Adolescents and young adults use more tobacco than all other adults, yet the percentage of this younger population eventually quitting the use of tobacco is lower. There is little evidence-based research to support adolescent smoking cessation programs. Using social learning theory (SLT) and the stages of change model, the purpose of this project was to evaluate the effectiveness of the Not-On-Tobacco (N-O-T) program, an evidence-based adolescent smoking cessation program, in reducing or preventing the number of cigarettes smoked by high school boarding students and to evaluate how best to individualize the program for this high school going forward. The DNP questions were asked to see to what extent the N-O-T program would reduce the prevalence of student smoking and what changes to the current program curriculum should be made to tailor the program to this particular high school. Pre- and post survey data were obtained from 10 students 15-17 years of age enrolled in the N-O-T program for violating the campus' tobacco-free policy. A secondary data analysis using paired samples t test did not determine a statistically significant effect on smoking cessation in this small population of students. The findings did show a significant positive correlation between those who found the program 'very helpful' and a decrease in the number of cigarettes smoked pre- and post program. Content analysis of student data resulted in recommendations to modify the program to make it more effective for this school. Awareness of interactions and relationships with others and successfully dealing with social changes through a program like the N-O-T program will lead to increased life-long health benefits, decreased medical costs, and lost productivity associated with tobacco use. School nurses are in an ideal position to implement a successful smoking cessation program.

This study was an effort to replicate and extend findings from our previous research, which suggested that the efficacy of tailored messages is influenced by high levels of content personalization within the message and by individuals trait expectancies about tailored interventions. We tested whether tailoring-related expectancies regarding smoking-cessation booklets could be altered via a brief expectancy-priming intervention, and whether this would enhance the impact of the cessation materials. A 2x2 factorial design crossed personalization level and expectancy priming on evaluation of the intervention content, readiness to quit smoking, cessation self-efficacy, cognitive processing, and progress towards quitting. Smokers (N = 205) were randomized to one of four cells in which they received a highly personalized (placebo tailored) or standard intervention. Participants in the priming conditions received a pre-intervention letter to enhance their expectations for either standard or tailored interventions. Post-priming expectancies were assessed 7-10 days later, and intervention booklets were subsequently mailed. Results demonstrated main effects of personalization on content evaluation, readiness to quit, cognitive processing, and behavioral progress towards quitting. That is, the personalized booklets were more efficacious than the standard booklets. A priming by personalization interaction on tailoring-related expectancies indicated that the expectancy manipulation was effective, and priming main effects were found for content evaluation, readiness to quit, and cognitive processing. Thus, enhancing smokers’ expectancies about their materials improved participants’ perceptions of the intervention and strengthened outcomes. Theoretical and applied implications are discussed.

The need to understand the reinforcing properties of smoking and potential precipitants of relapse is exemplified by evidence that relapse rates exceed 95%. The Self-Control Strength model, which proposes that self-control is dependent upon limited resources and susceptible to fatigue, may offer insight into the relapse process. Indeed, there is empirical support that engaging in a task that requires self-control, relative to a comparable control, results in performance decrements on subsequent self-control tasks. The primary goal of the current study was to test whether self-control depletion (SCD) may serve as a novel antecedent for cessation failure, using a validated laboratory analogue of smoking lapse and relapse. We also aimed to compare SCD effects to those of a well-established relapse precipitant (i.e., nicotine deprivation), and test craving and behavioral economic indices as mechanisms for increased cessation failure. We used a 2 X 2 (12-hour deprivation vs. no deprivation; SCD vs. no SCD), crossed-factorial, between-subjects design (N=128 smokers). Replicating prior research, nicotine deprivation significantly increased craving, cigarette demand, delay discounting, and lapse behavior. Furthermore, craving was the only mediator of deprivation effects on lapse behavior. Finally, the primary hypothesis of the study was supported, as SCD increased lapse behavior (p = .04). Although no main effects were found for SCD on putative mediators (i.e., craving, demand, discounting), SCD was found to increase craving among nicotine deprived smokers (p = .04), which mediated cessation failure. SCD appears to play in important role in smoking behavior and may be a viable candidate for intervention.

