Background: Arab Americans, a growing population in the U.S., tend to have high rates of smoking and low rates of smoking cessation. Arab Americans and their families are at a high risk for poor health outcomes related to smoking. Objective: The purpose of this study is to better understand the smoking behaviors of Arabs in the U.S., using the two publishable manuscripts format. The first manuscript is a systematic review of the literature exploring the smoking behavior, prevalence and use among Arab Americans and examining studies addressing the effect of acculturation on this behavior. The second manuscript is a cross-sectional quantitative study investigating factors influencing desire to quit smoking among Arab Americans, and their association with acculturation and health beliefs. Results: The majority of the studies included in the first manuscript focused on smoking prevalence and cessation. Some discussed the impact of acculturation and health beliefs only two smoking cessation programs have been developed. Thus a cross-sectional descriptive study among adult Arab American smokers was conducted to measure tobacco use, nicotine dependence, desire to quit smoking, acculturation, and health beliefs. The desire to quit smoking was positively associated with perceived severity and susceptibility to cancer, perceived benefits of quitting smoking; and negatively associated with smoking barriers and nicotine dependence. Being female, having lower level of nicotine dependence, and higher perception of cancer severity predicted higher desire to quit smoking. Conclusion: Smoking cessation intervention studies need to target appropriate health beliefs, especially cancer severity of smoking among male Arab Americans.

Introduction: The World Health Organization (WHO) has declared hookah smoking to be a significant public health problem. According to Martinasek et al. the increase in the number of hookah smokers is due to lack of education and public awareness, there is a general impression that hookah is a safe alternative to cigarettes. (Martinasek et al., 2011). On the other hand, hookah is affordable and has appealing flavor. The US Food and Drug Administration does not regulate hookah and there is a lack of regulation in packet labeling (Martinasek et al., 2011). Hookah smoking and cigarette smoking produces the exact same toxic chemicals and carcinogens (Martinasek et al., 2011). The US Environmental Protection Agency claims that hookah smoking releases secondhand smoke which contains cancer causing agents (Martinasek et al., 2011). Overall, hookah smoking is increasing rapidly among youth due to social acceptance, low cost, appealing flavors, lack of regulatory policies and incorrect harm perception. Therefore, I propose a study that will aim to answer the following research questions: 1) What are the socio-demographic characteristics of middle school and high school students who have awareness of hookah? 2) What are the characteristics of middle school and high school students who report hookah is less harmful than cigarettes? 3) Does awareness of hookah, harm perception of hookah, ever user and current user of hookah differ by living with hookah users? 4) How does harm perception of hookah correlate with use of hookah among US youth? I hypothesize that American youth who perceive hookah as less harmful than cigarettes will more likely be users of hookah as compared to youth who perceive these products are more harmful. Methods: The secondary data analysis was conducted using the data from the 2013 National Youth Tobacco Survey (NYTS). The study population was middle and high school students. The independent variables of interest were students who were current users of hookah, had ever used hookah, as well as those aware of hookah smoking. The dependent variable was harm perception of hookah smoking. A weighting factor was adjusted in the survey to get a weighted proportion of students in each grade to match with the national population. The prevalence of current and ever users of hookah, as well as those aware of hookah among middle school and high school students, was examined. The frequency of high school and middle school students who are living with hookah users, and those who were not evaluated. The association of harm perception of hookah among current and ever users, as well as those aware of hookah