Thesis (Ph. D.)--School of Nursing. University of Missouri--Kansas City, 2006. / "A dissertation in nursing." Advisor: Peggy Ward-Smith. Typescript. Vita. Description based on contents viewed Nov. 13, 2007; title from "catalog record" of the print edition. Includes bibliographical references (leaves 103-119). Online version of the print edition.

Thesis (Ph.D.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed on June 29, 2009). Includes bibliographical references (p. 97-109).

Thesis (M.S.)--University of Michigan, 1995.

Thesis (M.S.)--University of Michigan, 1995.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Homoeopathy, Durban University of Technology, 2011. / ‘Cigarette smoking is a modern day epidemic that poses a substantial health burden’, it has been proven that smokers die on average fourteen years earlier than non smokers as a direct result of their smoking. An abundance of evidence indicates that the health risks associated with cigarette smoking can however be reversed with a sufficient period of abstinence. Thus achieving life-long abstinence must be a health priority for both developing and developed countries (Caponnetto &, Polosa, 2008). Over 80% of smokers express a desire to stop smoking and 35% of them try to stop each year. However, less than 5% are successful in un-aided attempts to quit (American Psychiatric Association, 1995). The greatest challenge facing smokers who wish to quit are nicotine withdrawal symptoms; these include dysphoric or depressed mood, insomnia, irritability, frustration, anger, anxiety, difficulty concentrating, restlessness, decreased heart rate and increased appetite or weight gain (American Psychiatric Association, 1995). The aim of this double blind placebo controlled quantitative study was to determine the effectiveness of a homoeopathic complex (Caladium seguinum 30 CH, Nux vomica 30 CH and Staphysagria delphinium 30 CH); a tautopathic preparation and the combined effect thereof, in the treatment of nicotine withdrawal syndrome as determined by the Tolerance Dependence Questionnaire, Smoking History and Perceptions of Treatment Questionnaire. Methodology Forty participants recruited by means of convenience sampling were randomly and equally divided into one of four treatment groups, namely tautopathic group, homoeopathic group, combined tautopathic and homoeopathic group and placebo group. The duration of the study was 2 weeks and two consultations with each participant were conducted. The respective interventions were administered in oral spray format; participants were asked to spray their respective preparations directly into their mouth three times daily and to repeat the dose whenever they had a craving for a cigarette. iv Measurements in the form of the Tolerance Dependence Questionnaire (Appendix D), Perceptions of Treatment Questionnaire (Appendix H), and Smoking History (Appendix G) were used to quantify response to treatment. Non-parametric statistical analysis was conducted to analyse the data. Results All four research groups experienced a statistically significant reduction in the amount of cigarettes smoked, favourable perceptions of their response to treatment and improved tolerance. Statistically however when the groups were compared with each other they were similar with respect to their tolerance to nicotine, perception of response to treatment and reduction in amount smoked. Although interventions were statistically similar in terms of effectiveness, the data does suggest that Tautopathy as an intervention warrants exploration. The Tautopathic group achieved the highest reduction in the number of cigarettes smoked when comparing medians (11 less smoked per day), achieved the highest percentage of participants who experienced reduced cravings, and the highest percentage of participants who would continue using the intervention (90% respectively) as well as improvements in 6/9 variables of the Tolerance Dependence Questionnaire. Conclusions The study concludes that each of the four subject groups (including placebo) proved to be successful in aiding the participant to cease smoking. The results showed a significantly positive perception of the participants to the interventions used. The influence of the placebo effect however was very evident in this study; in addition other factors such as the unique method of administration of the medication (oral spray format on demand) the Hawthorn effect and the participants’ desire/commitment to quit smoking may have contributed to the positive results obtained. Notwithstanding the above and although not statistically significant; positive trends within the data do suggest that the Tautopathic approach used in this study should be further investigated in future.

published_or_final_version / abstract / Nursing Studies / Master / Master of Philosophy

The incidence of smoking among mentally ill people is very high. Smokers have a 50%, rate of mental illness diagnosis compared with 23% rate for general population. To address this problem, the purpose of this project was to plan a smoking cessation program for patients in a mental health facility. The theoretical foundation for this project was based on the theory of planned behavior, which identifies the predictive nature of smoking and the benefits that can be derived from implementing a systematic approach for change. The project question examined the effectiveness of smoking cessation program using educational support, pharmacological strategies, and bi-weekly meetings to help patients in a mental health hospital to decrease smoking behavior. The project design was based on use of smoking questionnaires, the Hooked on Nicotine Checklist (HONC), effective pharmacological strategies, educational support, and counseling treatments to evaluate symptoms of dependency. The key results of this project included the creation of a plan that could foster reduction in illness, improved quality of life, and reduced costs related to the onset of major illness in this vulnerable population. This data collection process focused on a qualitative design in which selected professionals were asked to review the materials and answer questions. This project could increase awareness of the issue of smoking; in addition, this project could equip nurses with the tools to deliver evidence based interventions for tobacco dependence that may significantly reduce tobacco use. This project has the implications for positive social change through its potential to improve the health of people with mental illnesses. It also creates a safe and healthy environment in mental health facilities for patients who do not smoke.

