Current understanding of periodontal disease derives from studies mostly conducted in developed countries. However, the disease process among those studied populations may be confounded by the professional dental care. There have been few attempts to investigate factors related to the disease among populations of developing countries where the natural history of the disease is minimally confounded by care. This imbalance is evident in risk assessment research on the associations between periodontal disease and smoking-one of the most significant risk factors for the disease. Also, most studies on smoking used convenience or purposive samples, which may bias the findings. Therefore, there is a need for research conducted among a representative sample of a developing country. The present study aimed to describe the prevalence, extent and severity of chronic adult periodontitis among representative Vietnamese middle-aged adults. Also, it aimed to investigate smoking, which is highly prevalent in Vietnam, as a risk indicator for periodontal disease in a population with minimal access to dental care. The study was designed as a cross-sectional population-based study with a multistage, stratified random sample with probability of selection proportional to population size. The US National Institute of Dental Research (NIDR) protocol was used to assess loss of periodontal attachment among 575 dentate subjects in two randomly selected provinces. Assessment was made at mesial and buccal sites of every present tooth, excluding third molars. A parallel social survey collected socio-demographic information and smoking history, which were assessed for possible association with the disease status. Periodontal disease was highly prevalent among the sample. The patterns of the disease were similar to those reported from other populations. Virtually all subjects expressed some levels of disease, whereas only a few subjects or sites had severe disease. Bivariate analyses revealed significant associations between smoking and lower socio-economic status with more severe expression of the disease. Smoking was consistently associated with poorer periodontal status irrespective of outcome measure investigated. Multivariate models showed that smoking was the most predictive factor for the disease. The Odds Ratio of having severe periodontitis (that is, having 2+sites with loss of attachment more than or equal to 5 mm and 1+sites with pocket depth more than or equal to 4 mm) was 7.93 for heavy smokers compared to non-smokers. A dose-response effect of the association between smoking and the outcomes of the disease was also evident. The study provided a picture of the periodontal status of the representative sample from Vietnamese middle-aged adult population where the disease was less confounded by dental care. Furthermore, the study contributes consistency, strength and dose-response effect to the association of smoking as a risk indicator for periodontal destruction. The study should be used to assist the public health agencies in planning appropriate policies for Vietnam to address smoking and periodontal disease. / Thesis (M.Sc.)--Dental School, 2001.

This thesis examined three different research questions to help build a knowledge base for future intervention strategies by better understanding the reasons behind smoking among pregnant women in Nunavut. The first study focused more at the individual level and investigates clinical and socioeconomic factors and their relationship to readiness to quit smoking. The second manuscript moved beyond the individual level to the broader social and structural environment to identify a broader range of barriers and facilitators to smoking and smoking cessation among Inuit women. This second manuscript draws upon in-depth interviews focusing on perceptions of smoking, and perceived barriers and facilitators of smoking behaviours. Finally, the third manuscript investigated the perspectives of health care providers regarding the barriers and facilitators of smoking cessation for pregnant women in the Baffin Region of Nunavut and describes perceptions of smoking cessation resources available to health care providers in the Baffin Region.

Introduction: To evaluate the effectiveness of smoking cessation intervention, reliable outcome is essential. Exhaled nitric oxide (ENO) is decreased in smokers, tends to normalize after cessation and might be a good tool to evaluate abstinence. Objective: To evaluate changes in ENO after smoking abstinence of 7 or more days. Methods: 58 smokers in a cessation attempt and 12 non-smokers were recruited: 7 visits for smokers and 2 for non-smokers. Carbon monoxide and cotinine were used to detect smoking status. Results: ENO is decreased in smokers compared to non-smokers (10.8 vs. 20.1 ppb, p<0.001). There was no significant difference in ENO pre and post quitting (p=0.080) although there was a trend to increase as early as 3 days after abstinence (10.78 vs. 15.11, p>0.05). There were no differences in nasal NO measurements (p=0.278). Conclusion: ENO doesn’t seem to be a reliable marker of short-term abstinence.

Social inequalities exist in smoking-attributable mortality rates of males. Change in these social inequalities in the past two decades in developed countries remains uncertain. This study was conducted in Canada, France, Poland, and Switzerland to quantify differences in smoking-attributable mortality rates, at ages 35-69 years, among different social strata in recent years and to examine the changes in social inequalities in these rates between 1986 and 2001. Analyses included 377,878 deaths from a total population of 13,482,210 males of these four countries. Smoking-attributable mortality rates reduced in all strata over the comparative time periods, in all countries, except France. This work specifically focuses to fill the gap in knowledge about whether tobacco control has reached the poor or lower social strata in developed countries. This study will enable follow up research including quantification of effects of the specific tobacco control policies in each country.