smoking adjusted by those who are living with hookah users was assessed. Data was analyzed in SAS 9.3 to examine the association between the independent and dependent variables. Frequency, logistic regression and a chi-square tests were used to find the odds ratio and p-value between the dependent and independent variables. Results: Association of harm perception of hookah among current users of hookah, ever users, as well as those aware of hookah smoking, reported that 55.64% of current users of hookah (Adjusted OR = 4.99, CI: 3.78-6.59), 43.80% of ever users of hookah (Adjusted OR = 4.96, CI: 4.02-6.13) and 21.50% of those who were aware of hookah smoking (Adjusted OR = 3.20, CI: 2.82-3.91) believed that hookah smoking is less harmful than cigarette smoking in both middle and high school. Participants who were current users of cigar smoking i.e.26.57% (crude OR = 2.80 CI: 2.45-3.20), Adjusted OR = 1.18, CI: 0.96-1.45)) as well as ever users of cigar smoking i.e. 24.76% (crude OR= 3.18, CI: 2.78-3.65), adjusted OR = 2.24, CI: 1.85-2.71)) believe hookah smoking is less harmful than cigarette smoking compared to individuals who were not current as well as ever users of cigar smoking. There was no significant difference between odds of male and female in believing that hookah smoking is less harmful than cigarette smoking. Discussion: Overall these results suggest that students who were associated with hookah usage believe that hookah smoking is less harmful than cigarette smoking. Moreover, students who were ever users of cigar smoking had 2.24 odds of believing that hookah smoking is less harmful than cigarette smoking compared to individuals who were not ever users of cigar smoking. Conclusion: Therefore, American youth who perceive hookah as less harmful than cigarettes will more likely be users of hookah as compared to youth who perceive these products are more harmful

Bakgrund: Inom primärvården möter läkare och distriktssköterskor dagligen patienter som söker hjälp för symtom som är direkt relaterade till rökning. Att arbeta sjukdomsförebyggande genom livsstilsförändringar är en viktig del av distriktssköterskans ansvarsområde. Enligt Socialstyrelsens (2011) nationella riktlinjer finns tydliga rekommendationer för hur distriktssköterskor ska gå till väga med patienter som söker hjälp för att sluta röka. Syfte: Syftet var att belysa distriktssköterskans erfarenheter av arbetet med rökavvänjning för patienter samt vilka arbetsmetoder de använder för detta. Metod: En kvalitativ metod användes och 14 semistrukturerade intervjuer utfördes med distriktssköterskor som arbetar med rökavvänjning inom primärvård i ett län i södra Sverige. Vid dataanalysen användes manifest kvalitativ innehållsanalys. Resultat: Analysen av data resulterade i två kategorier: Distriktsköterskans tillvägagångssätt och Faktorer som påverkar rökavvänjning med fem underkategorier under vardera kategori. Resultatet i studien visar att distriktssköterskornas arbetsmetoder vid rökavvänjning består av Motiverande samtal MI (Motivational Interviewing) och kvalificerade rådgivande samtal med patienter. Distriktssköterskornas erfarenhet är att dessa två arbetsmetoder är de mest effektiva att använda för att kunna finna ut hur beslutsam samt hur motiverad patient är till rökstopp och hur de tillsammans kan planera vägen dit. Distriktssköterskornas erfarenhet av rökavvänjningsarbetet är att det ger positiv energi när patienten lyckas bli rökfri.  Det ger också ny energi till att fortsätta med motivationsarbetet. En generell svaghet som konstaterats är bristerna i uppföljning av om patienternas rökfrihet varit varaktig efter avslutad behandling. Slutsats:  Motiverande samtal i kombination med nikotinersättningsmedel beskrevs av distriktssköterskorna som betydelsefullt i strävan efter att stödja patienter till rökfrihet. Stöd av kollegor i form av nätverksträffar, utbildning inom samtalsmetod samt arbetslivserfarenhet var viktiga delar för distriktssköterskorna och underlättade för dem i arbete med att försöka stödja patienter till varaktig rökfrihet. / Background: In primary care physicians and district nurses faces on a daily basis patients seeking help for symptoms that are directly related to smoking. Working disease prevention through lifestyle changes is an important part of the district nurse's responsibility. According to the National Board of Health (2011) National guidelines there are clear recommendations for district nurses to proceed with patients seeking help to quit smoking. Objective: The objective was to highlight the district nurse practice and experience of working with smoking cessation for patients in primary care. Method: A qualitative method was used, and 14 semi-structured interviews were conducted with district nurses in Southern Sweden. The data was analyzed according to the method manifest qualitative content analysis. Results: The analysis of the data resulted in two categories: The primary nurse approaches and factors affecting smoking cessationwith five sub-categories in each category. The results of the study show that the district nurses working methods consists of Motivational Interviewing, MI and qualified advisory conversations with patients and smoking cessation. District nurses common experience that these two methods are the two most effective to use to find out how determined and how motivated the patient is to quit smoking and how they together can plan the way to quit smoking. District nurses experience from smoking cessation is that it gives them positive feedback when they manage to get the patient non-smoking and it gives positive energy to continue with the motivational work. An identified general weakness are shortcomings in monitoring whether patients' abstinence has been sustained after the treatment is finished.  Conclusion: Motivational interviewing and nicotine replacement medicine was described by the district nurses as important in the quest for supporting patients to quit smoking. Support of colleagues, training in communication technique in the form of network meetings and work were important parts of the districts nurses and facilitating them in their work is often very difficult and important task to try to support patients to smoke.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Objective The purpose of the mixed methods study was to compare barriers and facilitators encountered by low-income African American women who engaged in different infant feeding practices. Methods Using the positive deviance approach and modified Integrated Model as theoretical frameworks, the research began with a qualitative study that informed a survey examining intention, skills, and environmental factors differentiating women’s infant feeding practices. Results Twenty-eight and 190 low-income African American adult women participated in focus groups or interviews and a survey, respectively. In the qualitative study, positive deviants, who breastfed for at least four months, seemed to have stronger breastfeeding intentions, self-efficacy and breastfeeding support than other women. In the final multinomial multiple logistic regression, for a one unit increase in the PBC scale of the revised Breastfeeding Attrition Prediction Tool, there was a 50% (OR 1.5[1.3-1.7]) and an 18% (OR 1.18 [1.03-1.3]) increase in the odds of breastfeeding at least three months (positive deviance) compared to only formula-feeding and breastfeeding for less than three months, respectively. Women who did not smoke postpartum were 4.3 [1.5-12.3] and 5.6 [2.1-15.1] times as likely to be positive deviants; women who had C-sections were 3.6 [1.3-9.6] and 2.9 [1.0-7.8] times as likely to be positive deviants compared to only formula-feeding and breastfeeding for less than three months, respectively. Women who ranked WIC full breastfeeding packages as most valuable were 14.9 [4.8-45.5] and 16.1 [5.3-50.0] times as likely to be positive deviants compared to only formula-feeding and breastfeeding for less than three months, respectively. Discussion High breastfeeding self-efficacy was associated with positive deviance, although the qualitative study findings suggested that general self-efficacy may also influence breastfeeding success. The likelihood of not smoking being associated with longer duration of breastfeeding is consistent with previous research. The C-section results may reflect a longer length of hospital stay leading to increased mastery of breastfeeding prior to discharge. Analysis of participants’ valuation of WIC infant feeding incentives led to the suggestion that WIC incentives be re-examined. Further exploration of these findings and subsequent interventions may lead to improved breastfeeding rates among low-income African American women.

