cessation smoking system is reducing the health diseases associated to smoking. But at the same time, there are differences in the preventive measures of the developed and developing countries.

In the current environment, the developed countries are enjoying the reduction in the incidences of smoking from the last several years but at the same time, developing countries like Saudi Arabia are still facing a rapid increase in the smoking habit among the people. It depicts that smoking is still one of the most important reasons for the preventable death in developing countries. The increase in the preventable death rates also causes an increase in the cost of the countries. In order to reduce this costly habit, governments have taken up so many smoking cessation strategies from the last several years.

Health Care Smoking Cessation systems among male smokers
Health professional plays an important role in applying health care smoking cessation system. The health professionals play two different, but complementary roles for the control of tobacco and prevent the human health from the associated diseases of smoking. The health care providers are responsible to provide significant information to the patients or the people about the harmful effects of smoking. They are also uniquely positioned to provide information and assistance to quit smoking through counseling. The health care professionals also prescribe medicines, which are effective for smoking cessation.

The other role of health professionals is as the prominent advocacy group in the society. In this role, health professionals provide assistance to the government in making policies and programs for the comprehensive tobacco control. Health care professionals provide the need and benefits of the programs and policies to the government, which help to implement comprehensive tobacco control policies. These policies and programs in Saudi Arabia assist smokers in quitting smoking habit. At the same time, it also prevents non-smokers to take-up the habit of smoking and also reduces its effect on community and environment.

Health professionals in Saudi Arabia are also the model of behavior as about 80 of the non-smoker heath care professionals report that a physician, who smokes is less effective and significant to reduce smoking among his patients. According to the fact sheet, this problem is identified in more than 64 health professionals, who smoke. This study suggests the importance of health professionals in preventing smoking habit among their patients as a role model for the people who want to quit smoking (Saudi Arabia). The counseling and the preventive medicines provided by the health professionals are also important to formulate smoking cessation strategies and programs for male smokers in Saudi Arabia.

In Saudi Arabia the health care smoking cessation programs are available to a limited extent as less availability of counseling and medication for smoking cessation. The health care professionals provide a certain level of services to the patients for smoking cessation as study suggests an increase of smoking habit among the medical students and health professionals too (Morrell, Cohen  Dempsey 2008). The role, as well as, preparation of health professionals in offering counseling is a powerful tool for smoking cessation to the smokers. It is reported that 69 health professional are well prepared for counseling in Saudi Arabia.

The health professionals also recommend various measures and strategies to reduce smoking among the male smokers in Saudi Arabia such as banning on smoke at the public places, use of the statutory print warning on cigarette packets etc. The other strategies, which are recommended by the health professionals for smoking cessation among male smokers of Saudi Arabia are banning on the sale of tobacco products to minors and to stop the sponsorship to the tobacco industry.

The health professionals as the prominent advocacy social group also suggest a ban on the advertisement of tobacco products completely, as advertisement plays an important role in increasing the smoking habits among the youth of Saudi Arabia (Saudi Arabia). The health care smoke cessation programs also favor to keep the hospital smoke free, so that a better environment can be created to assist the patients, who want to quit smoking. In Saudi Arabia, the health professionals have excellent knowledge about the harmful effects of the smoking on health. They are also aware about the importance of the non-smoking health professionals in assisting the patients, which help to formulate an effective smoking cessation program for the male smokers.

The health care smoking cessation in Saudi Arabia is quite helpful for the health professionals, who smoke, as well as, for other patients in quitting the habit of smoking. An increase in the access of medication and self-help is quite useful to improve the effectiveness of smoking cessation counseling and interventions in Saudi Arabia. The health professionals in Saudi Arabia play an important role in advocating and supporting the implementation of a tobacco control policy, which includes all the relative aspects.

The Ministry of Health in Saudi Arabia provides a result that 100 million of people have lost their lives in the 20th century due to harmful impact of smoking and it is estimated to increase by 1000 million in the 21st century. In the total population of Saudi Arabia, about 35 to 45 males smoke and it is causing an increase in the social, economical and health troubles in the country. The increase in the burden or trouble is also causing an increase in the total cost of kingdom, which is about to five billion riyals per year. The tobacco control program is formulated to reduce the cost and social, economical and health burden on the country.

