In this thesis paper, I will recount the creative and technical processes of making my graduate thesis film, KOOL. I will describe how the story was developed and written, then analyze the phases of pre-production, principle photography, and post production. I will then evaluate my leadership skills, and strengths and weaknesses as a film director.

Introduction: Cigarette preference increases as a function of nicotine content, but preference can be shifted by manipulating cigarette cost. The aim of the present study is to model whether the behavioral-economic metric of unit price (cigarette cost/nicotine content) accounts for cigarette preference shifts and whether preference changes to very low nicotine content cigarettes (VLNCs) are associated with corresponding changes in smoking rate. Methods: 169 daily smokers from populations vulnerable to smoking completed sessions in which choices between smoking normal nicotine content (NNC) (15.8mg/g) and VLNC (0.4mg/g) cigarettes were concurrently available. In Condition 1, choices for both products were available ad-lib at an equal cost of 10 responses/choice. In Condition 2, VLNCs were again available ad-lib at 10 responses/choice, but NNCs were available on a progressive-ratio (PR) schedule wherein response cost (and unit price) increased following each NNC choice (10,160,320…8400 responses/choice). Results were analyzed using ANOVAs and a binomial test (p<.05). Results: Participants preferred NNCs over VLNCs in Condition 1, but shifted preference to VLNCs in Condition 2 (p<.001) immediately before the point in the PR progression where unit price for NNCs exceeded unit price for VLNCs (p<.001). Additionally, this preference shift corresponded with reduced total cigarette consumption compared to Condition 1 levels (p<.001). Conclusions: These results suggest that unit price of nicotine underpins cigarette preference and may provide a metric by which regulators can predict product preference and potentially impact it through policy. These results also demonstrate that VLNCs sustain lower smoking rates than NNCs even under acute laboratory conditions.

Introduction: Financial incentives increase smoking abstinence among pregnant and postpartum women. They have also been reported to reduce psychological symptoms using the Beck Depression Inventory (BDI) and Brief Symptom Inventory (BSI) in women at risk for perinatal depression. This prospective study aims to replicate and extend these findings using the BDI and Edinburgh Postpartum Depression Scale (EPDS). Methods: Participants were 169 pregnant cigarette smokers who were assigned to one of two treatment conditions: Best Practices only (n=88), which entails brief counseling and a referral to a pregnancy-specific quit-line, or Best Practices + Incentives (n=81). Participants were categorized as at increased risk (Dep+; n= 91) or lower risk (Dep-; n= 76) for depression based on history of depressive symptoms and baseline symptom scores. Treatment effects on smoking status and BDI/EPDS scores were examined across nine perinatal assessments using repeated measures analyses of covariance. Results: Financial incentives increased rates of biochemically-verified abstinence through 12-weeks postpartum independent of depression risk (ps ≤ .01) but did not differentially decrease BDI or EPDS scores (ps > .05). Scores decreased with both interventions for the Dep+ women (p = .001). Conclusions: These results replicate earlier evidence that financial incentives increase perinatal smoking abstinence in Dep+ women but not their efficacy in differentially reducing depressive symptoms at levels greater than Best Practices. The failure to replicate effects on depressive symptoms may be due to use of different control conditions in the current and prior study or increased screening and intervention for perinatal mental health during routine obstetrical care.

Cigarette smoking has been a public health concern for many years, and the possible impact of smoking on surgical site infection (SSI) has been studied broadly. However, a gap in understanding has persisted concerning whether there is an association between smoking tobacco and the development of SSI among patients who undergo lower extremity surgery, specifically total knee arthroplasty (TKA). The purpose of this study was to examine the association between smoking and lower extremity SSI. Andersen's behavioral model (BM) was used to understand the risk factors relevant to the interaction between smoking and SSI. Application of the BM categories of predisposing, enabling, need, and behavioral habits facilitated the discussion of surgical outcomes. A quantitative, cross-sectional approach was used to analyze data from a legacy registry of an east coast hospital. The research question addressed whether there was a relationship of the smoking status of three groups (i.e., smokers, nonsmokers, and previous smokers) and the variables in the BM categories (predisposing variables of age, gender, and body mass index [BMI]; enabling variable of health care insurance coverage; and need variables of health diagnoses, diabetes, hypertension, deficiency anemia, rheumatoid arthritis [RA]) to postoperative SSI. Multiple logistic regression test was used and no statistical association was found between smoking status and SSI; however, RA had a significant association with SSI. Positive social change may occur through the dissemination of new knowledge to reduce the financial burden of the prevalence of SSI through behavioral changes and improvements to health wellness.

