There is widespread recognition of the need for preventive healthcare to support people in adopting healthy lifestyles that will reduce their risk of long term conditions such as diabetes, cardiovascular disease and cancer. In recent years, a number of observational studies have shown that social networks may play an important role in health behaviour change. Thus far, however, there has been limited success in translating these findings into effective interventions, suggesting a failure to tap into real-world social processes. The aim of my thesis is to develop our understanding of the role that social networks play in one key area of health behaviour change, namely smoking cessation, with a view to gaining insights into how networks can be better utilised to improve quit outcomes. Whilst most research into health behaviour change is rooted in psychological theory, this study draws on a somewhat different perspective, that of social network studies in health. More specifically, it uses a longitudinal qualitative approach to investigate the role of social networks in giving up smoking. Thirteen participants from diverse sociodemographic backgrounds were recruited through three stop smoking services in central Scotland, and interviewed four weeks after quitting; nine participants took part in a follow-up interview two months later. In-depth interviews combined an interactive network mapping exercise with a detailed exploration of the complex inter-relationships between participants’ social networks and their experiences of quitting. A thematic data analysis was undertaken. Quitting was found to be enmeshed in an intricate web of social relationships and interactions. Quitters were not, though, powerless in the face of these social forces, but rather actively sought to navigate their social networks. Existing theorisations tend to view the social network as acting on a passive individual and, as such, overlook the importance of subjective meaning and dynamic interaction in shaping the quit attempt. My thesis demonstrates, however, that the mechanisms of subjectivity and interaction operate in complex ways, encompassing a myriad of overlapping sources of meaning which include the immediate context of interactions, the wider nature of individual relationships, and the overall construction of the social network. These processes jointly unfold, moreover, as the quit attempt proceeds. Efforts to develop network-based cessation interventions must, therefore, move away from attempts to “fix” the network, and must instead seek to find ways of helping quitters to more effectively navigate their social networks.

This study explores how young people conceptualise addiction to smoking and, also the relationship between young people's addiction beliefs and intentions to smoke cigarettes. Addiction to smoking is a major health problem, not just for adults, but also for young smokers, up to 60% of whom are dependent on nicotine. However, anti-smoking prevention efforts targeted at young people generally emphasise ill-health effects and little attention is paid to addiction education which is generally considered relevant only to adult smoking and cessation efforts. Perhaps as a consequence, young people appear to have many misconceptions and unrealistic ideas about addiction, and these may possibly have influenced initial decisions to take up smoking. For example, between 50% and 60% of young smokers believe that it would be easy or very easy to stop smoking altogether if and when they choose to and the majority of daily smokers mistakenly believe that they will not be smoking for more than five years. For these young smokers, becoming addicted is often an unforeseen consequence and most are surprised to find that they cannot give up smoking as easily as they thought. The majority of addicted smokers regret ever taking up smoking but nevertheless continue to smoke cigarettes for perhaps 30 to 40 years because they find it very difficult to stop. This backdrop provides the impetus for the present study.

Policy-makers, research funders, and practitioners acknowledge the need for theories about the uptake of scientific evidence into policy and programs to reduce population-wide risk factors for the major avoidable chronic non-communicable diseases. Models of evidence-informed practice in public health settings have not been developed through systematic scientific inquiry. This study explores and develops a realistic account of evidence-informed tobacco control practice in Ontario public health agencies. In-depth, intensive, semi-structured qualitative interviews were conducted with twelve local public health agency senior executives and other key tobacco control staff in three diverse public health agencies in Ontario, Canada. Interviews explored aspects of tobacco control related decision-making and practice, as well as supports from regional, provincial, and national levels that might enhance tobacco control practice. Interview data were supplemented by field notes and other documentation provided by interviewees, as well as unobtrusive sources. A grounded theory approach to the analysis of textual data identified six major and many subcategories and dimensions implicated in evidence-informed tobacco control practice in local public health agencies. The major category structure includes: information and evidence, interpretation and decision-making, organizational aspects, organizational environment, practice integration, and time. An overall model and five sub-models were developed describing the relations among core category and sub-category factors. Propositions were developed a priori based on an extensive review of the literature. Potentially relevant social theories and concepts were also identified based on a selective review of the literature, including critical realist and other perspectives pertaining to agency-structure issues. Theories and propositions were reviewed, which resulted in a minor modification to the subcategory structure of one branch. Public health agency tobacco control case descriptions were developed based on a final category structure, including six branches, 27 sub-branches, and 98 twigs, and verified (subject to some adjustments) through a member check. Working knowledge is seen to be complex and socially constructed, incorporating aspects of social cognitive and planned behavior theories and Aristotelian intellectual virtues. Realist social theory offers insights into potential change processes. Contributions of the study of theory, practice and methods are discussed, as are strengths and limitations, and areas of needed future research.

