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Objective: To explore the role of interprofessional collaboration in the delivery of team-based tobacco dependence treatments within primary care. Methods: A narrative review of the literature was completed to examine FHT team functioning in Ontario, followed by a single, multi-site qualitative exploratory case study. Results: Interprofessional collaboration contributed to changes in tobacco dependence treatment through the initiation of system-wide change, cultivation of collective action, and supporting enhanced quality of smoking cessation care. Conclusion: Interprofessional collaboration can enhance the comprehensive delivery of evidence-based treatments for individuals trying to quit smoking. Supportive public policy, education for patients and providers, and evaluation research is needed to advance FHT functioning.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology, Homoeopathy, Technikon Natal, 1996. / The aim acupuncture of this study was to compare the treatment and homoeopathic treatment smoking cessation. The study was a clinical trial, in which an acupuncture treatment group group. Thirty was compared with a homoeopathic treatment volunteers who were anxious to stop smoking participated in the trial and were randomly divided into two groups. One group received acupuncture treatment (n=l5), while the other group received homoeopathic treatment (n=l5) in the form of isotherapy. The study took place over a period of 9 months and each participant completed a 3-month trial period. Prior to the trial period each sUbject completed a set of questionnaires. These ~ncluded the Fagerstrom Tolerance Test which determined their dependence on nicotine; a questionnaire to determine if the subject smoked predominantly for reduction of negative affect, for positive affect or as an habitualaddiction; and a questionnaire to determine the subject's estimation of the health risks of smoking. / M

M.Tech. / There are an estimated 1.2 billion smokers globally (WHO, 2004) and according to Groenewald et al. (2007) approximately 24% of South African adults smoke. The use of tobacco is the second highest cause of death and disability in the world (WHO, 2004), the primary cause of death in the United States (Abrams et al., 2003) and the third leading risk factor in South Africa (Norman et al., 2007). This malady is preventable and as such, the use of tobacco must be regarded as an important public health and treatment priority. In dealing with smoking cessation Lebargy (2000), concluded that nicotine replacement therapy has a success rate of between 20% and 25%. What is significant though is that currently used and recommended conventional smoking cessation techniques have many side-effects and contra-indications. They further stress the importance of new more effective techniques in order to fight the pan-epidemic of smoking (Henningfield et al., 2005; Mitrouska et al., 2007) The remedy being investigated is a homoeopathic preparation, Anti Smoking complex, consisting of Avena sativa D3, Daphne indica D6, Nux vomica D6, Caladium seguinum D60, Nicotinum D60 and Nicotiana tabacum D60. The aim of the research was to evaluate the efficacy of the Anti Smoking complex in the treatment of smoking cessation and nicotine withdrawal symptoms of smokers between the ages of eighteen and sixty years. The efficacy of the Anti Smoking Complex was evaluated in terms of the Fagerström Test of Nicotine Dependence (FTND), the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68), weekly smoking logs, and withdrawal symptoms for the purpose of identifying a safer alternative in the treatment of smoking cessation and nicotine withdrawal symptoms. A sample group of thirty participants was recruited at the University of Johannesburg Health Centre and various local pharmacies. Participants attended an initial interview, where they were screened by means of questionnaires and physical examinations. Inclusion criteria comprised of: adults between the ages of 18 and 60 years, who were smoking more than 10 cigarettes a day for at least a year with a score of five to seven on the FTND. Reliability and validity of clinical investigations was ensured by adherence to procedural documentation. 3 The study was conducted over a nine week period and was a random double-blind placebo-controlled clinical trial. Participation in the study was voluntary and participants were free to refuse treatment or withdraw from the study at any time. Participants were placed into two groups of fifteen – the experimental group had to take 10 drops of the Anti Smoking complex four times daily for six weeks and the control group had to take placebo on the same basis. Follow up appointments to monitor results took place on week 1, 4, 7 and 9 respectively. Collected data was analysed using descriptive statistics (frequencies and percentages). The data gathered from the FTND, the WISDM-68 and questionnaires was statistically analysed. The results of the experimental and controlled groups were compared using independent samples t-tests. Disparities of clear-cut variables was analysed using Chi-squared tests. Over time differences was analysed using repeated measures ANOVA (Eiselen, 2007). The homoeopathic complex, Anti Smoking Complex is effective in the treatment of smoking cessation. Both the results of the Fagerström Test for Nicotine Dependence and Wisconsin Inventory for Smoking Dependence supported the above. An overall smoking cessation rate of 20.0% was obtained after the nine week trial period. Of particular importance, there was no significant effect on any of the parameters of the withdrawal symptoms questionnaire. As withdrawal symptoms are a key component of smoking cessation, the action of the complex is incomplete.

