Wan, Lai Yin. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 100-126). / Abstract also in Chinese. / ABSTRACT --- p.i / 摘要(ABSTRACT IN CHINESE) --- p.ii / ACKNOWLEDGEMENTS --- p.iii / TABLE OF CONTENTS --- p.iv / LIST OF TABLES --- p.vi / LIST OF FIGURES --- p.vii / Chapter CHAPTER I: --- INTRODUCTION --- p.1 / APPLYING THE THEORY OF PLANNED BEHAVIOR TO ADOLESCENT SMOKING --- p.5 / ATTITUDES TOWARDS THE BELIEFS ABOUT SMOKING --- p.6 / SUBJECTIVE NORMS ABOUT SMOKING --- p.11 / PERCEIVED BEHAVIORAL CONTROL OVER SMOKING --- p.14 / BEHAVIORAL WILLINGNESS AS A COMPLEMENTARY ASSESSMENT TO BEHAVIORAL INTENTION --- p.15 / EXTENSION OF THE TPB´ؤIMPORTANCE OF PERSONALITY IN ADOLESCENT SMOKING --- p.16 / ROLE OF DIRECT FAMILY AND PEER SMOKING --- p.24 / GENDER AS MODERATOR IN ADOLESCENT SMOKING --- p.25 / OVERVIEW OF THE STUDY --- p.29 / Chapter CHAPTER II: --- METHOD --- p.35 / PARTICIPANTS --- p.35 / PROCEDURE --- p.37 / MEASURES --- p.38 / DATA ANALYSES --- p.45 / Chapter CHAPTER III: --- RESULTS --- p.48 / DESCRIPTIVE STATISTICS AND CORRELATIONS AMONG MAJOR VARIABLES --- p.48 / DIFFERENCES IN MAJOR VARIABLES ACROSS GENDER AND ACROSS CURRENT SMOKING STATUS --- p.53 / MEASUREMENT APPLICABILITY OF INSTRUMENTS --- p.56 / IDENTIFICATION OF THE BASIC TPB MODEL --- p.57 / INCORPORATION OF BEHAVIORAL WILLINGNESS AS AN OUTCOME VARIABLES INTO TPB MODEL --- p.60 / "EFFECTS OF PERSONALITY, FAMILY SMOKING AND PEER SMOKING" --- p.63 / MULTI-SAMPLE INVARIANCE ANALYSES --- p.68 / MULTI-SAMPLE INVARIANCE ANALYSES WITH MALE AND FEMALE SAMPLES --- p.69 / MULTI-SAMPLE INVARIANCE ANALYSES WITH EVER-SMOKER AND NEVER-SMOKER SAMPLES --- p.75 / Chapter CHAPTER IV: --- DISCUSSION --- p.82 / GENERALIZABILITY OF RESULTS WITH THE PRESENT SAMPLE --- p.82 / APPLICABILITY OF MEASURES USED IN CHINESE ADOLESCENT SMOKING RESEARCH --- p.83 / SMOKING WILLINGNESS AS A MORE SENSITIVE ASSESSMENT IN ADOLESCENT SMOKING --- p.84 / UTILITY OF TPB COMPONENTS IN PREDICTING SMOKING INTENTION AND WILLINGNESS --- p.85 / THE IMPORTANT ROLE OF PERSONALITY IN EXPLAINING SMOKING INTENTION AND WILLINGNESS --- p.87 / SIGNIFICANT INFLUENCES OF FAMILY AND PEER SMOKING ON ADOLESCENT SMOKING --- p.91 / DIFFERENCES IN PREDICTING ADOLESCENT SMOKING ACROSS GENDER --- p.92 / IMPLICATIONS OF THIS STUDY --- p.94 / LIMITATIONS OF THIS STUDY --- p.95 / DIRECTIONS FOR FUTURE RESEARCH --- p.97 / REFERENCES --- p.100

