published_or_final_version / Public Health / Master / Master of Public Health

Smoking causes Type II diabetes (T2DM). However, there were limited research on the needs, concerns and intention of smokers with T2DM about quitting smoking. This study aimed to explore the behaviors and perceptions on smoking and quitting smoking in patients with T2DM. I conducted both qualitative and quantitative studies. The qualitative study involved T2DM patients who were current smokers or ex-smokers, and could communicate in Cantonese. Semi-structured focus group and individual in-depth interviews were conducted. The quantitative study was cross-sectional, using a standardized questionnaire to identify the intention to quit smoking, knowledge regarding the health risks of smoking and their determinants in T2DM smokers who (1) were aged 18 years or above; (2) can communicate in Cantonese; (3) had daily consumption of at least 2 cigarettes in the past 30 days; and (4) diagnosed with T2DM for at least 6 months with stable condition. Structured multiphase regression analyses were used to identify factors associated with intention to quit smoking and knowledge on the health impact of smoking. In the qualitative study, I recruited 22 current smokers and 20 ex-smokers with T2DM at data saturation. The current T2DM smokers did not quit smoking because of satisfaction with their current health status, misconceptions of no association between T2DM and smoking, and the perceived hazards of quitting. In contrast, ex-smokers had a positive evaluation of quitting smoking, accepted the quit advice from medical professionals and received more family support. Moreover, psychological addiction and weight gain after smoking cessation were the major barriers for T2DM patients to quit smoking. In the cross-sectional study, I recruited 526 smokers with T2DM from nine outpatient clinics specialized in diabetes. They scored on average 47.5 (95% CI=45.6-49.4) out of 0-100 in knowledge regarding health impact of smoking, and 389 (74%, 95% CI=70.3%-77.8%) of them were in pre-contemplation stage. The multiphase regression analysis showed that T2DM smokers with no intention to quit were those who smoked during alcohol drinking (OR=5.98, 95% CI=1.89-18.98, p=0.002). In contrast, those less likely associated with pre-contemplation stage were those who perceived a worse level of health (OR=0.41, 95%, CI=0.19-0.86, p=0.019), perceived greater importance of quitting (OR=0.67, 95% CI=0.58-0.78, p<0.0001), had higher confidence of quitting (OR=0.77, 95% CI=0.67-0.88, p<0.0001), or had more knowledge regarding health impact of smoking (OR=0.98, 95%, CI=0.97-0.999, p=0.035). In addition, a higher score on Decisional Balance Inventory-Cons of smoking (coefficient=1.61, 95% CI=0.56-2.66, p=0.003) or confidence in quitting was associated with a higher knowledge score (coefficient=1.30, 95% CI=0.59-2.01, p<0.001). Conclusively, this is the first study to assess the smoking behaviors and perceptions in patients with T2DM. Many T2DM smokers were reluctant to quit smoking due to inadequate knowledge of the health impact of smoking. Patient education, weight control and behavioral counseling are suggested as the critical components of an effective smoking cessation intervention for T2DM patients. / published_or_final_version / Nursing Studies / Master / Master of Philosophy

Background and Objective: Smoking is one of the major risk factors for chronic periodontitis. However, the mechanisms involved in tissue degradation due to cigarette smoking are not clear. Receptor activator of nuclear factor kappa B ligand (RANKL) and osteoprotegerin (OPG) are a system of molecules that regulate bone resorption. The aim of this study was to compare the levels of soluble RANKL (sRANKL), OPG and their relative ratio in GCF among periodontitis patients with varying smoking histories. Material and Methods: GCF samples were collected from 149 periodontitis patients who were never smokers (n=58), former smokers (n=39) and current smokers (n=52). sRANKL and OPG concentrations in GCF were measured by enzyme-linked immunosorbent assays. Results: sRANKL, OPG and their relative ratio were not statistically significant among the never smokers, former smokers and current smokers. However, OPG was significantly reduced and subsequently the sRANKL:OPG ratio was significantly increased in the high pack-years group as compared with never smokers. The positive correlation between packyears and sRANKL:OPG ratio was statistically significant even after adjusting for age and current smoking status. Conclusion: Increased lifetime exposure to cigarette smoking above a minimum threshold suppresses OPG production and leads to increased sRANKL:OPG. This may partially explain increased bone loss in smoking-related periodontitis. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1352109 / Thesis (D.Clin.Dent.) - University of Adelaide, School of Dentistry, 2009

Background and Objective: Smoking is one of the major risk factors for chronic periodontitis. However, the mechanisms involved in tissue degradation due to cigarette smoking are not clear. Receptor activator of nuclear factor kappa B ligand (RANKL) and osteoprotegerin (OPG) are a system of molecules that regulate bone resorption. The aim of this study was to compare the levels of soluble RANKL (sRANKL), OPG and their relative ratio in GCF among periodontitis patients with varying smoking histories. Material and Methods: GCF samples were collected from 149 periodontitis patients who were never smokers (n=58), former smokers (n=39) and current smokers (n=52). sRANKL and OPG concentrations in GCF were measured by enzyme-linked immunosorbent assays. Results: sRANKL, OPG and their relative ratio were not statistically significant among the never smokers, former smokers and current smokers. However, OPG was significantly reduced and subsequently the sRANKL:OPG ratio was significantly increased in the high pack-years group as compared with never smokers. The positive correlation between packyears and sRANKL:OPG ratio was statistically significant even after adjusting for age and current smoking status. Conclusion: Increased lifetime exposure to cigarette smoking above a minimum threshold suppresses OPG production and leads to increased sRANKL:OPG. This may partially explain increased bone loss in smoking-related periodontitis. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1352109 / Thesis (D.Clin.Dent.) - University of Adelaide, School of Dentistry, 2009