Findings are presented from matched case-control studies of risk factors for diabetes, cryptorchidism and inguinal hernia in children using routine data collected by the Oxford Record Linkage Study since 1965. There were 315 cases born 1965-85 in the diabetes study, 947 and 1449 cases in studies of cryptorchidism diagnosed at birth and at orchidopexy respectively, and 1701 male and 347 female cases in the study of inguinal hernia. Each case was individually matched with up to eight controls on sex, year, and hospital or place of birth. A potential bias caused by differential migration of cases and controls was identified. A sample of 753 controls born in Oxfordshire was checked against the Oxfordshire Family Health Services Authority register to determine migration out of the study area in relation to perinatal risk factors. A general procedure was developed to estimate the strength of the migration bias. Pre-eclampsia was identified as a significant pre-natal risk factor for diabetes. The studies of cryptorchidism identified significantly raised risks with low birth weight, low social class and breech presentation. The results suggested that asymmetric growth retardation in the third trimester may be involved in the aetiology of undescended testes that do not spontaneously descend in later life. Analysis of risk factors among siblings of cases and controls suggested that permanent changes to the mother may occur around the time of the pregnancy involving the affected child. Low birth weight, short gestation and smoking during pregnancy were associated with significantly raised risks of inguinal hernia among boys. Among girls the results were similar, suggesting that mechanisms independent of the sex of the child may be important in the aetiology of this condition. Estimates of disease risk in siblings showed a strong familial aggregation, especially among girls.

A thesis submitted in fulfilment of the requirements for the degree of Master of Public Health in the department of school of Public Health Faculty of Health Sciences University of the Witwatersrand Johannesburg, 2003 / Smoking is a preventable cause of death. Young people start smoking at an early age due to certain external influences such as peer pressure, advertising etc. Once they start smoking, they often remain smokers forever because of the addictive effects of nicotine. The international studies show that the high morbidity and mortality rates caused by cigarette smoking can be reduced if health promotion strategies target school going children. The aim of the study was to investigate knowledge, attitudes and practices of students in matric as regards smoking in the Greater Tshwane Metropolitan area (Pretoria). This will inform the health promotion programmes, in particular health education, dealing with tobacco smoking prevention and control in schools / IT2018

Adolescent substance use is associated with a number of pressing problems on the public health agenda, including an increased risk of contracting sexually transmitted diseases, teenage pregnancy, violence-related injuries, depression, homicide, sexual assault, and accidental death. Teenage substance use remains high in South Africa, with a prevalence of smoking and alcohol binge-drinking estimated at 18.5% and 23% respectively. A previous quantitative cross-sectional analysis of data from a study cohort from which this study’s sample was drawn, demonstrated an association between adolescents’ sense of coherence (SOC) – a measure of coping ability – and smoking. The current study, using a qualitative approach, thus sought to gain more insight into adolescent substance use, particularly smoking, and to better understand how it may relate to coping. A mixed method sampling strategy was used in selecting 22 research participants between the ages of 16 and 19 in two high schools in Pretoria. They were then interviewed individually by an interviewer blinded to their SOC level and substance use status as documented in the quantitative survey in which this study builds on. The interviews were transcribed in full and a content analysis strategy was used in the analysis of the data. The results obtained were then merged with participants’ substance use status and SOC levels. Of the 22 participants, 6 had strong SOC and had never used substances; 8 had weak SOC and were current substance users. The other 8 also had weak SOC but