published_or_final_version / Public Health / Master / Master of Public Health

This study aims to explore the challenges faced by Street level bureaucrats in the implementation and regulation of the Tobacco Products Control Act 83 of 1993 (and the Tobacco Control Amendment Act of 1999) in relation to the selling of tobacco products (especially cigarettes) to minors in the Pietermaritzburg central business district area. These Acts are national policies formulated through the various stages of policymaking for tobacco control. Policymaking is not complete once a policy is approved. Instead implementation and regulation determine the success or failure of a policy or programme therein. Common implementation challenges include amongst others large number of participants in a programme, diverse goals, lack of commitment to the programme, lack of resources and technical difficulties. It is the purpose of this study to critically analyse and discuss the implementation problems faced by street level bureaucrats who have certain discretionary powers and are at the frontline of policy implementation. Specific focus will be given to environmental health officers and police officers in the Msunduzi Municipality and the Drugs and Liquor Section respectively (Pietermaritzburg central business district area). / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2005.

Tobacco use among Mauritian adolescents has increased steadily since 2008. Currently, Mauritius has not implemented any school-based anti-tobacco program and there is no instrument to assess the effectiveness of existing anti-tobacco school policies. Since the first cigarette can rapidly lead to nicotine dependence, targeted interventions must be assessed before established patterns of smoking appear. This study evaluated a tobacco use prevention education instrument to determine the effectiveness of a school-based anti-tobacco program. 26 male students completed a survey before and after receiving anti-tobacco lessons. Smoking initiation age could not predict likelihood of tobacco addiction (r(12)=0.320, p=0.311). However, after receiving the anti-tobacco lessons, participants were less likely to believe that youth who smoke have more friends (p < 0.001) and were more knowledgeable about tobacco’s dangers (t(25)=3.94, p=0.001). This indicated that, with a few changes, the instrument can be used to assess the implementation of a school-based anti-tobacco program in Mauritius.

Thesis (M.S.)--University of Hawaii at Manoa, 2006. / Includes bibliographical references (leaves 64-70). / viii, 70 leaves, bound ill. 29 cm

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Nursing Studies / Doctoral / Doctor of Philosophy

<strong>Background. </strong> Post-secondary institutions account for more smokers than any other occupational setting in Canada (Hammond, 2005). Unfortunately, little is known about tobacco use among this distinct population of students. The purpose of this study was to identify the prevalence of smoking and patterns of cigarette use among undergraduates at the University of Waterloo. The current study also sought to investigate the role of school connectedness in predicting students? smoking behaviours, and to explore the relation of student smoking status as determined by a behavoural measure and self-reported smoking status. <br /><br /> <strong>Methods. </strong> A secondary analysis of data collected using the University of Waterloo Tobacco Use Survey (2004) was employed for this research. Data were analyzed using descriptive statistics (frequencies, means, and percentages), non-parametric statistics (chi-square and Cohen?s kappa), principle components factor analysis and logistic regression in order to serve the exploratory purposes of the study. <br /><br /> <strong>Results. </strong> Overall, 17. 55% of the respondents reported current cigarette use (3. 37% daily; 14. 18% non-daily). Although most (85. 5%) students? self-perceptions remained as ?nonsmokers who never smoke? from university entrance to the study date, a greater proportion of students made a negative change in their self-perceived smoking status over this time period than a positive change (10. 13% vs. 4. 38%, respectively). Among students who perceived themselves as ?nonsmokers who never smoke? or ?ex-smokers? at university entrance, being more academically engaged predicted making a negative change in ones? self-perceived smoking status (OR= 1. 924, CI₉₅= 1. 064-3. 480). Finally, the proportion of non-daily smokers differed between the two measures of smoking status. Many students classified as ?occasional smokers? using the behavioural measure actually perceived themselves as ?nonsmokers who smoke sometimes?. <br /><br /> <strong>Discussion. </strong> The results of this study provide valuable new insights into smoking among Canadian university students. Students who are more academically engaged may be at risk of initiating smoking, perhaps as a means of stress reduction. Furthermore, the adult measure of occasional smoking typically used in tobacco research may be insufficient to inform tobacco control efforts for this population as it results in different proportions of non-daily smokers when compared against students? self-perceived smoking status. The findings of this exploratory research await replication with larger samples and different measures. Implications of the results for practice and further research are discussed. <br /><br /> <strong>Conclusions. </strong> This strategy of assessing connectedness to school shows promise in predicting post-secondary students? cigarette smoking behaviours. The results also provide support for continued investigation into the best ways to measure and assess current cigarette use in this unique population.