Background Smoking poses a risk for increased morbidity and mortality from many diseases. The ethnic group of American Indians has the highest prevalence of smokers compared to other racial/ethnic groups in the United States, and therefore may be at a greater risk of smoking-related death. This study aimed to estimate all-cause mortality attributable to smoking, and specifically to examine the association of smoking and mortalities from cardiovascular disease (CVD) and cancer in American Indians using data from the Strong Heart Study. Methods The Strong Heart Study is a large, community-based, prospective survey of CVD risk factors in American Indians from in three tribes residing in North and South Dakota, seven tribes in southwestern Oklahoma, and three tribes in central Arizona. A total of 4549 tribal members aged 45 to 74 years, representing 62% of total population in this age group, were recruited from all eligible individuals at the baseline survey between July 1989 and January 1992. The participation rates were 55% in the Dakota center, 62% in the Oklahoma Center, and 72% in the Arizona center. Baseline data were collected using personal interview and a physical examination. Mortality and causes of death were followed up from 1993 through the end of 2009. The numbers of deaths attributable to smoking until the end of 2009 were estimated using multivariable-adjusted relative risk analysis stratified according to gender and center. Results Overall, there was a significant association between smoking and death from any cause after adjustment for multiple risk factors. In 2009, a total number of 363 deaths were found attributable to smoking among American Indian population aged 45-74, of which 105 deaths were among men and 258 deaths among women. There is a significant association smoking and CVD mortality only in Dakota center. In cancer deaths, there was a significant association both in men and women: a total of 1462 deaths were attributable to smoking among American Indian population aged 45-74, of which 571in men, and 891in women. Conclusions Smoking was associated with increased risk of death among American Indians, especially with cancer deaths. There was no overall association between smoking and CVD deaths, but a significant association was observed in Dakota center. Reducing the prevalence of smoking might benefit in prevention of smoking related mortality among American Indians. / acase@tulane.edu

In order to facilitate effective tobacco cessation services within dental school clinics, it is necessary to understand the perceived barriers encountered by dental students while providing these services. The aim of this study was to identify which factors fourth year dental students perceive to be associated with barriers to providing tobacco intervention services. A written survey was developed and completed by the incoming fourth year dental students at the University of Iowa College of Dentistry in 2008. The survey assessed the perceived barriers to providing tobacco intervention services and related factors. Descriptive, bivariate and logistic regression analyses were conducted. The response rate was 97 percent. Some of the most frequently reported barriers included: patient's resistance to tobacco intervention services (96%), inadequate time available for tobacco intervention services (96%) and forgetting to give tobacco intervention advice (91%). The following variables were significantly (p<0.05) related to greater perceived barriers in providing tobacco intervention services: lower "adequacy of tobacco intervention curriculum coverage of specific topics covered over the previous three years" and "perceived importance of incorporating objective structured clinical examination teaching method for learning tobacco intervention." Students could benefit from additional didactic training and enhanced clinical experience in order to facilitate effective intervention services in the dental school.

