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BACKGROUND:India has the second largest diabetic population (61 million) and tobacco users (275 million) in the world. Data on smoking cessation among diabetic patients are limited in low and middle income countries. The objective of the study was to document the effectiveness of diabetic specific smoking cessation counseling by a non-doctor health professional in addition to a cessation advice to quit, delivered by doctors.METHODS:In our parallel-group randomized controlled trial, we selected 224 adult diabetes patients aged 18 years or older who smoked in the last month, from two diabetes clinics in South India. Using a computer generated random sequence with block size four / the patients were randomized equally into intervention-1 and intervention-2 groups. Patients in both groups were asked and advised to quit smoking by a doctor and distributed diabetes specific education materials. The intervention-2 group received an additional diabetes specific 30 minutes counseling session using the 5As (Ask, Advise, Assess, Assist and Arrange), and 5 Rs (Relevance, Risks, Rewards, Roadblocks and Repetition) from a non-doctor health professional. Follow up data were available for 87.5% of patients at six months. The Quit Tobacco International Project is supported by a grant from the Fogarty International Centre of the US National Institutes of Health (RO1TW005969-01).The primary outcomes were quit rate (seven day smoking abstinence) and harm reduction (reduction of the number of cigarettes / bidis smoked per day > 50% of baseline use) at six months.RESULTS:In the intention to treat analysis, the odds for quitting was 8.4 95% confidence interval (CI): 4.1-17.1] for intervention-2 group compared to intervention-1 group. Even among high level smokers the odds of quitting was similar. The odds of harm reduction was 1.9 (CI: 0.8-4.1) for intervention-2 group compared to intervention-1 group.CONCLUSIONS:The value addition of culturally sensitive diabetic specific cessation counseling sessions delivered by non-doctor health professional was an impressive and efficacious way of preventing smoking related diabetic complications.TRIAL REGISTRATION:Clinical Trial Registry of India (CTRI/2012/01/002327)

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Nursing Studies / Master / Master of Nursing

Objective: To explore the role of interprofessional collaboration in the delivery of team-based tobacco dependence treatments within primary care. Methods: A narrative review of the literature was completed to examine FHT team functioning in Ontario, followed by a single, multi-site qualitative exploratory case study. Results: Interprofessional collaboration contributed to changes in tobacco dependence treatment through the initiation of system-wide change, cultivation of collective action, and supporting enhanced quality of smoking cessation care. Conclusion: Interprofessional collaboration can enhance the comprehensive delivery of evidence-based treatments for individuals trying to quit smoking. Supportive public policy, education for patients and providers, and evaluation research is needed to advance FHT functioning.

