Critical Appraisal of a Paper

This document provides a critical appraisal of a paper that examines the relationship between housing improvements and smoking habits. It discusses the study design, research questions, factors measured, outcomes, biases, and more. The study suggests that housing improvements are associated with the intention to quit smoking but not with the actual reduction in smoking habits. Other factors, such as mental health and counseling, also play a significant role in reducing smoking habits. The document highlights the need for additional services alongside housing improvements to achieve accurate results.

Running head: CRITICAL APPRAISAL OF A PAPER
Critical appraisal of a paper
Name of the Student:
Name of the University:
Author note:

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CRITICAL APPRAISAL OF A PAPER
Question 1:
In the study conducted by Bond et al. (2012), Quasi-experimental, 2-year longitudinal
study design was applied as epidemiological study design. There are two features of Quesi
experiments that were used in this paper. The first feature is that unlike the true experiment, the
participants who were participated in the study were with a specific condition such as smoking
habits (Brown, Currie & Kenworthy, 2015). The second features are both independent and
dependent variables are present in the Quesi- experiments, unlike true experiment where no
variables are present. In the current study, the dependent variable is smoking habits which
dependent the independent variables such as the present in the study such as residents or housing
accommodation.
Question 2:
In the study conducted by Bond et al. (2012), two research questions are present such
as the first question is does having an HI lead to a reduction in smoking or to an intention to quit
smoking? And second is Could this be explained by improvements in mental health and/or
reductions in stress subsequent to the HI?. The current context, Two research hypothesis can be
formed based on these two research question.
The first hypothesis would be house improvements or residential improvement leads to
the reduction in smoking or to an intention to quit smoking.
The second hypothesis would be an improvement in mental health or reduction of stress
subsequent to the housing improvement .

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CRITICAL APPRAISAL OF A PAPER
Question 3:
In the study conducted by Bond et al. (2012), study factors were housing improvements
or residential improvements, reduction in smoking as well as mental health status. These factors
are such as the smoking status of the participants and the mental health of the participants which
were compared between residents’ smoking and intention to quit smoking for HI group with a
non-HI group of participants. These were measured by measuring the mental health of the
participants through SF-12v2 scales, along with the self-reported experience of each participant
and General Practitioner (GP) who consulted the participants with smoking habits, anxiety, and
depression of each participant in the last 12 months.
Question 4:
In the study conducted by Bond et al. (2012), total 1062 individuals with the habits of
smoking have participated in the study. In the current context, the outcome factors are a mental
status of the participants, the gender of the participants, the socio-demographic status of patients,
housing status, economic status, and health behaviors, smoking. To measure these outcomes,
four multivariate models were used examining the association between HI and intention to quit
and the three assessments of mental health. All of these models were adjusted for the
sociodemographics status of participants and health measures such as SF12 mental health scores
of 2008. The measurement was also taken with respect to the gender of each participant in order
to gain an understanding of the association.
Question 5:
Considering Table 2 presented in the study conducted by Bond et al. (2012), although the
significant association between the study factor and outcome factors few factors were not related.

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CRITICAL APPRAISAL OF A PAPER
In the currents study, the study factors were the house improvements is significantly associated
with the reduction in smoking habits whereas the outcome factors are the mental health status of
the participants with respect to the HI and non-HI status of each participant, behavior changes as
well as smoking status. Therefore, it was observed that housing improvement in participants
according to the socio-demographic status of participants such as living in a disadvantageous
area is associated with intention of quit smoking rather than the actual reduction of smoking
habits. However, housing factors not in terms of property rather improvements of the status of
the house such renewal or improvement of an existing house which contributed to the large
reduction of smoking habits. Considering the mental health status of the participants in the
second hypothesis, improved mental health is related to a reduction in smoking but not with
housing improvement.
The result of the study suggested that there was a significant difference in the prevalence
of smoking at the baseline (2006) two groups where the minimization of smoking rates
approximately 10% lowered from the previous rate. This result further suggested that there is no
significant relationship between the HI improvements with intention of quitting smoking; it is
only related to the features of house not allocation. The underlying reason behind it is that
Housing improvements factor is not depending on the smoking status of the participants. A
radical change in someone’s existing circumstances such as the move to a new house or having
any changes existential house may act as a transitional factor from smoking habits to quit
smoking. Therefore, HI program can be an effective way for reducing smoking habits. On the
other hands, self-efficacy and beliefs as well counseling of GP has a significant effect on the
reduction of smoking habits in participants. The study also highlighted that housing

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CRITICAL APPRAISAL OF A PAPER
improvements are not only driving factors for the reduction of smoking habits, but other
additional services are also required to obtain an accurate result.
Question 6:
Presence of Selection of bias has observed in the study conducted by Bond et al. (2012).
It was observed from the study that the approaches of linking records from two crosses sectional
study influenced the bias. In the two years of the span for the cohort study, some of the
participants may have had done their residential improvements two ears age, some of them had
done six months or few of them had done recently. Consequently, it highly affected the
association between smoking habits and housing improvements. Another selection bias is only
individuals who lived in multi deprivations or lower socioeconomic status was selected for the
study. Therefore, the association between the improved housing and smoking habits or
intentions of smoking habits in individuals who have lived with few deprived factors or with the
medium socioeconomic status were cannot be obtained. This bias further suggested that based on
only one socioeconomic group, it is impossible to gain the understanding of the relationship
between housing improvement and intention of quit smoking and recommend housing
improvements as the intervention for quit smoking for all citizen in the UK.
Question 7:
Considering the study conducted by Bond et al. (2012), information bias has an effect
on the results. It was observed from the study that the approaches of linking records from two
cross-sectional studies influenced the bias. In the two years of the span for the cohort study,
some of the participants may have had done their residential improvements two ears age, some of
them had done six months or few of them had done recently. Therefore, it was difficult to track