The tobacco control program is one of the most important means for the smoking cessation among the male smokers of Saudi Arabia. This program provides various services, which help to improve the effectiveness of smoking cessation program of health professionals, as this program improves the awareness related to the scientific and consultation issues pertaining to tobacco. This program also includes the establishment of tobacco control clinics all over the Saudi Arabia.

The main objective of the tobacco control program is to take all the possible procedures and measures to prevent the spread of smoking and tobacco among the people of Saudi Arabia. This program is responsible to protect the future generation from the harmful impact of smoking. It also helps health professionals in making appropriate smoking cessation to prevent the use of different ways of smoking among the people as it is also aimed to make smoking unacceptable among the society (Bassiony 2009). It makes people aware of harms of active and passive smoking and its effect on society, in general.

The tobacco control program in the Saudi Arabia is mainly formulated to accomplish the following goals and objectives -
Protect the society from the harmful effect of smoking, especially, the youth.
Assist the smokers in quitting smoking habits.
To protect the non-smokers and children from the impact of second hand smoke.

To improve the research in finding more strategies to fight against smoking (Al-Munif 2009), the Ministry of Health in Saudi Arabia raises awareness among the people through awareness campaigns in schools, exhibitions, TV shows. It also takes the part in the world no tobacco day, which is the most important measure in preventing smoking among the people of Saudi Arabia. It also provides proper training facilities for the service providers, who are involved in the tobacco control programs. It is involved in the opening of tobacco control clinics, which help to follow the procedures and regulations related to the tobacco control activities.

The Ministry of Health in Saudi Arabia also has banned the smoking in ministries and organizations in its follow up procedures and regulations. It also supervises the ban of advertising of the tobacco products. At the same time, it also has implemented ban on sale of tobacco products to children. The different measures related to the health care smoking cessation helps to reduce smoking among the male smokers of Saudi Arabia. According to the Ministry of Health in Saudi Arabia about 71 people want to stop smoking, 63 people have tried to stop smoking in the previous year and 80 people have received help to quit smoking because of the health care smoking cessation system.

Dentists of Saudi Arabia also play a crucial role in implementing smoking cessation and prevention as tobacco also causes many problems in mouth, which are cured by the dentists. The smoking is the most important factor, which causes oral cancer among the smokers. These doctors have a significant role in smoking cessation as they provide regular treatments to their patients. Their advice to the patients has a lasting impact in quitting smoking among the people of Saudi Arabia. But in Saudi Arabia, most of the dentists dont follow smoking cessation strategies because they themselves are indulged in smoking. The habit to smoke is quite high among the adult males of Saudi Arabia, which shows that males are more prone to smoking in comparison of the females. The increase in the smoking among the males of Saudi Arabia describes the need of some urgent interventions or health care smoking cessation system in order to protect the people from its consequences.

The following table shows the difference between the smoking habit among the males and females from different age groups -

(Source Al-Quahtani, et al 2007).
NRT in Saudi Arabia is responsible for the formulation of smoking cessation programs and strategies. It is a comprehensive body of evidences, which includes a broad range of strategies and interventions for smoking termination. The behavioral therapy, several types of counseling, different self help strategies are the some important interventions, which are included in the smoking cessation system of the health professionals. Under the interventions of NRT, the health professionals are responsible to generate awareness about the harms caused due to the habit of smoking. It is the basis of self- help program or strategy under which, the individual undertakes all the measures to manage his smoking cessation process or program. The self- help therapy is a low cost therapy in comparison of the other therapies.