<p><em><p>Syfte:</p>Syftet med undersökningen var att beskriva vad som formar ungdomars attityd till rökning. <em><p>Metod:</p>Sex kvalitativa intervjuer genomförds med ungdomar i åldern 14-15 år. Kategorier utarbetades genom analys av intervjuutskrifterna. <em><p>Resultat:</p>Det framkom att ungdomarnas attityd formas dels av yttre faktorer som närståendes rökvanor och dels av inre faktorer som nyfikenhet. Ungdomarna ansåg även att om cigaretter varit så ohälsosamma som det påstås så hade de varken tillverkats eller sålts. Ungdomarna beskrev rökare med ord som tuffa och coola. <em><p>Konklusion:</p>Resultatet antyder att ungdomarnas attityd till rökning formas dels av vännernas uppfattningar och dels av föräldrarnas attityd. Ungdomar lever i nuet och väger därför inte in hälsoriskerna i sitt beslut att röka. <em><p>Implikation:</p>Informera föräldrarna att ha en hårdare attityd emot tobak. Skapa ett informationsmaterial som förklarar varför det är politiskt svårt att förbjuda tobaksprodukter. Ytterligare forskning behövs om hur föräldrars rökvanor påverkar ungdomars attityd till rökning. </em></em></em></em></em></p> / <p><em><p>Objective:</p>The aim of our study was to describe how young people's attitudes towards smoking emerge. <em><p>Method:</p>Six qualitative interviews were conducted with adolescents aged 14-15. Categories were developed through an analysis of interview transcripts. <em><p>Results:</p>It was found that young people's attitude is shaped partly by external factors such as smoking habits by related parties and partly by internal factors such as curiosity. Young people also felt that if cigarettes were as unhealthy as it is claimed they had neither manufactured nor sold. Young people described the smokers with words like tough and cool. <em><p>Conclusion:</p>Young people's attitude to smoking is shaped partly by their friends’ views and partly by their parents' attitude. Young people are living in the moment and therefore they do not consider the health risks when deciding to start smoking. <em><p>Implication:</p>Inform the parents that they should have a tough stance against tobacco. Create information material which explains why it is politically difficult to ban tobacco products. Further research is needed on how parents' smoking habits affect young people's attitudes to smoking. </em></em></em></em></em></p>

<p>The onset of cigarette smoking begins primarily in adolescence, and prevalence of smoking among adolescents has been increased during the last ten years. The prevalence of adolescent smoking increases with age and is more common or at least as common in girls as in boys in most western countries.</p><p>Until recently the intensive investigation on health effects of smoking has been mostly conducted among adults. In adolescence the long-term health consequences have been reviewed, but current health problems are probably more important to adolescents and may be more motivating for smoking prevention and cessation. Increased morbidity among adolescent smokers has been reported, but specific current health problems and medication use have received little attention. More</p><p>Control of smoking is a primary health goal. An underlying premise for promotion of physical activity in adolescence is that it may mead to a healthy lifestyle persisting through adulthood. Encouraging participation in sports has been recommended as smoking prevention and as part of smoking cessation programs. Smoking habits within different types of sports has received less attention, and whether physical activity has an impact on lung function is debated.</p><p>Adolescent smokers are often unsuccessful in quitting and difficult to recruit and retain in smoking cessation programs. Occasional smoking may be the strongest risk factor for daily smoking, but occasional smokers could be an important target group for smoking cessation who could be discouraged from moving into daily smoking status. </p><p>The first aim of this thesis was to study associations between smoking and current health status by examining associations between daily smoking and subjective health problems (Paper 1), and gender specific effects on respiratory symptoms and lung function (Paper II). The associations between physical activity and lung function in never smokers and daily smokers were also assessed (Paper III). The second aim was to study factors that might be useful in smoking</p>

The onset of cigarette smoking begins primarily in adolescence, and prevalence of smoking among adolescents has been increased during the last ten years. The prevalence of adolescent smoking increases with age and is more common or at least as common in girls as in boys in most western countries. Until recently the intensive investigation on health effects of smoking has been mostly conducted among adults. In adolescence the long-term health consequences have been reviewed, but current health problems are probably more important to adolescents and may be more motivating for smoking prevention and cessation. Increased morbidity among adolescent smokers has been reported, but specific current health problems and medication use have received little attention. More Control of smoking is a primary health goal. An underlying premise for promotion of physical activity in adolescence is that it may mead to a healthy lifestyle persisting through adulthood. Encouraging participation in sports has been recommended as smoking prevention and as part of smoking cessation programs. Smoking habits within different types of sports has received less attention, and whether physical activity has an impact on lung function is debated. Adolescent smokers are often unsuccessful in quitting and difficult to recruit and retain in smoking cessation programs. Occasional smoking may be the strongest risk factor for daily smoking, but occasional smokers could be an important target group for smoking cessation who could be discouraged from moving into daily smoking status. The first aim of this thesis was to study associations between smoking and current health status by examining associations between daily smoking and subjective health problems (Paper 1), and gender specific effects on respiratory symptoms and lung function (Paper II). The associations between physical activity and lung function in never smokers and daily smokers were also assessed (Paper III). The second aim was to study factors that might be useful in smoking