were not current substance users. Further analysis of the results showed that adolescents’ substance use is associated with stress and coping as they (substance users) reported using substances in attempting to manage stressful life events. Of the 8 current substance users, 7 reported avoidance-oriented (disengagement) coping styles. Five of the 7 reported load imbalance such as academic and social pressures and distress (e.g. schoolwork overload, peer demands, and family problems) as a reason for using substances. The non-substance using adolescents with weak SOC reported strong social support, especially family and peer support in coping with life stressors. Hence, substances were more likely to make up for compromised coping where contextuallevel risk factors (demands/stressors) exceeded coping resources such as social support. Also, of the 8 substance users- in addition to stress related reasons for using substances- 4 reported sensation seeking, whilst 2 reported curiosity/experimentation- which are all non-stress related. Furthermore, although family and peer support were observed to be complementary in most cases, the reliance on peers for support was stronger amongst those whom family support was considered weak, which presented the context for social/peer pressure and vulnerability to substance use. The study findings suggest family support as a moderator of the influence of the adolescents’ inability to cope with stress (or have low SOC) on smoking behaviour. On the other hand, a close relationship was observed between strong SOC and using engagement coping responses and reporting family and school support as sources of support. Notably, all the participants with strong SOC reported that they had never used substances despite being equally affected by life stressors. The implications of the findings are also discussed, especially as related to enhancing SOC. More practically, in addition to providing life skills training to educate adolescents about substance use, school-based programmes could incorporate the notion of stress and coping in helping adolescents to develop desirable and effective coping strategies to deal with social demands as well as adopting advantageous lifestyles to meet their needs for stimulation and adventure (sensation seeking and experimentation). On the whole, the enhancement of social support and adolescents’ connectedness to various social systems may be the key to substance use prevention among South African adolescents.

Trata-se de um estudo descritivo, transversal com comparações entre grupos, desenvolvido em duas etapas. Na primeira etapa buscou-se identificar: padrão de consumo de tabaco, características da família, escola e pares. Na segunda etapa, com apoio de conceitos da teoria da identidade social, buscou-se identificar as representações que adolescentes têm de pessoas fumantes e não fumantes e suas identificações com as qualificações atribuídas a esses dois conjuntos de indivíduos. Foram participantes 494 adolescentes, com idades entre 15 e 18 anos, estudantes de ensino médio de duas escolas da cidade de Hermosillo, Sonora, México (62,5% do sexo feminino). Na primeira etapa foram empregados os seguintes instrumentos para coleta de dados: Questionário Mundial sobre Tabagismo em Jovens \", Global Youth Tobacco Survey (GYTS), e Questionário de Tolerância de Fageström (QTF).Na segunda etapa, 26 adolescentes foram entrevistados individualmente com apoio de um roteiro previamene elaborado. Os principais resultados da primeira etapa mostram que 45,7% (n=226) experimentaram cigarros uma vez na vida; 88,7% não são fumantes atualmente e 11,3% são fumantes. A idade de início do tabagismo compreende o período de 13 a 15 anos; 89,3% apresentam muito baixo nível de dependência de nicotina. Os lugares preferidos para fumar são as reuniões sociais e a escola. Não foram encontradas diferenças entre os grupos de fumantes e não fumantes quanto ao uso de cigarros por seus pais. Com relação ao uso de cigarros por amigos identificaram-se diferenças entre os grupos (X² = 62,75; p< 0,001); 49,1% dos adolescentes fumantes disseram que seus melhores amigos são também fumantes e 11% dos não fumantes assim responderam. Encontrou-se diferença também quanto a aceitar a oferta de cigarro dos melhores amigos (X² = 251,81; p< 0,001), 71.2% dos não fumantes responderam que não aceitariam enquanto que 71,4% dos fumantes responderam que