Copies of author's previously published articles inserted. / Bibliography: leaves 174-192. / xiii, 222 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Psychology, 1994

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.

Background: Planning has long been assumed to be an important element of any successful quit smoking strategy. However, recent research findings indicate that unplanned, or spontaneous quit attempts, may lead to more successful and longer cessation periods than planned attempts. This calls into question continued advice to plan and the validity of planning based behaviour change theories. Objectives: To: 1) assess the prevalence of planning; 2) identify the attributes of planners; 3) examine the association of planning and intentions to quit; 4) examine the association of planning and use of quit aids; and 5) examine the impact of planning on smoking cessation outcomes. Methods: Data from the longitudinal Ontario Tobacco Survey (OTS) were examined. Analyses consisted of 418 smokers who made a planned or unplanned quit attempt between their waves 4 and 5 survey response. Descriptive, bivariate, and multivariate analyses were conducted using specialized survey analysis procedures to account for the complex sampling and design features of the OTS. Multiple Imputation (MI) was used to fill in missing data to reduce bias. Results: The prevalence of planning among Ontario smokers who made a quit attempt in the past six months was 70%. Regression models indicated that women, smokers who felt that it would be “very hard to quit”, and those with intentions to quit in the next 6 months had higher odds of making a planned quit attempt. Individuals who made a planned quit attempt had increased odds for using a quit aid compared to those making unplanned attempts. Univariate regression models indicated that planned attempts did not result in higher odds ratios for being abstinent for at least one week and at least one month. Conclusions: The present results suggest that a majority of smokers who made a quit attempt did so with a plan. Planned quit attempts had higher odds use of any quit aid compared with unplanned attempts. Planning was not found to increase the odds of being abstinent compared to unplanned attempts. Although more research is needed, the current study contributes to the dialogue of planning and smoking cessation.

Background: Planning has long been assumed to be an important element of any successful quit smoking strategy. However, recent research findings indicate that unplanned, or spontaneous quit attempts, may lead to more successful and longer cessation periods than planned attempts. This calls into question continued advice to plan and the validity of planning based behaviour change theories. Objectives: To: 1) assess the prevalence of planning; 2) identify the attributes of planners; 3) examine the association of planning and intentions to quit; 4) examine the association of planning and use of quit aids; and 5) examine the impact of planning on smoking cessation outcomes. Methods: Data from the longitudinal Ontario Tobacco Survey (OTS) were examined. Analyses consisted of 418 smokers who made a planned or unplanned quit attempt between their waves 4 and 5 survey response. Descriptive, bivariate, and multivariate analyses were conducted using specialized survey analysis procedures to account for the complex sampling and design features of the OTS. Multiple Imputation (MI) was used to fill in missing data to reduce bias. Results: The prevalence of planning among Ontario smokers who made a quit attempt in the past six months was 70%. Regression models indicated that women, smokers who felt that it would be “very hard to quit”, and those with intentions to quit in the next 6 months had higher odds of making a planned quit attempt. Individuals who made a planned quit attempt had increased odds for using a quit aid compared to those making unplanned attempts. Univariate regression models indicated that planned attempts did not result in higher odds ratios for being abstinent for at least one week and at least one month. Conclusions: The present results suggest that a majority of smokers who made a quit attempt did so with a plan. Planned quit attempts had higher odds use of any quit aid compared with unplanned attempts. Planning was not found to increase the odds of being abstinent compared to unplanned attempts. Although more research is needed, the current study contributes to the dialogue of planning and smoking cessation.

published_or_final_version / Nursing Studies / Master / Master of Nursing

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

Cigarette smoking represents the most preventable cause of morbidity and mortality in the world today, and is responsible for enormous health-related economic burdens. Among other medical sequelae, erectile impairment has been shown to be associated with chronic tobacco use. The primary aim of the present study was to provide the first empirical investigation of the effects of smoking cessation on physiological and subjective indices of sexual health. Sixty-five long-term, heavy smoking men participated in a smoking cessation program and were assessed at baseline (while smoking regularly), at mid-treatment (while using a high dose nicotine transdermal patch), and at 4-week follow-up. Physiological and subjective sexual arousal indices, as well as self-reported sexual functioning (as measured by the International Index of Erectile Functioning (IIEF)) were assessed during each visit. Intent-to-treat analyses indicated that at followup successful quitters (n = 20), compared to those who relapsed (n = 45), showed significant improvements in physiological and subjective sexual arousal. Specifically, men demonstrated enhanced erectile responses, decreased latencies to reach maximum erectile capacity, and faster onset to reach maximum subjective sexual arousal. Although participants displayed across-session enhancements in self reported sexual function, successful quitters did not show a differential improvement compared to participants who relapsed. The results of the present investigation provide the first empirical evidence that smoking cessation significantly enhances both physiological and self-reported indices of sexual health in long-term male smokers, irrespective of baseline erectile impairment. It is hoped that these results may serve as a novel and enticing means to influence men to quit smoking. Increasing successful smoking cessation in men would significantly enhance quality of life, substantially reduce premature death, and alleviate enormous economic burdens caused by smoking-related diseases. / text

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.

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.

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.