M.Tech. / There are an estimated 1.2 billion smokers globally (WHO, 2004) and according to Groenewald et al. (2007) approximately 24% of South African adults smoke. The use of tobacco is the second highest cause of death and disability in the world (WHO, 2004), the primary cause of death in the United States (Abrams et al., 2003) and the third leading risk factor in South Africa (Norman et al., 2007). This malady is preventable and as such, the use of tobacco must be regarded as an important public health and treatment priority. In dealing with smoking cessation Lebargy (2000), concluded that nicotine replacement therapy has a success rate of between 20% and 25%. What is significant though is that currently used and recommended conventional smoking cessation techniques have many side-effects and contra-indications. They further stress the importance of new more effective techniques in order to fight the pan-epidemic of smoking (Henningfield et al., 2005; Mitrouska et al., 2007) The remedy being investigated is a homoeopathic preparation, Anti Smoking complex, consisting of Avena sativa D3, Daphne indica D6, Nux vomica D6, Caladium seguinum D60, Nicotinum D60 and Nicotiana tabacum D60. The aim of the research was to evaluate the efficacy of the Anti Smoking complex in the treatment of smoking cessation and nicotine withdrawal symptoms of smokers between the ages of eighteen and sixty years. The efficacy of the Anti Smoking Complex was evaluated in terms of the Fagerström Test of Nicotine Dependence (FTND), the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68), weekly smoking logs, and withdrawal symptoms for the purpose of identifying a safer alternative in the treatment of smoking cessation and nicotine withdrawal symptoms. A sample group of thirty participants was recruited at the University of Johannesburg Health Centre and various local pharmacies. Participants attended an initial interview, where they were screened by means of questionnaires and physical examinations. Inclusion criteria comprised of: adults between the ages of 18 and 60 years, who were smoking more than 10 cigarettes a day for at least a year with a score of five to seven on the FTND. Reliability and validity of clinical investigations was ensured by adherence to procedural documentation. 3 The study was conducted over a nine week period and was a random double-blind placebo-controlled clinical trial. Participation in the study was voluntary and participants were free to refuse treatment or withdraw from the study at any time. Participants were placed into two groups of fifteen – the experimental group had to take 10 drops of the Anti Smoking complex four times daily for six weeks and the control group had to take placebo on the same basis. Follow up appointments to monitor results took place on week 1, 4, 7 and 9 respectively. Collected data was analysed using descriptive statistics (frequencies and percentages). The data gathered from the FTND, the WISDM-68 and questionnaires was statistically analysed. The results of the experimental and controlled groups were compared using independent samples t-tests. Disparities of clear-cut variables was analysed using Chi-squared tests. Over time differences was analysed using repeated measures ANOVA (Eiselen, 2007). The homoeopathic complex, Anti Smoking Complex is effective in the treatment of smoking cessation. Both the results of the Fagerström Test for Nicotine Dependence and Wisconsin Inventory for Smoking Dependence supported the above. An overall smoking cessation rate of 20.0% was obtained after the nine week trial period. Of particular importance, there was no significant effect on any of the parameters of the withdrawal symptoms questionnaire. As withdrawal symptoms are a key component of smoking cessation, the action of the complex is incomplete.