provavelmente aceitariam. Quanto à crença que deixar de fumar é difícil, as diferenças entre os grupos foi também significante (X² = 22,44; p< 0,001), 42,6% dos não fumantes respondeu que é difícil deixar de fumar e 41,8% fumantes responderam que não é difícil deixar de fumar. As representações que os adolescentes têm de mulheres e de homens que fumam são também diferentes (X² = 37, 13, p< 0,001; X² = 39, 84, p< 0,001 respectivamente). Em geral são atribuídas características negativas sendo que as mulheres são rotuladas negativamente em maior proporção. Quanto aos resultados da segunda etapa do estudo, obteve-se que quando adolescentes fumantes e não fumantes qualificam indivíduos não fumantes eles tendem a atribuir-lhes características positivas. O contrário ocorre quando se trata de qualificar indivíduos que fumam. Há, ainda, uma porcentagem de entrevistados para os quais não há características distintivas de indivíduos fumantes e não fumantes. Ao avaliarem a si mesmos quanto a apresentarem as características que atribuíram a indivíduos fumantes e não fumantes verifica-se que os fumantes tenderam a não se ver naquelas representações. Por seu turno, os não fumantes tenderam a ver-se com as características de indivíduos não fumantes. Tais resultados são relevantes para a compreensão do que pensam adolescentes sobre o comportamento de fumar. E de fatores relacionados a esse comportamento. / A descriptive, cross-sectional study, with comparisons between groups, was performed in two steps. The first one approached the pattern of tobacco consumption, the characteristics of family, school and peers. In the second one, based on concepts of the social identity theory, was looked for identify the representations that the adolescents have about smokers and nonsmokers and their identifications with the qualifications attributed to those two groups of individuals. In this study participated, 494 students aged 15-18 studying at two high schools of the city of Hermosillo, Sonora, Mexico (62,5% females). In the first step the following instruments were used: Global Youth Tobacco Survey (GYTS) and the Questionnaire of Tolerance of Fagerstrom (QTF). In the second, 26 teenagers were interviewed individually with support of a guide previously made. The main results of the first stage show that 45, 7% (n = 226) smoke cigarettes once in life; 88.7% are nonsmokers at the moment and 11, 3% are smokers. The age of beginning of the tobacco consumption is between 13 and 15 years old; 89.3% show a very low level of nicotine dependency. The preferred places to smoke are social meetings and school. Differences between groups of smokers and nonsmokers were not found regarding parents\' smoking. About the use of cigarettes by friends, differences between groups were identified (X² = 62, 75; p< 0,001); 49.1% of teenager smokers mentioned that their best friends are smokers too and 11% of the non smokers gave the same answer. We found a difference about accepting the supply of cigarettes provided by their best friends (X² = 251, 81; p< 0,001), 71.2% of the nonsmokers answered that they would not accept it and 71, 4% of the smokers answered that probably they would accept. Regarding the belief that quit smoking is difficult, the difference between the groups was significant (X² = 22, 44; p< 0,001), 42, 6% of the nonsmokers answered that it is difficult to quit smoking and 41, 8% of smokers mentioned that is not difficult. The representations that adolescents have of women and men who smoke, are also different (X² = 37, 13, p< 0,001; X² = 39, 84, p< 0,001 each). In general, negative characteristics are attributed more to the women, they are labeled negatively in greater proportion. The results of the second step of the study show that smoker and nonsmoker teenagers tend to attribute to the nonsmokers positive characteristics. The opposite occurs when they qualify smokers. A percentage of adolescents consider that there are not differences between smokers and non smokers. When evaluating themselves, regarding the characteristics that they attributed to smokers and nonsmokers, we verify that the smokers tend not to see themselves in those representations. Nonsmokers tend to see themselves with the characteristics of nonsmokers. Findings from this study have important implications for the understanding of what the adolescents think about smoking and factors related to that behavior.