Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2010. / Available via ProQuest Digital Dissertations. Vita. Includes bibliographical references (leaves 69-80).

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

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

No description available.

Vapour products (e-cigarettes) have rapidly grown in sales. While competing claims about the effects of vaping are fiercely debated within the public health community, no studies have examined the claims accepted in the regulatory arena. In the first article of this manuscript-based dissertation, my co-authors and I utilized narrative policy framework to identify the claims about vapour devices in legislation recommendation reports from Queensland Australia, Canada, and the European Union, and the United States. The vast majority of claims represented vapour devices as a threat, while the potential benefits were very rarely presented, resulting in bans and strict regulations. Evidence on two claims, youth vaping as a risk for nicotine dependence, and vapour products as a cessation aid, was evaluated with systematic reviews. For the youth claim, we retrieved population surveys on (1) the first product used, (2) non-nicotine vaping, (3) the prevalence of infrequent users among past-30-day users, and (4) cannabis vaping. Surveys indicated that a near majority of students who were past-30-day users vaped only once or twice a month, and an appreciable number, 25% and more, reported consuming non-nicotine liquids. Furthermore, 80% to 90% of ever-users tried cigarettes first. Far fewer youth are at a risk for nicotine addiction than indicated by any past-30-day use. On the other hand, vaping as a mode of administration of other drugs has received little attention, and presents an unknown risk to youth. We evaluated the claims about cessation with a review of systematic reviews (umbrella review). Three reviews, Hartmann-Boyce et al. (2016), Malas et al. (2016) and El-Dib et al. (2017) received the better quality ratings. They were unable to reach a definitive conclusion due to the limited number of randomized controlled trials and the low quality of most of the studies. We considered the reviewers’ tentative statements on their findings, the findings of the quality cohort studies, the potential underestimation of effectiveness in the studies, and the improved nicotine delivery of newer models. The weight of the evidence allowed us to state our optimism that vapour products have potential as a cessation aid. In the jurisdictions studied in this dissertation, vapour products have been claimed to be a threat by leading youth to smoking and impeding cessation. Does the evidence support the claims? The possible risk of youth becoming dependent on nicotine from vaping is substantially lower than indicated by the metric of any past-30-day use. There is reasonable evidence that vapour products may be an effective cessation aid. With a better understanding of these two claims, we in public health should revisit the regulations, policies, and interventions for vapour products so that they are in line with the evidence, not unsupported claims. / Graduate / 2019-04-02

Class of 2008 Abstract / Objectives: The purpose of this study is to determine the usefulness of expanded pharmaceutical care services and pharmacist involvement in smoking cessation for patients in a community setting, to identify demographical parameters for the population which might benefit the most from pharmacist intervention, and to examine the cost benefit of such intervention. Methods: This descriptive retrospective study was conducted through a MEDLINE search for all available literature regarding the efficacy of pharmacists in a community setting and smoking cessation outcomes. The results from these studies were then analyzed in order to identify demographic factors which may be associated with higher rates of positive outcome, and the potential cost benefit of such intervention. Information examined from the various articles included: type of study, method of data anaylsis, study/intervention location, patient age, sex, race, other comorbid conditions, and success rates including p values/odds ratios when stated. Results: After the original search, 63 publications were found using MEDLINE, including 12 systematic reviews and 3 clinical trials. After filtering, a total of 28 articles were analzyed. No correlations between demographic factors and successful smoking abstinence were found. All publications, save one, found a positive correlation between higher levels of intervention and increased smoking abstinence rates. Cost effectiveness varied depending on which method of NRT was utilized, ranging from $720 to $2360 per QALY saved. Several national health organizations have published guidelines stating the role of the pharmacist as essential in smoking cessation. Conclusions: Pharmacists have begun to play an essential role in smoking cessation, as evidenced by many successful ventures that have taken place to date. Still, there is vast potential for expansion of pharmaceutical care services in this area.

The present study examined various psychosocial variables that may influence success in a stop smoking program (QuitSmart) used by the North Texas Veterans Health Care Service (NTVHCS). The QuitSmart program utilizes the Stages of Change Model, with its focus on the last three stages (preparation, action, and maintenance). It was proposed that factors including shame-proneness, guilt, anger/hostility, depression, self-efficacy - both global and smoking situational, neuroticism, and level of nicotine dependence might individually or in combination predict attrition from the NTVHCS smoking cessation program. Results indicate that shame-proneness, guilt, anger/hostility, and depression did not individually predict attrition. Persons with high levels of smoking situational self-efficacy tend to utilize self-change strategies leading to greater success in smoking cessation. Participants with a psychological diagnosis, when combined with neuroticism and shame-proneness, appear to have more difficulty with cessation than those with only a medical diagnosis. Clinical implications and suggestions for change to the NTVHCS smoking cessation program are discussed.