Dados da literatura indicam que os fumantes apresentam distúrbios psiquiátricos e psicológicos em maior frequência do que os não fumantes. Esses fatores podem contribuir para o início do tabagismo, bem como para sua manutenção, e induzir dificuldades no abandono. Entretanto, não existe na literatura nenhuma escala construída com a finalidade de avaliar as características emocionais de fumantes frente aos cigarros, de maneira simples e rápida. Este estudo teve como finalidade desenvolver uma escala que avaliasse o estado emocional geral dos fumantes em face ao uso do tabaco. Para tanto, fumantes que procuravam ambulatórios de cessação de tabagismo em hospitais públicos do Município de Ribeirão Preto foram submetidos a entrevistas padronizadas. Indivíduos não fumantes foram selecionados entre funcionários dessas mesmas instituições e entre acompanhantes e familiares dos fumantes. Inicialmente, níveis de Ansiedade, Depressão, Estresse Percebido, Autoestima e Solidão de um grupo de 120 fumantes (idade mediana: 54,6 anos; 74 mulheres) foram comparados com os de um grupo de 76 não fumantes (idade mediana: 45,5 anos; 47 mulheres). Os fumantes mostraram valores significantemente piores do que os não fumantes, em todas as medidas investigadas. Correlações entre os escores dessas medidas psicológicas, além da característica Apego aos Cigarros, foram feitas com as medidas do Teste de Dependência a Nicotina de Fagerström (TDNF) no grupo de fumantes. Os parâmetros psicológicos mostrando as melhores correlações com o TDNF foram selecionados para fazer parte de uma escala de 6 itens chamada Teste Emocional do Fumante (TEF). As pontuações do TEF deste grupo inicial e de uma amostra adicional de fumantes (n = 102; idade mediana= 52,6 anos; mulheres = 63) foram submetidas a análises psicométricas e testes de validação. O TEF mostrou uma estrutura consistente de dois fatores, ansiedade / depressão e apego aos cigarros. As pontuações de TEF apresentaram correlações significativas com o TDNF (r=0,418), número de cigarros defumados (r=0,299), tempo antes de sentir necessidade de um novo cigarro (r=-0,441) e prazer em fumar (r=0,346). A consistência interna do TEF foi maior do que a dos escores de TDNF (alfa de Cronbach: respectivamente 0,712 e 0,542). A confiabilidade teste-reteste do TEF foi excelente (coeficiente de correlação intraclasse=0,944). As pontuações de TEF superiores a 4 puderam distinguir fumantes de não fumantes com sensibilidade de 87,3% e especificidade de 92,7%. Pode-se concluir que o TEF é um instrumento simples que dá uma estimativa do status emocional relacionado ao tabagismo e pode definir um novo e valioso constructo da dependência do tabaco. O TEF tem potencial para se tornar uma ferramenta útil nas intervenções de cessação do tabagismo / Literature data show that smokers exhibit psychiatric and psychological abnormalities in higher frequency than non smokers. These factors may contribute to smoking beginning, as well as to its continuity, and bring obstacles for quitting. However, there is not in the literature any scale designed to evaluate the emotional features of smokers. This study aimed at developing a new scale to evaluate the overall emotional status of smokers in face of tobacco use. Smokers who look for treatment in public smoking cessation clinics of Ribeirão Preto city were submitted to standardized interviews. Non smokers were selected among workers from these facilities and companions and relatives from the smokers. Levels of Anxiety, Depression, Perceived Stress, Self Esteem, and Loneliness of a group of 120 smokers (median age: 54.6 years; 74 women) were compared with those of a group of 76 non smokers (median age: 45.5 years; 47 women). Smokers showed scores significantly worsen than non smokers regarding these measures. Correlations between these psychological scores, plus the feature Attachment to Cigarettes, and FTND counts were explored among smokers. Psychological features showing the best correlations with FTND were selected to be part of a 6 item scale called Smoker\'s Emotional Test (TEF). TEF scores of this initial group and of an additional sample of smokers (n=102; age= 52.6; women= 63) were submitted to psychometric analyses and validation tests. Results: TEF showed a consistent structure of two factors, Anxiety/Depression and Attachment to Cigarettes. TEF scores showed significant correlations with TDNF (r=0.418), number of smoked cigarettes (r=0.299), time to urge for a new cigarette (r=-0.441) and pleasure of smoking (r=0.346). The internal consistency of TEF was higher than that of FTND scores (Cronbach\'s alpha: respectively 0.712 and 0.542). The test-retest reliability of TEF was excellent (intraclass correlation coefficient=0.944). TEF scores higher than 4 could distinguish smokers from nonsmokers with sensitivity of 87.3% and specificity of 92.7%. In conclusion, TEF is a simple instrument that gives an estimative of smoking-related emotional status and may define a new valuable construct of tobacco addiction. TEF has the potential to become a useful tool in smoking cessation interventions.

Yeung, Chun Yiu. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 53-62). / Abstracts in English and Chinese. / Abstract --- p.i / 論文摘要(Chinese Abstract) --- p.ii / Acknowledgements --- p.iii / List of Tables --- p.iv / Chapter Chapter 1: --- Introduction --- p.1 / Smoking: The greatest single preventable cause of death --- p.1 / Negative health impacts of smoking on non-smokers --- p.1 / Smoking ban in Hong Kong in 2007 --- p.2 / Lack of theory-based local smoking research --- p.3 / Self-Determination Theory --- p.4 / Extensions to current SDT research on smoking --- p.6 / Differentiating autonomous motivation in personal-relational dimension --- p.6 / Relational-interdependent self-construal and nature of autonomous motivation --- p.8 / Perceived competence and condition-specific self-efficacy --- p.9 / Proposed framework --- p.10 / Research purpose --- p.11 / Hypotheses --- p.11 / Statistical analyses --- p.12 / Chapter Chapter 2: --- Method --- p.14 / Recruitment strategies --- p.14 / Attrition of participants --- p.16 / Instruments --- p.16 / Variables of smoking pattern --- p.21 / Chapter Chapter 3: --- Results --- p.24 / Characteristics of participants --- p.24 / Attrition analysis --- p.25 / Descriptive statistics and construct score change from baseline to T2 assessment --- p.27 / Correlation analysis --- p.28 / Logistic regression for predicting quitters and non-quitters --- p.31 / Logistic regression for comparing the fundamental SDT and extended theoretical framework --- p.32 / Exploring the interaction effects between SDT variables and RISC in the prediction of quitting --- p.33 / ANOVAs on major variables for smokers with different quitting progress --- p.33 / "Additional analyses examining the differences in self-efficacy among quitters, quit attempters, and recalcitrant smokers" --- p.36 / Chapter Chapter 4: --- Discussion --- p.38 / Autonomous motivation and smoking cessation --- p.38 / Dilemma among health concerns and quitting behaviors --- p.39 / Possible priming effects in smoking cessation counseling sessions --- p.40 / Discrepancies in research design between the present study and previous SDT studies --- p.41 / Reflecting on the SDT and stages of health behavioral change --- p.42 / Findings related to proposed theoretical extensions --- p.43 / Relational autonomous motivation and RISC --- p.43 / Role of self-efficacy in smoking cessation: inspirations from process models of health behaviors --- p.44 / Recalcitrant smokers and their self-efficacy to respond to internal tempting conditions --- p.46 / Quit attempters and their self-efficacy to respond to external tempting conditions --- p.47 / Research limitations --- p.48 / Future directions and recommendations --- p.49 / References --- p.53

