Medicine and Health Sciences Commons^™

Improving Smoking History Screening And Documentation To Increase Lung Cancer Screenings In Primary Care Clinics, Destinee R. Rein

DNP Projects

BACKGROUND: In the United States, lung cancer has the highest mortality rate of all other cancers among men and women. Kentucky is ranked 50th among all states, leading the nation in new lung cancer cases each year. Lung cancer screening using Low dose Computed Tomography (LDCT) can reduce lung cancer-related morbidity and mortality. Lack of smoking history documentation to identify eligible patients is a major contributing factor to low national screening rates. Obtaining complete smoking history remains the most important technique in identifying candidates for lung cancer screening.

PURPOSE: The purpose of this quality improvement project was to evaluate …

Evaluating The Relationship Between Tobacco Use And Pain Perception Using The Global Pain Scale (Gps) In Opioid Dependent Adults: A Retrospective Analysis, Kristina Robinson

DNP Projects

Background: Chronic pain, smoking, and opioid use, contribute to a significant economic burden in the United States. Chronic pain affects all aspects of life, and is influenced by the use of cigarettes and opioids alike. Researchers suggest that there is a higher use of cigarettes and opioids in individuals with chronic pain. Chronic pain can promote smoking and smokers are more likely to use opioids. With the evidence that patients who smoke a higher number of cigarettes per day report higher pain, it is possible that smoking may be a stress-reducing behavioral response related to pain. Moreover, higher frequency and …

Tailoring A Nicu-Based Tobacco Treatment Program For Mothers Who Are Dependent On Opioids, Amanda Fallin-Bennett, Kristin Ashford

Nursing Faculty Publications

Objective—To collect formative information to design a tailored tobacco treatment intervention for women with newborns treated or evaluated for neonatal abstinence syndrome and to explore current tobacco use behaviors and facilitators and barriers to smoking cessation.

Design—Qualitative descriptive study.

Setting—An academic medical center in the southern United States.

Participants—Mothers of newborns who were treated or evaluated for neonatal abstinence syndrome at birth within the preceding three months. Women were recruited who were older than 18 and reported opioid dependence and smoking during pregnancy.

Methods—Participants took part in semi-structured individual interviews that lasted approximately one hour. …

Advertising Exposure And Use Of E-Cigarettes Among Female Current And Former Tobacco Users Of Childbearing Age, Kristin Ashford, Emily Rayens, Amanda T. Wiggins, Mary Kay Rayens, Amanda Fallin-Bennett, Molly Malany Sayre

Nursing Faculty Publications

Objective: The study examined the relationship between exposure to e‐cigarette advertising and e‐cigarette use by pregnancy status, including use of flavored e‐cigarette products, among women of childbearing age.

Design: A cross‐sectional, correlational design was used.

Subjects: Female current or former tobacco users in Central and Eastern Kentucky, 18–45 years old (N = 194, 52% pregnant).

Measures: Demographics, pregnancy status, cigarette and e‐cigarette use, and exposure to e‐cigarette advertising.

Results: Younger age, white non‐Hispanic race, and greater exposure to e‐cigarette advertising were associated with a higher likelihood of ever using e‐cigarettes (p < .05 for each variable). Pregnancy was not associated with ever use (p = .11). Younger age was associated …

Explore The Relationship Among Lung Cancer Stigma, Social Support, And Psychosocial Distress, Lisa Maggio

Theses and Dissertations--Nursing

There is longstanding causal relationship between cigarette smoking and lung cancer. Smoke-free policies and anti-smoking campaigns have been linked to the decline in smoking acceptance and contribute to the unintended consequence of stigmatizing smokers. Lung cancer is viewed as a self-inflicted disease and patients’ feel judged in a manner different from other cancers affecting social interactions between family, friends, and healthcare professionals. Lung cancer stigma contributes to depression, anxiety, poor self-esteem, guilt, shame, blame, threatens a person’s social identity, and limits social support that deeply affects patients and their support persons.

