Thesis (Ph.D.)--University of Delaware, 2007. / Principal faculty advisor: Marian L. Palley, Dept. of Political Science & International Relations. Includes bibliographical references.

Objective: This study compared the prevalence of use of six alternative tobacco products [ATPs] among Canadian students in grades 9 and 10, identified between-school variability in the current use of each ATP, and identified the school- and student-level characteristics associated with the use of each ATP. Methods: This cross-sectional study used nationally representative student data collected from 14,916 students in grades 9 and 10 from 134 secondary schools as part of the 2010-11 Youth Smoking Survey and data from the 2010-11 Enhanced Points of Interest data file. Multilevel regression analyses examined the association between school- and student-level characteristics and the use of each ATP. Results: Among Canadian students in grades 9 and 10, 15.4% reported currently using a tobacco product. Cigarillos or little cigars were the most prevalent product (6.3%) and bidis were the least prevalence product (0.6%). School-level differences accounted for between 14.1% and 31.2% of the variability in use. Grades 9 and 10 students who attended schools with a high rate of senior students that smoked manufactured cigarettes were significantly more likely to currently use cigarillos or little cigars (AOR 1.79, 95%CI 1.21 to 2.65) and roll-your-own cigarettes (AOR 1.88, 95%CI 1.15 to 3.07). Grades 9 and 10 students who reported having ever used flavoured tobacco products were significantly more likely to currently use cigarillos or little cigars, cigars, roll-your-own cigarettes, smokeless tobacco, and a hookah (AOR range 1.87 to 18.40). Finally, grades 9 and 10 students who reported currently using alcohol (AOR range 1.99 to 3.06) or marijuana (AOR range 2.09 to 3.47) were significantly more likely to currently use cigarillos or little cigars, cigars, and a hookah. Conclusions: Many students reported currently using one or more ATPs, and these data illustrate that there is a population of students who are not represented in current smoking prevalence estimates. The school environment continues to play an important role in tobacco control as the rate of tobacco use among senior students affects the use of ATPs by younger students. Future tobacco control strategies need to be inclusive of all tobacco products.

Background: Tobacco use is a major public health problem associated with a host of preventable morbidities and premature mortality. It is a behavior that most often is initiated during adolescence; therefore schools are an ideal setting for intervention. Policy interventions have the greatest impacts on changing behaviors on a population scale. Comprehensive tobacco-free school (TFS) model polices can be replicated and applied throughout the State of Georgia to help prevent youth from initiating smoking and support their attempts to quit. Engaging stakeholders is necessary in order to ensure proper implementation and enforcement of these policies. Creating healthier school environments that support a 100% TFS policy will continue to demonstrate health improvements resulting from Public Health interventions. The following study assesses associations of key stakeholders in Georgia school districts responsible for overseeing their tobacco-free school policies with the implementation and enforcement of evidence-based components of a comprehensive tobacco-free school policy. Methods: Developed in collaboration with the Tobacco Use Prevention Program of the State of Georgia (GTUPP), a cross-sectional survey design was used to conduct this study. The survey instrument (based on a previously used survey) consists of 49 items related to 100% tobacco-free school policy adoption and enforcement for students, staff, and visitors. The survey was electronically administered to 3,000 school stakeholders (principals, administrators, school board members). Chi-square tests examined association among those stakeholders in charge of policy enforcement and the various components of Georgia’s model comprehensive TFS policy. A p-value of <0.05 and 95% confidence intervals were used to determine statistical significance of analytic tests. Results: 328 stakeholders who were invited to participate completed surveys. This represents a response rate of 10.9%. Of the 328 total stakeholders, 315 actually had a TFS policy in place within the surveyed school district and only thirteen respondents replied from schools that did not have any policy in place. Therefore, those surveys completed by non-adopting school officials were not included in the associative analyses for this study. Results indicated that assistant principals who carried the charge of TFS enforcement had the greatest compliance with model policy enforcement (92.9%) regarding posting signage, although the majority of respondents indicated that there was no single stakeholder identified as the policy ‘champion’ (n=65, 40.8%). In schools where ‘other stakeholders’ were identified as being in charge of enforcement of TFS policies—respondents indicated 100% compliance with posting of signage at school. However, these results were not found to be statistically significant [χ=.844(3), p>0.05]. In terms of mass media messaging, while assistant principals and other stakeholders less frequently were champions of TFS policy messaging, they had the highest reports of sharing information about mass media messaging and community-based tobacco prevention efforts (71.4% and 82.6%, respectively). In comparison, among respondents who identified as principals or as another type of stakeholder, reports of sharing information were remarkably lower (55%), although this association was not found to be statistically significant. One point to consider is that all respondents of the survey may or may not have been the actual stakeholder targeted for that school district, but rather a possible representative completing the survey in lieu of the stakeholder. Conclusions: Study results can help the State of Georgia enhance resource allocation of tobacco prevention funds so that districts with the greatest health threats/greatest opportunities to improve can be targeted. Findings suggest that perhaps assistant principals or other stakeholders who champion the implementation and enforcement of policies may be more compliant with all elements of the Georgia model policy. The analysis conducted for this thesis and the results provided show the need for further in-depth research that examines the roles key stakeholders play in TFS policy adoption, implementation and enforcement.