Background and Objectives: Environmental tobacco smoke (ETS) is widely recognized as a serious health hazard. No safe level of exposure to ETS has been identified (USDHHS, 2006; WHO, 2007). The importance of smoke-free spaces in improving health outcomes for both smokers and non-smokers is clearly understood and as such, many individuals living in Ontario have made their homes smoke-free. Although those living in units within multi-unit dwellings (MUDs) have the option of making their own unit smoke-free, they may still be involuntarily exposed to ETS drifting from smoking units to their unit. The present study explores tenant’s perceptions of this drifting ETS and the potential market for smoke-free rental housing. Methods: Anonymous surveys were sent to 3724 households within rented MUDs (apartments and row housing) with five or more units in Kitchener, Ontario. In addition to demographic questions, the survey addressed respondents’ experiences with, perceptions of, and reactions to drifting ETS and their views on smoke-free rental housing. Three hundred and five surveys were returned, and 291 met the final inclusion criteria to be included in the analysis. Survey data were weighted by age and education level. Descriptive analyses and logistic regression models were run to answer the research questions. Results: Over half of the respondents who do not smoke in their unit on a daily basis indicated they were exposed to drifting ETS in their home at least ‘sometimes’. Of those who were exposed, 89.5% were bothered and nearly half were bothered ‘a lot’. This suggests drifting ETS is a concern for many tenants living in MUDs. The majority of tenants indicated they did not live in a smoke-free building however there was a strong interest in smoke-free rental housing. Nearly 90% of tenants showed at least some interest in smoke-free rental housing, and many tenants would prefer to live in a building with the strongest possible restrictions on smoking in place. Younger tenants, non-smokers, those who spent less time at home on weekends and those who perceived indoor smoking as a fire risk were more likely to be interested in smoke-free rental housing. Conclusions and Significance: This study provides insight into the magnitude of the problem of drifting ETS in MUDs and can be used to inform policy on smoke-free MUDs. Many respondents indicated they were exposed to drifting ETS and the majority of those who were exposed were bothered by this exposure. There also appears to be a strong market for smoke-free rental housing. The response rate for this study was low at 8.5% and as such the results must be interpreted with caution. Future research should be completed in other jurisdictions and with larger sample sizes. Landlord surveys and air quality monitoring studies are also needed. While additional research is needed, the current study suggests this is an important public health issue, and provides additional evidence supporting the need to explore policy options in the public and private realm for smoke-free housing.

<strong>Objective:</strong> This study was designed to inform the development of a web tool to simplify access to and analysis of available evidence for youth tobacco control. This tool will support planning, evaluation and research related to youth tobacco control. Primary objectives were to examine useful functions and characteristics of potential end-users. <br /> <strong>Methods:</strong> A pilot-tested, web-based questionnaire was administered to potential end-users (N=43). A purposeful sample of participants was selected to represent individuals working in youth tobacco control from research, health, and education sectors in Western, Central, and Eastern Regions of Canada. Data were analyzed using frequency calculations and cross-tabulations by sector. Results guided the creation of a prototype. Interviews were conducted with a subset of participants (N=6) to validate the prototype and identify further functions. Data were analyzed using content analysis. <br /> <strong>Results:</strong> Useful functions of the prototype identified varied slightly across sectors. Research participants felt that access to raw data was a useful function. Health sector practitioners were interested in accessing data and creating summary reports of data. Educators were mostly interested in obtaining summary information from data, through reports. Further, health and research participants felt the information resources function was redundant. This research has provided important insights that will guide the development of a functional web tool. <br /> <strong>Implications:</strong> This tool can enable users to identify effective interventions, track the progress of school or health regions relative to benchmarks, and identify high risk schools or communities to target intervention efforts. This tool is an innovative way to maximize the use of available resources to link research, policy, and practice.