This dissertation contains a review of the literature related …

Tobacco Treatment For Individuals With Substance Abuse And Psychiatric Disorders, Chizimuzo T.C. Okoli

Nursing Presentations

Overview of this presentation:

• Discuss smoking among persons with substance use and mental illness
• Present smoking cessation outcomes from an evidence-based program for persons with substance use disorders and mental Illness
• Conclusion with current and future Projects

Evidence-Based Smoking Cessation Treatment For Disparate Populations, Chizimuzo T.C. Okoli

Nursing Presentations

Overview of this presentation:

• Describe Research Group and Program of Research among disparate Populations
• Discuss smoking among persons with substance use and mental illness
• Present smoking cessation outcomes from evidence-based programs for persons with substance use disorders and mental Illness
• Conclusion with current and future Projects

Role Of The "Tobacco Free Teens" Mobile Application In Adolescent Smoking, Juawanna L. Schuller

DNP Projects

Adolescent tobacco use rates have plateaued. Tobacco use education is not mandatory in all states, yet schools remain a good opportunity to reach this population. School nurses should be able to identify components of effective tobacco use prevention education programs and learn to overcome barriers to implementation of these programs. The "Tobacco Free Teens" mobile application is a novel tool that may decrease adolescent tobacco use rates. A pilot study found that the Tobacco Free Teens mobile application was satisfactory to most participants but appealed to girls more than boys. Further research is needed to determine the effectiveness of this …

Delivery Of Evidence-Based Tobacco Use Interventions In Primary Care, Amber Silberman

DNP Projects

This capstone report presents three manuscripts which focus on tobacco use interventions in the primary care setting. The first manuscript presents a critical analysis of the Public Health Service guideline on Treating Tobacco Use and Dependence. The second manuscript presents a literature review pertaining to interventions that increase primary care provider compliance with guideline recommendations. The literature obtained from these first two manuscripts led to a descriptive study, which examined the documentation and implementation of specific guideline recommendations in a primary care clinic. The third and final manuscript details this study, and presents some practical implications for improving documentation …

A Content Analysis Of Media Coverage Of The Introduction Of A Smoke-Free Bylaw In Vancouver Parks And Beaches, Arezu Moshrefzadeh, Wendy Rice, Ann Pederson, Chizimuzo T.C. Okoli

Nursing Faculty Publications

The Board of Parks and Recreation in Vancouver, BC approved a smoke-free bylaw in the city's parks, beaches and recreational facilities, effective 1 September 2010. We analyzed local news coverage and portrayal of the bylaw to understand the potential influence of news media on public perception of the bylaw in order to inform the media advocacy work of public health interest groups. We compiled a data set of newspaper articles (n = 90) and conducted a quantitative content analysis to examine content related to the outdoor smoke-free policy, including article slant, topics related to smoking and tobacco control, and any …

Smoking Cessation Outcomes Among Individuals With A History Of Psychotic Disorders As Compared To Those Without, Chizimuzo T.C. Okoli, Milan Khara

Nursing Presentations

Background: Psychotic disorders (e.g., Schizophrenia, schizoaffetive disorder) are associated with a higher smoking prevalence (relative to other psychiatric disorders) and smoking attributable mortality. Until recently, little has been done to address the disproportionate smoking in this population. The objectives of our study are to: 1) describe the characteristics of smokers with a history of psychiatric disorders (i.e., none, psychotic, and depressive/anxiety) and 2) examine smoking cessation/reduction outcomes by history of psychiatric disorders.

Methods: Retrospective analyses were conducted from charts of 982 participants accessing a tailored, evidence-based, tobacco treatment program within mental health and addictions services in Vancouver, Canada. Demographics, tobacco …

Smoking On The Margins: An Equity Analysis Of Vancouver's Outdoor Smoke-Free Policy In Parks And On Beaches, Chizimuzo T.C. Okoli, Ann Pederson

Nursing Presentations

Background: Increasingly, jurisdictions worldwide are addressing smoking restrictions in outdoor public spaces to reduce secondhand smoke exposure, discourage youth initiation, enhance cessation, and reduce environmental hazards (i.e., fire and cigarette-related litter). However, there is little research on the policy context and health-equity impact of such policies to help guide wider implementation efforts.

Objectives: On September 1, 2010, the Board of Parks and Recreation in Vancouver, Canada, introduced a smoke-free bylaw for the city’s parks and beaches. The Smoking on the Margins project is examining the policy context and potential health-equity impact of this bylaw.

