Background: Tobacco use remains a major public health issue. Population-level efforts to curb tobacco use include media to promote smoking cessation. However, these campaigns (including tobacco package warning labels) commonly emphasize the addictiveness of nicotine and the difficulty of quitting with statements like ?nicotine is as addictive as heroin and cocaine?. Addiction oriented messages may have an iatrogenic effect on cessation by undermining behavioural precursors such as self-efficacy, cessation outcome expectations, behavioural control, and quit-aid efficacy. <br /><br /> Objectives: First, to determine the effects of addiction focused messages in comparison to efficacy enhanced messages and control messages on smokers? self-efficacy, cessation outcome expectations, behavioural control, and quit-aid efficacy. Second, to determine if the impact of addiction focused messages differ according to participant nicotine dependency level. <br /><br /> Methods: A sample of adult smokers (n>101) from Kitchener/Waterloo and Owen Sound were randomly assigned into one of three intervention conditions: addiction focused (M1), efficacy enhanced (M2), and control (M3). Outcome measures were collected at baseline, post intervention and 30-day follow-up and included: self-efficacy, outcome expectations, behavioural control, quit-aid efficacy, and outcome expectancies. The 30-day follow-up also included measures of smoking consumption, quit attempts and use of a quit-aid. <br /><br /> Results: Majority of the participants were males and between 18-25 years of age. Mean number of cigarettes smoked ranged from 12 to 15 across groups whereas the mean number of years smoked ranged from 12 to 17. General linear analyses revealed no significant effect of message type or nicotine dependence (as measured by the Fagerstrome Test for Nicotine Dependence) on the outcome variables of interest. However, when perceived addiction was substituted as the measure of nicotine dependence, the analysis revealed a main effect for nicotine dependence on self-efficacy post intervention and on cessation outcome expectations at follow-up. An interaction effect was found for outcome expectancy at post intervention. <br /><br /> Conclusion: The results of this study suggest that acute addiction oriented messages may not negatively impact smokers? self-efficacy, outcomes expectations, behavioural control, quit-aid efficacy, and outcome expectancies. However, this does mean that message orientation should be ignored when constructing smoking cessation messages. In fact, program designers are encouraged to employ messages that limit the use of addiction oriented statements such as ?nicotine is as addictive as heroin and cocaine?. Further research is required to examine the potential cumulative impact of addiction oriented messages on quitting behaviour and its precursors.

In Canada, nicotine replacement therapy (NRT) is a best practice for adult smoking cessation, but it is not recommended for use by youth smokers. Previous research has indicated that more than 20 percent of high school-aged smokers in Canada had used NRT, despite the cross-Canada requirement that youths under the age of 18 have a physician’s prescription to purchase NRT. The goal of this study was to examine both student and school-level characteristics associated with use of NRT by youths. Data from 29,296 grade 9 to 12 students who participated in the 2008-2009 National Youth Smoking Survey (YSS) were combined with Canadian census and built environment data in multilevel logistic regression models. The associations between lifetime and current NRT use with student characteristics (i.e., smoking status, social smoking connections) were examined alongside school environment factors such as urban/rural location and pharmacy density within a one kilometre radius of schools. In 2008-2009, 21.1% of youth smokers in Canada had ever used NRT and 5.1% were currently using NRT. Odds of NRT use were highest among daily smokers, boys, youths who had made multiple quit attempts, and youths who self-identified as smokers. Attending a school located within an urban area increased youths’ odds of NRT use, whereas higher density of pharmacies surrounding a school was inversely associated with NRT use. This study is the first to identify significant between school differences in NRT use. It also reveals that many youths are using NRT in the absence of a quit attempt. Further research is needed to identify school characteristics that impact NRT use, and understand how youths are accessing NRT.

Background: Across North America, smoking prevalence is highest among young adults (YAs). Understanding the cessation behaviours of YAs is critical given their higher smoking rates; however, there is a paucity of prospective studies on YA cessation from a population-based sample of smokers. Objectives: This study characterizes younger and older adult smokers as well as identifies the rate of making a quit attempt (QA) and smoking cessation among a representative sample of younger and older adult smokers. Guided by the Social Cognitive Theory (SCT), this study also examines the interpersonal predictors of moving toward smoking cessation among YAs. Methods: Self-report data on 592 YA and 2777 older adult smokers were compiled from the Ontario Tobacco Survey baseline and six-month follow-up interviews. Smoking cessation behaviour was measured as an ordinal variable: made no attempt to quit, made a QA that lasted for less than 30 days, and successfully quit for 30 days or longer. Design-based analyses examined the characteristics of young and older adult smokers. Making a QA and smoking cessation during a six-month follow-up period were modeled according to the SCT constructs while accounting for the complex study design. Results: Young adult smokers were more likely to be men with lower levels of addiction but greater self-efficacy and an intention to quit than their older counterparts. While YA smokers were more likely to make a QA than their older counterparts (25% vs. 17%, respectively), they were no more likely to succeed (14% vs. 10%, respectively). Having an intention to quit smoking and having made two or more lifetime number of QAs predicted making a QA; the use of smoking cessation aids or resources and having knowledge that stop smoking medications make quitting a lot easier also contributed to making an attempt to quit. Self-efficacy, use of smoking cessation aids or resources and having someone to support one‘s QA were positive predictors of quitting whereas having high levels of addiction was a negative predictor of cessation. Conclusions: Young and older adults are distinct types of smokers with different personal and smoking characteristics. Different factors predicted making a QA and smoking cessation among YAs. Smoking cessation interventions for YAs should provide social support and skills to build and maintain self-efficacy to quit. It is critical to ensure YA smokers have effective smoking cessation aids and services that are easily accessible and appropriate for this population. Future research is needed to understand long-term smoking cessation and relapse in this vulnerable population.