In Deutschland fehlen bislang belastbare epidemiologische Daten über sowohl die Häufigkeit nikotinabhängiger Raucher im primärärztlichen Versorgungsbereich als auch das Ausmaß der von Hausärzten angebotenen Raucherentwöhnungsmaßnahmen. Die Ziele in der "Smoking and Nicotine Dependence Awareness and Screening (SNICAS)"-Studie waren/sind: (1) die Ermittlung repräsentativer Daten zur Prävalenz des Rauchens und der Nikotinabhängigkeit in Deutschland, (2) die Beschreibung des Rauchverhaltens und der Aufhörmotivation von Rauchern in der primärärztlichen Versorgung sowie (3) die Feststellung von Einstellungen, Fertigkeiten und Erfahrungen von Hausärzten im Zusammenhang mit der Raucherentwöhnung. SNICAS basierte auf einem zweistufigen epidemiologischen Studiendesign, woran sich eine derzeit noch laufende, klinische Interventionskomponente anschloss. In Stufe I (Vorstudien-Fragebogen) wurde eine repräsentative Auswahl von 889 Ärzten (Allgemeinärzte, praktische Ärzte, Internisten) hinsichtlich Erfahrungen und Einstellungen zu Raucherentwöhnungsmethoden charakterisiert. In Stufe II wurde an einem Stichtag (7. Mai 2002) in diesen Praxen n = 28 707 unausgelesene, konsekutive Patienten zunächst mittels eines Patientenfragebogens untersucht (konservative Ausschöpfungsrate: 52,8%). Daran schloss sich für jeden einzelnen Patienten eine unabhängige, standardisierte Arztbeurteilung (Erhebung des Rauchstatus, des Gesundheitszustands, vergangener und aktueller Interventionen u.ä.) an. Der Beitrag enthält eine Darstellung von Design und Methode der SNICAS-Studie und berichtet über die Gewinnung, Ausschöpfung und Repräsentativität der Arzt- und Patientenstichprobe. Auf der Grundlage ausgewählter Daten des Vorstudien- Fragebogens, aus denen eine geringe Anzahl (17,6%) an sich intensiv mit der Raucherentwöhnung befassenden Ärzten hervorgeht, werden ärztliche Interventionsstrategien, aber auch Einstellungs- und Strukturbarrieren vorgestellt. / Aims, Design and Methods of the "Smoking and Nicotine Dependence Awareness and Screening" (SNICAS) Study Germany lacks robust epidemiological data on the prevalence of smoking and nicotine dependence in primary care patients as it does on smoking cessation interventions provided by primary care physicians. Objectives of the "Smoking and Nicotine Dependence Awareness and Screening" (SNICAS) study are (1) to provide nationally representative data on the frequency of smoking and nicotine dependence among primary care patients in Germany, (2) to describe their smoking behaviour and motivation to quit as well as (3) attitudes, skills and experiences of physicians regarding smoking cessation. SNICAS is based on a 2-stage epidemiological design, supplemented by a subsequently conducted clinical intervention trial still ongoing. Stage I consists of a prestudy characterization of a nationwide sample of 889 primary care doctors (general practitioners, family doctors and internists with primary care functions). Stage II consists of a target day assessment (May 7th 2002) of n=28,707 unselected consecutive patients by means of a patient questionnaire (conservative response rate: 52.8%). For each patient a structured clinical appraisal form (screening of the patients' smoking status, physical and mental health, current and past interventions etc. ) was accomplished by the doctor. This article presents design and methods of the SNICAS study and describes its sampling strategy, its response rates and the representativity of primary care doctors and patients. By means of selected pre-study data, showing that only a small proportion of physician is extensively involved in smoking cessation (17.6%), intervention strategies of the doctors are presented as well as obstacles for smoking cessation (e.g. structures, attitudes).

