The importance and use of data and information to make sound programmatic decisions are receiving increased attention as state and federal funding for public health programs grows tighter and as demands for accountability continue. This dissertation provides insight into fundamental questions regarding the utilization of a Web-based reporting system on knowledge management practices for Tobacco Prevention Programs and examines what happened in Texas after the merger of the Tobacco Prevention Program into the Substance Abuse Prevention Program. A phenomenological qualitative approach was used to explore meaning of actions and to identify common themes as they relate to information sharing and utilization of Texas’ Program Management and Tracking System (PMATS). Twenty-four semi-structured interviews were conducted. First, core functions of PMATS are examined through the experiences of its end-users; and second, the impact of the merger on retention and use of PMATS within the Department of State Health Services is explored. Four themes were identified as they relate to core functions of PMATS, including its use as a codification system, its use to track performance measures, and its use for report generation and for programmatic decision-making. These four primary uses of PMATS remained the same pre- and post- merger, although how the systems were utilized during these periods differed. A central theme that permeated all interviews was the impact of the merger of the Tobacco Control Program into the Substance Abuse Program on individual beliefs and attitudes (i.e., job security, low morale, etc.), on systems characteristics (i.e. feedback, internal reporting structures, etc.), and on organizational culture (i.e., training, leadership, etc.). Since entering into PMATS was contractually required, individual attitudes and beliefs did not impact use of PMATS. However, competing IT systems, lack of a champion, lack of knowledge and support by upper management, and lack of communication were identified as key influences on systems characteristics and on organizational culture, which ultimately contributed to the termination of PMATS. Both applied research and practice recommendations are discussed, including IT due diligence, creating a knowledge culture, and network analysis of information sharing practices. / text

Bakgrund: Tobak är den enskilt största livsstilsfaktorn som leder till ohälsa. Att tobak är skadligt och leder till flertalet svåra sjukdomar är idag känt bland de flesta. Trots detta röker fortfarande 10% av Sveriges befolkning och ca 800 000 snusar. Inom sjukvården röker en av tio sjuksköterskor dagligen. Sjuksköterskan ses som en nyckelperson för patienten inom tobaksprevention och bör vara en förebild. Patientens sjukhusvistelse ses därför som ett bra tillfälle att lyfta frågan om att sluta med tobak. Sjuksköterskor som röker har visats vara sämre på att ge råd och vara mindre benägna att hjälpa sina patienter att sluta röka vilket strider mot den yrkesverksamma sjuksköterskans arbetsuppgift, vilken är att främja hälsa och förebygga sjukdom. Syfte: Syftet med denna studie var att undersöka användandet av tobak bland sjuksköterskestudenter vid Uppsala universitet samt studenternas syn på användning av tobak som yrkesverksamma sjuksköterskor. Metod: En kvantitativ metod valdes då ett stort antal personer skulle undersökas och en studiespecifik enkät skickades ut till totalt 632 sjuksköterskestudenter. Resultat: Av studenterna använde 38% tobak. Av dessa rökte 3,1% dagligen och 12% snusade dagligen. Studenterna ansåg att sjukvårdspersonal är förebilder i hälsoförebyggande vård och sjuksköterskor som använder tobak ansågs inte vara bra förebilder. Slutsats: Den dagliga rökningen var mindre bland sjuksköterskestudenterna jämfört med tidigare undersökningar gjorda på sjuksköterskor. Studenterna såg sjuksköterskor som förebilder för patienten inom hälsa och anser att sjukvårdspersonal bör värna om sin egen hälsa och inte bruka tobak. Det sågs en skillnad mellan studenterna som använde tobak och de som inte använde tobak.  