The incidence of smoking among mentally ill people is very high. Smokers have a 50%, rate of mental illness diagnosis compared with 23% rate for general population. To address this problem, the purpose of this project was to plan a smoking cessation program for patients in a mental health facility. The theoretical foundation for this project was based on the theory of planned behavior, which identifies the predictive nature of smoking and the benefits that can be derived from implementing a systematic approach for change. The project question examined the effectiveness of smoking cessation program using educational support, pharmacological strategies, and bi-weekly meetings to help patients in a mental health hospital to decrease smoking behavior. The project design was based on use of smoking questionnaires, the Hooked on Nicotine Checklist (HONC), effective pharmacological strategies, educational support, and counseling treatments to evaluate symptoms of dependency. The key results of this project included the creation of a plan that could foster reduction in illness, improved quality of life, and reduced costs related to the onset of major illness in this vulnerable population. This data collection process focused on a qualitative design in which selected professionals were asked to review the materials and answer questions. This project could increase awareness of the issue of smoking; in addition, this project could equip nurses with the tools to deliver evidence based interventions for tobacco dependence that may significantly reduce tobacco use. This project has the implications for positive social change through its potential to improve the health of people with mental illnesses. It also creates a safe and healthy environment in mental health facilities for patients who do not smoke.

Adolescents and young adults use more tobacco than all other adults, yet the percentage of this younger population eventually quitting the use of tobacco is lower. There is little evidence-based research to support adolescent smoking cessation programs. Using social learning theory (SLT) and the stages of change model, the purpose of this project was to evaluate the effectiveness of the Not-On-Tobacco (N-O-T) program, an evidence-based adolescent smoking cessation program, in reducing or preventing the number of cigarettes smoked by high school boarding students and to evaluate how best to individualize the program for this high school going forward. The DNP questions were asked to see to what extent the N-O-T program would reduce the prevalence of student smoking and what changes to the current program curriculum should be made to tailor the program to this particular high school. Pre- and post survey data were obtained from 10 students 15-17 years of age enrolled in the N-O-T program for violating the campus' tobacco-free policy. A secondary data analysis using paired samples t test did not determine a statistically significant effect on smoking cessation in this small population of students. The findings did show a significant positive correlation between those who found the program 'very helpful' and a decrease in the number of cigarettes smoked pre- and post program. Content analysis of student data resulted in recommendations to modify the program to make it more effective for this school. Awareness of interactions and relationships with others and successfully dealing with social changes through a program like the N-O-T program will lead to increased life-long health benefits, decreased medical costs, and lost productivity associated with tobacco use. School nurses are in an ideal position to implement a successful smoking cessation program.

Research Doctorate - Doctor of Philosophy (PhD) / Despite the emergence of smoking care guidelines and best practice recommendations over the past 13 years, it has been suggested that smoking care is not routinely provided in hospitals. Although there is a relatively large body of evidence regarding the prevalence of patient smoking cessation after hospitalisation and the effectiveness of interventions to increase cessation levels, much less is known regarding the prevalence of best practice smoking care routinely provided in hospitals or the effectiveness of interventions to increase such care provision. This thesis seeks to address these deficiencies in the evidence base. In particular this thesis aimed to: 1. Examine the prevalence of hospital smoking care in the international and Australian contexts. This is addressed via a literature review of studies that have reported the level of smoking care delivered routinely in hospitals and a survey of hospital managers in New South Wales, Australia. 2. Examine the effectiveness of interventions to increase the routine delivery of smoking care in hospitals. This is addressed via a literature review of studies that have reported the effect of an intervention on smoking care levels, and via the implementation of a quasi-experimental study that was designed to increase the hospital-wide delivery of a broad range of smoking care elements. 3. Propose recommendations for future practice and research regarding the routine provision of hospital smoking care. This thesis consists of six chapters that address the above aims. Each of the chapters has been written as a relatively distinct report in the style of a journal article. The approach has been adopted to facilitate the reading of the thesis, and results in some repetition in some chapters. At the time of submission, two papers based on the chapters of this thesis have been published in peer-reviewed journals. A further two papers are under editorial review.

Since the introduction of tobacco into New Zealand, smoking and smoking related illnesses have become more prevalent in the Maori population than New Zealand's general population. The aim of the present research was to investigate smoking from a Maori perspective. It was hoped this information would provide a better understanding of how Maori can become smokefree. The present research also investigated a number of possible benefits that could be obtained by Maori through becoming smokefree. These benefits were analysed through Mason Durie's Whare Tapa Wha model, a Maori holistic health model. Semi-structured in-depth interviews were conducted with four Maori people, two of whom were current smokers and two who were ex-smokers. Common themes emerged from these interviews including the social aspect of smoking for Maori and the influence of the enviroment on smoking behaviour. Suggestions were given to illustrate how the social aspect of smoking and the cycle that subsequently develops can be broken. Using the Whare Tapa Wha model and the personal accounts given, the benefits of breaking such a cycle were discussed. Lastly, the importance of nurturing smokefree environments, especially Maori environments, was outlined. The notion of being positive about becoming smokefree and the need to celebrate giving up smoking were highlighted throughout this research.