Durch eine stärkere Einbeziehung deutscher Hausärzte in die Raucherentwöhnung soll die Versorgung von Rauchern flächendeckend verbessert werden. Inwiefern dieser Anspruch realisierbar ist, wird im Rahmen der "Smoking and Nicotine Dependent Awareness and Screening" (SNICAS) Studie überprüft. SNICAS ist eine zweistufige epidemiologische Punktprävalenzstudie [Stufe I (Vorstudie): Charakterisierung einer repräsentativen, bundesweiten Stichprobe von n = 889 Hausärzten; Stufe II: Stichtagserhebung an n = 28 707 unselektierten konsekutiven Patienten], an die sich eine regionale klinische Interventionskomponente anschließt. In diesem Beitrag werden Prävalenzraten des Rauchens, Aufhörmotivation und bisherige Aufhörversuche von Primärarztpatienten berichtet. Dargestellt werden Erkennens- und Interventionsraten von Rauchern durch Hausärzte, das ärztliche Interventionsverhalten sowie deren Einschätzung der Chancen und Barrieren von Raucherentwöhnung im Praxisalltag. Die Ergebnisse der Studie belegen ein großes Interesse der Hausärzte am Thema Raucherentwöhnung. Dennoch weisen niedrige hausärztliche Interventionsraten bei gleichzeitig hohen Prävalenzraten von Rauchen und Nikotinabhängigkeit auf ein beträchtliches Versorgungsdefizit. Als Ursachen hierfür werden neben ambivalenter Aufhörmotivation der Patienten strukturelle Barrieren diskutiert. Die Autoren fordern neue klinische Versorgungsmodelle, die ein abgestimmtes Zusammenspiel von Hausärzten mit anderen, auf Raucherentwöhnung spezialisierte Berufsgruppen fokussieren. / Through smoking cessation interventions, primary care physicians could play an important part in the treatment of smokers in Germany. In the "Smoking and Nicotine Dependent Awareness and Screening" (SNICAS) study, we examined whether this increased involvement of primary care physicians might be implemented. SNICAS is a two-stage epidemiological point prevalence study. In stage I (pre-study), a nationwide sample of 889 primary care doctors was characterized; in stage II, 28 707 unselected consecutive patients were assessed on the target day. The investigation was followed by regional clinical interventions. The present article contains our findings on the prevalence of smoking, the motivation to quit, and the history of quit attempts among primary care patients. Information will be provided on how frequently physicians recognize and treat smokers; what kind of interventions they offer; as well as how they judge the opportunities and obstacles for smoking cessation in routine care. Despite the high prevalence of smoking and nicotine dependence and the primary care doctors’ interest in treating smokers, insufficient interventions are provided. Reasons for this situation include, but are not limited to the patients’ ambivalent motivation to quit and structural barriers. Hence, new clinical models of health care with an improved cooperation between primary care physicians and other specialists in the field of smoking cessation seem necessary.

Tabakkonsum bei Jugendlichen und erwachsenen Risikopopulationen. Einflussfaktoren und Ansätze zu Prävention und Intervention Die vorliegende Arbeit beschäftigt sich mit den Einflussfaktoren des Tabakkonsums bei verschiedenen Zielgruppen sowie möglichen Ansätzen zur nachhaltigen Beeinflussung des Rauchverhaltens. Die Arbeit besteht aus insgesamt sechs Manuskripten, die in nationalen und internationalen Fachzeitschriften publiziert oder zur Publikation angenommen sind. Diese sechs Beiträge lassen sich zwei Schwerpunkten zuordnen, die inhaltlich die zwei wichtigsten Möglichkeiten zur Reduktion des Tabakkonsums in der Bevölkerung widerspiegeln: die Verhinderung des Neueinstiegs in das Rauchen bei Kindern und Jugendlichen (Prävention) sowie die Förderung des Ausstiegs aus dem Rauchen (Intervention). Im ersten Teil wird im Rahmen eines Reviews sowie zweier Studien untersucht, ob sich verhältnispräventive Maßnahmen an Schulen auf das Rauchverhalten der Schüler auswirken. Im zweiten Teil untersuchen drei Studien die Motivation zur Verhaltensänderung, die Inanspruchnahme von Hilfsangeboten bzw. die Effektivität von Tabakentwöhnung bei Rauchern mit einer Alkoholabhängigkeit, Müttern in der Mutter-Kind-Rehabilitation sowie Patienten mit tabakassoziierten körperlichen Erkrankungen. / „Smoking in adolescents and adult risk populations. Factors of influence and approaches concerning prevention and intervention” This dissertation is concerned with factors influencing the smoking behaviour of different target groups and potential approaches for lasting changes of these behaviours. The dissertation consists of six manuscripts that are published or accepted for publication in national and international peer-reviewed journals. These six papers refer to two main emphases that reflect the two most important possibilities to reduce tobacco consumption in the population: Prevention of smoking initiation in children and adolescents (prevention), and support for smoking cessation (intervention). In the first part of the dissertation, a literature review and two empirical studies assess the influence of school tobacco policies on the smoking behaviour of students. In the second part, three empirical papers examine motivation to change, utilisation and effectiveness of smoking cessation in smokers with an alcohol dependence, mothers in mother-child rehabilitation and patients with smoking-related physical diseases.

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / abstract / toc / Community Medicine / Doctoral / Doctor of Philosophy

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy