A growing number of states and cities in the United States have enacted smoke-free policies in public areas and, to improve the health outcomes of employees and patrons, have extended the policies to indoor tourism and hospitality venues including casinos, bars, and restaurants. However, the introduction of smoke-free policies in casinos has lowered gaming revenues by up to 20% in some jurisdictions (Eadington, 2011; Pakko, 2005; Thalheimer & Ali, 2008). Smoke-free policies have the potential to reduce the participation rate of gamblers either because smoking gamblers choose not to gamble if they cannot smoke, or because they choose to migrate to an alternative gambling opportunity which allows smoking. Since the goal of implementing smoke-free policies is to improve the health outcomes of employees and customers, some states' or locales' exemption from the bans may be temporary (Goodman, Agnew, McCaffrey, Paul, & Clancy, 2007). As a result of these changing external influences, it may be necessary to develop effective marketing strategies for continued growth in the casino industry. This study aimed to enhance insight into this phenomenon that results from external market influences by focusing on gamblers' behavioral changes with respect to their decisions to visit casinos when smoking bans are implemented. This dissertation proposed and tested a gambling-specific behavior model to examine the antecedents of individual changes in gambling patronage. The model was tested by using Path Analysis on data that were collected through an online survey of gamblers who visited gaming facilities in Deadwood, South Dakota. The results indicated that both the psychological reactance trait and the attitude importance of the freedom to smoke influence gambling behavioral changes after a smoking ban went into effect. Individual attitudes towards secondhand smoking also explained changes in casino patronage. No moderator effect was found in the path analysis. Supplementary analyses for other hospitality sectors were also conducted and the results also showed psychological reactance trait, the attitude importance of the freedom to smoke, and the attitude towards secondhand smoking explain changes in restaurant and bar patronage, and video lottery terminal participation. Discussion on the results of hypotheses testing and implications are presented followed by future research directions. / Tourism and Sport

The purpose of this study was to determine if the VTSF elementary school compendium programs are effective in the prevention of youth tobacco use based on evaluations provided by the VTSF. In the years (2003-2005), tobacco use trends among middle and high school students in Virginia started moving upward despite the fact that the Virginia Tobacco Settlement Foundation (VTSF) spent nearly $16 million in 2004 and approximately $11 million in 2005 for marketing, programs, enforcement, research and evaluation. This study is primarily a review of evaluations and not individual people or groups of people. The study reviewed the final evaluations of the various programs of the compendium in the 2005-2006 VTSF grant cycle. Only elementary programs (Pre-K – 5 and in some systems 6) were reviewed. The VTSF provides a variety of evaluation formats ranging from short, descriptive outcomes to quasi-experimental statistical analysis. Information was extracted from the evaluations to answer the primary research question: Do the elementary school compendium programs prevent tobacco use among Virginia's youth? Two additional questions were answered: 1) Does the current program evaluation process provide useful information to determine if the programs are effective in tobacco use prevention? and 2) Are community or school-based programs more effective? The following conclusions were drawn from this comparative program analysis: 1) Based on this current data approach to evaluating the elementary compendium programs, we cannot determine if the programs are effective in preventing youth tobacco use. However, based on the review of literature combined with these finding it is logical to conclude that the programs may not be preventing tobacco use in their intended population. 2) The evaluation process and the information included in the evaluations on an elementary level are not effective in providing information regarding tobacco use or future tobacco use. 3) School programs are more efficient and reach more students than community-based programs. There is no indication in terms of tobacco goals that one setting is better than another. The following recommendations were suggested: 1)Transition funding for compendium programs involving pre-initiation age students to late elementary, middle, and high school. 2) Concentrate funding for community-based programs on at-risk students. 3) Require school systems that apply for funds to offer programs on all levels: late elementary, middle, and high school, 4) Only those programs that directly address tobacco or tobacco and other drugs should be on the compendium list, 5) Streamline the evaluation process and make it consistent for all schools for comparative purposes, 6) Provide curriculum for all 4th-12th grade health and PE teachers rather than compendium programs as a separate unit, 7) Fund the development and implementation of curriculum that integrates tobacco prevention objectives into all school curriculum grades 4-12, 8) Explore ways to reach parents, 9) Focus more initiatives on teen tobacco cessation. / Ph. D.

The purpose of this study was to investigate the prevalence of smoke-free environment polices throughout the Commonwealth of Virginia at worksites employing fifty or more workers. Specifically, this study assessed policy prevalence, development, implementation, and enforcement. In addition, this study assessed smoke-free environment policy effectiveness. The population for this investigation consisted of telephone surveys of 374 worksites located throughout the Commonwealth of Virginia. Of these worksites, 340 (91%) completed the telephone survey. The population (n = 340) was spread throughout five health regions, Northern, Northwest, Central, Southwest, and East. Descriptive analysis and One-way Analysis of Variance (ANOVA) were applied to investigate differences between these five health regions. An alpha of .05 was selected for this study. Based on the findings, the following conclusions were drawn: (1) Fifty-percent of the worksites located throughout the Commonwealth of Virginia have some form of smoke-free environment policies; (2) The smoke-free environment policy constructs used in the telephone survey guide were statistically significant in identifying differences between the five health regions; (3) Smoke-free environment policies at the worksite are dependent upon health region; (4) Implementation of smoke-free environment policies is dependent upon health region; (5) Enforcement of smoke-free environment policies is dependent upon health region, and (6) Effectiveness of smoke-free environment policies is dependent upon health region. The following recommendations were suggested: (1) Further studies assessing smoke-free environment policy enforcement should be conducted annually; (2) Studies incorporating a qualitative research methodology regarding smoke-free environment policy prevalence should be conducted; (3) Studies involving common smoke-free environment policies at different states should be investigated, and (4) Additional in-depth surveys should be conducted to evaluate health outcomes associated with the implementation of smoke-free environment policies. / Ph. D.

Two approaches to smoking cessation were evaluated. One approach, the standard condition, utilized a nicotine fading procedure, group support, and an attendance contingent monetary contract. The other approach, the maintenance condition, utilized nicotine fading, group support, and a smoking-contingent monetary contract. The maintenance condition also received two additional post-cessation sessions and additional instructions for cessation. Both conditions significantly improved over the course of the study. The maintenance condition achieved significantly better outcome on the reported average cigarettes per day, cessation rates, and CO levels for the follow-up periods. The maintenance condition also had significantly lower SCN levels at the three month follow-up. The maintenance condition also had significantly lower diastolic and systolic blood pressure at the six month follow-up when compared to the standard condition. However, few other significant health differences emerged when smoking subjects were compared with reduced smoking or nonsmoking subjects for this study. The maintenance condition was shown to be more cost effective than the standard condition. The results were interpreted as indicating the promise of nicotine fading and behavioral contracting procedures. Limitations of the wide-scale application of these methods was noted, however. In particular, group smoking cessation projects reach limited subjects, successful projects still have only moderate success rates, and the wide-spread application of these methods would strain available resources. It is recommended that further research and clinical efforts continue with nicotine fading, behavioral contracting and rapid smoking cessation programs. In addition, efforts at applying behavioral contracting principles without therapeutic support was suggested. Finally, more research on the functional determinants of tobacco smoking was recommended. / Ph. D.

Environmental tobacco smoke (ETS) has been well established as a danger to children. Exposure to secondhand smoke can cause coughing and wheezing, bronchitis, pneumonia, ear infections, asthma, and sudden infant death syndrome (SIDS). Childhood exposure to ETS may also increase the risk of developing leukemia and lymphoma in childhood (Mitchell, 1997) as well as developing lung cancer as an adult (Glantz, 1992). Despite the great strides recently made in the implementation of regulatory measures to safeguard children from ETS in public places like schools, there remains significant concern regarding children's exposure at home and in their out-of-home care facilities (Ashley and Ferrence, 1998, Jarvis, 2000). In 1996, the Centers for Disease Control and Prevention estimated that there were 336,749 Virginia youth exposed to ETS in the home (State Tobacco Control Highlights, 1999). The purpose of this study was to ascertain the number of family day home providers who allow smoking in their home and/or those that have some type of smoking policy. The sample consisted of 746 licensed, registered or locally approved family day home providers through the Department of Social Services. Of these childcare providers, 81.5% (n=608) completed a questionnaire about their tobacco use policy and its effects. An overwhelming majority (94.7%) of providers reported having a tobacco use policy in their family day home. Most of the providers, 67.6% indicated that smoking was allowed outdoors only while 26.3% noted that smoking was not allowed anywhere at any time, indoor or outdoor. Other policy specifics and background information are discussed in the study. The implications of these findings and recommendations for future training and educational programs for family day home providers are also reviewed. / Master of Science