Methods: Applying critical multiplism and equity-focused …

Support For A Smoke-Free Bylaw In Parks And On Beaches, Chizimuzo T.C. Okoli, Ann Pederson, Wendy Rice

Nursing Faculty Publications

BACKGROUND: In September 2010, Vancouver, Canada enacted a smoke-free bylaw in parks and on beaches.

OBJECTIVE: To examine demographic and attitudinal factors associated with the public opinion on Vancouver's outdoor smoke-free bylaw.

METHODS: From 496 randomly selected Vancouver residents, information on demographics, smoking status, and opinions and support for or opposition to the smoke-free bylaw were obtained by telephone surveys.

RESULTS: Approximately 84.2% of the sample endorsed the legislation; a greater proportion of non-smokers supported the bylaw than smokers (88.6% vs. 52.0%). In multivariate analysis, demographic variables significantly associated with supporting the smoke-free bylaw were being female, having completed community …

Tobacco Treatment Outcomes From A Specialist Smoking Cessation Clinic Based Within Cardiology Services, Milan Khara, Chizimuzo T.C. Okoli

Nursing Presentations

BACKGROUND: Populations with cardiac conditions often continue to smoke at high rates (up to 62%), even after experiencing life-threatening cardiac events. The purpose of our study is to examine pilot treatment outcomes of an outpatient Smoking Cessation Clinic (SCC) provided within Cardiology Services.

METHODS: This study is based on a retrospective review of the charts of 118 participants of the SCC (between Sept 2010 and May 2012). The primary components of intervention include tailored pharmacotherapy and behavioural counselling. The main outcome of interest is self-reported 7-day point-prevalence of smoking abstinence verified by expired CO level (when available).

RESULTS: 34.7% …

Transforming Our Parks And Beaches, Chizimuzo T.C. Okoli

Nursing Presentations

This presentation covers a study that examines the health and health equity impact of the newly implemented smoke-free policy for Vancouver’s parks and beaches.

Military Tobacco Dependence Treatment: Implications Of Treatment Type On Abstinence And Weight Management Ability, Bradley A. Briscoe

DNP Projects

Military readiness, employer productivity and individual health are all significantly impacted by high rates of tobacco use. Current research, to date, suggests that use of brief, individually tailored behavioral modification strategies through group therapy may be most effective in smoking cessation. The objective of this Practice Inquiry Project was to explore aspects of tobacco use the U.S. military population and examine potential relationships between type of treatment, smoking abstinence, and maintenance of body weight (e.g. avoid weight gain) among those seeking tobacco use cessation. The findings of this project can provide guidance on enhancing current tobacco cessation efforts to enable …

Understanding And Treating Smoking Among Individuals With A Mental Illness, Chizimuzo T.C. Okoli

Nursing Presentations

• Background and significance

• Reasons for smoking among individuals living with a mental illness

• Smoking cessation treatment for individuals living with a mental illness

Smoking On The Margins: An Equity Analysis Of The Outcomes Of An Outdoor Smoke-Free Policy, Chizimuzo T.C. Okoli, Ann Pederson

Nursing Presentations

• Purpose: To analyze the health and health equity impact of the newly implemented smoke-free policy for Vancouver’s parks and beaches

• CIHR Operating Grant: Population Health Intervention Research – designed to study an intervention in action not controlled by the investigators

• End date of funding, March 31, 2013 (with potential 12-month extension)

Treatment Outcomes Of A Tailored Smoking Cessation Programme For Individuals Accessing Addiction Treatment Services, Milan Khara, Chizimuzo T.C. Okoli

Nursing Presentations

Background: Individuals with substance use disorders (SUD) have disproportionately higher smoking prevalence and tobacco-related mortality than the general population. This high prevalence of smoking warrants a need for targeted tobacco treatment efforts.

Objectives: To examine smoking cessation outcomes and predictors of successful smoking cessation among individuals with SUD accessing a tobacco dependence clinic (TDC) within Addiction Services.

