HLTH 6403 Module 1 Behavior Change Theory Comparison Example

Which Theory Explains the Can in the Back Pocket? Comparing Five Behavior Change Theories for Dip and Nicotine Pouch Use Among Young Men in a Rural Plains County

Student Name

American College of Education

HLTH6403: Theories and Principles of Behavior Change in Health Education

Module 1 Assignment

Instructor Name

January 12, 2026

Introduction

In a composite county on the northern Plains, where most jobs are in ranching, grain hauling and oilfield services, the round can of moist snuff in a young man's back pocket has been a familiar sight for generations. In the last few years it has been joined by a smaller, flatter tin of flavored nicotine pouches, which leave no spit cup and no stain. The county's school nurses and the health department report that oral nicotine use among young men aged 16 to 24 is common and rising, even as cigarette smoking falls. Before anyone designs a response, the county's health education team needs to understand why young men start and keep using these products. This paper compares five behavior change theories against that question: the health belief model, the transtheoretical model, the theory of planned behavior, the prototype willingness model and social cognitive theory. The social ecological model serves as a frame for the comparison. Each theory is judged on three criteria: how well it explains the behavior in this population, how strong the evidence behind it is and how useful it would be for designing an intervention.

The Behavior and Why It Resists Simple Explanation

Two features of the behavior make theory choice difficult. First, smokeless products are widely seen as a lesser harm. In a study of 594 male baseball players at 36 rural California high schools, participants rated smokeless tobacco as similar to cigarettes on mouth cancer and getting in trouble but as less likely to cause systemic harm and more likely to bring benefits such as relaxation, and most rated cigarettes as the more harmful product (Chaffee & Cheng, 2018). Second, the newer pouches are marketed as clean and modern. An updated scoping review found that U.S. sales of oral nicotine pouches more than tripled between 2021 and 2024, that 1.8% of middle and high school students reported current use in the 2024 National Youth Tobacco Survey and that adult use was concentrated among people under 45 and existing tobacco users (Travis et al., 2026). A theory that assumes young men fear the product will miss both facts.

The Social Ecological Frame

The social ecological model is not a theory of individual choice but a way of organizing influences at intrapersonal, interpersonal, institutional, community and policy levels (McLeroy et al., 1988). It is useful here as a frame because oral nicotine use in this county plainly has causes at every level: individual beliefs about harm, friends and fathers who dip, workplaces that ban smoking but tolerate snuff, stores that sell pouches beside the register and state policy on flavors and taxes. Each theory below can be placed on this frame to see which levels it reaches and which it leaves out.

Health Belief Model

The health belief model holds that people act against a health threat when they feel vulnerable to it, judge its consequences serious, expect the action to help and meet few obstacles, with cues to action and, in later versions, self-efficacy added. A decade of research reviewed by Janz and Becker (1984) found perceived barriers the most consistently powerful predictor across studies. For this behavior, the model's strength is its attention to beliefs about harm, which clearly shape use: young men who see pouches as nearly harmless are unlikely to avoid them. Its weakness is that it treats the behavior as a response to health threats, when for many young men dipping is not a health decision at all but a social and work habit. It reaches only the intrapersonal level, and it offers little for explaining why a product is taken up in a hunting blind or a truck cab.

Transtheoretical Model

Prochaska's model describes change as movement through stages from precontemplation to maintenance and matches processes of change to each stage (Prochaska & Velicer, 1997). It is useful for cessation, since users of oral nicotine differ widely in readiness to quit, and stage-matched messages are a practical tool for clinics and coaches. It is weaker for explaining initiation, which is the larger concern among 16- and 17-year-olds, and critics have questioned whether the stages are distinct categories rather than points on a continuum. Like the health belief model, it concentrates on the individual.

Theory of Planned Behavior

This theory predicts behavior from intention, which in turn depends on attitudes, subjective norms and perceived behavioral control (Ajzen, 1991). Its inclusion of norms is a clear advance for this behavior, since approval from friends, teammates and older coworkers is plainly part of the story. Its limitation is the assumption that behavior follows a reasoned intention. Many young men in the county describe their first dip as something they did because it was offered on a job site or a road trip, not because they had planned to. A theory built on deliberate intention risks explaining the later habit well and the first use poorly.

