published_or_final_version / Public Health / Master / Master of Public Health

Background: Secondhand smoke exposure (SHS) causes many fatal diseases to children and there is no safe level of exposure. In Hong Kong, around 41%of infants are exposed to household SHS and leading to the additional hospital admissions of the infants. Objectives: To study the effectiveness of a theory-based family intervention delivered by the smoking cessation counselor (SCCs) which aims to reduce household SHS exposure to infants under 18-months, by helping fathers to quit smoking and motivating mothers to establish a smoke-free home . Methods: Families with a smoking father, non-smoking mother and an infant attended the Maternal and Child Health Centres (MCHCs) were invited to join this randomized controlled trial. The family (mother and father) was randomized after the completion of mother’s baseline questionnaire and the collection of saliva samples from mothers and infants. Father was then contacted for telephone baseline interview. Individual interventions were provided to both mothers and fathers at baseline, 1-week and 1-month, and a family session involving both parents was offered to the intervention group. The control group received information on the hazards of SHS and the benefits of smoking cessation. The intervention and control groups were followed-up at 6-and 12-monthsto assess father’s smoking behavior and the execution of a complete no-smoking policy at home. Chi-squares and independent t-tests were used to assess the group differences in father’s smoking behavior and the initiation of a smoke-free home. Generalized estimating equations were used to examine the group changes of mothers’ and infants’ saliva cotinine levels from baseline to 12-month. Logistic regressions were performed to identify the predictors on father’s smoking behavior and the initiation of a smoke-free home. Results: There were 1,158 families randomized. Significantly more fathers in the intervention groupattainedhigher7-day point prevalence quit rate at 6-(8.0% vs 4.1%, p= .007)and 12-months (13.7% vs 8.0%, p= .002)respectively, stopped smoking at home at 12-month (35.7% vs 28.8%, p= .023), higher continuous quit rates at 6-(3.3% vs 0.7%, p= .002) and 12-month (1.8% vs 0.2%, p= .006), reduction of daily cigarette consumption over 50% at 12-month (33.4% vs 23.9%, p= .006), improvement in the stage of readiness to quit smoking at 6-month (13.0% vs 8.9%, p= .04) and more quit attempts (30.9% vs 24.1%, p=.015). No group differences were found in the establishment of the smoke-free home and the changes of saliva cotinine levels of infants and mothers from baseline to follow-ups. Discussion: This theory-based family intervention is effective in reducing household SHS exposure to infants by helping fathers to quit and stopped them to smoking at home, but it is less effective in motivating the mothers to initiate a smoke-free home. Significance: This is the first study testing a theory-based family intervention in reducing household SHS exposure to healthy infants. The family intervention provides a new insight in using ‘family’ as a unit for the intervention to reduce household SHS exposure to healthy infants by improving fathers' household smoking behavior and helping them to quit smoking. / published_or_final_version / Nursing Studies / Doctoral / Doctor of Philosophy

In this dissertation I assessed three distinct policy questions: the implications of introducing a new tuberculosis diagnostic in southern Africa, the potential value of research related to HIV treatment policy in South Africa, and the causal effect of state cigarette taxes imposed between 1996 and 2013 on health outcomes in the United States.

published_or_final_version / Community Medicine / Master / Master of Philosophy

Globally tobacco use and exposure to tobacco smoke represent some of the greatest risk factors for mortality. Best practice guidelines and standards of practice support nurses' provision of smoking cessation interventions. Nurses employed in primary health care settings interact with large numbers of people who smoke, and have the potential to significantly reduce tobacco use in the population. Evidence shows that nurses do not consistently implement smoking cessation interventions. The purpose of this cross-sectional study was to describe nurses' perceptions of factors that influence their intentions related to providing smoking cessation interventions in primary health care settings. A conceptual framework derived from the Theory of Planned Behavior and relevant empirical literature guided the study. A questionnaire measuring the concepts of interest was mailed to a random sample of Registered Nurses and Nurse Practitioners in Ontario. Responses of 237 eligible participants were available for analysis. Multiple regression analyses were used to examine the hypothesized relationships between nurses' attitudes, subjective norms and perceived behavioural control, and their intention to implement smoking cessation interventions, and the association between intention and practice related to smoking cessation. The Theory of Planned Behavior concepts explained up to 48.5% of variance in behavioural intention. Perceived behavioural control was most strongly associated with intention to provide smoking cessation interventions. Behavioural intention was correlated with smoking cessation practice. Analysis of responses to open-ended questions identified factors that facilitated (wish to improve patients' health, organizational support, access to resources, a perception of patient readiness to quit, and training in smoking cessation) and hindered (lack of time, lack of patient readiness, lack of support and resources, and lack of knowledge) nurses' provision of smoking cessation interventions. Overall, the study results suggest that nursing intention to engage in smoking cessation practices in primary health care settings was associated with organizational factors. Further research is required to explore how primary health care organizations can support nurses so that they fully realize their role in reducing the impact of tobacco use on the health of the people in Ontario.