Thesis (M.A.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Increasing evidence indicates that the sooner treatment begins for patients with Alzheimer's Disease (AD), the better the chance of delaying progression of the disease. As a result, studies have begun focusing on risk factors for AD with the goal of identifying individuals with AD at the earliest possible stage. Such studies have found that individuals with Mild Cognitive Impairment (MCI) are at increased risk for AD and other forms of dementia. This study examines the potential mediating effect of a set of prospective risk factors, smoking and ApolipoproteinE (ApoE) genotype, on the incidence of MCI and AD. Although results of this study provide some preliminary evidence of an interaction, the study models presented here fail to reach significance. Additional studies are needed to confirm the hypothesis of an ApoE mediated relationship of smoking on MCI and AD. / 2999-01-01

Yes / Smokers usually lack confidence to quit smoking due to previous unsuccessful attempts. This study aimed to assess self-efficacy and quitting smoking among current adult smokers in Suva, Fiji. Methods: This study applied a mixed method design among current adult smokers who attended three randomly selected healthcare centers in Suva, Fiji between 1st May to 31st July 2020. A self-administered questionnaire was used to collect quantitative information on smoking and smoking cessation, self-efficacy, and stage of smoking. A semi-structured, open-ended questionnaire was used to guide the interviews. Qualitative data was transcribed and thematic analysis was applied to identify the common themes. Results: Four hundred sixty-four smokers participated in the quantitative study, with a mean age of 32.7 (SD=12.1). Only 16.6% of participants were at the stage of “Preparation” and 4.95% of them were at the stage of “Action”, according to the stage of change model. Majority of participants (43.1%) had low self-efficacy to quit smoking. Thirty-five smokers participated in in-depth interviews, with majority (48.57%) in the age group of 18-24. Two themes were identified including “Determinants of self-efficacy” and “Factors affecting quit smoking”. Conclusions: This study showed that adult smokers had low confidence to quit smoking. Developing a tailored intervention using models such as Transtheoretical Model (TTM) and stage of change may help smokers to quit smoking in Fiji. / This project was funded by the Fiji National University grant.

published_or_final_version / Public Administration / Master / Master of Public Administration

published_or_final_version / Community Medicine / Master / Master of Philosophy

Cigarette smoking is the leading cause of preventable disease and is the cause of nearly 1 in 5 deaths in the United States. The prevalence of smoking has had a leveling off effect after many years of significant decline. Certain subgroups of the population, such as those with low income and certain illnesses, continue to smoke at disproportionately high rates. Reasons for these disparities in smoking rates are complex. Developing a better understanding of the issues related to persistent smoking particularly for those with medical illness and limited access to cessation resources can help focus interventions to help these high risk smokers quit. This dissertation includes a systematic review of the literature associated with hardcore smoking; an analysis of the reliability and validity of a self-efficacy instrument in a sample of low-SES, medically ill smokers; and the results of a cross-sectional, non-experimental study exploring the relationship between smoking-related factors and planning to quit in a sample of medically ill smokers. A sample of 70 current and recent smokers was surveyed at a free clinic. Quitting self-efficacy was measured using an instrument not previously tested in a rural, medically ill sample. Modifications to the survey were made based on qualitative interviews with smokers and a single question measuring self-efficacy was also tested. There was a high correlation among the self-efficacy measures (Spearman’s rho .99, p < .001) and between the longer instrument and the single question (Spearman’s rho .65, p < .001). Each measure demonstrated acceptable reliability and validity. In the study exploring potential factors associated with planning to quit, the number of prior quit attempts and confidence to quit explained 43% of the variance in those planning versus not planning to quit. Providing interventions focused on increasing confidence and experience with quit attempts can be effective in promoting a plan to quit in this group of smokers who, because of their medical illness, can benefit significantly from cessation. Research is needed to explore cessation outcomes when employing these targeted interventions with medically ill smokers in rural areas.