Numerous agencies have accumulated evidence since 1964 which implicates habitual cigarette smoking as a causal or facilitating factor in the development of many circulatory and respiratory diseases. This study sought to identify those psychological variables which possibly contribute to the maintenance of cigarette smoking and therefore, had two main purposes. First, this study investigated the individual and simultaneous physiological changes, i.e., Electroencephalography, Electromyography, Heart Rate, Blood Pressure and Skin Temperature that occurred during and immediately after the smoking of one cigarette. Second, the study investigated the hypothesis that smoking frequency would decrease when individuals were trained via biofeedback procedures to increase 8-12 Hz occipital EEG activity as a substitute for smoking. Three male, very heavy smokers (35 or more cigarettes per day ) and three male moderate smokers (15-24 cigarettes per day) physiologies were monitored while smoking, non-smoking and while they were provided with 8-12 Hz occipital EEG biofeedback training using a multiple baseline design. Results of the study indicate that of the six smokers physiologically monitored, four or more of the smokers demonstrated the following physiological changes while actually smoking one cigarette: the percent of time producing 4-8 cycles per second bra .in waves increased (S2 ,S3 ,S5); heart rate (beats per minute) increased (Sl,S2,S3,S4,S5,S6); and the percent of time producing 8-12 cycles per second (Hz) brain waves decreased (Sl,S2,S3,S4,S5,S6). Immediately after the smoking of one cigarette, four or more of the smokers demonstrated an increase in their rates (Sl,S2,S3,S4,S5, S6) and subjects 1,4,5 and 6 demonstrated an over-the-entire-session decrease in their skin temperatures. There did not appear to be any specific consistent brain wave changes across the subjects. However, the following subject-specific brain wave changes were evident: Subject 1 data indicates an increase in Alpha brain waves (8-12 Hz), a decrease in Theta brain waves (4-8 Hz), and a decrease in Beta brain waves (12-20 Hz). Subject 2 data indicates a decrease in Alpha brain waves, an increase in Theta brain waves, and a decrease in Beta waves. Subject 3 data indicates an Alpha wave decrease, Theta wave increase, and Beta wave increase. Subject 4 data indicates an Alpha wave decrease, Theta wave increase, and no observable change in Beta activity. Subject 5 data indicates an Alpha increase, a Theta decrease, and no observable change in Beta activity. Subject 6 data indicates an Alpha decrease, a non-observable change in Theta production and an increase in Beta activity. During the training period, when the smokers were given music feedback whenever they produced 8-12 Hz, four of the six smokers learned to increase the percent of time producing 8-12 Hz, (Sl,S2,S5, S6). Two of these four smokers were able to continue producing high levels of 8-12 Hz activity without the use of biofeedback equipment (Sl,S2). These smokers had quit smoking completely at the end of a six-month follow-up period. These two smokers were contacted by phone at the eight-month follow-up period and reported they were still absent from any cigarette smoking. The four smokers who could not increase their 8-12 Hz activity without the use of 8-12 Hz auditory feedback (Phase D) decreased their frequency of cigarette smoking at the six-month follow-up period as follows: Subject 3, from 38 to 15 cigarettes smoked per day; Subject 4, from 50 to 44 cigarettes smoker per day; Subject 5, from 18 to 8 cigarettes smoked per day; and Subject 6, from 17 to 10 cigarettes smoked per day. Possible reasons why Subjects 1 and 2 quit smoking are discussed and directions for future research are presented.

In Mississippi, approximately 4,700 deaths are caused by smoking and approximately 3,500 young Mississippians begin smoking each year. Nearly 9 out of 10 smokers start smoking by age 18, and 99% start by age 26. Because of the early age of initiation, policy changes and other initiatives that affect smoking rates among youth are of particular interest, including tax increases. In 2009, Mississippi increased its state excise tax on tobacco from $.18 to $.68 per pack which was in addition to the federal tax increase to $1.0066 (an increase of $.6166 from the previous amount of $.39). This study examined the effect of Mississippi's tobacco tax increase on youth smoking initiation and tobacco consumption behavior using difference-in-difference analysis. Using the SmartTrackTM School Survey this study analyzed changes in youth who reported ever smoking and their recent consumption from the three years prior to the tax increase to the three years following it using data from the Louisiana Caring Communities Youth Survey as the control group since Louisiana did not experienced a state-level cigarette tax increase during this period. The analysis showed mixed results for a statistically significant difference in smoking initiation (ever smoked cigarettes) rates, and moderately supported the hypothesis of past 30 day youth smoking rates being reduced by the tax increase on cigarettes in Mississippi. While youth smoking rates declined significantly during the study period, the difference-in-difference analysis of youth who reported ever smoking showed only a small but statistically significant effect across all grades, but had a notable impact on 6th graders. The analysis of past 30 day use showed no short term effect on Mississippi youth in the year after the 2009 tax increase, but difference-in-difference comparisons showed a moderate and statistically significant impact on those rates the longer term. The results of this study will be of interest to scholars, policymakers, and tobacco control advocates as they make decisions about whether to increase state level taxes on cigarettes to prevent smoking initiation and curb youth tobacco use. / acase@tulane.edu