Research Doctorate - Doctor of Philosophy (PhD) / Despite the emergence of smoking care guidelines and best practice recommendations over the past 13 years, it has been suggested that smoking care is not routinely provided in hospitals. Although there is a relatively large body of evidence regarding the prevalence of patient smoking cessation after hospitalisation and the effectiveness of interventions to increase cessation levels, much less is known regarding the prevalence of best practice smoking care routinely provided in hospitals or the effectiveness of interventions to increase such care provision. This thesis seeks to address these deficiencies in the evidence base. In particular this thesis aimed to: 1. Examine the prevalence of hospital smoking care in the international and Australian contexts. This is addressed via a literature review of studies that have reported the level of smoking care delivered routinely in hospitals and a survey of hospital managers in New South Wales, Australia. 2. Examine the effectiveness of interventions to increase the routine delivery of smoking care in hospitals. This is addressed via a literature review of studies that have reported the effect of an intervention on smoking care levels, and via the implementation of a quasi-experimental study that was designed to increase the hospital-wide delivery of a broad range of smoking care elements. 3. Propose recommendations for future practice and research regarding the routine provision of hospital smoking care. This thesis consists of six chapters that address the above aims. Each of the chapters has been written as a relatively distinct report in the style of a journal article. The approach has been adopted to facilitate the reading of the thesis, and results in some repetition in some chapters. At the time of submission, two papers based on the chapters of this thesis have been published in peer-reviewed journals. A further two papers are under editorial review.

Most adult smokers begin smoking during adolescence; nicotine dependence can develop relatively quickly and, once established, most smokers smoke for approximately 40 years. For adolescents dependent upon nicotine, cessation interventions are not well established. It is, therefore, essential that public health interventions focus on preventing initiation and maintenance and decreasing the prevalence of youth smoking. In spite of legislation to protect New Zealand adolescents, a large proportion continues to use tobacco at least weekly. Recent surveys have shown a slight decrease in cigarette smoking prevalence, overall, but, no reduction and marked increases have been reported within some subgroups. The overall aim of this research was to identify school and personal factors associated with secondary school students smoking. The specific research objectives included: a) identifying factors at the personal, family, peer, school and 'tobacco-genic' environment levels which were associated with regular and established cigarette smoking; b) describing the extent of smoke-free policy and health education programmes in secondary schools; and, c) evaluating the relations between cigarette smoking among students and potential protective factors, smoke-free policies and practices and health education programmes. The research was based on data from 3,434 secondary school students from 82 schools. The multi-stage sampling procedures and data analyses ensured that the results were able to be generalised to the New Zealand secondary school student population. Smoking was more prevalent amongst girls for all measures of smoking frequency and significant differences were found for smoking prevalence between ethnic groups and school decile. In terms of family influences, the smoking behaviours of parents were not associated with increased odds of smoking nor were perceived relationships between students and their parents, or exposure to SHS. In contrast, the smoking behaviour of siblings was associated with increased odds of smoking but it is likely that both student and sibling smoking are both influenced by the same processes within the family. Similarly, low levels of self-concept were not associated with increased odds for daily smoking. The smoking behaviour of a best friend was a pervasive risk factor as was a high level of disposable income, frequent episodes of unsupervised activities, and 'pro-smoking' knowledge. Being male, visiting a place of worship, and the intention to stay at school until after Year 13 reduced the odds of daily smoking among students. Multilevel models were used to identify school level effects. After adjusting for student, family and school characteristics significant between-school variance in smoking prevalence remained and this suggests that there are factors, arguably beyond the immediate control of the student or family that may influence a student�s smoking behaviour. The presence of a school effect also supports the WHO concept of 'health promoting schools' in that schools can make a difference to health outcomes. Understanding how the health promoting schools model has been interpreted and implemented in NZ schools, along with critique of the implementation of the amended legislation making all schools smoke-free, would be a pertinent 'next-step' in identifying characteristics of schools which are associated with decreased tobacco use.

Since the introduction of tobacco into New Zealand, smoking and smoking related illnesses have become more prevalent in the Maori population than New Zealand's general population. The aim of the present research was to investigate smoking from a Maori perspective. It was hoped this information would provide a better understanding of how Maori can become smokefree. The present research also investigated a number of possible benefits that could be obtained by Maori through becoming smokefree. These benefits were analysed through Mason Durie's Whare Tapa Wha model, a Maori holistic health model. Semi-structured in-depth interviews were conducted with four Maori people, two of whom were current smokers and two who were ex-smokers. Common themes emerged from these interviews including the social aspect of smoking for Maori and the influence of the enviroment on smoking behaviour. Suggestions were given to illustrate how the social aspect of smoking and the cycle that subsequently develops can be broken. Using the Whare Tapa Wha model and the personal accounts given, the benefits of breaking such a cycle were discussed. Lastly, the importance of nurturing smokefree environments, especially Maori environments, was outlined. The notion of being positive about becoming smokefree and the need to celebrate giving up smoking were highlighted throughout this research.

