SURVEY OF THE KNOWLEDGE AND CONFIDENCE OF RESPIRATORY THERAPY STUDENTS REGARDING TOBACCO SMOKING AND RESPIRATORY DISEASES by Delano S. DuCasse INTRODUCTION: Tobacco abuse is the main cause of illness and avoidable death in the world (World Health Organization, 2010). Smoking-related diseases claim an estimated 443,000 American lives each year, including those affected indirectly, such as babies born prematurely due to prenatal maternal smoking and victims of "secondhand" exposure to tobacco’s carcinogens (American Lung Association, 2011). Of all healthcare providers, respiratory therapists are most often in contact with patients that are diagnosed with smoking related diseases. Therefore, students entering into the field should be well equipped with the knowledge, skills and attitude to educate patients about the importance of smoking prevention and cessation. The purpose of this study was to evaluate students’ knowledge and confidence regarding tobacco addiction and cessation following enrollment in a pulmonary disease course. METHODS: Students enrolled in a bachelor’s degree respiratory therapy program at a southeastern university were surveyed prior to and following a required pulmonary disease course. Participation was completely voluntary and no incentives to participate were offered. A total of 31 students participated in the pre-tobacco education survey on January 24, 2013 and 24 students participated in the post-tobacco survey on April 29, 2013. DATA ANALYSIS: The data was analyzed using SPSS 19.0. Descriptive statistics to include frequencies and percentages were used to evaluate the RT student’s responses to survey questions. RESULTS: Majority of the students only had 1 to 2 hours of lecture that focused on tobacco smoking. The actual tobacco education they received was not a clear cut topic within the pulmonary disease course itself; the topic tobacco smoking was only mentioned under diseases processes such as, COPD and Lung Cancer. The RT students’ confidence levels slightly improved after being enrolled in the pulmonary disease course. The pre surveyed RT students’ average was 55.5%, and the post surveyed average was 69.8%. CONCLUSIONS: Based on the results, the content of tobacco education within the school’s curriculum is inadequate. With respiratory therapists mostly coming in contact with patients suffering from smoking related diseases, topics that include tobacco smoking and cessation should be included more in respiratory therapy school’s curriculum.

Concern is mounting over the increase in prevalence and severity of overweight and obesity in children worldwide. Intrauterine life has been identified as a critical period for the development of overweight or obesity and other related chronic diseases. Prenatal exposure to maternal cigarette smoke (PEMCS) has consistently emerged as an important risk factor for excess weight in the offspring and is a targetable behaviour for prevention strategies. This study examines first the relationship between PEMCS and overweight status of children at 10 years of age and second, whether PEMCS is associated with distinct longitudinal BMI trajectories. Analyses include multivariate and multinomial logistic regression and longitudinal group based modeling methods. PEMCS was found to be a significant risk factor for overweight in children independent of birth weight and catch-up growth. However, PEMCS was not associated with BMI trajectory membership. Our results lend support to the paradigm of in-utero excess weight prevention.

Background: Currently, there are no population-level smoking cessation interventions widely promoted in China. Economic concerns are one of the major barriers to a greater promotion of smoking cessation interventions in China. Objectives: The objective of this study was to use evidence on the effectiveness of physician counselling and nicotine replacement therapy (NRT) patches use from Western countries, with the most recent smoking data from China to predict the potential effectiveness and cost-effectiveness of physician counselling and NRT patch in the healthcare system in urban China. Methods: In Study 1, statistical analysis was conducted to estimate smoking and cessation rates in urban China. In Study 2, a Comparative Relative Assessment model was used to estimate the effectiveness and cost-effectiveness of physician counselling and NRT patch use for smoking cessation. Study 2 determined the estimates and costs of additional quitters and avoided lung cancer deaths from the implementation of physician counselling and NRT patch use in the healthcare system in urban China. Results: In Study 1, smokers intending to quit were significantly more likely to have quit at follow-up than those not intending to quit. A total of 35.4% of smokers in urban China reported visiting a doctor in the past 12 months. Smokers who visited a doctor were significantly more likely to intend to quit and to have quit smoking at follow- up compared to those who did not visit a doctor. In Study 2, brief counselling to all smokers visiting the healthcare system in China was the most effective and cost-effective smoking intervention by generating a total of 2.35 million quitters at $2.32-$7.73 per quitter. Smoking cessation counselling were found to be cost saving when compared with the total cost of lung cancer to Chinese society. The wide promotion of the NRT patch would be costly, requiring significant financial investments. Conclusions: Implementing smoking cessation counselling in the healthcare system in urban China will result in cost savings from lung cancer. The high retail price and low acceptance of NRT patches in China may be required to achieve a population-level impact from pharmaceutical interventions.