Policy-makers, research funders, and practitioners acknowledge the need for theories about the uptake of scientific evidence into policy and programs to reduce population-wide risk factors for the major avoidable chronic non-communicable diseases. Models of evidence-informed practice in public health settings have not been developed through systematic scientific inquiry. This study explores and develops a realistic account of evidence-informed tobacco control practice in Ontario public health agencies. In-depth, intensive, semi-structured qualitative interviews were conducted with twelve local public health agency senior executives and other key tobacco control staff in three diverse public health agencies in Ontario, Canada. Interviews explored aspects of tobacco control related decision-making and practice, as well as supports from regional, provincial, and national levels that might enhance tobacco control practice. Interview data were supplemented by field notes and other documentation provided by interviewees, as well as unobtrusive sources. A grounded theory approach to the analysis of textual data identified six major and many subcategories and dimensions implicated in evidence-informed tobacco control practice in local public health agencies. The major category structure includes: information and evidence, interpretation and decision-making, organizational aspects, organizational environment, practice integration, and time. An overall model and five sub-models were developed describing the relations among core category and sub-category factors. Propositions were developed a priori based on an extensive review of the literature. Potentially relevant social theories and concepts were also identified based on a selective review of the literature, including critical realist and other perspectives pertaining to agency-structure issues. Theories and propositions were reviewed, which resulted in a minor modification to the subcategory structure of one branch. Public health agency tobacco control case descriptions were developed based on a final category structure, including six branches, 27 sub-branches, and 98 twigs, and verified (subject to some adjustments) through a member check. Working knowledge is seen to be complex and socially constructed, incorporating aspects of social cognitive and planned behavior theories and Aristotelian intellectual virtues. Realist social theory offers insights into potential change processes. Contributions of the study of theory, practice and methods are discussed, as are strengths and limitations, and areas of needed future research.

Background and Objectives: Environmental tobacco smoke (ETS) is widely recognized as a serious health hazard. No safe level of exposure to ETS has been identified (USDHHS, 2006; WHO, 2007). The importance of smoke-free spaces in improving health outcomes for both smokers and non-smokers is clearly understood and as such, many individuals living in Ontario have made their homes smoke-free. Although those living in units within multi-unit dwellings (MUDs) have the option of making their own unit smoke-free, they may still be involuntarily exposed to ETS drifting from smoking units to their unit. The present study explores tenant’s perceptions of this drifting ETS and the potential market for smoke-free rental housing. Methods: Anonymous surveys were sent to 3724 households within rented MUDs (apartments and row housing) with five or more units in Kitchener, Ontario. In addition to demographic questions, the survey addressed respondents’ experiences with, perceptions of, and reactions to drifting ETS and their views on smoke-free rental housing. Three hundred and five surveys were returned, and 291 met the final inclusion criteria to be included in the analysis. Survey data were weighted by age and education level. Descriptive analyses and logistic regression models were run to answer the research questions. Results: Over half of the respondents who do not smoke in their unit on a daily basis indicated they were exposed to drifting ETS in their home at least ‘sometimes’. Of those who were exposed, 89.5% were bothered and nearly half were bothered ‘a lot’. This suggests drifting ETS is a concern for many tenants living in MUDs. The majority of tenants indicated they did not live in a smoke-free building however there was a strong interest in smoke-free rental housing. Nearly 90% of tenants showed at least some interest in smoke-free rental housing, and many tenants would prefer to live in a building with the strongest possible restrictions on smoking in place. Younger tenants, non-smokers, those who spent less time at home on weekends and those who perceived indoor smoking as a fire risk were more likely to be interested in smoke-free rental housing. Conclusions and Significance: This study provides insight into the magnitude of the problem of drifting ETS in MUDs and can be used to inform policy on smoke-free MUDs. Many respondents indicated they were exposed to drifting ETS and the majority of those who were exposed were bothered by this exposure. There also appears to be a strong market for smoke-free rental housing. The response rate for this study was low at 8.5% and as such the results must be interpreted with caution. Future research should be completed in other jurisdictions and with larger sample sizes. Landlord surveys and air quality monitoring studies are also needed. While additional research is needed, the current study suggests this is an important public health issue, and provides additional evidence supporting the need to explore policy options in the public and private realm for smoke-free housing.