Studenterna som inte använde tobak ansåg att en sjuksköterska som använder tobak inte är en bra förebild för patienterna och de ansågs vara mindre benägen att hjälpa patienterna att sluta med tobak. Medan de studenter som använde tobak ansåg oftare att detta inte hade någon betydelse för vården. Men de studenter som rökte planerade ändå att sluta tills de skulle ta sin examen. / Background: Tobacco is the single largest lifestyle factor leading to a bad health. That smoking is harmful and leads to many serious diseases are known among most people. Despite this 10% of the Swedish population and about one out of ten nurses at the hospital still smoke daily. Nurses are supposed to be role models and play a key role in tobacco use prevention. The patient’s time at the hospital is therefore seen as a good opportunity to raise the question about tobacco cessation. Nurses who smoke are proven to be less likely to provide advice and help these patients stop using tobacco, which is opposing the nurses tasks, to promote health and to prevent illness Aim: The purpose of this study was to investigate the use of tobacco among the nursing students at Uppsala university and the students opinion about the use of tobacco as professional nurses. Method: A quantitative method was chosen because of the large number of people that would be examined and as study specific questionnaire was sent out to a total of 632 nursing students. Results: In total 38% of students used tobacco. Among those, 3.1% were daily smokers and 12%used Swedish snus. The students considered nurses as role models for the patient in health. Nurses who used tobacco were seen as poor role models. Conclusion: The daily smoking is declining among the nursing students compared to previous studies on nurses. The students considered nurses as role models for the patients in health and they believe that hospital workers should care about their own health and not use tobacco. A difference was found between the students who used tobacco and those who did not use tobacco. The students who did not use tobacco considered that a nurse who uses tobacco is not a good role model and for the patients and are considered as not as good in giving tobacco cessation advice. The students who used tobacco thought more often that the nurses use of tobacco did not matter for the care he or she gives. At the same time the students who smoke still plan to quit smoking before graduation.

La lutte contre le tabagisme représente un enjeu de santé publique majeur. En France, seules des méthodes déclaratives (questionnaires, entretiens) sont utilisées à ce jour pour étudier l'impact des messages de prévention sur la population. Les neurosciences et les sciences cognitives peuvent pourtant apporter de précieuses informations pour la compréhension des processus attentionnels, émotionnels et mnésiques mis en jeu lorsqu'un individu fumeur est exposé à une campagne de prévention anti-tabac. Depuis 2011, en France, des avertissements sanitaires anti-tabac combinés (comportant une photo et un texte) sont apposés sur tous les paquets de cigarettes. Ces avertissements qualifiés de « chocs » par les médias, peuvent évoquer de la peur ou du dégout chez les individus car certains d'entre eux représentent des pathologies graves dues au tabagisme. L'objectif de ce projet de recherche était d'utiliser les outils des sciences cognitives et des neurosciences afin d'observer le traitement cognitif des avertissements sanitaires combinés actuellement apposés sur les paquets de cigarettes en France. Une première étude a permis d'observer quelles émotions étaient évoquées par les avertissements et si ces émotions impactaient l'attention portée aux avertissements et leur mémorisation chez des fumeurs et des non-fumeurs. Dans un second temps de notre projet, nous avons donc observé grâce à la méthodologie de l'Imagerie par Résonance Magnétique fonctionnelle, si l'exposition à des avertissements sanitaires combinés modulait l'activité cérébrale évoquée chez les fumeurs lors de l'exposition à des stimuli liés au tabac. / Fighting tobacco represents one of the biggest global health challenges for public policymakers. In France, cognitive (neuro)sciences are not used to develop and test anti-tobacco strategies prior to scaling them. However they could provide valuable insights in the understanding of attentional, emotional and memorization processes at play when a person is exposed to strategies aiming at fighting tobacco consumption. Since 2011, France has been using the set of graphic warnings provided by the European Commission in combination to text warning on cigarette packets. In a series of experimental studies, funded by the Ligue Nationale Contre Le Cancer, we used methodology from cognitive sciences (eye-tracking) and functional neuroimaging (fMRI) to investigate processes involved when smokers and non-smokers are exposed to such tobacco warnings. Tobacco warnings used in France may induce disgust or fear because some of them depict body damages caused by tobacco related diseases. In a first study, we observed the relationship between the nature of basic emotions evoked by those warnings in smokers and non smokers and the attentional and memorization processes. In a second study, we tested whether being exposed to tobacco warnings modulates the specific brain activity observed in fMRI when smokers are exposed to tobacco related images, a mechanism involved in “smoking cue reactivity”.