Prototype Willingness Model

The prototype willingness model was developed to address exactly that gap. Gerrard et al. (2008) describe two paths to adolescent risk behavior: a reasoned path through intentions, as in the theory of planned behavior, and a social reaction path through willingness, the openness to a risky act if the opportunity arises. Willingness is shaped by the images, or prototypes, that young people hold of the kind of person who does the behavior, and by how similar they feel to that image. For a product offered on a tailgate by an older coworker, willingness and the image of the hard-working man who dips may explain more than any plan. The model's limits are its focus on adolescents and young adults, which fits this population, and a smaller evidence base than the older theories.

Social Cognitive Theory

Bandura's theory explains behavior through the reciprocal interaction of personal factors, behavior and environment, with self-efficacy, outcome expectations, observational learning and environmental supports at its center (Bandura, 2004). It reaches beyond the individual more than the other theories, since it attends to what people see modeled around them and to environmental barriers and facilitators. For oral nicotine, observational learning from fathers, older teammates and coworkers is central, and outcome expectations, such as staying alert on long shifts or fitting in with a crew, are specific and testable. The theory's breadth is also its weakness: it can explain almost any behavior after the fact, which makes it hard to test and easy to use loosely.

Comparing the Five

On explanatory fit, the prototype willingness model and social cognitive theory perform best, because they account for unplanned first use and for learning from others, the two features most visible in this population. The theory of planned behavior explains continued use well but first use less well. The health belief model and transtheoretical model explain parts of the picture, harm beliefs and readiness to quit, but miss its social core. On evidence, the health belief model, transtheoretical model and theory of planned behavior have the largest literatures, and social cognitive theory underpins many successful interventions, while the prototype willingness model's evidence is younger but growing. On usefulness for intervention, social cognitive theory offers the most levers, and the prototype willingness model suggests one that the others miss: changing the image of the typical user. None of the five reaches the institutional, community and policy levels well, which is why the ecological frame must stay in view.

A Provisional Choice

For the modules that follow, I will use the prototype willingness model as the primary theory for explaining initiation among the youngest men and social cognitive theory for explaining continued use and planning change, with the ecological model keeping workplace, retail and policy influences in the analysis. The transtheoretical model will be kept in reserve for a cessation component. This combination is not the most economical, but the behavior has two distinct phases, starting and continuing, and no single theory explains both well. Module 2 will apply the prototype willingness model to the behavior in detail.

Conclusion

Comparing theories against one behavior in one population shows that the choice is not academic. Theories that treat oral nicotine use as a response to health threats would design warnings for young men who already believe the products are relatively safe and who began using them without deciding to. Theories that attend to images, willingness, modeling and environments point toward interventions that work with how the behavior actually spreads.

References

Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179-211. https://doi.org/10.1016/0749-5978(91)90020-T

Bandura, A. (2004). Health promotion by social cognitive means. Health Education & Behavior, 31(2), 143-164. https://doi.org/10.1177/1090198104263660

Chaffee, B. W., & Cheng, J. (2018). Cigarette and smokeless tobacco perception differences of rural male youth. Tobacco Regulatory Science, 4(4), 73-90. https://doi.org/10.18001/TRS.4.4.8

Gerrard, M., Gibbons, F. X., Houlihan, A. E., Stock, M. L., & Pomery, E. A. (2008). A dual-process approach to health risk decision making: The prototype willingness model. Developmental Review, 28(1), 29-61. https://doi.org/10.1016/j.dr.2007.10.001

Janz, N. K., & Becker, M. H. (1984). The health belief model: A decade later. Health Education Quarterly, 11(1), 1-47. https://doi.org/10.1177/109019818401100101

McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351-377. https://doi.org/10.1177/109019818801500401

Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12(1), 38-48. https://doi.org/10.4278/0890-1171-12.1.38

Travis, N., Warner, K. E., Hartmann-Boyce, J., Goniewicz, M. L., Ma, C., Meza, R., & Levy, D. T. (2026). Oral nicotine pouches and public health: Evidence from an updated scoping review. Nicotine & Tobacco Research. Advance online publication. https://doi.org/10.1093/ntr/ntag203