While up to 45% of women quit smoking during pregnancy, nearly 80% return to smoking within a year after delivery. Current interventions to prevent this return have had limited success. The aim of this study was to use the Theory of Planned Behavior to understand the factors influencing intention to resume smoking postpartum, specifically focusing on the role of subjective norms, or the social environment. During the postpartum hospital stay, we conducted in-depth, individual interviews with 24 women who had quit smoking during pregnancy. Over 300 pages of transcripts were analyzed by all four investigators using qualitative methods to identify common themes facilitated by Atlas.ti software. Respondents were predominately white (63%) and primipara (54%) with a mean age of 26. When reflecting on their experiences of being a smoker, the women emphasized the importance of their social relationships. Common themes were: 1) virtually all were embedded in large, complex social networks of smokers (partners, family, friends, co-workers) that influenced their smoking behavior, 2) the subjective norm (the perceived social pressure) for many women was that, while smoking during pregnancy is unacceptable, smoking after pregnancy is tolerable, and 3) partners were particularly influential on these womens smoking behaviors. In conclusion, we found that social environment played a large role in these women's past smoking behavior and future intentions. Thus, this factor may continue to influence their behavior after pregnancy. Further research is needed to establish the generalizability of these findings; however, our study suggests that the influence of the social environment should be integrated into postpartum smoking interventions.

Thesis (Ph. D.)--West Virginia University, 2009. / Title from document title page. Document formatted into pages; contains ix, 154 p. Includes abstract. Includes bibliographical references (p. 112-128).

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Little is currently known about the ability of electronic cigarettes to manage tobacco withdrawal symptoms and their abuse liability. In the current study eight conventional cigarette smokers completed nine within-subject study sessions. In the first session participants practiced using an electronic cigarette containing 16 mg/ml of nicotine over six 10-puff bouts. Remaining study sessions were comprised of four two-day blocks (one for each condition), which assessed measures of tobacco withdrawal symptoms and abuse liability following unrestricted cigarette smoking and 24-hour tobacco deprivation. Study conditions included an electronic cigarette with 0, 8, or 16 mg/ml nicotine concentrations, or preferred brand of conventional cigarette. Following 24-hours of tobacco deprivation, smoking conventional cigarettes ameliorated many of the self-report and physiological symptoms (decreased heart rate) associated with tobacco deprivation, while no attenuation of withdrawal symptoms was indicated following using electronic cigarettes, independent of nicotine dose. On abuse liability measures there were no significant changes following using an electronic cigarette (regardless of nicotine concentration), while conventional cigarettes engendered significant changes on abuse liability measures. Within the conditions of this study, first-generation electronic cigarettes had no measurable efficacy in ameliorating tobacco withdrawal symptoms and a reduced abuse liability compared to conventional tobacco cigarettes.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

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The Association of Hypertension Diagnosis with Smoking Cessation: Application of Multiple Logistic Regression Using Biostatistical and Epidemiological Methods by LaTonia A. Clay Under the Direction of Yu-Sheng Hsu, PhD. ABSTRACT Hypertension and smoking are two major issues threatening the nation’s health. Previous studies examining their relationship have resulted in conflicting reports. The aim of this study is to determine if a relationship exists between smoking cessation and hypertension diagnosis. Data from the Third National Health and Nutrition Examination Survey (NHANES III) were used in this investigation. Physical examination measurements of blood pressure and self-reported diagnosis and smoking behavior were used to define hypertension and smoking status. The odds of prior hypertension diagnosis associated with smoking cessation was estimated from a multivariate logistic regression model, adjusting for gender, age, ethnicity, BMI, physical activity, HDL cholesterol, and alcohol use. Results of the investigation found that unsuccessful smoking cessation was associated with a decreased odds of prior hypertension diagnosis, adjusting for the presence of confounders (OR=0.816, p<.001). Thus, hypertension diagnosis may indeed lead to the decision to quit smoking. Future studies on this finding are encouraged. INDEX WORDS: hypertension, smoking, cessation, diagnosis, logistic regression, NHANES