Schönherr Qwick, R-M Öronakupunktur. Upplevelser och känslor av öronakupunktur isamband med rökavvänjning. Examensarbete i omvårdnad 15 högskolepoäng, D-nivå.Malmö högskola: Hälsa och samhälle, Utbildningsområde omvårdnad, 2009.Bakgrund Tobaksbruket medför stora hälsorisker och för många en för tidig död. Mångarökare önskar inget hellre än att sluta. Att sluta röka är ofta svårt, då nikotinet är en starkdrog och abstinserna kan vara svåra, även om evidens baserad hjälp finns i form avmetoder och hjälpmedel. Allt fler patienter önskar hjälp med akupunktur menkunskaperna och erfarenheterna om hur metoden fungerar och upplevs av rökare är få.Metod Åtta kvinnliga rökare, anställda inom Vård och Omsorg i Malmö, intervjuades dåde som frivilliga deltog i rökslutarbehandling med öronakupunktur under tre veckorvåren 2009. Intervjuerna analyserades enligt Burnards innehålls analys och resultaten hardiskuterats i relation till folkhälsoteorierna av Ajzen ”The Theory of Planned Behavior”och Prochaska & Di Clemente “The stage of Change Model.” Vårdgivarens upplevelserhar diskuterats i relation till omvårdnadsteorin av Jean Watson och Barbara Carper.Syftet Med denna studie har varit att undersöka upplevelser och känslor avöronakupunktur i samband med rökavvänjning. Vidare att se om behandlingen skullekunna ge lindring av abstinens och undersöka vilka bakomliggande motiv som ligger tillgrund för beslutet att sluta röka. Syftet var också att undersöka vårdgivarens upplevelserav att ge denna behandling.Resultat Presenteras utifrån olika kategorier av känslor och upplevelser som framkommithos deltagarna under behandlingen med öronakupunktur. Deltagarna rapporteradepositiva effekter av behandlingen. Samtliga deltagare var från början väl motiverade attsluta röka och till metoden. De ansåg att det var en verksam behandlingsmetod somhjälpte dem att sluta röka eller minska på nikotin behovet. De uttryckte lindring iabstinensen till följd av behandlingen samt känslor av välbefinnande och harmoni.Vårdgivaren upplevde arbetet givande och metoden som ett bra verktyg.Konklusion Mottagaren av öron akupunktur i samband med rökavvänjning upplever enlindring av abstinens. Den upplevs lugnande och rogivande. Vårdgivaren upplevdemetoden som ett effektivt, förtroende ingivande hjälpmedel. Mera forskning behövs föratt vidare utforska behandlingens effektivitet när det gäller den procentuella andelen sompå sikt slutar röka helt. / Schönherr Qwick, R-M. Earacupuncture. Experience and feelings of ear acupuncture inconjunction to quit smoking. Degree Project, 15 Credit Points, Advanced level. MalmöUniversity and Society, Department of Nursing, 2009.Background The use of tobacco smoking has severe health hazards and for many anincreased risk of premature death. Many smokers have a strong wish to quit tobacco.However smoking cessations is difficult, since nicotine is a strong addictive drug, and hasmany with- drawl symptoms, even if evidence based methods and nicotine replacementsare used. Many quitters wants to try alternative methods in smoking cessation asacupuncture but knowledge and experience about effect and sensations combined withthe treatment of smokers is scarce among caregivers.Aim Of this study was to explore the experiences and feelings of ear acupuncture inconjunction with smoking cessation. Further to examine if the treatment were able toreduce abstinences, to examine motives for smoking cessation and to examine thecaregivers experiences in providing this form of treatment.Method Eight women from the health care sector in Malmö volunteered to participate inthis tobacco cessation project by ear acupuncture during three weeks in spring 2009 inMalmö, Sweden. This qualitative interview study were analyzed using content analysisby Burnard and the findings have been analyzed in relation and people health theory ofAjzen “Theory of planned behavior” and Prochaska & Di Clemente” The stage ofChange Model.” The experiences from the caregiver in providing the treatment wereanalysed in relation to the caring theory by Jean Watson, Barbara Carper.The results All participants were motivated to quit smoking using ear acupuncture.Participants reported positive effects of ear acupuncture as a treatment reducing“crawings” for nicotine associated with in smoking cessation. The results also show thatparticipants were relived in main abstinences and they felt comfort and harmony in thecontext of the individual treatments. The caregiver experienced the method as efficient,rewarding and as a good tool.Conclusion The patient who receives ear acupuncture feels relief in symptoms ofwithdrawal associated with smoking cessation. The treatment perceives as calming andsoothing. More research is needed to further explore the efficiency of the treatment insuccess rate of smoking cessation.