The State Tobacco Activities Tracking and Evaluation (STATE) System is an interactive web-based application and data tool providing up-to-date state-level information related to tobacco use. Indicators in STATE present data related to current and former tobacco use, smoking cessation, funding, tobacco-related health costs, and tobacco control policies. The STATE System also serves as a primary data source for many objectives in Healthy People 2020’s Tobacco Use chapter. Currently, there is no common thread between access to information pertaining to Healthy People 2020 objectives and STATE System data. For this reason, a comprehensive evaluation was conducted of the STATE System’s individual reports and static web-content as it relates to Healthy People 2020 objectives. Implications for research and evaluation are intended to educate the Office on Smoking and Health’s staff & colleagues in the states, networks, and territories on identifiable, cross-promotional opportunities that highlight both state and national data.

published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Objective: This study compared the prevalence of use of six alternative tobacco products [ATPs] among Canadian students in grades 9 and 10, identified between-school variability in the current use of each ATP, and identified the school- and student-level characteristics associated with the use of each ATP. Methods: This cross-sectional study used nationally representative student data collected from 14,916 students in grades 9 and 10 from 134 secondary schools as part of the 2010-11 Youth Smoking Survey and data from the 2010-11 Enhanced Points of Interest data file. Multilevel regression analyses examined the association between school- and student-level characteristics and the use of each ATP. Results: Among Canadian students in grades 9 and 10, 15.4% reported currently using a tobacco product. Cigarillos or little cigars were the most prevalent product (6.3%) and bidis were the least prevalence product (0.6%). School-level differences accounted for between 14.1% and 31.2% of the variability in use. Grades 9 and 10 students who attended schools with a high rate of senior students that smoked manufactured cigarettes were significantly more likely to currently use cigarillos or little cigars (AOR 1.79, 95%CI 1.21 to 2.65) and roll-your-own cigarettes (AOR 1.88, 95%CI 1.15 to 3.07). Grades 9 and 10 students who reported having ever used flavoured tobacco products were significantly more likely to currently use cigarillos or little cigars, cigars, roll-your-own cigarettes, smokeless tobacco, and a hookah (AOR range 1.87 to 18.40). Finally, grades 9 and 10 students who reported currently using alcohol (AOR range 1.99 to 3.06) or marijuana (AOR range 2.09 to 3.47) were significantly more likely to currently use cigarillos or little cigars, cigars, and a hookah. Conclusions: Many students reported currently using one or more ATPs, and these data illustrate that there is a population of students who are not represented in current smoking prevalence estimates. The school environment continues to play an important role in tobacco control as the rate of tobacco use among senior students affects the use of ATPs by younger students. Future tobacco control strategies need to be inclusive of all tobacco products.

While smoking prevalence among the general Canadian population has declined to 17%, declining rates have not been achieved equitably across all sub-populations (Statistics Canada, 2011). Smoking prevalence is particularly high among blue-collar workers, and individuals employed in the construction industry have the highest smoking prevalence (34%, Conference Board of Canada, 2013). Though studies have attempted to understand these disparities and how to combat them, research is necessary to understand the social contexts in which construction workers smoke. This study sought to understand these contexts by exploring experiences and meaning of smoking. Semi-structured, in-depth interviews were conducted with 14 construction workers living and working in Southern Ontario. Qualitative inductive analysis was conducted in three phases: (1) simultaneous data gathering and generating nodes, (2) coding and subgroup analysis, and (3) limited theory development. Grounded theory approach to analysis identified six main categories encompassing various subthemes. These included: day-to-day workplace experiences, experience of smoking, reasons for smoking, sociability of smoking, mechanisms associated with continued smoking, and experiences with quitting or cutting back. Sub-group analyses identified differences between participants depending on age, skill level (unskilled worker versus skilled tradesperson), and job sector (residential versus commercial/industrial). Social theories and concepts identified in the literature review were referred to, including the Social Contextual model by Sorensen and colleagues (2004). A potential set of contextual factors and modifying mechanisms that may be impacting construction worker’s tobacco use on or off jobsites are presented. The findings indicate that smoking is a complex issue among construction workers. For many, smoking goes hand-in-hand with working. Smoking is a social experience, and common on worksites. Workers experience various smoking policies on different jobsites. Policies may or may not be followed or enforced. Smoking has different meanings for different workers. However, factors external to the workplace must also be considered (e.g. partner smoking status). Supports that could be offered in workplace contexts include incentives, coverage of quitting aids, and limiting smoking (e.g. smoke-free policy). These findings have implications for policy and practice. Further research, including collaborative intervention development, is necessary to address high and persistent rates of tobacco use among construction workers.

Approximately 10% of women use cocaine and 20% smoke cigarettes during pregnancy. Animal studies indicate that both cocaine and nicotine are neuroteratogenic agents, although findings with humans are inconsistent. Studies with human infants have been plagued by unreliable subject identification procedures, poor control over confounding factors, and invalid measures of CNS integrity. The literature on prenatal cocaine and nicotine use is reviewed and two studies are presented along with an intriguing case report. The effects of maternal prenatal cocaine use (Study 1) and two levels of cigarette smoking (Study 2) on newborn information processing ability were examined using an auditory habituation-recovery paradigm. Case-control designs were employed in which subjects were individually matched on a number of maternal and infant factors. Cocaine exposure was determined by newborn meconium analysis, urine analysis, and maternal self-report. Maternal smoking was determined by self-report and a variation of the bogus pipeline method. Fetal cocaine- and nicotine-exposure were associated with differential impairments in neonatal information processing. Cocaine-exposed newborns exhibited deficits on measures of habituation and recovery to novelty. Dose-response effects of nicotine-exposure were evident on measures of orientation and habituation, but recovery to novelty was not consistently affected. The results imply that fetal cocaine-exposure severely impairs neonatal auditory information processing ability, whereas fetal tobacco-exposure is associated with deficits in information-processing which may be secondary to impairments in arousal regulation. These auditory processing deficits may be related to the later language impairments reported in follow-up studies with cocaine-and tobacco-exposed infants. Following the two studies, a case is presented of an infant born to a woman who reported using large amounts of cocaine throughout pregnancy, although the infant's meco