M.Tech.

M.A. / The aim of this study was to investigate the psychological barriers to the cessation of smoking behaviour as experienced by addictive smokers in a South African context, and also to assess the relative importance of these barriers. These barriers were viewed as arising from perceptions of the costs and benefits or pros and cons of smoking and smoking cessation. This cognitive appraisal process was understood as being a series of schema for comprehending both the cognitive and motivational aspects of human planning for future action. The transtheoretical or stages of change model was used as a theoretical framework upon which the research was constructed. The model holds that two interrelated dimensions are necessary in order to adequately assess the behaviour modification of smoking and other such health compromising behaviours: stages of change and processes of change. Stages of change refer to the temporal, motivational, and constancy aspects of change while processes of change focus on activities and events that facilitate successful modification of a problem behaviour such as smoking, and represent coping activities used to modify smoking behaviour. The study hypothesized firstly that precontemplative smokers would demonstrate the highest ratings on the risks of smoking cessation and the lowest ratings on the benefits, while smokers in the contemplation stage would demonstrate a greater balance of risks and benefits of smoking cessation and smokers in the preparation stage would demonstrate highest ratings on the benefits of smoking cessation and the lowest ratings on the risks. In this way the study assessed the validity of various stages of change research in a South African context regarding the weighing up of the pros and cons of smoking behaviour and the expected linear shift in perceptions as the action stage is approached. However, for the purposes of the research conducted, the contemplation and preparation stages were combined to form what was referred to as the planning stage. Secondly, the study hypothesized that at each of the various stages, certain perceptions of the risks and benefits of smoking cessation would emerge as being of greater significance than others. A positivist approach to theory and investigation was utilized for the purposes of conducting the research. In accordance with this approach, quantitative self report data was collected. The Perceived Risks and Benefits Questionnaire was used as a means of assessing the perceived risks and benefits associated with smoking cessation. The results of this study demonstrated that stages of change did indeed have an effect on the way in which the risks and benefits of smoking cessation were perceived. In this regard, the variations between the various stages were in accordance with the findings of prior stages of change research. Certain risks and benefits also emerged as being of greater significance than others for smokers in the various stages. Results also underlined the importance taking a smokers stage of change of change into account when considering smoking cessation programmes. Processes of change as identified within the transtheoretical model emerged here as having a potentially important role to play, but more research investigating the matching of stages and processes of change in a South African context is required. In addition, it is also recommended that future research in this area be conducted within a variety of demographic and socio-economic contexts in South Africa. Research that is longitudinal in nature is also viewed as being potentially beneficial, as is research of a qualitative nature. Such investigations are viewed as important because they would continue to enrich our understanding of the journey towards smoking cessation as experienced by South African smokers. / Dr. Hilton Rudnick

Class of 2005 Abstract / Objectives: To assess students’ confidence levels about smoking cessation implementation from different types of training experience and assess what factors contribute the strongest towards successful interventions for students in the practice setting. Methods: The project design involved the administration of a questionnaire for students distributed by the investigator to 1st, 2nd, and 3rd year University of AZ College of pharmacy students. Section I provided a grid which asked the student to fill in how many hours of each tobacco cessation training areas they had completed. Section II was focused on how the student addressed these issues in their work setting, and used confidence intervals to identify how confident they were in addressing these issues with patients. Section III focused on work history and addressed issues such as work hours, exposure to patients, counseling opportunities, etc., to get a feel for how active the students were in counseling at their worksite. Section IV of the questionnaire addressed the student’s demographic characteristics, such as race/ethnicity, marital status, and age. Question 18 at the end of Section IV provided the student space for constructive comments about the survey. Results: Scores were derived from the surveys and confidence intervals were compared to total training time using a Pearson r. The third year students were significantly more confident (p < 0.035) for all aspects of counseling, asking, advising, assessing readiness, arranging, and monitoring. Third year students were also more confident than second year students in all aspects of counseling except asking. The differences between the first and second years were not significant for any of the aspects of counseling (p > 0.05). Third year students also had significantly more experience (2.9 years) than first (1.1 years) or second (1.8 years) year students (p = 0.001). Correlations were drawn to compare confidence and: total training hours, work experience, times counseled; to correlate training time and times counseled, and to compare work experience to actual times counseled. The highest correlation drawn to actual times counseled was shown to be total training time, suggesting this is the most important predictor of patient counseling for pharmacy students. ANOVA tests were used to assess any differences in demographics between year of student categories. Implications: Students effectively counseling patients on smoking cessation is most closely related with formal training they complete, rather than how confident they feel or how knowledgeable they are about the effects of smoking.