A grounded theory approach was used to explore the reasons why staff who work in alcohol and drug treatment services smoke cigarettes. Eleven in-depth interviews were conducted with staff in Victoria across a variety of service types and roles. Data gathered from the interviews were analysed and grouped into categories. From analysis of the interviews it appeared that cigarette smoking is given legitimacy in the alcohol and drug treatment field that reinforces its place in these services. Legitimacy was evident in three main ways - Permission, a Therapeutic Tool and Rewards. Permission to smoke was communicated by means which included the opportunity to smoke at work, the provision of smoking areas, the absence of no-smoking rules and policies, and an acceptance of smoking. Smoking was seen as a therapeutic tool that enhanced the treatment provided to clients. Some smokers saw cigarettes as a tool to convey empathy, develop rapport, promote a feeling of engagement and manage difficult clients. Smokers also received some rewards to reinforce their behaviour. There was a benefit of feeling an increased acceptance by other staff, increased socialising, work breaks, a reduction in perceived stress levels and the opportunity to readily satisfy cravings for nicotine that reinforced the smoking behaviour. Punishments, or negative rewards, for smoking were also described. These included being recipients of harassment or pressure from non-smoking staff and concerns about the impact of smoking on their health. These three categories of permission, therapeutic tool and rewards contribute to the legitimacy of smoking in this field and support the continued presence of this behaviour.

The effects of household exposure to cigarette smoke on the incidence of respiratory illness were examined among 1007 18 month old children at Lu-wan District, Shanghai City, People's Republic China. The passive smoking quantity was estimated by summing the total daily cigarette consumption of family members. No mothers who smoked were found. A significant dose-response relationship of passive smoking to hospitalization for respiratory illness during the children's first 18 months of life was found, for which no confounding factors were discovered. The relative risk was 2.4 for children living in families including people who smoked 20 or more cigarettes a day compared with those living in nonsmoking families. The children who were boys or artificially (bottle) fed were more affected than those who were girls or breast fed. The cumulative incidence of bronchitis and pneumonia increased significantly with increasing cigarette smoking of family members, that did not change when sex, birth weight, type of feeding, coal for cooking, or parental education were taken into account. Family smoking status was not found to be significantly associated with the cumulative incidence of asthma, whooping cough, sinusitis or measles. / Graduation date: 1993

Flertal tidigare studier har visat på både positiva och negativa resultat av motiverande samtal (MI) för att få patienter att sluta röka. MI används idag av sjuksköterskor i slutenvården såväl som i primärvården för att skapa beteendeförändringar som exempelvis till tobaksrökstopp. Syftet med studien var att undersöka varför det är oklart om motiverande samtal är en metod som kan leda till tobaksrökstopp. Studien gjordes som en litteraturöversikt och sökningarna gjordes i Cinahl, Oxford Journals, PsycINFO, PubMed och SveMed+. Sökningarna resulterade i 15 utvalda artiklar. Flertal av resultatartiklarna visade signifikanta resultat att MI vid tobaksrökstopp har effekt men det fanns också studier där ingen effekt kunde påvisas. Resultatartiklarnas resultat visade på att MI kan vara till hjälp för att få patienter att minska tobaksrökningen. Några resultatartiklar visade på att studiedeltagare med lägre motivation lyckades sämre med ett tobaksrökstopp än studiedeltagare med hög motivation. Slutsatsen är att mer forskning behövs om sambandet mellan MI och motivation för att uppnå tobaksrökstopp, aktsamhet ska tas då MI vid tobaksrökstopp ska appliceras i vården. / Several earlier studies on MI as a method to smoking cessation shows positive and negative results to help smokers quit. MI is used by nurse’s today inpatients and in primary care to create behavior changes for instance smoking cessation. The aim of this study was to examine why it´s obscure if motivational interviewing (MI) is a method that can result to smoking cessation. The study was made as a literature review. Searches were made in Cinahl, Oxford Journals, PsycINFO, PubMed and SveMed+ and resulted in 15 selected articles. Several studies showed significant results that MI as a method for smoking cessation had effect but there were studies where MI showed negative effect. In the studies there are significant results that MI can help patients reduce smoking. The results of a few articles showed that participants with lower motivation didn´t succeed in smoking cessation. The conclusion is that more research on MI must be conducted on the connection between MI and motivation in smoking cessation. Caution must be taken if MI should be applied in care as a method for smoking cessation.

Our study investigated the potential for a combination of diabetes and nicotine treatment to affect blood pressure in the rat. We used streptozotocin injection and oral nicotine feeding as models of type-1 diabetes and smoking respectively. Blood pressure was assessed using the indirect tail-cuff technique. In an attempt to further characterize our experimental model, we also observed body weight, plasma glucose and the contractility of aortic segments in various treatment groups. Our data was expressed as mean ± SEM, and significance was regarded as P < 0.05. We found that a combination of streptozotocin and nicotine treatment resulted in a significant elevation of systolic blood pressure compared with either treatment alone, or control. Furthermore, assessment of aortic contractility showed alteration of reactivity to both phenylephrine and sodium nitroprusside as a result of the combination treatment. We also observed a trend for our combination treatment to exacerbate the elevation of plasma glucose level seen in streptozotocin induced diabetic rat models. This study serves as an experimental basis to underline the importance of cessation of tobacco use for individuals with diabetes mellitus.