Methods: Based on clinical guidelines, participants of the TDC received behavioural therapy combined with tailored pharmacotherapy for tobacco treatment (at no cost). A retrospective chart review from 678 participants enrolled in the TDC between Sept 2007 and Dec 2011 was analyzed. 7-day point-prevalence …

Sex And Gender In Tobacco Reduction - The State Of The Evidence, Iris Torchalla, Chizimuzo T.C. Okoli

Nursing Presentations

• Global prevalence, risk, and mortality from smoking

• Gender/Sex specific diseases associated with tobacco use

• Gender/Sex specific reasons for smoking

• Gender/Sex specific factors in treating tobacco use

Special Ops: Vulnerable Populations And Tobacco Treatment, Chizimuzo T.C. Okoli, Audrey Darville

Nursing Presentations

• Reasons for Smoking among individuals with co-morbid substance use (SUD)and/or psychiatric disorders (PD)

• Smoking cessation treatment for individuals with co-morbid substance use (SUD) and/or psychiatric disorders (PD)

• Smoking among the Homeless population

Equity, Evidence & Ethics: Assessing The Implications Of Outdoor Smoke-Free Policies For Vulnerable Populations, Natasha Jategaonkar, Ann Pederson, Chizimuzo T.C. Okoli, Wendy Rice, Phoebe M. Long, Joan L. Bottorff, Natalie Hemsing, Lorraine Greaves

Nursing Presentations

Smoke-free policies in outdoor settings are becoming increasingly common. Economic and social conditions tend to influence tobacco use patterns as well as exposure to secondhand smoke. Thus, active and passive smoking are both health equity and social justice concerns.

Smoking on the Margins is a multi-component,mixed-methods project that applies an ethical framework to outdoor smoke-free policies in order to identify both concerns and opportunities to promote health and health equity.

Justification for smoke-free policies

Smoke-free spaces are primarily justified on the basis of three goals:

1) Reducing exposure to secondhand smoke;

2) Encouraging people to quit smoking; and

3) Preventing …

Smoking On The Margins? Assessing The Effects Of A Smoke-Free Law In Parks And On Beaches, Ann Pederson, Chizimuzo T.C. Okoli, Wendy Rice, Steve Chasey, Arezu Moshrefzadeh, Joan L. Bottorff, Natalie Hemsing, Lorraine Greaves, Nancy Poole

Nursing Presentations

This study uses a health equity lens to examine the development, adoption and implementation of an outdoor smoke-free bylaw in Vancouver, BC, Canada. The study aims to:

• Understand the health and health equity effects of a new outdoor smoke-free policy in parks and on beaches;

• Assess the differential impacts of the policy for diverse groups of women and men, in particular those with a high prevalence and susceptibility to smoking and those who are exposed to secondhand smoke (SHS);

• Develop recommendations to enhance the effectiveness of future smoke-free policies to reduce any unintended contributions to health inequities arising from their …

Effects Of A Smoke-Free Law In Parks And Beaches On Smoking Behaviour: Methods To Determine Effectiveness, Chizimuzo T.C. Okoli, Ann Pederson, Steve Chasey, Anna Liwander, Andrew Johnson

Nursing Presentations

OVERVIEW

As part of a comprehensive approach to tobacco control, smoke free laws have resulted in reductions of indoor air pollution, improvements in respiratory and cardiovascular health, reduction of smoking uptake by youth, and increasing tobacco use cessations in various jurisdictions.

Although many studies have demonstrated the beneficial effects of smoke-free policies in indoor spaces (e.g. restaurants, bars, workplaces, hospital settings, etc.), little is known about the effectiveness of such policies in outdoor public spaces.

On September 1^st, 2010, Vancouver’s smoke-free by-law for the city’s parks, beaches, and facilities came into effect.

The aims of this study are …

Outcomes Of A Tailored Smoking Cessation Program For Individuals With A Substance Use And/Or Psychiatric Disorder, Chizimuzo T.C. Okoli, Milan Khara

Nursing Presentations

BACKGROUND: Tobacco use remains a significant cause of morbidity and mortality globally. Although there has been a steady decline in the overall smoking prevalence in North America during the last decade some subsets of the population continue to smoke at high rates, particularly individuals with a history of substance use disorders (SUD) and/or psychiatric disorders (PD). Studies suggest that individuals with SUD’s and PD’s often have disproportionately higher smoking-related mortality. Studies further suggest that in clinical samples an estimated 75% of individuals with PD and up to 90% of individuals with PD concurrently smoke. This high prevalence of smoking among …