The behavioral intervention of NRT includes various aspects such as social skill training, self control, coping, contingency management etc. It is one of the less resource consuming therapies, which are used by the health professionals to manage the smoking cessation program among the male smokers of Saudi Arabia. It is also the most economically viable therapy for the patients, who want to quit smoking. The different types of interventions of NRT can be described as follows
Self- help  It is the most effective intervention, which relies on several strategies such as video based support material, paper based material etc. This intervention helps to increase the smoking cessation rate, but its effect is not much wider. But the application of self help with the other therapies or interventions significantly increases the smoking cessation rates. The success of the self help in Saudi Arabia also depends on the material as tailoring material helps more in comparison of the standardized material. But at the same time, it is reported that this therapy have lesser impact on the people to quit smoking than the other interventions. It is also the most common component of the smoking cessation program, which ranges from the brief clinical interventions to large community campaigns.

Individual Therapy  It is also known as the behavioral intervention. The survey over 7000 participants describes that this strategy is more likely to improve the smoking cessation. The involvement of other therapy doesnt result an increase in the effectiveness of intervention in smoking cessation. This therapy includes three stages. In first stage, the health professionals review smoking history of the patients and motivate them to quit smoking. After it, he provides assistance to identify all the possible risks situation and harms of smoking. In the final stage of individual counseling, health professionals develop problem solving strategies for high risk situations, which may occur due to smoking (AL-Doghether 2004).

Group Therapy  The group therapy is beneficial to analyze the behavior of the group members and to provide them a social learning. The group intervention helps to generate emotional experiences among the group members, which helps to improve the effectiveness of smoking cessation. It also provides information and teaches new skills to the smokers for quitting their habit. The group intervention offers understanding about the behavioral techniques, which can be implemented in the smoking cessation. In Saudi Arabia, the health professionals set a specific date for quitting smoking and enhance the self-monitoring among the group members.

Aversion Therapy  This intervention is quite helpful to increase the odds in smoking cessation. It is less effective in order to prevent the rapid growth in smoking, so it is not used in Saudi Arabia for patients to help in getting rid of this habit (Smoking Cessation Interventions and Strategies 2008).

Minimal Clinical Intervention  Minimal clinical intervention is advice given by the health professionals to the smokers, which have a greater influence on them. It consists of brief cessation suggestions to the smokers instead of their requirement to quit smoking. In this intervention, health professionals ask their patients about their current smoking habits, advise them to stop and also offer the required assistance for stopping smoking.

In Saudi Arabia, most of the health professionals use behavioral interventions for smoking cessation. It is also known as the change theory. This theory suggests that smokers should move from the content of smoke and should think and plan to quit smoking. He should also attempt to quit and should maintain smoking cessation. These are the important stages for an effective smoking cessation system. Most of the youths in Saudi Arabia start smoking in the depression and there is not much effective health care smoking cessation. The lower rate of health care smoking cessation is causing an increase in the number of smokers in Saudi Arabia. In order to increase number of quitters, the Saudi government should facilitate an effective health care smoking cessation system.

Social Care Smoking Cessation System among male smokers
The health care professionals play an important role to support the programs and policies related to the smoking cessation. In the current environment, it is necessary for the organization of for the society to adopt some preventive measures to reduce smoking habits among people of the country. Society can help to develop some standard procedures and measures to prevent or reduce the use of tobacco as increase in smoking is causing an increase in the cost of society. The most successful smoking cessation programs are supported by the institutional policies, which is an important part of the society.

There are many smoking prevention inventions are available for smoking cessation. In order to increase the effectiveness of social care smoking cessation, these strategies should be implemented in an effective manner as it would help to reduce the risk associated with smoking. There are different strategies demonstrated for smoking cessation in Saudi Arabia. The health care administrator, society, Ministry of Health, insurers, and purchasers play an important role in enhancing the use of smoking prevention strategies. The support from the other members in the family or in peer group also improves quit rate.

