HLTH 6403 Module 2 Theory Application to a Population Health Behavior Example

Willing Before Intending: Applying the Prototype Willingness Model to a Young Man's First Dip or Nicotine Pouch in Plains Ranch and Oil Country

Student Name

American College of Education

HLTH6403: Theories and Principles of Behavior Change in Health Education

Module 2 Assignment

Instructor Name

January 19, 2026

Introduction

Module 1 set five theories against dip and pouch use by 16- to 24-year-old men in a composite Plains county where ranching, grain hauling and oilfield work dominate. It concluded that the prototype willingness model best explains first use, because much first use in this population is unplanned. This paper applies the model in detail. It describes the model's two pathways, works through each construct using local data and published evidence, assesses how well the model fits and considers what it implies for health education. Local data come from the county's 2025 youth risk survey, completed by 612 students in grades 9 through 12, and from four focus groups the health department held with 29 young men: two with high school athletes and two with men aged 18 to 24 working in agriculture and the oilfield.

The Model in Brief

The prototype willingness model proposes that adolescent and young adult health risk behavior follows two paths (Gerrard et al., 2008). The reasoned path runs from attitudes and subjective norms to intention and then to behavior, much as in the theory of planned behavior. The social reaction path runs through willingness, a person's openness to the behavior in a situation that makes it easy, and willingness is shaped by prototypes, the images a person holds of the typical individual who engages in the behavior. The more favorable the prototype and the more similar a person feels to it, the greater the willingness. In early work, Gibbons et al. (1998) showed that willingness and intention were related but distinct and that each predicted adolescent smoking independently, supporting the model's claim that much adolescent risk behavior is not planned.

The Behavior in the County

Nationally, 7.5% of high school boys reported current smokeless tobacco use in 2019, compared with 1.8% of girls (Farrelly et al., 2021), and pouch use among students has risen since (Travis et al., 2026). The county's survey shows higher use: 14% of boys in grades 11 and 12 reported using moist snuff or nicotine pouches in the past 30 days, and 31% of boys said they had tried one or the other. Among those who had tried, 68% said the first time was when someone offered it, most often a teammate, an older brother or a coworker, and only 11% said they had planned to try it beforehand. These figures already favor the social reaction path.

Prototypes

Focus group participants described the typical young man who dips in strikingly consistent terms: hard-working, outdoorsy, tough, a little rebellious and respected by older men. The typical pouch user was described differently: younger, more likely to be an athlete or a student, clean-cut and modern, someone who wanted the nicotine without the mess. Both images were broadly favorable. Few participants described the typical user as unhealthy, addicted or unattractive, although several mentioned stained teeth and bad breath as drawbacks of snuff. When asked how similar they were to these images, most athletes identified with the pouch user and most working men with the snuff user. The favorability and similarity of these prototypes, rather than any calculation of risk, seem to be what makes an offer hard to refuse.

Willingness

The county survey included two willingness items adapted from the model's standard format: if a friend or coworker offered you a pouch or a dip at a party or on a job site, how willing would you be to take it? Among boys who had never used either product, 26% reported some willingness, compared with only 9% who said they intended to try one in the next year. That gap between willingness and intention is the model's signature. Focus group participants described the situations that raise willingness: long drives to away games, hunting trips, harvest and calving seasons, long shifts on a rig where smoking is banned, and any setting where older men they respect are using. In those settings, several said, refusing would have felt more awkward than accepting.

The Reasoned Path

The reasoned path matters too, especially for continued use. Attitudes toward pouches were positive among users: they described staying alert, calming down before a game and avoiding the smell of cigarettes. Subjective norms were mixed. Teammates and coworkers were seen as approving, parents as disapproving of snuff but uncertain about pouches and coaches as officially opposed but rarely enforcing. Among regular users, most said they now planned their use, keeping a tin in the truck and buying on a schedule, which suggests that after first use the behavior shifts toward the reasoned path. This matches the model's prediction that willingness is most important early and intention becomes more important with experience.

Risk Images and Perceived Harm

The model predicts that willingness is lower when people perceive a behavior as risky, especially when risks are concrete and relevant to their image of themselves. In the county, perceived risk was low and abstract. Mouth cancer was mentioned, but as something that happens to old men after decades of use, and pouches were widely believed to be safe because they contain no tobacco leaf. This pattern echoes the finding among rural high school baseball players that smokeless tobacco was rated as less harmful than cigarettes and as carrying real benefits (Chaffee & Cheng, 2018). The risks that did register in the focus groups were social and cosmetic: stained teeth, bad breath, a girlfriend's disapproval and trouble with a coach.

How Well Does the Model Fit?

The model fits this behavior well in three respects. It explains why most first use is unplanned, why intention measures understate risk and why the image of the user matters so much. The broader evidence supports using it with this age group: a meta-analysis of 81 studies found that the model explained 20.5% of the variance in behavior, that willingness added 4.9% over and above intention and that the model worked best in adolescent samples (Todd et al., 2016). The same meta-analysis found that intention was usually more strongly related to behavior than willingness and that results varied widely by behavior, so the model should not be treated as a complete explanation. It also says little about the environmental and commercial forces, such as pouch marketing and retail placement, that shape which prototypes circulate in the first place.

Implications for Health Education

If the model is right, three implications follow. First, education that raises intentions not to use, the goal of many classroom lessons, will miss young men who never intended to use but were willing when offered. Programs should reduce willingness directly by rehearsing specific offer situations, such as the bus ride, the hunting trip and the rig, and by giving young men ways to decline that protect their image. Second, programs should work on prototypes, making the typical user less appealing and less similar, for example by drawing attention to dependence, which contradicts the image of an independent man, and to the cosmetic effects young men already notice. Third, because older men model the behavior, interventions should involve coaches, fathers and crew leaders. Module 3 will examine the sociological influences, including those older men, in more depth.

Conclusion

Applied to oral nicotine use in a rural Plains county, the prototype willingness model accounts for the unplanned nature of first use, the gap between willingness and intention and the power of favorable images of the typical user. It is weaker on environmental forces, which later modules will address. Its main lesson for health education is that preventing first use means changing how young men see the user and how they respond in the moment of an offer, not only what they intend.

References

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

Farrelly, M. C., Taylor, N. H., Nonnemaker, J. M., Smith, A. A., Delahanty, J. C., & Zhao, X. (2021). "The Real Cost" Smokeless campaign: Changes in beliefs about smokeless tobacco among rural boys, a longitudinal randomized controlled field trial. BMC Public Health, 21, Article 2282. https://doi.org/10.1186/s12889-021-12356-6

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

Gibbons, F. X., Gerrard, M., Blanton, H., & Russell, D. W. (1998). Reasoned action and social reaction: Willingness and intention as independent predictors of health risk. Journal of Personality and Social Psychology, 74(5), 1164-1180. https://doi.org/10.1037/0022-3514.74.5.1164

Todd, J., Kothe, E., Mullan, B., & Monds, L. (2016). Reasoned versus reactive prediction of behaviour: A meta-analysis of the prototype willingness model. Health Psychology Review, 10(1), 1-24. https://doi.org/10.1080/17437199.2014.922895

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