Susceptibility to smoking has been widely measured in an effort to detect those teens who lack of a firm commitment to not smoke. This measure, however, has not been applied to Chinese-Canadian adolescents. The overall goal of this study was to understand susceptibility to smoking among Chinese-Canadian non-smoking teens. The dissertation includes three papers, each of which has addressed one of the three primary aims of this study. The first paper aims to document the prevalence of susceptibility to smoking among a sample of non-smoking teens in British Columbia, Canada, and to examine the factors that explain the variation in susceptibility to smoking. I employed a quantitative secondary analysis of data from the BC Youth Survey of Smoking and Health. More than one quarter of the respondents were found to be susceptible. The Chinese-Canadian adolescents appeared to have a similar rate of susceptibility to smoking as their White/Caucasian counterparts, even though the smoking prevalence was lower among Chinese-Canadian group than in White/Caucasian group. In the second paper, I explored non-smoking Chinese-Canadian adolescents’ views about the protective factors and the risk factors that might lead them to be susceptible to smoking. In this paper I report an analysis of four qualitative focus groups which included 24 Chinese-Canadian participants. Negative attitudes toward smoking, befriending non-smoking teens, being peer pressured not to smoke and a collectivist cultural perspective were identified as protectors that helped Chinese Canadian teens remain tobacco free in their adolescence. The teens argued that authoritarian parenting had both positive and negative effects on Chinese teens’ susceptibility to smoking. These findings enhanced our understanding of the role that an ethnic group’s culture might play in adolescent smoking. In the third paper, I use Chinese-Canadian teens’ perspectives to reconsider the operationalization of the measure of susceptibility to smoking. Avoiding absolute answers was viewed by the participants as a unique cultural style among Chinese-Canadian teens. They also commented on the ambiguity of using the term “smoking” in the smoking susceptibility measure. Further research is needed to gain a better understanding of the operationalization of the measure in this cultural group.

Background: Tobacco marketing has been established as the main motivator for tobacco use among youth. A proliferation of tobacco promotional activities in retail stores has been observed yet little is known about its impact on adolescent smoking behaviours. The purpose of this study is to use secondary data to describe the prevalence of retail tobacco point-of-purchase (PoP) activities, examine its associations with adolescent smoking behaviours, and determine what ecological factors moderate the relationship between PoP activities and student smoking behaviours in British Columbia. Methods: This cross-sectional study surveyed grade 10-11 students from 22 randomly-selected schools in BC on student smoking behaviour and conducted observations in 57 retail stores on tobacco PoP activities located within a 1 km radius of these schools. Descriptive analysis was conducted on retail tobacco PoP variables. Individual data on smoking behaviour and school level data on retailers were linked to analyse the association between retail tobacco PoP activities and student smoking behaviour using logistic regression. Moderating effects of contextual factors were also examined. GIS maps were generated to illustrate study findings. Result: A moderate to strong presence of tobacco PoP activities was observed in all tobacco retail stores located in BC school neighbourhoods. Nearly all stores displayed cigarette products in a visible manner (98.25%) and posted tobacco control signage (94.74%). In this model, proportion of stores in the school neighbourhood with presence of tobacco advertising increased the odds of a student being a smoker (OR = 1.28-3.27). Proportion of stores in the school neighbourhood with presence of tobacco control signage decreased the odds of a student being a smoker (OR = 0.11-0.66). The odds of a student being a smoker increased if they resided on the island compared to living in the lower mainland (OR = 1.11-1.75). Discussion: Convenience stores exhibited more tobacco PoP activities than other store types. Retailers in the school neighbourhood that had tobacco advertisements and tobacco control signage exhibited both detrimental and protective effects on student smoking. This provides supportive evidence to ban tobacco advertising in retail stores and increase efforts for creating an anti-tobacco environment in neighbourhood retail stores. Maps generated served descriptive and hypothesis generating purposes.