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CRITICAL APPRAISAL OF A PAPER
the impact of housing improvements as an intervention on the reduction of smoking or intention
of quit smoking. Therefore, it is considering the mental health of the participants, variation in
the time scale observed for three kinds of mental health issues. Regular mental health problems
were reported by a very small amount of participants which has no significant relationship with
housing improvements.
Question 8:
Confounders defined as a variable which influence both dependent and independent
variable causing a spurious association. Cui et al. (2016), highlighted that confounders are a
causal concept which cannot be defined ide described in terms of correlation. However, it is
crucial to address confounders because it may increase the chances of the variance in the study.
Bond et al. (2012), addressed confounders through collecting the data from the deprived
group using Scottish index of multiple deprivations where this deprivation greatly influenced the
smoking habits as well as the housing improvements. They collected the data of socio-
demographic factors such as educational attainment, economic status for evaluating the
improvements. In the current study considering table 2, it was observed that a greater proportion
of people in relatively poor circumstances, who are more likely to smoke and less likely to be
successful at quitting smoking. The confounders are this result sociodemographic status of
participants influenced the association of quitting smoking and housing improvements. Zeng et
al. (2016), suggested that smokers who lived in multiple deprivations are less likely to quit
smoking which may be because of a number of factors such as barriers of participation in the
cessation program, deprived neighborhood, internal stressing factors influence the association
between the study factors and outcome factors.

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CRITICAL APPRAISAL OF A PAPER
Question 9:
According to the results shown in Table 3, Bond et al. (2012), have addressed the
research question two which is Could this be explained by improvements in mental health and/or
reductions in stress subsequent to the HI?.
In the current context, in order to obtain the result of the second question, authors four
multivariate models were used examining the association between HI and intention to quit and
the three assessments of mental health. The result suggested that although a substantial effect of
the housing improvements remains in each case, it doesn’t strongly associate with the housing
improvements. Yu et al., (2017) highlighted that considering after consulting general
practitioners about the emotional problem for 12 months strongly associated with intention of
quit smoking but it has a significant relationship with housing improvements. The prime reason
behind it is the motivational advice given by general practitioner which influences them to quit
smoking. From the assessment of mental health also suggested that experiencing an
improvement in depression with the association of the intention of quit smoking. Only the result
from the SF12-MH showed a positive association.
Question 10:
As illustrated by the authors, the smoking rates in both HI and non-HI groups were much
higher than the national norm of 26% for men and 23% for women. In the current study, it was
observed that housing improvements were related to the property not characteristics of the
housing. The reason behind no significant relationship between these factors is the respondents
provided with the housing improvements not based on their smoking habits and non-smokers
cannot seek for the improvements. Another explanation of this study is that some of the

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CRITICAL APPRAISAL OF A PAPER
respondents are actually intended to quit smoking without housing improvements. Participants
from disadvantageous areas when provided with house improvements, the intent to quit smoking
which has no association with the smoking rate in men and women. Moreover, those individuals
who lived in adverse conditions with multiple deprived factors are continued to smoke on the
daily habits and they have no intention of the quitting smoking. The prime reason behind it is the
educational attainment, unemployment and deprived of the neighborhood. Therefore, smoking
rates have no significant association with the housing improvements.
Question 11:
In the current context and temporality is the Bradford Hill’s criteria for evaluating
causality can be established through this study. The prime reason behind it is that the factor
which has been hypothesized in to cause something must proceed with time and it can co-occur
with the other factors (Fedak et al., 2015). In the current context, it was observed that housing
improvement is related to the intention of quit smoking but not only driving factor to reduce the
prevalence of smoking. A study suggested that health services in the housing can reduce the
smoking habits or reduction of smoking habits. On the other hand, considering the improvement
of mental health with housing improvement, these two factors are not related to each other. This
temporality criterion of Bradford Hill’s is established throughout the study. It is the unique
features of the prospective study since Prospective cohort studies and prospective clinical trials
are only studies provide stronger evidence of temporality than retrospective studies or cross-
sectional studies. This was only designed for prospective study for identifying whether exposure
precedes the outcome or not.

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CRITICAL APPRAISAL OF A PAPER
Question 12:
The result is generalized to the smoking groups. The prime reason behind it is that the
hypothesis, house improvements or residential improvement is one of the possible interventions
that lead to the reduction in smoking or an intention to quitting smoking. That further indicates
that it is not only criteria for the reduction of smoking. Moreover, it was also observed that the
study was based on multi deprivation factors such as low sociodemographic factors, barriers to
smoking cessation, no educational attainment, smoking addiction from childhood. The existence
of these factors influenced both study factors and outcome factors.

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CRITICAL APPRAISAL OF A PAPER
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