Smoking related conditions kill approximately 5,000,000 people every year. There is evidence that smoking behaviour varies for men and women. Yet, determinants of smoking remain poorly understood, especially by gender. This Ph.D. thesis remediates this important gap in the literature, adopting a novel, transdisciplinary approach. The thesis was an epidemiological investigation of the joint and separate utility of sociodemographic factors, mental health and Social Cognitive Theory constructs as predictors of smoking for men and women. Participants were 3,502 residents of Queensland, Australia, taking part in a larger statewide population-based study investigating cancer risk knowledge and behaviours. The study consisted of a CATI telephone interview and a subsequent battery of self-report questionnaires. The thesis entailed four empirical studies. Study 1 (Chapter Two) investigated the utility of sociodemographic factors as predictors of smoking status by gender and by area by gender. Results revealed that sociodemographic variables were poor predictors of smoking status and that predictors of smoking differed by gender when analyses were conducted separately. Younger men and men involved in a relationship were more likely to be smokers, while younger women and women who were well educated were more likely to be smokers. Gender differences were also present when analyses were conducted by area by gender. In addition, smoking status for urban women was not significantly predicted by any of the employed sociodemographic variables. These results indicated that additional determinants of smoking, such as mental health, should be investigated. Study 2 (Chapter Three) was a psychometric evaluation of a tool utilized in the thesis to measure symptoms of anxiety and depression, the Kessler Scale of Non-Specific Psychological Distress, also known as the K-10. Results revealed that the K-10 is a psychometrically sound scale, ideal for measuring symptoms of anxiety and depression in the general population. It was also concluded that the K-10 is multidimensional, and that the best model for its factor structure is a first-order model composed by four first-order factors: nervousness, restlessness, negative affect and fatigue. Study 3 (Chapter Four) evaluated the discriminant utility of mental health variables measured with the K-10, separately and jointly with sociodemographic variables, in predicting group membership. The study investigated whether these variables could discriminate between ever-smokers and neversmokers, and among ever-smokers, between current smokers and former smokers by gender. This was intended to provide a glimpse into smoking initiation and smoking persistence. Analyses classified only a small percentage of smokers correctly. Nevertheless, results showed that psychological distress examined alone predicted smoking uptake among women. In contrast, smoking initiation for men was vi predicted by sociodemographic variables. In addition, persistent smoking for men was predicted by psychological distress while that for women it was predicted by sociodemographic factors. Study 4 (Chapter Five) investigated the utility of Social Cognitive Theory (SCT) constructs as determinants of smoking. This last empirical study investigated whether the addition of self-efficacy and outcome expectancies to mental health and sociodemographic variables improved prediction of smoking behaviour. Study 4 examined the utility of three models as determinants of measures of smoking among current smokers (smokers who have never attempted to quit and those who attempted to quit and failed). Nicotine dependence, age of smoking initiation, number of cigarettes smoked per day and past quit attempt, as well as intention to quit were the measures of smoking investigated. Results indicated that the full social cognitive model (containing both self-efficacy and outcome expectancy) was the most robust model, although neither self-efficacy nor outcome expectancies as constructs were particularly strong predictors. Nevertheless, self-efficacy was generally better than outcome expectancies. Both self-efficacy and outcome expectancies predicted measures of smoking for men, while only self-efficacy predicted the same measures of smoking for women. None of the models predicted a quit attempt in the last year among males. For women, only decreased fatigue predicted a quit attempt in the last 12 months: In addition, analyses conducted to classify which smokers intended to quit smoking in the near future correctly classified only a small percentage of those who did intend to quit in the near future, but correctly classified most smokers who did not. Analyses investigating which quitting method was most popular among smokers revealed that “going cold turkey” was still the preferred quitting method of more than half of smokers who had attempted to quit in the past 12 months but failed. Less than 15% of those who “went cold turkey” had also employed a cessation aid. The thesis supports the hypothesis that determinants of smoking differ by gender. The role of psychological distress in smoking uptake among women and in smoking persistence among men warrant further investigation. Future research should also examine the effect of other types of selfefficacy upon smoking behaviour. Smoking prevention and/or cessation programs might be more effective if conducted for men and women separately, addressing the particular determinants of smoking for each gender.

Politicians and social marketers considering whether, and how, to implement a national smoking ban in their countries require sound evidence regarding what the causes of support are amongst key stakeholders, how this support will develop over the short to medium term in which they seek to be re-elected, and how support relates to critical outcomes like enforcement. In response to this need, I use structural equation models to develop a model of the antecedents of support, based on theories of self interest and common sense justice, amongst hospitality industry managers. I show that support is determined more by fairness related constructs than self interest constructs, that support for national smoking bans increases consistently over time, and that the initial level of support, and the rate at which support increases, is positively related to subsequent enforcement behaviour by bar managers, in the year after implementation of such a ban, in New Zealand. I use growth mixture modeling to identify two subgroups of bar managers whose support changes at different rates. First, a class of bar managers with a high proportion of smokers who reported fewer instances of respiratory related health problems, showed low initial support, and whose support for the legislation slowly decreased. And second, a class of bar managers comprised of fewer smokers, but reporting more instances of respiratory related health problems. This class began with a high degree support, and steadily increased in support for the national smoking ban. I discuss the implications of these findings for social marketers, health educationalists, and politicians interested in introducing a similar ban in other countries.

Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, 2005. / Bibliyografya var.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.