Background: Tobacco use remains a major public health issue. Population-level efforts to curb tobacco use include media to promote smoking cessation. However, these campaigns (including tobacco package warning labels) commonly emphasize the addictiveness of nicotine and the difficulty of quitting with statements like ?nicotine is as addictive as heroin and cocaine?. Addiction oriented messages may have an iatrogenic effect on cessation by undermining behavioural precursors such as self-efficacy, cessation outcome expectations, behavioural control, and quit-aid efficacy. <br /><br /> Objectives: First, to determine the effects of addiction focused messages in comparison to efficacy enhanced messages and control messages on smokers? self-efficacy, cessation outcome expectations, behavioural control, and quit-aid efficacy. Second, to determine if the impact of addiction focused messages differ according to participant nicotine dependency level. <br /><br /> Methods: A sample of adult smokers (n>101) from Kitchener/Waterloo and Owen Sound were randomly assigned into one of three intervention conditions: addiction focused (M1), efficacy enhanced (M2), and control (M3). Outcome measures were collected at baseline, post intervention and 30-day follow-up and included: self-efficacy, outcome expectations, behavioural control, quit-aid efficacy, and outcome expectancies. The 30-day follow-up also included measures of smoking consumption, quit attempts and use of a quit-aid. <br /><br /> Results: Majority of the participants were males and between 18-25 years of age. Mean number of cigarettes smoked ranged from 12 to 15 across groups whereas the mean number of years smoked ranged from 12 to 17. General linear analyses revealed no significant effect of message type or nicotine dependence (as measured by the Fagerstrome Test for Nicotine Dependence) on the outcome variables of interest. However, when perceived addiction was substituted as the measure of nicotine dependence, the analysis revealed a main effect for nicotine dependence on self-efficacy post intervention and on cessation outcome expectations at follow-up. An interaction effect was found for outcome expectancy at post intervention. <br /><br /> Conclusion: The results of this study suggest that acute addiction oriented messages may not negatively impact smokers? self-efficacy, outcomes expectations, behavioural control, quit-aid efficacy, and outcome expectancies. However, this does mean that message orientation should be ignored when constructing smoking cessation messages. In fact, program designers are encouraged to employ messages that limit the use of addiction oriented statements such as ?nicotine is as addictive as heroin and cocaine?. Further research is required to examine the potential cumulative impact of addiction oriented messages on quitting behaviour and its precursors.

Delay discounting is considered by many to be a risk factor for substance use disorders and other health-related behavior problems. While these health-related behavior problems are often treated with incentive-based interventions, little is known about whether delay discounting (DD) moderates response to that treatment approach. The present study examined how response to incentive-based smoking-cessation treatment varied as a function of baseline DD scores among pregnant women participating in randomized controlled clinical trials examining the efficacy of financial incentives. Women were assigned to a condition wherein they earned vouchers exchangeable for retail items contingent on abstinence from recent smoking or to a control condition wherein they received vouchers of comparable value but independent of smoking status. Individual differences in DD of hypothetical monetary rewards were measured at the study intake and follow-up assessments. We examined whether individual differences in baseline scores on that instrument predict antepartum and postpartum smoking status using logistic regression, and if sustaining abstinence caused changes in DD scores from intake to 24-weeks postpartum. We did not see any significant main effects of DD or interactions of DD with treatment on antepartum or postpartum smoking status. Treatment condition, baseline smoking rate (cigs/day), a history of quit attempts pre-pregnancy, and educational attainment were all associated with increased odds of abstaining from smoking at the late-pregnancy antepartum assessment, and treatment condition was the only significant predictor of abstaining from smoking at 24-weeks postpartum, three months after the treatment formally ended. We saw no discernible evidence that sustained abstinence from smoking was associated with post-treatment decreases in DD. Overall, we saw no evidence that being a steeper discounter is associated with a lack of success in quitting smoking in either treatment condition. Being assigned to the incentives condition was the only predictor of antepartum and postpartum abstinence. The observed associations of a lower baseline smoking rate, higher educational attainment, and a history of having attempted to quit smoking previously with increased odds of success in achieving antepartum smoking abstinence is consistent with results from previous reports on predictors of response to this treatment underscoring the reliability of these relationships.

Background: Current smoking-cessation medicines can assist smokers to quit, but have limited efficacy. Supplementing them with a replacement for the sensory and behavioural aspects of smoking, which are hypothesised to act as secondary reinforcers, could in theory help to alleviate urges to smoke and withdrawal, and may assist smoking cessation. Methods: Three studies were conducted to examine sensorimotor replacement (SMR) effects. The first two employed a cross-over design to assess the effects of two SMR products, nicotine-free electronic cigarettes (ECs) and de-nicotinised cigarettes (DNCs), on short-term withdrawal, urges to smoke, and user acceptability. Study 1 (N= 35), compared EC to a stress ball (SB) to control for behavioural distraction and Study 2 (N=41) tested whether SMR effects were ‘dose dependent’ by comparing DNCs with ECs. The final study was part of a randomised controlled trial (N= 200) of DNCs in combination with standard treatment. It examined whether SMR effects on abstinence are moderated by scores on a ‘behavioural’ dependence measure (GN-SBQ). Results: The EC was preferred over the SB, and alleviated urge to smoke more than SB, but the effect was modest and short-lived. The DNC and EC had similar effects acutely, but DNC suppressed urges to smoke and withdrawal to a somewhat greater extent over a day of abstinence. DNCs combined with standard smoking-cessation treatment improved short-term abstinence regardless of GN-SBQ scores. Conclusion: SMR effects on urge and withdrawal alleviation were modest and a ‘dose response’ effect was not clearly established. An attempt to identify smokers for whom SMR may be of particular benefit was not successful. SMR however, was perceived as helpful and appealing, and results from the trial suggest that adding SMR may enhance existing treatments. It was proposed that rather than directly alleviating urges/withdrawal, SMR may operate as a coping tool in ‘high-risk’ situations, by providing an alternative to smoking.