Flertal tidigare studier har visat på både positiva och negativa resultat av motiverande samtal (MI) för att få patienter att sluta röka. MI används idag av sjuksköterskor i slutenvården såväl som i primärvården för att skapa beteendeförändringar som exempelvis till tobaksrökstopp. Syftet med studien var att undersöka varför det är oklart om motiverande samtal är en metod som kan leda till tobaksrökstopp. Studien gjordes som en litteraturöversikt och sökningarna gjordes i Cinahl, Oxford Journals, PsycINFO, PubMed och SveMed+. Sökningarna resulterade i 15 utvalda artiklar. Flertal av resultatartiklarna visade signifikanta resultat att MI vid tobaksrökstopp har effekt men det fanns också studier där ingen effekt kunde påvisas. Resultatartiklarnas resultat visade på att MI kan vara till hjälp för att få patienter att minska tobaksrökningen. Några resultatartiklar visade på att studiedeltagare med lägre motivation lyckades sämre med ett tobaksrökstopp än studiedeltagare med hög motivation. Slutsatsen är att mer forskning behövs om sambandet mellan MI och motivation för att uppnå tobaksrökstopp, aktsamhet ska tas då MI vid tobaksrökstopp ska appliceras i vården. / Several earlier studies on MI as a method to smoking cessation shows positive and negative results to help smokers quit. MI is used by nurse’s today inpatients and in primary care to create behavior changes for instance smoking cessation. The aim of this study was to examine why it´s obscure if motivational interviewing (MI) is a method that can result to smoking cessation. The study was made as a literature review. Searches were made in Cinahl, Oxford Journals, PsycINFO, PubMed and SveMed+ and resulted in 15 selected articles. Several studies showed significant results that MI as a method for smoking cessation had effect but there were studies where MI showed negative effect. In the studies there are significant results that MI can help patients reduce smoking. The results of a few articles showed that participants with lower motivation didn´t succeed in smoking cessation. The conclusion is that more research on MI must be conducted on the connection between MI and motivation in smoking cessation. Caution must be taken if MI should be applied in care as a method for smoking cessation.

We investigated the efficacy of standard (8-week nicotine, 16-week placebo) vs extended (24-week nicotine) patch therapy for smoking cessation, and the effect of slow nicotine metabolism, indicated by CYP2A6 reduced metabolizer (RM) genotype or low 3-hydroxycotinine/cotinine ratio (3HC/COT), on abstinence. RM versus normal genotype predicted lower 3HC/COT. Extended vs standard treatment produced higher abstinence at 24 weeks (32% vs 20%), but not at 52 weeks (both 14%). Low 3HC/COT and RM genotype predicted higher abstinence on extended versus standard treatment at 24 (47% vs 25%, 38% vs 17%) and 28 weeks (34% vs 19%, 23% vs 11%), while high 3HC/COT or normal genotype did not. Within extended treatment, low versus high 3HC/COT predicted higher abstinence at 8 (48% vs 29%), 24 (47% vs 25%), and 28 weeks (34% vs 16%), with similar trends for the genotype effect. Overall, extending nicotine treatment increased abstinence during therapy, particularly for slow metabolizers.

We investigated the efficacy of standard (8-week nicotine, 16-week placebo) vs extended (24-week nicotine) patch therapy for smoking cessation, and the effect of slow nicotine metabolism, indicated by CYP2A6 reduced metabolizer (RM) genotype or low 3-hydroxycotinine/cotinine ratio (3HC/COT), on abstinence. RM versus normal genotype predicted lower 3HC/COT. Extended vs standard treatment produced higher abstinence at 24 weeks (32% vs 20%), but not at 52 weeks (both 14%). Low 3HC/COT and RM genotype predicted higher abstinence on extended versus standard treatment at 24 (47% vs 25%, 38% vs 17%) and 28 weeks (34% vs 19%, 23% vs 11%), while high 3HC/COT or normal genotype did not. Within extended treatment, low versus high 3HC/COT predicted higher abstinence at 8 (48% vs 29%), 24 (47% vs 25%), and 28 weeks (34% vs 16%), with similar trends for the genotype effect. Overall, extending nicotine treatment increased abstinence during therapy, particularly for slow metabolizers.