Numerous findings have suggested that the increased prevalence of childhood illnesses such as cancer, infection, and allergy may be due to environmental exposures. One such cause may be maternal smoking or passive smoke exposure. Known immunotoxicants in cigarette smoke and environmental pollution include polycyclic aromatic hydrocarbons such as 1,2:5,6 Dibenzanthracene (DBA). The objective of these studies was to evaluate the immunosuppressive effects of DBA on various stages of immune system development. Adult mice were administered DBA daily in corn oil at dose levels of 158, 500, 1580, and 5000 µglkg S.C. for 28 days. Immunosuppression was not observed at levels less than 5000 µgkg in the following immune parameters: NK cell activity, anti-CD3 antibody-mediated proliferation and mixed-leukocyte response. In contrast, holistic assays such as the PFC response to the T-dependent antigen, sRBC and the delayed type hypersensitivity response were significantly suppressed at dose levels of 500 µglkg and greater. Mice exposed to DBA in utero and through lactation showed neither immunosuppressive nor sex differences among the immune parameters tested when evaluated at weaning, postnatal day (PND) 21, or when evaluated at sexual maturity (PND 42). Transference of DBA metabolites from mother to pup is suggested by HPLC analysis of milk extracted from PND 8 pups. In contrast, juvenile mice administered DBA beginning on PND 21 at dose levels from 0.25 to 2500 µgkg for 28 days demonstrated a dose-dependent suppression (43-79%) of the PFC assay, statistically significant at or above the 2.5 µglkg dose level. Neither immunosuppressive nor sex differences were observed among the various other immune parameters evaluated. Collectively, these studies indicate that the juvenile life stage in B6C3F1 mice is the most vulnerable to DBA-induced immunotoxicity with a 200-fold enhancement in immunosuppression of the PFC response as compared to adult mice. These studies provide insight into how environmental contaminants, such as DBA, may impact children's health.

The purpose of this investigation was to evaluate the effects of smoking and gender on 1) tetrahydroisoquinolines (TIQs) and beta-carbolines (BCs) in a population of healthy subjects and 2) TIQs in an alcohol-dependent population undergoing in-patient detoxification. Comparison in plasma TIQs between the populations was additionally conducted. To support the clinical investigations, a HPLC-FD method was developed and validated to assess plasma concentrations of BCs, harman and norharman, while a HPLC-ESI-MS/MS method was validated to quantify the TIQs, R/S-salsolinol along with dopamine. Forty-one young volunteers were recruited including 19 nonsmokers (NS), 11 light smokers (LS) and 11 heavy smokers (HS), stratified by their smoking history. Each group had, at least, 5 males and females. Plasma samples were obtained for analyte measurement within 30 minutes of smoking for LS and HS groups. Two–way ANCOVA was performed on the log-transformed concentrations. Significant differences were found between HS-NS and LS-NS in analyte concentrations. A comparison to eighteen subjects (6 NS, LS and HS) abstaining from smoking for 15 hours resulted in a difference only between NS and HS, suggesting that acute tobacco smoking has a major influence on circulating TIQs and BCs between smoking status groups. In a study involving thirty-five alcohol dependent subjects (12 NS, 11 LS, and 12 HS, balanced with gender), TIQ measurements were taken on day 1, 2, 3, 8 and 15 of inpatient detoxification. A significant effect of time was observed, with TIQ concentrations slightly increasing from admission to day 15. Both factors of smoking status and gender did not have a significant effect on plasma TIQ's at any of the time points evaluated. Although, measures of acute and chronic alcohol intake had no effect on TIQ levels, liver function showed moderate correlation with plasma TIQs. Comparison of both populations showed that alcoholics had a lower average TIQ concentration than healthy subjects. The results indicate that smoking status 1) has an effect on plasma TIQs and BCs in healthy individuals and 2) does not have an effect in alcoholics during detoxification. The alcoholics possessed lower TIQ concentrations than the healthy subjects. No gender effect was observed in either study.

