In my thesis, I summarized the main reasons for specific German position towards tobacco advertising directives. In my opinion, the main reason consisted in tobacco companies and lobby groups activity. Adoption of tobacco directive was partly inevitable, but the above mentioned interest groups succeeded (via Germany) in limiting the directive's impact and postponing its adoption. Long-term and elaborated tobacco company's strategy succeeded in persuasion the German public. They, inter alia, indirectly force them to believe that tobacco industry is essential for the German economic growth. In my opinion, the strategy was successful because of its complexity and sophistication. Even though Germany was not successful before European Court of Justice with its second action for directive annulment, it still indirectly achieved to limit the directive impact and postponed its adoption for several years. But at the end, Germany was also forced (under the threat of fine) to implement the directive into its legal system.

Cigarette use is more prevalent among veterans who have mental disorders than it is in the general population. Rates of tobacco use are also high among individuals who suffer from post traumatic stress disorder, addiction, and human immune deficiency disease. Approximately 22.7 million American veterans and their families are at risk of tobacco-related health problems. Concerned about heavy tobacco use among veterans, the U.S. Department of Veterans Affairs developed a Tobacco-Cessation Guideline to be used nationally. This guideline was updated in 2008 to include the '5A' mnemonic (ask, assess, advise, assist, and arrange) and is recommended for use by physicians, nurses, nurse practitioners, social service providers, and psychologists in Veterans Health Administration facilities when screening veterans for tobacco use. This doctoral capstone project involved evaluation of the Tobacco-Cessation Guideline by deploying a retrospective chart audit to assess implementation by first-line clinicians. Randomization of patient identifiers was used so that 18 Health Insurance Portability and Accountability Act patient identifiers were not recorded. The project was conducted at a Domiciliary and Residential Rehabilitation Treatment Program located in an urban area in the southern United States. Results of this project included raised awareness of first-line clinicians through electronic health record reminders, clinical outcome evaluations, and patient satisfaction surveys. These initiatives improved providers' effectiveness in documenting interventions, in addition to substantially improving the treatment progress made by each veteran. The sustainability of this effort will require long-term organizational commitment that will help to drive a change in practice and encourage positive attitudes toward tobacco cessation in the general population.

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The effects of smoking cigarettes on sensory gating, P50 and stimulus-bound gamma band (32-48 Hz) oscillations were examined in two paradigms: paired-tone and oddball. During a paired-tone paradigm, our previous work (Crawford, McClain-Furmanski, Castagnoli, & Castagnoli, Neuroscience Letters 317(2002) 151-155) found heavy smokers exhibited chronic (rather than acute) effects in the frontal region: (1) larger P50 and GBO responses; (2) greater P50 and GBO sensory gating suppression, as well as earlier GBO sensory gating suppression. During an oddball paradigm, we (McClain-Furmanski, Crawford, Castagnoli & Castagnoli, in prep.) found an acute effect between 0 and 20 ms post-stimulus in the GBO, however we were unable to determine whether this effect was due to nicotine or the act of smoking. In the present study, participants were 24 heavy cigarette (20+/day) right-handed, non-depressed smokers with no known medical or psychiatric problems, and no known familial history of psychiatric problems. In the morning, they were tested after abstaining overnight and after smoking a cigarette containing either 1.1 mg of nicotine, or a denicotinized cigarette (< 0.04 mg). In study 1 (oddball paradigm), although some effects were found related to nicotine and/or smoking, observed as condition by group interactions with the groups changing differently across conditions, they differed in temporal and spatial localization from those hypothesized. Thus, the present study was unable to differentiate between nicotine effects and effects due to the act of smoking. In study 2 (paired-pulse paradigm), in traditional evoked potential analysis, we observed signficant chronic sensory gating, as measured by the ratio of N40-P50 amplitude in response to the second tone (S2) as compared to the response to the first tone (S1). The effect was greatest at the hypothesized location (FCZ). In time series analysis of the underlying GBO, we replicated our earlier findings in that S2/S1 effects could be detected across 60 msec of the response. These results are discussed in relation to the neurochemistry and neural processes underlying sensory gating at GBO production, as well as in relation to the known and hypothesized psychpharmacological effects of smoking tobacco. Furthermore, these results are related to the theorized basis of addiction. / Ph. D.

The purpose of this research was to determine if one program funded by the Virginia Tobacco Settlement Foundation produces a more effective result in increasing student knowledge about the harmful effects of tobacco use than another program. Of particular interest is whether there is a difference in effectiveness based on the environment or settings in which these programs are presented. According to the CDC (2006), approximately 4,000 people between the ages of 12 to 17 will initiate smoking. In Virginia, a tobacco-growing state, there are 88,500 high school smokers. The health costs to Virginia are approximately 2.08 billion dollars per year with an estimated cost of 2.42 billion (Campaign for Tobacco-free Kids, n.d.). By providing the VTSF an analysis of their programs, they will be better equipped at making an informed decision on which programs to support financially. The research questions that were posed are: 1) is there a difference between school-based programs, faith-based programs, and community-based programs in increasing knowledge about tobacco's harmful effects? 2) is there a difference between programs in increasing knowledge and the location in which they are presented, urban versus rural?, and 3) is there a difference between programs implemented in middle schools in increasing knowledge about tobacco? From the focused analysis, the following conclusions can be drawn: 1) given the current evaluation and reporting process of the VTSF, no determination of whether there is a difference between program settings in increasing knowledge can be made, 2) in addition, no determination can be made in regards to whether there is a difference in increasing knowledge in regards to program location-urban versus rural, and 3) no conclusion can be drawn about middle school program effectiveness. What one can conclude is that the evaluation process used by the VTSF needs to be reformed so that a more consistent method is utilized by all parties so that a comparison can be made about the effectiveness of implemented programs. Also, long-term studies on programs need to be conducted since there are so few available. Studies to determine whether knowledge acquisition actually translates into behavior change also need to be performed. The key to tobacco prevention and cessation must be a multi-faceted approach. Educational programs, anti-tobacco media messages, tobacco taxation, and restriction of tobacco sales are all important in the prevention of tobacco use by the youth of Virginia. Each plays an important piece to the puzzle. / Ph. D.