Gender Identity, Ethnic Identity, And Smoking Among First Nations Adolescents, Lorraine Greaves, Joy Johnson, Annie Qu, Chizimuzo T.C. Okoli, Natalie Hemsing, Lucy Barney

Nursing Faculty Publications

Smoking rates among Aboriginal adolescents are the highest of any population group in British Columbia, Canada. Recent studies suggest that substance use is affected by gender and ethnic identity among youth. The purpose of our study was to explore the association of gender and ethnic identity with smoking behaviour among First Nations adolescents. This study is based on a convenience sample (i.e., an on-hand, readily available sample) of 124 youth (123 First Nations and 1 Métis) recruited at youth drop-in centres, health fairs, and cultural activities. We obtained information on demographics, smoking history, Bem Sex Role Inventory (BSRI), composite measure …

Equitable Consequences? Issues Of Evidence, Equity And Ethics Arising From Outdoor Smoke-Free Policies, Ann Pederson, Wendy Rice, Phoebe M. Long, Natasha Jategaonkar, Lorraine Greaves, Steven Chasey, Natalie Hemsing, Chizimuzo T.C. Okoli, Joan L. Bottorff

Nursing Faculty Publications

From Introduction:

Kass argues that an ethical approach in public health is one that places the fewest burdens on individuals’ health without significantly reducing the potential benefits of intervening. Yet many population health regulations are highly intrusive, compromising individual liberty and imposing penalties for non-compliance. Moreover, the benefits of these regulations and the burdens they impose may not be shared equally. When developing interventions, the state has, therefore, an obligation to consider the benefits and burdens, particularly on those vulnerable to health inequities and other disparities.

Smoking And Breast Cancer: Girls’ And Boys’ Reactions To Tailored, Internet Delivered Messages, Joan L. Bottorff, Chris G. Richardson, Rebecca Haines-Saah, John Oliff, Peter Hutchinson, Pamela A. Ratner, Chizimuzo T.C. Okoli, Carolyn Gotay, Kenneth Johnson

Nursing Presentations

Background

• Active smoking and exposure to secondhand smoke (SHS) are causally linked to premenopausal breast cancer (BC).

• To date, there have been few efforts to raise awareness of active smoking and SHS as risk factors for BC.

Purpose

• To develop and evaluate messages for Aboriginal and non-Aboriginal adolescent girls and boys to raise awareness about tobacco exposure as a risk factor for BC.

Outcomes Of An Intensive Smoking Cessation Program For Individuals With Substance Use Disorders, Milan Khara, Lindsay Killam, Chizimuzo T.C. Okoli

Nursing Presentations

BACKGROUND: Individuals with substance use disorders (SUD) are disproportionately affected by tobacco use morbidity and mortality. Yet, with adequate intervention, such individuals can be successful in their smoking cessation efforts. The Tobacco Dependence Clinic (TDC) provides tobacco dependence treatment using combined behavioural counseling and pharmacotherapy for clients through the Mental Health and Addiction Services of the Vancouver Coastal Health Authority, British Columbia, Canada.

OBJECTIVES: To a) provide smoking cessation outcomes of participants accessing the TDC b) examine predictors of program completion and smoking cessation of participants of the TDC.

METHODS: Participants of the TDC receive a structured 8 week group …

Tobacco Use Dependence And Approaches To Treatment, Audrey Darville, Chizimuzo T.C. Okoli

Nursing Presentations

Counseling Demonstrates a Dose-Response Effect/Comes in Many Forms

• Brief advice during a “window of opportunity” can increase quit attempts by 40%

• Medication combined with counseling doubles the success rate

• Quitlines: proactive fax to quitline most effective

• Online (becomeanex.org, smokefree.gov, mylastdip.com)

• Cooper Clayton Classes at many local health departments; schedules and provision of medication varies

• I-Phone apps/text to quit

Tailoring NRT to the tobacco user

• Studies show efficacy in smokers and smokeless tobacco users (Ebbert, et al, 2010)

• Combining patch with shorter acting form of NRT has been shown to be safe and effective (Stead, et al, Cochrane Review, 2008; Kozlowski, …