The consumption of alcohol and smoking of cigarettes are both common practices in Australian society. With continued public health efforts exposure to both alcohol and nicotine during pregnancy has diminished, however little is known about exposure to these toxins in the postnatal period and the effect on the breastfed infant. To investigate the pattern of alcohol consumption and cigarette smoking in the postnatal period and the effect on breastfeeding outcomes, a longitudinal study was conducted in two public hospitals with maternity wards in Perth, Australia. Data for the Perth Infant Feeding Study (PIFSII) were collected from 587 mothers between mid-September 2002 and mid-July 2003. While in hospital participating mothers completed a self-administered baseline questionnaire. Follow-up telephone interviews were conducted at 4, 10, 16, 22, 32, 40 and 52 weeks. Data collected included sociodemographic, biomedical, hospital related and psychosocial factors. Further analysis of alcohol data was undertaken on the 1995 and 2001 National Health Survey (NHS) data sets to provide a national perspective. Alcohol and smoking related data were analysed and described using frequency distributions, means and medians. Univariate logistic regression was used to screen for potentially significant variables for subsequent incorporation in the multivariate analysis. Multivariate logistic regression analysis was employed to determine the effect of alcohol consumption and cigarette smoking on breastfeeding outcomes prenatally, antenatally and postnatally, after adjusting for factors identified in the literature as being associated with breastfeeding initiation and duration. The relationship between smoking status and breastfeeding duration was determined using survival analysis. / Analysis of the relationship between breastfeeding duration and the level of postpartum intake was investigated using a Cox hazards model with repeated measures for alcohol consumption. Results showed that: 1. PIFSII. During pregnancy approximately 32% of women stopped drinking alcohol. Thirty five percent of pregnant women continued to consume alcohol during their pregnancy with 82.2% of these women consuming two or fewer standard drinks per week. At 4, 6 and 12 months postpartum, 46.7%, 47.4% and 42.3% of breastfeeding women were consuming alcohol, respectively. 2. NHS. Sixteen point four percent and 1.3% of pregnant women from the 1995 and 2001 NHS, respectively were consuming more than that recommended in ‘Guideline 11’ from the National Health and Medical Research Council of Australia (ie >7 standard drinks/week). 3. NHS. Thirteen percent of lactating mothers from the 1995 NHS and 16.8% from the 2001 NHS were consuming seven or more standard drinks of alcohol in the reference week, thus exceeding the NHMRC recommended level. 4. PIFSII. After 6 months of follow up, women who consumed alcohol at levels of more than two standard drinks per day were almost twice as likely to discontinue breastfeeding earlier than women who drank below these levels (HR 1.9, 95% CI 1.1, 3.0). 5. PIFSII. With regard to smoking, 226 (39%) of mothers reported smoking pre- pregnancy. Mothers who smoked were more likely to have a partner who smoked, to have consumed alcohol prior to pregnancy and less likely to attend antenatal classes. / They were also less likely to know how they were going to feed their baby before conception and be more inclined to consider stopping breastfeeding before four months postpartum. 6. PIFSII. Women who smoked during pregnancy had a lower prevalence and shorter duration of breastfeeding than non-smoking mothers (28 weeks versus 11 weeks, 95% CI: 8.3-13.7). This effect remained even after adjustment for age, education, income, father’s smoking status, mother’s country of birth, intended duration of breastfeeding >6 months and birth weight (risk ratio HR 1.59, 95% CI 1.22 to 2.08). 7. PIFSII. Two hundred and twenty six (39%) mothers reported smoking prior to pregnancy and 77 (34%) of these stopped smoking during pregnancy. Quitting smoking during pregnancy was significantly associated with breastfeeding for longer than six months (OR = 3.70, 95% CI 1.55 to 8.83; p<0.05). The results of the present study suggest a negative association between drinking alcohol in the postpartum period and breastfeeding outcomes. Similarly, smoking cigarettes before, during and after pregnancy negatively affects breastfeeding. There is a need for guidelines outlining the safe intake of alcohol during lactation and for the cessation of cigarette smoking in the prenatal and antenatal period.

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