Inledning: I Länsstyrelsen Blekinges projekt TBU, som står för tobaksfria barn och unga i Blekinge, har ambassadörer från gymnasiet använts för att nå ut med information om tobak till ungdomar i högstadiet. Arbetet med ambassadörer relaterar till metoden peer education som innebär att jämlikar utbildar jämlikar. Att använda jämlikar som är lik målgruppen i exempelvis ålder eller erfarenheter innebär en annan inlärningssituation än den som sker mellan till exempel lärare och elev. Syfte: Syftet med studien var att undersöka ambassadörernas arbete med peer education som tobaksprevention samt hur ambassadörer kunde påverkas av arbetet som peer educators. Metod: Metoden som använts i studien är intervjuer med ambassadörer samt en fokusgruppsintervju med TBU:s projektgrupp. Det insamlade empiriska materialet analyserades genom innehållsanalys. Resultat: Resultatet visar att ambassadörerna hade, eller utvecklade, ett intresse för sitt arbete och en förmåga att kommunicera med sin målgrupp, vilket de även nämnde som viktiga delar i rollen som ambassadör. Ambassadörerna hade också påverkats av sitt arbete, bland annat i form av stärkta kommunikationsförmågor och ökad kunskap, vilket även ansågs bero till största del på att ambassadörerna fick genomgå en utbildning innehållande olika delar och perspektiv. Konklusion: Det viktigaste i ambassadörernas arbete för att förebygga tobaksbruket hos högstadieelever var den utbildning som ambassadörerna fick under den första veckan av sitt arbete. Vi föreslår därför att TBU utvecklar ett konkret underlag för utbildningen med tydliga metoder och mål som tar hänsyn till att utveckla ambassadörernas intresse för ämnet och kommunikationsförmågor. Fortsatta studier kan förslagsvis undersöka hur högstadieeleverna upplevde relationen mellan ambassadörerna och dem. / Introduction: In the project known as TBU, tobacco free adolescents in Blekinge, ambassadors in the ages 16-19 have been used for spreading information about tobacco to adolescents in the ages 13-15. This approach is related to the method peer education. The use of peers who are close in age or have similar experiences represents another way of learning than the more common situation between a teacher and a student. Objective: The objective of this study was to examine how ambassadors use peer education as tobacco prevention and how the ambassadors could be affected by their work as peer educators. Method: The methods used in this study were interviews with the ambassadors and a focus group interview with the project group of TBU. The material was analysed with a content analysis. Results: The results show that the ambassadors had, or had developed, an interest for their work and an ability to communicate with their target group, which they also stated as important parts of the role as an ambassador. The ambassadors had also been affected by their work. Their communication skills had been improved and they had had an increase in knowledge, which was thought to be a result of their education containing different parts and perspectives. Conclusion: The most important in the work of the ambassadors to prevent the use of tobacco in adolescents was the education the ambassadors had the first week of their work period. Therefore, we suggest that TBU develops a concrete material for the education with well- defined methods and targets which would aim to develop the ambassadors interest for the subject and their communication skills. Further studies could examine the relationship between students and ambassadors from the student's perspective.

Tobacco use among Mauritian adolescents has increased steadily since 2008. Currently, Mauritius has not implemented any school-based anti-tobacco program and there is no instrument to assess the effectiveness of existing anti-tobacco school policies. Since the first cigarette can rapidly lead to nicotine dependence, targeted interventions must be assessed before established patterns of smoking appear. This study evaluated a tobacco use prevention education instrument to determine the effectiveness of a school-based anti-tobacco program. 26 male students completed a survey before and after receiving anti-tobacco lessons. Smoking initiation age could not predict likelihood of tobacco addiction (r(12)=0.320, p=0.311). However, after receiving the anti-tobacco lessons, participants were less likely to believe that youth who smoke have more friends (p < 0.001) and were more knowledgeable about tobacco’s dangers (t(25)=3.94, p=0.001). This indicated that, with a few changes, the instrument can be used to assess the implementation of a school-based anti-tobacco program in Mauritius.