Introduction: To evaluate the effectiveness of smoking cessation intervention, reliable outcome is essential. Exhaled nitric oxide (ENO) is decreased in smokers, tends to normalize after cessation and might be a good tool to evaluate abstinence. Objective: To evaluate changes in ENO after smoking abstinence of 7 or more days. Methods: 58 smokers in a cessation attempt and 12 non-smokers were recruited: 7 visits for smokers and 2 for non-smokers. Carbon monoxide and cotinine were used to detect smoking status. Results: ENO is decreased in smokers compared to non-smokers (10.8 vs. 20.1 ppb, p<0.001). There was no significant difference in ENO pre and post quitting (p=0.080) although there was a trend to increase as early as 3 days after abstinence (10.78 vs. 15.11, p>0.05). There were no differences in nasal NO measurements (p=0.278). Conclusion: ENO doesn’t seem to be a reliable marker of short-term abstinence.

Social inequalities exist in smoking-attributable mortality rates of males. Change in these social inequalities in the past two decades in developed countries remains uncertain. This study was conducted in Canada, France, Poland, and Switzerland to quantify differences in smoking-attributable mortality rates, at ages 35-69 years, among different social strata in recent years and to examine the changes in social inequalities in these rates between 1986 and 2001. Analyses included 377,878 deaths from a total population of 13,482,210 males of these four countries. Smoking-attributable mortality rates reduced in all strata over the comparative time periods, in all countries, except France. This work specifically focuses to fill the gap in knowledge about whether tobacco control has reached the poor or lower social strata in developed countries. This study will enable follow up research including quantification of effects of the specific tobacco control policies in each country.

Using data from OECD countries, one can investigate the effect of cultural diversity on anti-smoking policies. We use panel data models to test the impact of culture on the effectiveness of anti-smoking policies. It is assumed that two forces are effecting tobacco consumption in a society. These forces can be smoke preventive and smoke encouraging factors. Each of these forces consists of smaller subsets. Preventive policies and the time effects are the main parts of the smoke preventive forces. Culture and its effect on personal capital and social capital can be a part of smoke encouraging or smoke preventive forces. Using different proxies for culture and fixed effect models, this study allows one to investigate the differences in effectiveness of public policies in different OECD countries. The results from empirical investigation indicate that effectiveness of public policies depends on culture, therefore varies across countries. This is important for policymakers who need to avoid imposing uniform policies across a region with cultural diversity without accounting for cultural differences.

Using data from OECD countries, one can investigate the effect of cultural diversity on anti-smoking policies. We use panel data models to test the impact of culture on the effectiveness of anti-smoking policies. It is assumed that two forces are effecting tobacco consumption in a society. These forces can be smoke preventive and smoke encouraging factors. Each of these forces consists of smaller subsets. Preventive policies and the time effects are the main parts of the smoke preventive forces. Culture and its effect on personal capital and social capital can be a part of smoke encouraging or smoke preventive forces. Using different proxies for culture and fixed effect models, this study allows one to investigate the differences in effectiveness of public policies in different OECD countries. The results from empirical investigation indicate that effectiveness of public policies depends on culture, therefore varies across countries. This is important for policymakers who need to avoid imposing uniform policies across a region with cultural diversity without accounting for cultural differences.

The purpose of this study was to evaluate the support program, given to cancer patients in order to promote their own efforts to quit smoking and to study if they kept their changed cigarette consumption 6-18 months after their cancer treatment was done.Method: We have used a descriptive qualitative method with semistructured interviews which were made in the spring of 2010 at Uppsala University. The informants in this study were smoking cancer patients which had been given radiotherapy at the oncology department at Ryhov hospital in Jönköping, Sweden.The results showed that three out of eleven informants were still not smoking after their treatment ended. All informants agreed that information about the effects of smoking on their radiotherapy were important.This study also showed that there are areas in which the support program could benefit from being changed. Of those informants who did not succeed in their efforts to quit smoking, many felt that the support should have been more direct in the sense that the staff should have followed up on their progress more frequently. These unsuccessful informants also stressed that the location for where the information was given could have been more private. Also some of the informants felt that the hospital staff giving the information seemed to be stressed and/or did not seem to have time to support them in their efforts to quit smoking.

Title from title page of PDF (University of Missouri--St. Louis, viewed February 9, 2010). Includes bibliographical references (p. 107-119).