As in years past, use of tobacco remains the leading cause of preventable death in this country. Smoking has been associated with elevated risks of 15 other forms of and has also been identified as a major cause of such chronic conditions as cardiovascular disease, cerebrovascular disease, bronchitis and emphysema. In 2008, an estimated 8.6 million Americans suffered from smoking-related chronic conditions (American Cancer Society, 2010). As 80% of tobacco use begins in adolescence (Villanti, Boulay & Juon, 2010), this age group has long been the focus of intervention efforts. Furthermore, animal studies suggest that the adolescent brain is at increased risk for developing an addiction to nicotine compared to an adult brain (Morrell, Song & Halpern-Felsher, 2011). Additional studies have demonstrated that the younger an adolescent begins smoking, the more likely he is to become a regular smoker and less likely to quit smoking (Brown et al., 2010). The public health opportunity for primary and secondary prevention intervention is clear. To track adolescent risk-taking in the state, The Georgia Department of Education administers the Georgia Student Health Survey II [GSHS II] throughout all school districts. The purpose of this thesis study was to examine known smoking risk factors using the GSHS data in order to assess associations using an adolescent sample. Findings demonstrated that age, gender, and urbanicity were associated with smoking. Findings from this study provide insights for programming that can be tailored to meet the needs of adolescent subgroups that may be vulnerable to smoking initiation.

Summary Estimating the epidemiological situation of smoking and motivation to quit smoking among the student population in Kaunas universities. Public Health Educology Mindaugas Škėma Supervisor Vaclovas Šveikauskas, Dr., Department of Preventive medicine. Faculty of Public Health, Kaunas University of Medicine.– Kaunas, 2005. – P. 59 Objective: To estimate the epidemiological situation of smoking and motivation to quit smoking among the student population in Kaunas universities Methods: the smoking situation was assessed by spreading questionnaires among students in Kaunas universities. The systematic random sample of the target population was 706 students of undergraduate studies; 410 females and 296 males. Respondents were 18-30 years of age. Statistical data analysis was performed with the statistical package SPSS 11.0 for Windows. The differences inside the sample were tested with Pearson’s χ2 – test, to find the difference among means a Stjudent’s t – test was used. Results: 19,9 percent of females and 25,7 percent of males are daily smokers. There is a stronger relationship between respondents smoking if their parents and/or friends are smokers. 53 percent of smokers have tried to quit smoking. 52 percent of respondents have gained advice to quit smoking and most often they give preference to family influence. 52 percent of smoking respondents want to quit. Responses wanting to quit smoking were significantly higher if advice to quit was obtained. Conclusions: ·... [to full text]

Although explicit attitudes have traditionally been used in predictive models of health behaviour, recent theorizing suggests that implicit attitudes might be more useful in predicting socially undesirable or addictive behaviours. In Studies 1 through 3, smokers’ explicit and implicit attitudes were examined to compare the predictive utility of each. Results confirmed that implicit attitudes are better at predicting impulse-driven behaviours, such as smoking consumption. Consequently, implicit attitudes also predict whether a quit attempt will be successful. In contrast, explicit attitudes are better at predicting deliberative outcomes, such as having intentions to quit, and making planned quit attempts. Extending these findings, in Studies 4 and 5, the effectiveness of a novel affirmation intervention designed to break the association between smoking and stress-reduction is evaluated. Preliminary results demonstrate that an affirmation intervention designed to break the smokers’ reliance on smoking as a means of coping with stress can have beneficial and sustainable effects in cessation outcomes. The impact on smokers’ implicit attitudes as a possible mediating role is discussed. Implications for more effective health interventions are also discussed.