Addressing behavioral risk factors is essential to health promotion efforts and the accomplishment of the Healthy People 2020 goals. One behavioral risk factor identified by Knickman and Covner (2015) is “Secondhand Smoke Exposure in Children 6 Years and Younger.” Currently, an estimated 27 percent of children within this age range are regularly exposed to tobacco smoke, but the 2020 goal is to bring that level down to 10 percent (Knickman & Covner, 2015). In my community, this behavioral risk factor is negatively affecting children by putting them at risk of respiratory disease and other chronic health problems in the feature (Hancock & Cooper, 2011). This behavioral risk factor also affects my community by raising the cost of healthcare for individuals and for the healthcare system as a whole (Schwartz et al., 2010). Therefore, it is negatively impacting my community in terms of its effect on the physical and mental health of the individuals in the community, as well as their economic outlook.

Population-Based Intervention Model
In Health Care Delivery in the United States, Knickman and Covner (2015) lay out a Population-Based Intervention Model that includes downstream, midstream, and upstream interventions. When attempting to address secondhand smoke exposure as a behavioral risk factor, choosing an intervention from each phase can be justified. Specifically, downstream interventions are valuable because they involve direct outreach to individuals in order to promote behavioral change (Knickman & Covner, 2015). A midstream intervention can be justified by the fact that it is implemented at the population level and can involve preventive measures alongside change-focused interventions (Knickman & Covner, 2015). Finally, upstream interventions that target state and national public policy are valuable because they can have broader consequences throughout society (Milstead & Short, 2019).

Downstream Intervention
One downstream intervention that can be implemented to address this issue is to offer self-help programs for parents who smoke regularly (Knickman & Covner, 2015). In these programs, parents could learn about the negative health impacts of secondhand smoke on children under the age of 6, which could encourage them to modify their behavior and either quit smoking or ensure that they do not smoke in the vicinity of their children. Because children under the age of 6 do not directly have the power to lower their exposure to secondhand smoke, it is best to choose a downstream intervention that aims at promoting behavioral change in parents.

Midstream Intervention
It is also possible to address the behavioral risk factor of secondhand smoke exposure among children under the age of six through a midstream intervention at the population level. In particular, it would be valuable to implement a health plan-based primary care screening program (Knickman & Covner, 2015). Under this program, primary care providers would screen all children 6 years and under for secondhand smoke exposure at regular check-ups. This program would aid in the identification of families that require support, through a combination of the monitoring of the child’s respiratory health and the provision of educational materials for parents that can help them avoid exposing their child to secondhand smoke or quit smoking altogether.

Upstream Intervention
Upstream interventions are state and national policies that may aid in the achievement of a health goal. In relation to the behavioral risk factor of secondhand smoke exposure among children under the age of 6, an appropriate government policy is an economic incentive in the form of an excise tax on all tobacco products (Knickman & Covner, 2015). This could deter more parents from smoking tobacco, which would subsequently lead to an overall decrease in the proportion of children under the age of 6 being exposed to secondhand smoke.