Study Purpose: This research aimed to: (1) understand interactions between researchers and policy-makers in the Canadian tobacco control research community and, (2) explore the relationship between interaction and alignment of research and policy within tobacco control. Methods/Analyses: Semi-structured, in-depth interviews were conducted by phone or in-person with a purposeful sample of Canadian policy-makers at the provincial and federal-levels (n=10) and tobacco control researchers (n=8). A grounded theory methodology was used to guide interview conduct and analyses. Sampling of policy-makers was based on leadership roles for tobacco control in their respective jurisdictions and nominations. Sampling for researchers was based on nominations. Interviews were audio-recorded with permission and transcribed. Transcripts were shared with participants for verification. Results: The tobacco control context in Canada represents a mature field with a historically active policy agenda and an increasingly well-established research community. Through the analysis, nine data-driven categories emerged related to interactions between researchers and research users. The data were further examined to understand possible relationships between interaction and alignment. The nine major categories related to: (1) “two communities”, including the nature of policy and the differential timeframes of research and policy; (2) structures to support interaction, including within or cross-provincial and/or national facilitative mechanisms for interaction between researchers and research users to occur; (3) relationship building between researchers and research users, including the deliberate nature of building and reinforcing relationships over time; (4) interaction in the research process by research users; (5) interaction in the policy process by researchers; (6) independence and credibility of researchers; (7) incentives and barriers to interactions; (8) relevance and timeliness of evidence relative to decision-making needs, and; (9) alignment, including the extent to which research and policy share priorities and objectives. Significance: Results provide insight into the researcher and research user relationships in the Canadian tobacco control community. This study extends existing conceptual work in the area of knowledge exchange particularly from a public health perspective and has implications for other aspects of chronic disease prevention.

Tobacco smoking in Canada has decreased over the last 20 years but remains persistent in lower socioeconomic status (SES) groups. The current study is an examination of tobacco smoking among lower SES Canadians that seeks to explore the social context of tobacco smoking from the perspective of those individuals who participate in it. This study utilized in-depth interviews with nine working class males from the Greater Vancouver and the Capital Regional Districts. It followed the phenomenological method in attempting to understand the experience of a working class smoker, reading that analysis through a Bourdieusian conceptual framework. This framework served to define the social context in terms of multiple symbolic economies bounded by symbolic boundaries, providing a coherent geography within which to locate the experiences. The study finds that within the working class symbolic economy, tobacco smoking is seen as legitimate and is enmeshed within conceptions of leisure, of self and intimately tied to other culturally-mediated commodities such as alcohol and other drugs. The findings further indicate that tobacco smoking in and of itself is not a cultural capital, but becomes culturally relevant when it is performed correctly. Correct performance requires adherence to certain rules, however, the best performance of smoking is done when it is presented as natural. Tobacco smoking, the findings indicate, is so “taken-for-granted” that unless one is a committed, ‘real’ smoker all others, social smokers included, are considered non-smokers. Through sharing and semi-ritualized consumption, tobacco smoking helps to reinforce reciprocal relationships that strengthen potentially insecure social bonds. Finally, working class males present themselves as self-reliant individuals that find cessation aids and therapies to be an embarrassment to their conception of self, thus to use cessation aids is to admit failure. The implication of these findings is that tobacco persistence exists within a classed symbolic economy that is simply not reached by current tobacco cessation programs and health research. To be effective then, such programs need to take into account the value and role tobacco smoking plays within this economy. / Graduate

Study Purpose: This research aimed to: (1) understand interactions between researchers and policy-makers in the Canadian tobacco control research community and, (2) explore the relationship between interaction and alignment of research and policy within tobacco control. Methods/Analyses: Semi-structured, in-depth interviews were conducted by phone or in-person with a purposeful sample of Canadian policy-makers at the provincial and federal-levels (n=10) and tobacco control researchers (n=8). A grounded theory methodology was used to guide interview conduct and analyses. Sampling of policy-makers was based on leadership roles for tobacco control in their respective jurisdictions and nominations. Sampling for researchers was based on nominations. Interviews were audio-recorded with permission and transcribed. Transcripts were shared with participants for verification. Results: The tobacco control context in Canada represents a mature field with a historically active policy agenda and an increasingly well-established research community. Through the analysis, nine data-driven categories emerged related to interactions between researchers and research users. The data were further examined to understand possible relationships between interaction and alignment. The nine major categories related to: (1) “two communities”, including the nature of policy and the differential timeframes of research and policy; (2) structures to support interaction, including within or cross-provincial and/or national facilitative mechanisms for interaction between researchers and research users to occur; (3) relationship building between researchers and research users, including the deliberate nature of building and reinforcing relationships over time; (4) interaction in the research process by research users; (5) interaction in the policy process by researchers; (6) independence and credibility of researchers; (7) incentives and barriers to interactions; (8) relevance and timeliness of evidence relative to decision-making needs, and; (9) alignment, including the extent to which research and policy share priorities and objectives. Significance: Results provide insight into the researcher and research user relationships in the Canadian tobacco control community. This study extends existing conceptual work in the area of knowledge exchange particularly from a public health perspective and has implications for other aspects of chronic disease prevention.