Transdermal nicotine (TN) is a smoking cessation pharmacotherapy thought to work by suppressing tobacco/nicotine withdrawal and reducing the effect of a concurrently smoked tobacco cigarette. Clinical trials suggest that TN may be less efficacious for women. This study explored the possibility of gender differences in response to transdermal nicotine in 54 women and 70 men. Participants completed four within-subject, double-blind, randomized sessions corresponding to 0, 7, 14, and 21 mg TN and 4-hrs after TN application smoked an own-brand cigarette. Prior to session onset participants completed ≥ 8 hours of verified tobacco cigarette abstinence (i.e., expired air carbon monoxide levels ≤ 10 ppm). Subjective and physiological measures were administered throughout each session, and cognitive performance and smoking behavior were assessed at time points related to the smoking opportunity.Results revealed that there were few significant effects involving the gender factor across withdrawal suppression and concurrent smoking outcomes (13 significant gender-related effects out of 338 possible; 3.9%). Women were more sensitive to some of the direct effects of nicotine in the 21 mg TN condition (e.g., increased ratings of "Nauseous"). However, for women and men TN suppressed some of the signs and symptoms of withdrawal and attenuated smoking-related increases in heart rate and subjective effects that might be indicative of the positive reinforcing properties of smoking (e.g., "Was the cigarette satisfying?"). In addition, for women and men, TN did not attenuate properties of smoking that might be negatively reinforcing (e.g., smoking- induced reductions in withdrawal symptoms). Thus, although this study does not shed light on clinical observations that TN is less effective for women, results suggest that NRT might be more efficacious if combined with other interventions that supplement the withdrawal suppressing effects of TN and reduce the negative reinforcing qualities of smoking.

Background: Involuntary exposure to secondhand smoke (SHSe) is an important cause of morbidity in children who present to the pediatric emergency department (PED) and urgent care (UC). SHSe interventions delivered in the PED and UC would benefit both the smoker and child, but there have been no large trials testing the efficacy of such interventions. The Healthy Families program is the first randomized controlled trial to test whether a screening, brief intervention, and referral to treatment (SBIRT) intervention delivered in the PED and UC will be effective in decreasing SHSe in children and increasing cessation in smokers. Methods/design: This trial uses a randomized, two-group design in which caregiver-smokers of children 0-17 years old are recruited from the PED and UC. Eligible caregiver-smokers are randomized to either the: 1) SBIRT Condition with face-to-face, tailored counseling that focuses on the child's illness, the importance of reducing child SHSe, caregiver smoking cessation, and the option to receive nicotine replacement therapy; or 2) Healthy Habits Control Condition which includes face-to-face, tailored attention control "5-2-1-0" counseling that focuses on improving the child's health. Dyadic assessments are conducted in-person at baseline, and via email, phone, or in-person at 6-weeks and 6-months. The primary outcomes are biochemically-verified, 7-day point prevalence and prolonged smoking abstinence. Secondary outcomes are cigarettes smoked per week, 24 h quit attempts, and biochemically validated child SHSe at each time point. The costs of this intervention will also be analyzed. Discussion: This study will test an innovative, multilevel intervention designed to reduce child SHSe and increase smoking cessation in caregivers. If effective and routinely used, this SBIRT model could reach at least one million smokers a year in the U.S., resulting in significant reductions in caregivers' tobacco use, SHSe-related pediatric illness, and healthcare costs in this population of children.

This master thesis was tasked to find out how the parameter of interior atmosphere changes at student's club "Mrtvá Ryba", that means atmospheric aerosols sized from 0,524 to 20 micrometers. This work tries to show indoor aerosols before and after the smoking ban and its comparison. This work describes concentrations PM1 and PM10, and their behavior per day. Concentrations was measured by APS (Aerodynamic particle sizer). The measurement was the first step in the non-smoking club, then processing with retrieved informations in CoPlot, CoStat and Excel, where the statistical method has done, and comparison with previous values. T-tests was used for statistics and linear regresion. The result confirms, what was it supposed to, so concentracion values are significantly different. The average concentration of all measured days (six) of smoking campaign was at PM1 13,28 µg.m-3 and at PM10 23,38 µg.m-3. The average concentration of all measured days (thirty six) of non-smoking campaign was at PM1 4,88 µg.m-3 and at PM10 24,61 µg.m-3. Resulting concentration of aerosol particles was explicity lower at non-smoking period than at smoking period. Contamination of interior enviroment is influenced by many factors. The most important factor is presence of persons and their number, concentration of outdoor...