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.

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.

No description available.

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.

Thesis (Ph.D. in Nursing) -- University of Colorado at Denver and Health Sciences Center, 2006. / Typescript. Includes bibliographical references (leaves 144-159). Free to UCDHSC affiliates. Online version available via ProQuest Digital Dissertations;

Thesis (M.A.)--Carleton University, 1993. / Also available in electronic format on the Internet.

Thesis (M.Med.Sc.)--University of Hong Kong, 2004. / Also available in print.

Thesis supervisor: Steven M. Lily. Includes bibliographic references (p. 235-243).