Background Women are less likely than men to successfully quit smoking when using NHS cessation services (The Information Centre, 2012, ICD, 2011). Methods The research used mixed methods and consisted of two studies. Study one was a secondary data analysis of service use data from cessation services in Glasgow, North Cumbria and Nottingham. The study examined whether women had lower cessation outcomes compared to men. Further analyses explored whether women using cessation support differed from men in terms of demographics, smoking behaviour, interpersonal characteristics or patterns of service use. The predictors of cessation success for women were identified. Study two consisted of 25 semi-structured interviews and 1 focus group (n=5) which explored women’s experiences of smoking, smoking cessation and NHS cessation support. Thematic analysis was used to analyse this data. Results Lower quit rates were observed for women in the English samples (4 weeks, 52.1% vs. 57.8%, 52 weeks, 12.7% vs. 17.2%) compared to men. Women experienced more markers of disadvantage compared to men. Disadvantage appeared to mediate smoking cessation outcomes in women by increasing nicotine addiction. Markers of nicotine dependence predicted smoking cessation outcomes in women. However, the qualitative investigation indicated that the emotional side of addiction also appeared to have an important role in the smoking behaviour for women. Variation existed in the preferred intensity of cessation support. However, knowledge of available cessation support options was low; suggesting that cessation services should ensure smokers make an informed choice about the format of cessation support they use. Conclusions The key finding of this thesis was that it highlighted that smoking and smoking cessation may be affected by the emotional role that smoking can have within women’s lives. Ways that NHS support could be altered to meet women’s needs are discussed within this thesis.

Class of 2007 Abstract / Objectives: The purpose of this study was to examine the relationship between the demographics and attitudes of Arizona pharmacists regarding provision of smoking cessation services. Methods: Paper-based surveys were distributed to pharmacists attending the 2006 Arizona Pharmacy Alliance (AzPA) Annual Meeting in Tucson, Arizona. The instrument allowed collection of 12 demographic points from subjects for data cross-sectioning. Opinions of the pharmacists were collected for 35 statements of agreement level on a four-point Likert-type response scale. Association between the demographic and opinion variables was analyzed using either Kruskal-Wallis’ rank-sum or Spearman's correlation tests. Results: Of 350 surveys distributed, 78 subjects returned them and 63 (18%) met inclusion criteria. Respondents agreed to all barriers of smoking cessation, particularly lacks in time (82.5%), patient demand (79.7%), smoking cessation program availability (68%), and documentation system (56.6%). Participants’ demographics including age, gender, practice setting and position, time since completion of education, specific smoking cessation education received, time spent counseling a patient, and number of general and smoking cessation counsels were significantly associated with pharmacists’ perceived demand and resource barriers to provision of smoking cessation services, faith in a patient’s ability to quit or try, self-perception as a valuable and effective resource, comfort level approaching patients regarding smoking cessation, likelihood of intervention, and feelings of reward (all p-values < 0.05). Conclusions: This study identified several associations between pharmacists’ demographics and their thoughts towards provision of smoking cessation services, though causation is undetermined.