1. Why did the old fisherman not stop smoking?

• He did not think he could get cancer. ("I'll never get cancer. The people in my family are very hardy and healthy.")
  (Note that this is often called perceived susceptibility.)

• He thought that the disease caused by the behavior was not that serious. ("Well, I don't even know what emphysema is, but I'm sure it won't be anything that I can't handle even if I do get it.")
  (Note that this is often called perceived severity.)

• He thought that if he quit smoking, he would get cancer anyway. (“…[I]f I'm supposed to get it, I'm sure I will whether or not I quit smoking. I've smoked all my life!")
  (Note that this is often called perceived action efficacy.)

• He thought that it was too difficult to get rid of the habit. ("It's just too hard!")
  (Note that this is often called perceived self-efficacy.)

• He "forgot" that he had quit smoking. ("I just can't remember that I don't smoke!")
  (Note that this is often referred to as “cues for action.”)

• All of his friends smoked. ("Well, it would be a lot easier if all my friends didn't smoke! Every time I see them, it makes me start up again!")
  (Note that this is often called perceived social acceptability.)

• He believed that it was God's will that he smoke and get cancer.
  (Note that this is often called perception of divine will.)

2. In addition to using appropriate behavior change messages, what other activities did Rafaella and the fisherman initiate that may have helped the old fisherman to stop smoking?

• February: Rafaella engaged in consciousness raising and changing community norms (e.g., getting community leaders to agree to not allow smoking during official community meetings)

• February/May: Environmental control (getting rid of packs of cigarettes and ashtrays to get rid of cues that make him want to smoke)

• June: Starting a support group

• August: Starting a fishing cooperative (an alternate activity)

3. Did he finally stop smoking? How did he do it?

• He convinced his friends that they could save money. ("I convinced them that with the money we would save by giving up smoking, we could form a fishing cooperative.")
  (Note that this is one of the positive attributes of the action).

We need to take each of these possible “barriers” (or determinants) and potential promoters of action seriously and look into them when a particular practice is not being done. This does not need to take a lot of time. We will give an example later of how this was done in one country, the Dominican Republic, in a single afternoon. First we will talk about each of these determinants in a little more detail.