Background: The southern Appalachian states show a high prevalence of smoking, with associated high rates of both heart disease and cancer, yet cultural differences raise questions concerning the applicability of the most frequently used model for smoking cessation, the transtheoretical model, for smokers from this region of the country. Objective: To identify, by examining the applicability of the transtheoretical model for southern Appalachian smokers, the percentage of individuals in each of the five stages of change, the use of the processes of change from the transtheoretical model, and the scores on recognized predictors of smoking cessation including the temptation to smoke, the perceived barriers to cessation, the pros and cons of smoking, and nicotine dependence. Methods: This population-based, descriptive, cross-sectional study used a random sample of 3,800 telephone numbers, which were called up to eight times. The 659 smokers or former smokers who agreed to participate were mailed a written questionnaire consisting of six well-established scales that measure constructs from the transtheoretical model. The final sample consisted of 357 usable questionnaires. Results: The distribution of smokers in northeastern Tennessee differed from national samples across the first three stages of change, with 56% in precontemplation, as compared with previous findings of 40% in national samples. The subjects' scores for the pros of smoking were similar across the stages of change in this sample, and although the scores for the cons differed significantly across the stages in the sample, post hoc analysis indicated that the only significant change occurred between precontemplation and contemplation. The scores for temptation to smoke did not differ significantly across the stages of change in this sample. Discussion: Smokers from Appalachian Tennessee differ from smokers in other parts of the United States, and these findings raise questions about the applicability of the transtheoretical model for this population.

BACKGROUND: We wanted to determine whether an intervention to enhance partner support helps as an adjunct to a smoking cessation program. METHODS: We undertook a meta-analysis of English-language, randomized controlled trials of smoking cessation interventions through July 2002 using the following data sources: Cochrane Tobacco Addiction Group specialized register, Cochrane controlled trials register, CDC Tobacco Information and Prevention Database, MEDLINE, Cancer Lit, EMBASE, CINAHL, PsycINFO, ERIC, PsycLIT, Dissertation Abstracts, SSCI and HealthSTAR, with reviews of bibliographies of included articles. Included were trials that assessed a partner support component with a minimum follow-up of 6 months. The outcomes measured were abstinence and biochemical assessment at 6 to 9 months and more than 12 months after treatment. Partner Interaction Questionnaire scores were primary and secondary outcomes. RESULTS: Nine studies (31 articles) met inclusion criteria. Partner definition varied among studies. All studies included self-reported smoking cessation rates, but there was limited biochemical validation of abstinence. For self-reported abstinence at 6 to 9 months after treatment, the Peto odds ratio (OR) = 1.08 (95% confidence interval [CI], 0.81-1.44) and at 12 months Peto OR = 1.0 (95% CI, 0.75-1.34). Sensitivity analysis of studies using live-in, married, and equivalent-to-married partners found a higher odds ratio at 6 to 9 months after treatment, Peto OR = 1.64 (95% CI, 0.5-4.64). Sensitivity analysis of studies reporting significant increases in partner support found at 6 to 9 months after treatment Peto OR = 1.83 (95% CI, 0.9-3.47); and at 12 months Peto OR = 1.22 (95% CI, 0.67-2.23). CONCLUSIONS: Interventions to enhance partner support showed the most promise for clinical practice when implemented with live-in, married, and equivalent-to-married partners. Such interventions should focus on enhancing supportive behaviors, while minimizing behaviors critical of smoking.

Forty-six million individuals in the United States used tobacco products. People who use tobacco products attempt numerous strategies before giving up smoking habit altogether. The goal of this project was to evaluate the impact of a tobacco cessation program by evaluating pre-and post-cessation program data, and hospital records of participants attending the hospital smoking cessation program over a 6-month period to ascertain the degree of reduction in tobacco use and hospitalization from smoking-related diseases. The population sample comprised of both men and women between the ages of 18 years and above. The project question addressed whether the smoking cessation program had an impact on reducing the rate of tobacco use and hospital readmissions after attending a cessation program at a medical center. A paired samples t-test was conducted to analyze the pretest and posttest results. There was a statistically significant decrease (p <.001) in the participants' (N=49) rate of smoking after completing the smoking cessation program that lasted 6 months. The mean on smoking cessation pre-participation was 13.7 (SD = 1.56). The mean on smoking cessation post-six months participation was 6.67 (SD = 1.81). There was a statistically significant decrease in the rate of hospital admissions among participants. The mean on pre-participation hospital admissions was 4.18 (SD = .727). The mean on post-participation hospital admissions was 1.41 (SD = .643). Smoking cessation programs impact social change by improving the quality of life of participants and their families and decreasing the financial impact of hospital readmission cost