Tobacco use and the associated health risks are a major public health concern. Research suggests that parents’ own tobacco use, caregiver-adolescent antismoking communication, and parenting practices (e.g., prompting, parental monitoring) may work to influence adolescents’ tobacco-related attitudes and behavioral outcomes (e.g., refusal efficacy, intentions to use and actual use). Although historically African American adolescents have exhibited lower rates of tobacco use than their racial/ethnic counterparts, there is growing evidence to suggest that this may be changing because of increased use of tobacco products and/or underreporting of the use of alternative tobacco products or ATPs (e.g., cigars, cigarillos), among this population. The present study recruited a community-based sample of 101 urban African American caregivers that smoke (M = 41.1/SD = 9.9), and their adolescents between the ages of 12-17 (M = 14.4/SD = 1.9) to examine how caregiver tobacco-related messages (both verbal and non-verbal) shape adolescents’ tobacco attitudes, and behaviors. Dyads completed paper-pencil surveys separately and were compensated for their time and effort. A majority of the caregivers were single and living in low-income and public housing communities. Results from the analyses revealed high rates of adolescent tobacco use (lifetime) of both cigarettes and alternative tobacco products, and prompting (e.g., caregivers’ request that adolescents retrieve, buy, or smoke tobacco products with them). The findings also showed that all of the caregiver variables including: prompting, monitoring, as well as caregiver antismoking messages together impacted adolescents’ tobacco-related outcomes including their attitudes about tobacco, refusal efficacy and their intentions to use (at six months and adulthood), and their actual use. These findings underscore the need for more tobacco education that includes not only adolescents, but also parents, and other important caregivers (e.g., extended kin/family members) that helps increases knowledge surrounding the dangers of parental prompting, the importance of parental monitoring of youths whereabouts and peers, as well as parent-adolescent antismoking communication in reducing the prevalence of adolescent smoking/tobacco use (including the use of ATPs). This study also highlights the need for tobacco control and policies that limit adolescents’ exposure and access to tobacco products particularly among African Americans living in disadvantaged neighborhoods.

Introduction: E-cigarettes have been marketed as smoking cessation aids and harm reduction strategies. Prior regional surveys found that physicians are recommending them to patients despite the lack of evidence supporting these industry claims. Yet, little is known about physicians’ beliefs regarding e-cigarettes and whether these beliefs are associated with them recommending e-cigarette use in clinical practice. Methods: This three-manuscript dissertation used a mixed-methods approach including both qualitative and quantitative research methods. The aims were to: (1) Uncover the factors associated with primary care physicians’ (PCPs) decisions to recommend e-cigarettes to their patients for tobacco use cessation; (2) Estimate the prevalence of PCPs who recommend e-cigarettes to their patients as a tobacco use cessation aid; (3) Estimate the influence of factors identified in Aim 1 on PCPs’ decisions to recommend e-cigarettes to their patients for tobacco use cessation; (4) Evaluate the conceptual model which demonstrates the factors contributing to PCPs’ decisions to recommend e-cigarettes to their patients for tobacco use cessation. Results: Study 1 found that PCPs expressed a lack of information about e-cigarette safety and efficacy along with skepticism about the role of e-cigarettes in tobacco control in general and in smoking cessation in particular. However, once a patient initiates a discussion with them, PCPs seem to be endorsing patients’ interests in using e-cigarettes, as well as recommending e-cigarettes to particular types of patients who smoke for both smoking cessation and as a harm reduction strategy. Study 2 found that over three-quarters (82.7%, n=220) of PCPs reported previously discussing e-cigarettes with their patients. Overall, 57.8% (n=155) reported previously recommending e-cigarettes to an adult patient who smoked. Among those recommending e-cigarettes, the majority reported recommending them for smoking cessation and harm reduction (71.6%, n=111), 18.8% for smoking cessation only, and 9.6% for harm reduction only. The likelihood of recommending e-cigarettes to patients was associated with considering their patients’ interest in using e-cigarettes, PCP’s belief that e-cigarettes can help in quitting smoking, and PCP’s belief that e-cigarettes limit secondhand smoke exposure for others. Study 3 found that PCPs intend to recommend e-cigarettes for smokers with prior unsuccessful quit attempts (mean=3.63, ±2.1), followed by heavy smokers wanting to quit (3.57, ±2.2), and heavy smokers refusing to quit (mean=3.50, ±2.2). The mean for PCPs’ recommendation intentions was 3.04 (±2.0) for light smokers wanting to quit, and 3.01 (±1.9) for light smokers refusing to quit. Nevertheless, these recommendation intentions were driven by PCPs’ beliefs and perceptions of e-cigarette benefit and harm; however, these intentions varied by patients’ tobacco use profile. Discussion: Findings across the three studies highlight the significance of PCPs’ beliefs in driving their recommendations of e-cigarettes versus evidence based knowledge, as well as, the importance of patients’ factors and interest in using e-cigarettes for PCPs’ recommendations for e-cigarette use.