No description available.

Guidelines and laws prohibit smoking in public places, and evidence supports the safety and effectiveness of workplace wellness programs in promoting healthy environments. A long-term care (LTC) facility selected as the focus for this project does not offer wellness programs and does not restrict on-site smoking by employees. The purpose of this project was to construct an evidence-based smoking cessation education program for delivery to employees at the LTC facility. The practice-focused question addressed whether a workplace wellness smoking cessation education program would increase employees' knowledge of the harmful effects of smoking and promote engagement in smoking cessation strategies. A pretest and posttest to assess knowledge of the harmful effects of smoking was designed to be administered to employees prior to and after the education program. A panel of 6 experts consisting of 4 clinical nurse specialists, a nurse educator, and a nurse researcher was selected to assess the potential effectiveness of the education program. A 10-question survey was used to obtain the panel experts' evaluation of the program. Descriptive statistics were then used to analyze the results. Nearly all of the experts surveyed reported that they would recommend the education program to a friend or colleague, with 66% selecting "very likely" This is indicative of the potential for the program to be effective. Findings might support social change at the selected facility by increasing staff knowledge of the harmful effects of smoking and staff commitment to participating in a smoking cessation program.

Cigarette smoking in adults with serious mental illness (SMI) has increased even when accounting for a decrease of smoking among the general population. Most of the research has focused on the prevalence, rates, and effects of smoking in adults with SMI. Little research has examined the motivations for smoking and experiences with smoking cessation among adults with SMI. Such an understanding may facilitate a reduction in smoking in this population. To address this gap in the literature, 12 adults with SMI who live in the southern Nevada area and smoke were selected through invitations distributed at a treatment facility and the use of the snowball technique. Interviews were designed to elicit these adults' views and experiences of smoking and smoking cessation. The health belief model provided the conceptual framework for this phenomenological study. Interview data were recorded, transcribed, coded, and analyzed with emergent codes and themes. Three major themes emerged from participant stories: perceived benefits to cigarette smoking, problems related to smoking cessation, and risks related to cigarette smoking. Results indicated that participants found a sense of relaxation and means of socialization while smoking. Despite attempts to quit smoking, participants struggled with the withdrawals of nicotine which led to continuous smoking despite the negative consequences of smoking on their quality of life. This study contributes to positive social change by revealing the voices of adults with SMI, which helps illuminate a more holistic approach to treatment. Study findings may contribute in the development and implementation of smoking cessation programs for this specific population.

No description available.

ABSTRACT Background: In association with other occupational exposures like silica dust and radon, cigarette smoking impacts on the health of miners, especially with regard to the risk of developing COPD, PTB and lung cancer. These compensable diseases place a great burden on both miners and mines. The prevalence of smoking among black miners in South Africa is unknown and data for white miners are not recent. Objectives: To determine the prevalence of smoking and smoking trends in miners in a platinum mining company from 1998 to 2002 and to describe some important factors associated with their smoking habits. Methods: This was a cross-sectional study using medical surveillance data about employees of a platinum mining company from 1998 to 2002. Results: Over 80000 repeated records of over 25000 miners were studied over the five-year period. The prevalence of smokers was 44.4%. Miners were less likely to smoke in 2002 than in 1998 (OR 0.23, CI 0.21 – 0.25). Over this period, smoking prevalence dropped from 43.3% to 31.3%. The decrease was evident in most socio-demographic groups. There was also a decrease in cigarette consumption over time (p<0.001). Multivariable analysis showed that whites were more likely to “always” and/or “ever” smoke than blacks (adjusted OR=2.4, CI 1.79 – 3.20 and OR 2.5, CI 1.98 – 3.27, respectively). Conclusion: Even though there has been a decline in smoking prevalence since 1998, the relatively higher prevalence in platinum miners compared to that of the general population, and the additional effect of occupational exposures, are still a public health concern. There is need to establish smoking cessation and prevention programmes and to continue collecting detailed smoking information during annual surveillance programmes that could be used to monitor the effectiveness of such programmes.