published_or_final_version / Nursing Studies / Master / Master of Philosophy

Background Smoking is a well-established causal risk factor of premature death. The prevalence of smoking has been estimated to be more than 50% in Chinese men. However, previous reviews of the association between smoking and mortality from all-causes and lung cancer were mainly relied on developed countries. The current systematic review of cohort studies aims at summarizing the existing studies on the association of smoking with all-cause and lung cancer mortality in China. Methods Articles published from 1980 to 2014were searched systematically in databases including PubMed, EMBASE, China National Knowledge Infrastructure (CNKI) and Google scholar. Main results of all studies were extracted and summarized. Results A total of 14 cohort studies examining the association of smoking with all-cause and lung cancer mortality in Chinese populations were identified. Compared with never smoking, current smoking was associated with higher risks of all-cause and lung cancer mortality in all studies. The relative risks (RR) for current smokers were from 1.20 to 2.29 for all-cause mortality and from 2.44 to 9.40 for lung cancer mortality. Former smokers also showed higher RRs for all-cause mortality (RR=1.20-1.48) and for lung cancer mortality (RR=2.06-6.50) compared with never smokers. Furthermore, dose-response associations of increasing smoking categories with all-cause mortality and lung cancer mortality were observed in most of the studies. Conclusions The risk estimates for all-cause and lung cancer mortality from smoking in China were lower than those from the western countries suggesting that the tobacco epidemic is at an early stage in China. Further large cohort studies giving updated risk estimates are warranted for advocating stringent tobacco control policies in China. / published_or_final_version / Public Health / Master / Master of Public Health

The aim of this study was to investigate the current level of awareness and use of the Great American Smokeout (GASO) and the extent to which that may vary by lifetime smoking, socioeconomic status, age and gender. We hypothesized and found that the current levels of awareness and use were significantly less than the most recent reports available (over 13 years ago), and that awareness of the GASO was more likely in lifetime smokers, those with more education, and older age groups, but found no significant effect related to gender. The drop in awareness and use of the GASO was more than half and almost five times, respectively, compared to that of most recent previous reports. These findings highlight a critical need for more attention and resources to reinvigorate the GASO as a useful event for smokers. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2016. / FAU Electronic Theses and Dissertations Collection

published_or_final_version / Public Health / Master / Master of Public Health

Introduction: Due to the high prevalence of smoking in China, exposure to second hand smoke (SHS) is a serious public health issue. However, school-aged children’s behavioral responses to SHS exposure and the associated factors are unclear. Aims: This study aims to (a) identify the sources and settings of SHS exposure among school-aged sick children and their mothers in Guangzhou, China; (b) describe the behavioral responses of those children and mothers when exposed to SHS; and (c) examine the personal and environmental factors associated with children’s responses to SHS exposure. Methods: Qualitative and quantitative methods were combined in this study. Forty-five in-depth individual interviews were conducted to investigate sick school-aged children and their mothers’ understanding of and responses to SHS. A pilot survey was used to assess the validity and reliability of the questionnaire and the feasibility of the study. A cross-sectional survey was conducted with the children and their mothers at three hospitals in Guangzhou in 2012. All sick children who were aged 6 to 12 years, able to communicate in Mandarin Chinese, and not acutely or severely ill, along with their nonsmoking mothers, were invited to join this study. Results: A total of 339 pairs of sick children and their mothers were included in the data analysis. Of these pairs, 169 (49.9%) lived with smokers. All sick children and their mothers experienced high-level SHS and third hand smoke (THS) exposure inside or outside the home. Those living with nonsmokers were also at risk of household SHS and THS exposure from guests. Most of the sick school-aged children were unaware of the dangers of SHS and THS, while the mothers had a better understanding of SHS and THS. The majority of children would adopt self-protective behaviors when exposed to SHS. The regression model for children’s behavioral responses to SHS exposure by family smokers found two significant factors: amount of social support and family smoke-free policy. Five factors were associated with children’s behavioral responses to SHS exposure by guest smokers, including boys, living with smokers, amount of social support, family members informed of the dangers of smoking, and fathers protecting children from SHS. The amount of social support, and fathers protecting children from SHS were also associated with children’s behavioral responses to SHS exposure by stranger smokers. Conclusions: To our knowledge, this is the first study to describe self-protective behavioral responses to SHS exposure among sick school-aged children in mainland China and the personal and environmental factors associated with these responses. Boys, living with smokers, and a partial smoke-free policy at home were negatively related to children’s responses to SHS exposure; however, more information about smoking, fathers’ protection from SHS, and information about the harms of smoking by family members were associated with greater self-protection among sick school-aged children. Therefore, multiple-direction interventions should be considered for children’s health promotion about smoking and SHS. / published_or_final_version / Nursing Studies / Master / Master of Philosophy

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences