Class of 2007 Abstract / Objectives: The purpose of this study was to examine the relationship between the demographics and attitudes of Arizona pharmacists regarding provision of smoking cessation services. Methods: Paper-based surveys were distributed to pharmacists attending the 2006 Arizona Pharmacy Alliance (AzPA) Annual Meeting in Tucson, Arizona. The instrument allowed collection of 12 demographic points from subjects for data cross-sectioning. Opinions of the pharmacists were collected for 35 statements of agreement level on a four-point Likert-type response scale. Association between the demographic and opinion variables was analyzed using either Kruskal-Wallis’ rank-sum or Spearman's correlation tests. Results: Of 350 surveys distributed, 78 subjects returned them and 63 (18%) met inclusion criteria. Respondents agreed to all barriers of smoking cessation, particularly lacks in time (82.5%), patient demand (79.7%), smoking cessation program availability (68%), and documentation system (56.6%). Participants’ demographics including age, gender, practice setting and position, time since completion of education, specific smoking cessation education received, time spent counseling a patient, and number of general and smoking cessation counsels were significantly associated with pharmacists’ perceived demand and resource barriers to provision of smoking cessation services, faith in a patient’s ability to quit or try, self-perception as a valuable and effective resource, comfort level approaching patients regarding smoking cessation, likelihood of intervention, and feelings of reward (all p-values < 0.05). Conclusions: This study identified several associations between pharmacists’ demographics and their thoughts towards provision of smoking cessation services, though causation is undetermined.

Individuals suffering from mental illness are often adversely affected by tobacco use. Historically, clinicians are reluctant and inadequately prepared to recognize and treat comorbid nicotine addiction in the chronic mentally ill (CMI) client. As evidenced by a review of the literature, healthcare providers are missing opportunities for nicotine cessation treatment. There is a lack of educational preparation amongst clinicians to treat nicotine addition and a concern that treatment of nicotine addiction can negatively impact existing psychiatric disorders. The purpose of this project was to create an educational plan for nicotine cessation for CMI clients at a community health center. The conceptual framework to guide this project is premised on Lewin's Change Theory and the Logic Model. Nine clinicians, specializing in mental health, reviewed the developing education program at three distinct times and responded to a 12-item author-developed questionnaire to determine their understanding of nicotine cessation and their willingness to initiate the nicotine cessation program. A review of the questionnaire responses indicates the clinicians agreed nicotine abuse is a problem for the CMI client, they had not received adequate training on nicotine cessation, and they would be comfortable incorporating the nicotine cessation education program in their practice. The findings were presented to key organization stakeholders at the community mental health center. Social change will result with implementation of the education program empowering clinicians, in this mental health center, to gain the knowledge to effectively diagnose and intervene when clients present with comorbid nicotine addiction and mental health conditions.

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

Introduction: Mobility is critical for independence, social engagement and quality of life, which for many seniors equates with driving. Driving cessation has been associated with depression, isolation and decreased social and community engagement. However, apart from a few studies in the United States, research on the impacts of driving cessation and transportation use in general has been restricted to community dwelling seniors. It is estimated that 40,000 seniors in Ontario alone currently live in retirement facilities; a number expected to increase. Purposes: The aim of the wider project is to gain a better understanding of the transportation patterns and needs of older adults living in retirement homes. The specific aims of this study, which focused on residents who recently stopped driving (in the past two years), were to examine: 1) events leading to driving cessation, impacts (including depression), and possible associations with relocation; 2) transportation use, including how frequently they left the Village; and 3) connections with family and friends, and activity engagement in and outside the Villages. Methods: A survey of residents from four retirement Villages in Southern Ontario was conducted to examine driving status and use of other modes of transportation. An in-depth study was then conducted with a sample of 20 residents (9 men and 11 women, age 86.45 ± 5.16), recruited via letters, pamphlets, booths and door-to-door. The study involved both quantitative (questionnaires, scales on depression and balance confidence, activity checklists) and qualitative methods (small group discussions). Participants were also asked to complete travel diaries over two weeks for all trips outside the Village (purpose and mode of travel). Results: The transportation survey (N=407; 56% response rate) showed that 68% of residents had stopped driving (N=273), over half within 12 months of relocation. In the in-depth study, 36.8% had stopped driving before the move (average of 3.43±1.72 months, range 1 to 6), 42.1% after the move (average of 27.38±13.51 months, range 2 to 46), and 21.2% within the same month. While the quantitative data indicates a relationship between these transitions, this connection was often not made by residents themselves. Several mentioned health problems as the main reason they quit driving; two had lost their licenses. Regardless, most felt the decision to quit driving was voluntary and done at the “right time”. Except for a few people, this sample did not have depression symptoms and had adjusted to no longer driving. The majority (85%) had relatives in the area and most stayed connected to relatives and friends living outside the Village through visits and phone calls. Nearly all the residents (90%, n=18) received rides from others, most commonly from their daughters (70%), followed by friends outside the Village (60%). Half the sample said they used public buses occasionally, and those who did had significantly higher balance confidence scores on the ABC scale (73.33±18.50) compared to those who did not (49.44±21.02) (t=-2.69 p=0.015). Confidence scores, however, did not differ for those who used the Village shuttle (80%) and those who did not (20%). Based on their travel diaries, 76.5% of the residents (13/17) made at least one trip outside the Village over a two week period (average of 7.00±4.93, range 1 to 18), most often as a passenger in a private vehicle (58%). Recreation and social trips were the most common (44.2%), followed by: medical appointments (18%), shopping (17%), errands (15.3%) and religious activities (5.4%). The sample also took advantage of services and amenities inside the Village, including: meals in the dining room (95%), the café (90%), general store (80%), salon (65%), library (65%), laundry facilities as well as services of health professionals. They also participated in Village programs, including: music, concerts, movies (80%), physical activities (65%), games (55%) and religious services (50%). Conclusions: Seniors who can afford to live in upscale retirement homes may not suffer the adverse effects of driving cessation often found in community seniors. Despite advanced age and mobility restrictions (85% used a walker outdoors), these individuals remained connected to the outside community. This sample, at least, took advantage of the services and amenities in their Villages which may reduce their need for travel outside the Village. They do not appear to have unmet transportation needs, given that most had relatives in the area as well as other people to drive them when needed. More studies are needed on this growing segment of the senior population, particularly on other types of retirement facilities which may not offer as many services (such as shuttle buses or vans) for residents.

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