Im Rahmen der Smoking and Nicotine Dependence Awareness and Screening (SNICAS) Studie wurde neben strukturellen Bedingungen und Variablen auf Ärzteseite (z.B. Qualifikation, Einstellungen zum Rauchen und zur Raucherentwöhnung, spezielle Vorerfahrungen und Therapiepräferenzen, perzipierte Barrieren) daher auch die Aufhörmotivation und die Erfahrungen mit Aufhörversuchen auf Seiten der Patienten untersucht.

Women smokers with heart disease (HD) are at increased risk for negative health effects. At the time of invasive cardiovascular (CV) interventions is a critical opportunity to make lifestyle changes to reduce future CV interventions. The purposes of this study guided by the Health Belief Model were to determine which factors predict smoking cessation (SC) in women following an invasive CV procedure and to explore assistance received with SC. A correlational, prospective design was used. Data were collected from women smokers at the time of an invasive CV intervention and three months later. Instruments measured commitment to stop smoking, perceived threat of HD and future interventions, cessation self efficacy, barriers to SC, benefits of SC, cues to action, and motivation. Analyses included Chi-square, t-tests, and multiple, hierarchical, and logistic regression. On average women (N = 76) were middle-aged (M = 55.9 ± 8.0 yrs), smoked M = 15.3 ± 9.8 daily cigarettes and smoked for M = 33.6 ± 10.2 years. At baseline, fewer perceived barriers to SC, high cessation self-efficacy, and being more autonomously motivated to quit smoking explained 67 % of variance in commitment to stop smoking, F (6, 67) = 19.37, p < .001. At 3 months, only 8 (n = 54) women had quit smoking. Women smoked fewer daily cigarettes (M = 10.6 ± SD = 8.5) at 3 months compared to time of procedure (M = 15.3 ± 9.8), t(51) = 3.43, p < .01. Higher baseline cessation self-efficacy and lower HD threat were predictors of SC at three months, X2 (4, N=54) = 18.67, p = .001. At the three month follow up, the most common barrier to SC was anxiety (24%) and cigarette cravings (24%). While women were highly committed and confident they could quit, they reported receiving little help from their health care provider (HCP) other than simple advice to quit smoking. Most women undergoing an invasive CV procedure were unable to quit smoking even with a high desire to do so. Referrals for assistance from HCP to decrease anxiety and nicotine dependence and to address ongoing challenges to SC are needed.

Syftet med studien var att beskriva vilka metoder till rökstopp som fanns uttryckta i litteraturen samt beskriva vilken effekt dessa metoder hade, då detta är en avgörande behandling för patienter med Kronisk Obstruktiv Lungsjukdom. För att påvisa artiklarnas kvalitet granskades dessa med avseende på urvalsgrupp i relation till föreliggande studies syfte. Studiens metod utformades med en deskriptiv design. Litteratursökning utfördes i databaserna Cihnal och Pubmed (Medline) vilket resulterade i 15 artiklar som denna studie baserats på. Resultatet som framkom var att metoderna antingen var ickefarmakologiska eller farmakologiska. De ickefarmakologiska var: rådgivning, spirometri, presenterad lungålder. De farmakologiska metoderna var: NRT (plåster, tuggummi, nässpray, inhalator, sublingualtablett, sugtablett), antidepressivum (Bupropion, Nortriptylin), Vareniclin (binder till samma receptor som nikotin) och Selegilin (MAO-B hämmare). De flesta metoderna visade sig effektiva i förhållande till placebo och ofta uppmättes statistiskt signifikanta skillnader där emellan. Kunde inte statistisk signifikans uppmätas, visade sig resultaten ändå vara positiva. Slutsatsen av studien tyder på att alla metoder till rökstopp är bra, men vissa gav ett bättre intryck av effektivitet. Med mer utbildning och framtida forskning hoppas föreliggande studies författare att valet av rökstoppsmetod anpassas individuellt beroende på patientens förutsättningar och behov. / The aim of this study was to describe methods for smoking cessation that has been expressed in literature and to describe the efficacy of the methods, thus it is a crucial treatment for patients with Chronic Obstructive Pulmonary Disease. To show the quality of the articles, their sample groups were examined in relation to the aim of present study. The method of the study was formed with a descriptive design. The articles were obtained via databases Cihnal and Pubmed (Medline) which resulted in 15 articles that based this study. The results showed that the methods either were non-pharmacological or pharmacological. The non-pharmacological methods were: counseling, spirometry, presentation of lung-age. The pharmacological methods were: NRT (patch, chewing gum, nasal spray, inhalator, sublingual tablet, lozenge), antidepressants (Bupropion, Nortriptyline), Varenicline (binds to the same receptor as nicotine) and Selegilin (MAO-B inhibitor). Most of the methods showed efficacy in relation to placebo and statistical significance was often measured. Even if the difference was not significant, the results were often positive. The conclusion of the study showed that all methods were good, but some of them were more effective. With more education and future research the authors of this study hope that the choice of method for smoking cessation adapts individually regarding to the patient’s condition and needs.