Effectiveness of e-cigarettes in reducing smoking habit: A critical appraisal of evidence

This paper analyses the effectiveness of e-cigarettes in reducing smoking habits. It critically appraises a relevant article in detail along with its strength and limitations. The study addressed the question of how effective e-cigarettes are when compared to other Nicotine Replacement Therapy (NRT) and unaided quitting in the general population of smokers who are trying to quit their smoking habits.

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Title page
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HLSC122 Semester 2, 2018
Assessment 3: Critical appraisal of evidence
Word count: 1200
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Introduction
Smoking is considered as one of the biggest reasons behind the increased morbidity
and mortality rate among the people from all over the world. Various new policies and
equipments have been brought into the market to reduce the affect of smoking and one of
them is e-cigarettes (Qiu et al., 2017). It is assumed that the use of such cigarettes can reduce
the habit of smoking to a great extent (Ott, Takses, Obermeier, Schnoy & Müller, 2014). In
the given case study, Joanne wants to know the effectiveness of e-cigarettes, compared to
other nicotine replacement therapies in reducing her smoking habit. This paper will analyse a
relevant article in detail along with its strength and limitations. At the same time it will also
find the answer of the main research question which is related to the effectiveness of e-
cigarettes.
Body
Part A
Authorship
Brown, Beard, Kotz, Michie & West, (2014), in their article discussed the
effectiveness of e-cigarettes, compared to other nicotine replacement therapies. The authors
were associated with the Cancer Research UK Health Behavior Research Centre, University
College London, Department of Clinical, Educational and Health Psychology, University
College London, Department of Family Medicine, CAPHRI School for Public Health and
Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands, Health
Behaviour Research Centre, Department of Epidemiology and Public Health, University
College London and the e-mail id of the author has also been provided. Authors declared that
the study hypotheses arose before any inspection of the data and that all STROBE
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recommendations were followed properly, during the study and it will be using an established
methodology, aiming to assess the effectiveness of e-cigarettes in aiding smoking cessation
when compared to other nicotine replacement therapies. According to the area of expertise of
authors, they are associated with epidemiology and public health, cancer and health
behaviour research and their qualification was high in this aspect which is main strength in
finding the effectiveness of alternative methods to reduce the smoking habits and its adverse
effects on human health. Their study added noise and potential bias on smokers needing to
recall the time of relapse. The recall bias will work against finding the exact benefits of using
the e-cigarettes. All the authors have completed the Unified competing interest form and they
also clearly declared that they do not have any financial relationship or affiliation with any
particular company selling e-cigarettes and even the funders, associated with the study have
no role in the study design. The final decision about the study has been taken by the
investigators and was unrestricted.
Research Questions
The study addressed the question that how effective e-cigarettes are when compared
to other Nicotine Replacement Therapy (NRT) and unaided quitting in the general population
of smokers who are trying to quit their smoking habits. The research question was extremely
essential in finding how it can improve the health outcome and reduce the smoking habits
which in turn decrease the mortality rate caused by the disease that occurs due to smoking.
The study was published online on 8th of August, 2014 (Brown, Beard, Kotz, Michie & West,
2014).
Research design
In the paper, a cross-sectional household surveys have been designed as research
method. The study collected data from the month of July 2009 to February 2014. In order to
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examine the real world effectiveness of e-cigarettes the study was organized and
representative sample size has been chosen from the English population. Due to larger sample
size, the study used quantitative research method. If a study is comparative then according to
the authors, the methodology is associational (Hoffmann, Bennett & Del Mar, 2017). In this
article the main aim was to compare the effectiveness of e-cigarettes to others and hence, the
methodology was associational. The study included 5863 adults and each month a new
sample of approximately 1800 adults have been collected from the sample using random
location sampling. The sample size in this case study was large and hence, the cross-sectional
research design was appropriate for the study. However, it offers no control over the choice
and it allows bias to affect the result but, it is an affordable study method and it provides
better precision in the sampling process. The analysis of the data also becomes easier and
helps to draw the conclusion in an effective way (Hickman, Keevern & Hammes, 2015).
Even, this method keeps room for future research opportunities. Therefore, the research
design was quite appropriate for the study. The performance appraisal is directed towards the
goal. In this study the goal was established and it proved the fact that e-cigarette is more
effective in reducing smoking habit and thus the level of appraisal for the study is good.