There are various policies developed by the administrators at the offices, clinics and hospital levels along with managed care plan. The employees, insurers and office administrators help to implement these strategies to enhance the smoking cessation through the contract specifications. The agreement with insurers can be tailored through the performance expectations, incentives to enhance smoking cessation system. They are also responsible to ensure that smoking cessation interventions would be addressed at the delivery system level. The cost of implementing the smoking cessation strategies varies from the population mix, locations, intervention preferences, personal efforts for interventions etc. In Saudi Arabia, the social care smoking cessation system includes following strategies among male smokers

1. Implementation of tobacco user identification system in each institute  It is the screening system, which ensures the identification of smoking status. This system also documents data about smoking status among the male smokers. The identification and documentation about the smoking status results a higher rate of smoking cessation strategies, as well as, a higher quit rate among the male smokers in Saudi Arabia. This approach is quite significant to increase the probability of measuring use of tobacco. This approach of smoking cessation includes intensive interventions, which is more effective in comparison of the other social care approaches for smoking cessation (Smoking Cessation A Systems Approach 1997). This strategy of smoking cessation implements an office wide system, which requires responsible staff and change in office system for implementation of smoking cessation interventions.

2. Provides education, resources and feedback  The social care system of Saudi Arabia provides proper education and resources to promote the interventions for smoking cessation. The smoking cessation interventions are delivered by multiple health care providers and administrators, which improve the cessation rate in comparison of the other interventions without provider such as self administered intervention. Under this social care smoking cessation system, to increase the implementation of strategies, the administrators and insurers provide training and incentives to the clinicians. It helps to motivate the staff in providing smoking cessation treatment, as well as, it also measures the delivery of treatment by performance evaluation of staff.

In order to increase the effectiveness of this smoking cessation intervention, the health care system should ensure the availability of proper knowledge and training to the clinicians. It is also necessary to provide all the required resources for cessation and a time-to- time feedback to the clinicians about their cessation practices. The administrators should also communicate properly to the staff along with male smokers, the importance of smoking cessation.

3. Promote and support the smoking cessation policies  The Ministry of Saudi Arabia also promotes and supports the policies of hospital, which helps to promote smoking cessation. The hospitals are restricted as smoke free area to improve the effectiveness of smoking cessation treatment for patients. The smoke free environment also motivates the hospitalized patients to quit smoking. It also improves the effectiveness of clinicians in performing an important role as non-smoking model. To implement this strategy under the smoking cessation system a proper process should be adopted, which is as follows
First of all, the administrators should implement a system for identification and documentation the status of tobacco users including the hospitalized patients.
Provide smoking cessation treatment to all hospitalized patients.
Identification of clinicians to deliver smoking cessation consultation services.
Reimburse the clinicians for consultation services.
Improve in the formularies and strategies of the hospital for effective smoking cessation treatment (Smoking Cessation A Systems Approach 1997).
Educate the staff regarding harms of smoking including treatment.

4. Smoking cessation treatment as paid service  The smoking cessation treatment should be included in the health benefit packages as the paid services as currently it is not provided as the paid services for the purchaser of health insurance packages. It will also reduce the cost of the country, which is increasing continuously because of the increase in the habit of smoking among the male workers of Saudi Arabia. The social care smoking cessation system provides coverage to all insurance subscribers for the smoking cessation treatments and therapy and counseling. The implementation of this strategy includes the coverage, evaluation and the education to the smoking cessation providers, which increases the cessation rate.

5. Compensation agreements  The insufficient insurance reimbursement is the most important barrier in proving preventive services to reduce the high risk situations due to smoking. The increase in the insurance coverage depicts an increase in the rates of smoking cessation utilization, which consequently, increases the quitting rate. Smoking cessation treatment as the paid services to the subscribers of health care improves the cessation utilization rate. The increase in the reimbursement also motivates the clinicians to deliver more effective smoking cessation treatment.

The compensation agreement also motivates the clinicians to ask about the smoking habits and barriers in quitting at each of the visits of the patients. It also helps to identify the reasons of smoking and quitting. The patients and clinicians could be encouraged to attend this program by improving education and incentives for them. The increase in the reimbursed fee increases the smoking cessation consultation services by the providers or clinicians.

