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

Thesis (M.A.)--Rowan University, 2006. / Typescript. Includes bibliographical references.

Thesis (Ph. D.)--University of Hong Kong, 2010. / Includes bibliographical references (leaves 313-356). Also available in print.

Thesis (M.P.H.)--University of Hong Kong, 2006.

This study investigates factors that may be related to dependency on driving and decisions to continue or ceased riving in older age. Some older drivers may be unsafe to drive (Drachman & Swearer, 1993), but are unwilling to cease, this can result in referrals to mental health services. The potential influence of attitudes towards driving on driving behaviour has been highlighted (O'Neill, 1996) but as yet has not been fully investigated. A questionnaire was developed, based on the Theory of Planned Behaviour, to elicit factors which might predict older drivers' intentions to drive more or less often. Reliability was demonstrated for the questionnaire, which was completed by 99 older drivers. The results indicated that the majority of older drivers used their car frequently. Two components of the Theory of Planned Behaviour were demonstrated to predict 73% of the variance in driving behaviour, namely, perceived behavioural control and attitude towards driving. Those drivers who perceived more positive outcomes for driving and less negative outcomes were likely to intend driving more often. Also those drivers with higher levels of perceived behavioural control were likely to intend to drive more often. A self-report measure of actual driving behaviour two to three months later, suggested that behavioural intention was highly related to subsequent driving behaviour. Methodological issues, future research and clinical implications of the findings are discussed. In particular, interventions based on attitude change and problem solving to decrease perceived dependency on the car, may facilitate the process of giving up driving.

Class of 2005 Abstract / Objectives: To assess students’ confidence levels about smoking cessation implementation from different types of training experience and assess what factors contribute the strongest towards successful interventions for students in the practice setting. Methods: The project design involved the administration of a questionnaire for students distributed by the investigator to 1st, 2nd, and 3rd year University of AZ College of pharmacy students. Section I provided a grid which asked the student to fill in how many hours of each tobacco cessation training areas they had completed. Section II was focused on how the student addressed these issues in their work setting, and used confidence intervals to identify how confident they were in addressing these issues with patients. Section III focused on work history and addressed issues such as work hours, exposure to patients, counseling opportunities, etc., to get a feel for how active the students were in counseling at their worksite. Section IV of the questionnaire addressed the student’s demographic characteristics, such as race/ethnicity, marital status, and age. Question 18 at the end of Section IV provided the student space for constructive comments about the survey. Results: Scores were derived from the surveys and confidence intervals were compared to total training time using a Pearson r. The third year students were significantly more confident (p < 0.035) for all aspects of counseling, asking, advising, assessing readiness, arranging, and monitoring. Third year students were also more confident than second year students in all aspects of counseling except asking. The differences between the first and second years were not significant for any of the aspects of counseling (p > 0.05). Third year students also had significantly more experience (2.9 years) than first (1.1 years) or second (1.8 years) year students (p = 0.001). Correlations were drawn to compare confidence and: total training hours, work experience, times counseled; to correlate training time and times counseled, and to compare work experience to actual times counseled. The highest correlation drawn to actual times counseled was shown to be total training time, suggesting this is the most important predictor of patient counseling for pharmacy students. ANOVA tests were used to assess any differences in demographics between year of student categories. Implications: Students effectively counseling patients on smoking cessation is most closely related with formal training they complete, rather than how confident they feel or how knowledgeable they are about the effects of smoking.