Research methods
During the survey, some close-ended questions were asked to the participants and
codes were set for the questions. Before conducting the survey, the demographic
characteristics of the participants have been assessed. The number of quit attempts by the
participants have also been assessed. The data found in the research method have been
analysed using the χ2 test for the categorical variables and one-way analyses of variance have
been used for the continuous variables. As the study method was designed as cross-sectional
study so it was obvious that biases can arises and in order to test the bias, analysis of
covariance (ANOVA) has been used (Geels, McMeekin, Mylan & Southerton, 2015). Post-
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hoc sensitivity analysis methods have also been used in the study. The main limitation of
ANOVA is that it assumes equal standard deviations. However, the main strength of the
analysis method is, it is useful for multi-item scale and it is appropriate for the comparative
analysis.
Results
The aim of the present study was to utilize projective technique to examine the
effectiveness of e-cigarettes over other nicotine replacement therapies. Before conducting the
survey, the approvals were granted from the ethics committee of University College London,
UK and therefore it protects the right of people. The study effectively answered the main
research question. However, the result produced the disadvantage that e-cigarettes were more
likely to be used by the people of higher social grades. Selecting or recruiting study
participants was significant as the sample size was large. However, several limitations of the
study are there. The abstinence was not verified biochemically. Moreover, there was reliance
upon recall data which created the scope of bias. It was not possible to find the exact
statements about the relative effectiveness of e-cigarettes and other different products.
Part B
According to Greenhalgh, Bidewell, Crisp, Lambros & Warland (2016), in order to
find the best available resource, it is important to check the clinical guidelines and systematic
review. This study contains higher level of evidence. The findings from the study can be used
as evidence while implementing the critical appraisal in the clinical setting. It can be utilized
in motivating people as the research effectively shows how e-cigarettes are efficient in
reducing the smoking habits. The people who are smoking regularly or are trying to quit
smoking can be motivated with the use of the study. It is being recommended that if the study
would have mentioned about the usage of e-cigarettes then would be more helpful.
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While implementing the research finding in the clinical settings, various barriers can
be found. Users may indicate the limitations of the study for not using the proposed method
of quitting the smoking habits as it contains low level of carcinogens and toxicants. Some of
the people may not be interested in quitting their smoking habits and another significant
barrier can be associated with the expenses of using e-cigarettes. The affordability as well as
availability of e-cigarettes can be one of the biggest barriers while implementing into the
clinical settings. Even, some may raise question it can worsen their psychiatric symptoms and
satisfaction.
Conclusion
Smoking is one of the greatest concerns of healthcare professionals and the ways to
reduce the smoking habits are still being researched by the researchers. This paper analysed
how the primary research article compared the effectiveness of e-cigarettes and how the
information from the research paper can be critically appraised in clinical practice with the
use of other literatures relevant to this. It also illustrated the barriers while implementing into
the clinical practice. However, many limitations were there in the study and further research
is highly recommended in order to reduce the gap of the study. It is being assumed that
addressing the gaps can be helpful in providing more accurate result.
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References
Brown, J., Beard, E., Kotz, D., Michie, S., & West, R. (2014). Real‐world effectiveness of e‐
cigarettes when used to aid smoking cessation: a cross‐sectional population
study. Addiction, 109(9), 1531-1540.
Geels, F. W., McMeekin, A., Mylan, J., & Southerton, D. (2015). A critical appraisal of
Sustainable Consumption and Production research: The reformist, revolutionary and
reconfiguration positions. Global Environmental Change, 34, 1-12.
Greenhalgh, T., Bidewell, J., Crisp, E., Lambros, A., & Warland, J. (2016). Understanding
Research Methods for Evidence-Based Practice in Health 1e.
Hickman, S. E., Keevern, E., & Hammes, B. J. (2015). Use of the physician orders for life‐
sustaining treatment program in the clinical setting: A systematic review of the
literature. Journal of the American Geriatrics Society, 63(2), 341-350.
Hoffmann, T., Bennett, S., & Del Mar, C. (2017). Evidence-Based Practice Across the Health
Professions-E-pub (3rd ed). Elsevier Health Sciences. Chatswood, NSW: Churchill
Livingstone Australia.
Ott, C., Takses, A., Obermeier, F., Schnoy, E., & Müller, M. (2014). Smoking increases the
risk of extraintestinal manifestations in Crohn's disease. World Journal of
Gastroenterology: WJG, 20(34), 12269.
Qiu, F., Fan, P., Nie, G. D., Liu, H., Liang, C. L., Yu, W., & Dai, Z. (2017). effects of
cigarette smoking on transplant survival: extending or shortening it?. Frontiers in
immunology, 8, 127. Doi: https://dx.doi.org/10.3389%2Ffimmu.2017.00127
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