Importance of Health and Social Care Smoking Cessation System
The health and social care smoking cessation system among the male smokers in Saudi Arabia is quite significant in order to increase the quit rate and the rate of smoking cessation utilization by the smokers. The health care and social care system includes several interventions and therapies to reduce the smoking among the people of the country such as self- help, individual intervention, group intervention etc. The Ministry of Health in Saudi Arabia may improve the effectiveness of smoking cessation programs and tobacco control program by providing proper education and literature about the risks and harms associated with the smoking.

The smoking cessation system in Saudi Arabia is causing an increase in the awareness among the male smokers, but it is relatively low in comparison of the other countries around the world. After implementing smoking cessation system, the results shows less effectiveness in Saudi Arabia as smoking habit is increasing continuously. It is because of the increase in the smoking among the medical students and health professionals, which are positioned as role models for the patients.

The smoking habit of health professionals has a higher amount of influence on the adolescents, which is the reason behind a rapid growth in the numbers of smokers. The result from the study of smoking habit among the adolescents describes a critical situation in Saudi Arabia as it shows that 50 of the smokers start smoking as adolescents (Abdulrahman et al 2008). It also has some socio-economic implications such as an increase in the mortality and morbidity.

Other than the health professional, family is also one of the most important social units or the reasons, which improves smoking among adolescents as initiation of family members or friends also attract the adolescent towards smoking. Smoking history of a family plays an important for smoking behavior among other family members, especially, adolescent. At this time, the social care smoking cessation system plays an important role to reduce the smoking behavior of the smokers by providing education and knowledge about the harmful effects of smoking. The greater proportion of smokers in household also results into smoking behavior among the other family members, which is also reduced by the smoking cessation interventions.

Problems in Smoking Cessation System in Saudi Arabia
The discussion from the above study explains several problems in the smoking cessation system of Saudi Arabia among the male smokers to discontinue smoking. Saudi Arabia is facing enormous challenges as the number of interventions failure are increasing  continuously, which is causing an increase in the number of people, who have failed to quit smoking. The relapse rate is also increasing, which indicates the requirement of effective methods or interventions for smokers to increase smoking cessation (Abdulrahman et al 2008).

Recommendations
Saudi Arabia is facing several problems in implementing smoking cessation in an effective manner among the male smokers. In order to improve the effectiveness, the Health Ministry, health professionals and other social stakeholders should implement some strategies or monitor the smoking cessation system effectively. The health administrators should examine strictly on the tobacco advertisement as it is the most effective element to increase the smoking behavior among the adolescents. The smoking cessation providers should use the individual interventions as it is the most effective intervention to increase the rate of quitting.

Another option to increase the effectiveness of smoking cessation is the adaptation of ecological approach. This approach significantly focuses on the causes of health issues from multiple prospective. It also helps to design multiple interventions to provide smoking cessation to the smokers and the patients according to their requirements. This approach is beneficial to support the health promotion programs by properly reviewing the causes of health problems and the most effective promotion intervention to reduce that particular health problem. The increase in the anti-smoke advertisement and campaigns would also help to increase the awareness among the smokers, which would be beneficial to enhance effectiveness of smoking cessation system.

To examine the smoking policies, the contextual approach should be implemented as it helps to examine the smoking policies in context of social norms and smoking impact on environment. This approach would be effective to formulate more effective smoking cessation system as it includes heath, social and environmental aspects of smoking. It would also help to reduce the cost of the Saudi Arabia. It should also implement some effective programs related to the health issues and the risk associated with smoking, as it would enhance awareness among the smokers about the harmful effects.

Conclusion
As per the analysis of the study of the health and social care smoking cessation system among the male smokers in Saudi Arabia, it can be described that male students are more prone to smoke in comparison of the females students. The habit is also increasing among the medical students and the health professionals, even when they are aware about its harms. It is causing an increase in the smoking behaviors of others as they see health professionals as role models. It is also reducing the effectiveness of smoking cessation among these smokers. In order to increase efficiency of smoking cessation, the Ministry of Health should adopt some effective measures such as tobacco control act, ban on the advertising of tobacco products etc. The family members and friends should also support the smokers, who want to quit. It will improve the effectiveness of health and social care smoking cessation system among the male smokers in Saudi Arabia.