Cigarette use is more prevalent among veterans who have mental disorders than it is in the general population. Rates of tobacco use are also high among individuals who suffer from post traumatic stress disorder, addiction, and human immune deficiency disease. Approximately 22.7 million American veterans and their families are at risk of tobacco-related health problems. Concerned about heavy tobacco use among veterans, the U.S. Department of Veterans Affairs developed a Tobacco-Cessation Guideline to be used nationally. This guideline was updated in 2008 to include the '5A' mnemonic (ask, assess, advise, assist, and arrange) and is recommended for use by physicians, nurses, nurse practitioners, social service providers, and psychologists in Veterans Health Administration facilities when screening veterans for tobacco use. This doctoral capstone project involved evaluation of the Tobacco-Cessation Guideline by deploying a retrospective chart audit to assess implementation by first-line clinicians. Randomization of patient identifiers was used so that 18 Health Insurance Portability and Accountability Act patient identifiers were not recorded. The project was conducted at a Domiciliary and Residential Rehabilitation Treatment Program located in an urban area in the southern United States. Results of this project included raised awareness of first-line clinicians through electronic health record reminders, clinical outcome evaluations, and patient satisfaction surveys. These initiatives improved providers' effectiveness in documenting interventions, in addition to substantially improving the treatment progress made by each veteran. The sustainability of this effort will require long-term organizational commitment that will help to drive a change in practice and encourage positive attitudes toward tobacco cessation in the general population.

This thesis is concerned with the issue of smoking in the surgical population. Globally, over 300 million adults undergo surgery annually and around 60 million are smokers. The population impact of this is enormous. Moreover, smoking increases postoperative complications and is a leading cause of morbidity and mortality. Smoking rates are declining in the general population; but remains higher among surgical populations. Despite being an important modifiable risk factor, and the availability of treatments for smoking, many patients presenting for surgery still smoke and many resume smoking after surgery. Importantly, unfortunately in surgical settings, the implementation of evidence-based cessation interventions is still suboptimal. The time around surgery is a “teachable moment” and surgical guidelines recommend that all patients who smoke should be provided with evidence-based smoking cessation assistance. This thesis seeks to answers the following questions: What are the factors that determine abstinence from smoking after surgery? What is (are) the best smoking cessation intervention(s) in the surgical setting? What factors constitute barriers and facilitators to the implementation of effective smoking cessation interventions? Is cytisine effective for smoking cessation? Will the use of cytisine and behavioral counselling delivered via personalized video messaging increase abstinence from smoking at 6 months post-randomization among surgical patients? Using a variety of research methodologies, the data provided across the 5 papers in this thesis inform these knowledge gaps. Chapter 1 is an introduction providing the rationale for conducting each of the included studies. Chapter 2 is a secondary analysis from the Vascular events in Noncardiac Surgery Patients Cohort Evaluation (VISION) study that evaluated the determinants of smoking abstinence in a representative sample of patients undergoing major non-cardiac surgery. Chapter 3 is a systematic review, pairwise meta-analysis, and network meta-analysis of randomized controlled trials evaluating preoperative smoking cessation interventions. Chapter 4 is a scoping review that explores the barriers and facilitators to smoking cessation in the surgical setting. Chapter 5 is a systematic review and meta-analysis of cytisine for smoking cessation Chapter 6 reports on the rationale and design of the PeRiopEratiVE smokiNg CessaTion (PREVENT) randomized controlled trial evaluating the efficacy and safety of cytisine versus placebo, and in a 2x2 factorial, personalized video messaging versus standard care for smoking cessation among adults undergoing surgery. Chapter 7 is the conclusion chapter wherein I discuss the key findings, limitations, and implications of the research presented in this PhD thesis. / Thesis / Doctor of Philosophy (PhD) / Up to 1 in 7 adults having surgery are cigarette smokers. Smoking increases the risk of complications after surgery and negatively impacts patient’s health and survival in the long term. Patients who are smokers have to stop smoking while in hospital for their surgery but majority of them resume smoking right after surgery. This is a missed opportunity to turn enforced temporary abstinence from smoking to permanent abstinence. It is informative to understand the factors that determine this resumption of smoking after temporary abstinence, determine the most effective interventions to help smokers quit smoking permanently and importantly, understand the barriers and facilitators to smoking cessation in surgical settings. Additionally, the current methods for smoking cessation are sub-optimally utilized in surgical settings. We need further research to evaluate new interventions, and ways of delivering smoking cessation care for smokers undergoing surgery. The studies in this thesis inform on these knowledge gaps.

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