This thesis puts forward a unique perspective for how we can view changes in the context of sedentism, specifically with regard to the Middle and Late Woodland periods (ca. 400 B.C. – A.D. 1650) in southern Ontario. The transition to a more sedentary way of life leads to significant socio-economic changes in settlement type, subsistence, demography, architecture, and material culture, and acts as an incentive for change as it pertains to ideological transformations. In this thesis I concentrate on how changing ways of living impacted people’s ideology and related practices, focusing on the social habit of smoking, and its related material culture pre and post-sedentism in southern Ontario. I suggest that the changes witnessed in this practice (and associated paraphernalia) are reflective of a means of social group maintenance, and by extent a different mechanism of how societies regulated themselves. My study further examines the role smoking pipes had for group and individual recreational use, alongside group communal practices. I propose that more pipes per site signify daily use, reflecting a shift away from the pre-sedentary communal practice of smoking led by ritual specialists, to a post-sedentary individual and occasional group experience. Moreover, I argue for a link between smoking, social relationships, and the promotion of social solidarity. The stimulus for certain practices, and the structure of the socio-cultural system within which they occur, is significant for they are interwoven into all aspects of society. The aim of this thesis is to add to our perception of change and transformation during the Middle and Late Woodland periods of southern Ontario, while providing a unique perspective for understanding socio-cultural transformation in the context of sedentism more generally. / Thesis / Master of Arts (MA)

This thesis is concerned with the issue of smoking in the surgical population. Globally, over 300 million adults undergo surgery annually and around 60 million are smokers. The population impact of this is enormous. Moreover, smoking increases postoperative complications and is a leading cause of morbidity and mortality. Smoking rates are declining in the general population; but remains higher among surgical populations. Despite being an important modifiable risk factor, and the availability of treatments for smoking, many patients presenting for surgery still smoke and many resume smoking after surgery. Importantly, unfortunately in surgical settings, the implementation of evidence-based cessation interventions is still suboptimal. The time around surgery is a “teachable moment” and surgical guidelines recommend that all patients who smoke should be provided with evidence-based smoking cessation assistance. This thesis seeks to answers the following questions: What are the factors that determine abstinence from smoking after surgery? What is (are) the best smoking cessation intervention(s) in the surgical setting? What factors constitute barriers and facilitators to the implementation of effective smoking cessation interventions? Is cytisine effective for smoking cessation? Will the use of cytisine and behavioral counselling delivered via personalized video messaging increase abstinence from smoking at 6 months post-randomization among surgical patients? Using a variety of research methodologies, the data provided across the 5 papers in this thesis inform these knowledge gaps. Chapter 1 is an introduction providing the rationale for conducting each of the included studies. Chapter 2 is a secondary analysis from the Vascular events in Noncardiac Surgery Patients Cohort Evaluation (VISION) study that evaluated the determinants of smoking abstinence in a representative sample of patients undergoing major non-cardiac surgery. Chapter 3 is a systematic review, pairwise meta-analysis, and network meta-analysis of randomized controlled trials evaluating preoperative smoking cessation interventions. Chapter 4 is a scoping review that explores the barriers and facilitators to smoking cessation in the surgical setting. Chapter 5 is a systematic review and meta-analysis of cytisine for smoking cessation Chapter 6 reports on the rationale and design of the PeRiopEratiVE smokiNg CessaTion (PREVENT) randomized controlled trial evaluating the efficacy and safety of cytisine versus placebo, and in a 2x2 factorial, personalized video messaging versus standard care for smoking cessation among adults undergoing surgery. Chapter 7 is the conclusion chapter wherein I discuss the key findings, limitations, and implications of the research presented in this PhD thesis. / Thesis / Doctor of Philosophy (PhD) / Up to 1 in 7 adults having surgery are cigarette smokers. Smoking increases the risk of complications after surgery and negatively impacts patient’s health and survival in the long term. Patients who are smokers have to stop smoking while in hospital for their surgery but majority of them resume smoking right after surgery. This is a missed opportunity to turn enforced temporary abstinence from smoking to permanent abstinence. It is informative to understand the factors that determine this resumption of smoking after temporary abstinence, determine the most effective interventions to help smokers quit smoking permanently and importantly, understand the barriers and facilitators to smoking cessation in surgical settings. Additionally, the current methods for smoking cessation are sub-optimally utilized in surgical settings. We need further research to evaluate new interventions, and ways of delivering smoking cessation care for smokers undergoing surgery. The studies in this thesis inform on these knowledge gaps.