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Background: Currently, there are no population-level smoking cessation interventions widely promoted in China. Economic concerns are one of the major barriers to a greater promotion of smoking cessation interventions in China. Objectives: The objective of this study was to use evidence on the effectiveness of physician counselling and nicotine replacement therapy (NRT) patches use from Western countries, with the most recent smoking data from China to predict the potential effectiveness and cost-effectiveness of physician counselling and NRT patch in the healthcare system in urban China. Methods: In Study 1, statistical analysis was conducted to estimate smoking and cessation rates in urban China. In Study 2, a Comparative Relative Assessment model was used to estimate the effectiveness and cost-effectiveness of physician counselling and NRT patch use for smoking cessation. Study 2 determined the estimates and costs of additional quitters and avoided lung cancer deaths from the implementation of physician counselling and NRT patch use in the healthcare system in urban China. Results: In Study 1, smokers intending to quit were significantly more likely to have quit at follow-up than those not intending to quit. A total of 35.4% of smokers in urban China reported visiting a doctor in the past 12 months. Smokers who visited a doctor were significantly more likely to intend to quit and to have quit smoking at follow- up compared to those who did not visit a doctor. In Study 2, brief counselling to all smokers visiting the healthcare system in China was the most effective and cost-effective smoking intervention by generating a total of 2.35 million quitters at $2.32-$7.73 per quitter. Smoking cessation counselling were found to be cost saving when compared with the total cost of lung cancer to Chinese society. The wide promotion of the NRT patch would be costly, requiring significant financial investments. Conclusions: Implementing smoking cessation counselling in the healthcare system in urban China will result in cost savings from lung cancer. The high retail price and low acceptance of NRT patches in China may be required to achieve a population-level impact from pharmaceutical interventions.

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.

Research Doctorate - Doctor of Philosophy (PhD) / After decades of discrimination and deprivation, Australia’s Aboriginal and Torres Strait Islander population faces social circumstances and health status which resemble that of a third world population group. With a wide range of health risk factors and morbidities among this population, a logical place to begin tackling the health problems is at the beginning of life. With increasing recognition of the influence of the intrauterine environment upon health, not only during infancy but into adulthood, improving health during pregnancy offers substantial benefit for present and future generations. The poor health of Aboriginal and Torres Strait Islander Australians is deeply ingrained in social deprivation, poor mental well-being, and an array of modifiable risk factors. Smoking is one risk factor at the centre of this complex web. Smoking is often accompanied by, or used as relief in, stressful situations associated with socioeconomic status, mental health, illness, and other addictions. In order to determine the most appropriate way to tackle the smoking issue among Aboriginal and Torres Strait Islander women, a series of studies were conducted. Initial literature reviews found limited evidence derived from methodologically rigorous studies in mainstream populations, and even less evidence for Aboriginal and Torres Strait Islander, or other Indigenous groups. Exploration of the knowledge and attitudes of these women in relation to antenatal smoking was conducted to identify the most appropriate targets for intervention. The findings from extensive background studies were drawn upon to design an intervention which aimed to be culturally appropriate for Aboriginal and Torres Strait Islander women, providing intensive support to assist these women to quit smoking during their pregnancy. Pilot data from the resulting intervention is presented in Chapter 8 of this Thesis. The social network among Aboriginal and Torres Strait Islander communities appears to play a central role in the behaviour of individuals. With an array of risk factors and influences found not only in the individuals surrounding women, but in their socioeconomic circumstances and overall environment, it may be that the most important approach for achieving health and behaviour change among this population is the mobilisation of social support and efforts to intervene with multiple elements of that environment.

Thesis (M. P. H.)--University of Hong Kong, 2006.

Thesis (M. P. H.)--University of Hong Kong, 2007.