PC40019W Summative 2: Evidence-Based Health Promotion Analysis

This report, submitted by a student, examines the public health threat posed by tobacco smoking, which is responsible for millions of deaths globally. It explores the short-term and long-term health impacts of smoking, emphasizing the need for cessation. The report investigates the research question: Does dissemination of spirometry results help in smoking cessation? It details the search strategy used, including the databases (CINAHL and PubMed) and search terms employed. The report then critically appraises a selected article, evaluating the study's methodology, cohort recruitment, outcome measurements, and statistical analysis. The findings suggest that informing smokers about their 'spirometric-lung-age' (SLA) can motivate them to quit smoking. The report concludes by highlighting the importance of addressing tobacco smoking as a public health priority and encouraging healthcare professionals to utilize spirometry in promoting smoking cessation. References are provided to support the findings.

Running head: SUMMATIVE 2
PC40019W Using Evidence in Health Promotion and Public Health
Name of the Student
Name of the University
Author Note

1SUMMATIVE 2
Introduction- Tobacco smoking epidemic has been identified as one of the most chief
public health threats that are prevalent on a global basis and is responsible for the death of
around 8 million individuals (Banks et al. 2015). Reports suggest that 7 million of the
aforementioned deaths are a direct consequence of direct consumption of tobacco, while
roughly 1.2 million deaths occur due to the exposure of non-smokers to second-hand smoke.
In addition, an estimated 80% of the total 1.1 billion smokers on global scale are found to
reside in middle and low-income nations, where thus providing evidence for the highest
burden of tobacco-associated illness and deaths (World Health Organization 2019). In
addition, tobacco consumption is also associated to poverty since it diverts the domestic
expenditure from elementary needs such as shelter and food to tobacco. Hence, this
expenditure related behaviour is problematic to control owing to the addictive nature of
tobacco consumption. This essay will conduct a search for this public health evidence and
will elaborate on the search strategy used for extraction of articles. This will be followed by a
critical analysis of one article that has been considered most appropriate to the research
problem.
Importance of evidence in public health- The instantaneous and short-term
adversative health impacts of tobacco smoking are less probably to be directly lethal, when
compared to the long-term health impacts (Cantrell et al. 2015). Nonetheless, they are
significant public health indicators owing to their role in resulting in a suboptimal health
during the course of the life of smokers. The short-term negative health impacts that can be
attributed to tobacco smoking are generally observed amid smokers either instantaneously or
soon after exposure to nicotine (Hess, Lachireddy and Capon 2016). The health impacts of
tobacco smoking therefore originate at or near the age of beginning of tobacco smoking,
which in turn is typically during adolescence. In addition, a predominantly susceptible time
for both the foetus and the mother, in the course of their life is during pregnancy, and the

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ensuing months for the infant. It has been found that tobacco smoke comprises of not less
than 7,000 chemicals, which when inhaled, result in an exposure of the smokers to different
toxins, thus affecting their health (Douglas et al. 2018). Furthermore, the ultimate harm that
occurs due to exposure to tobacco smoke comprises of physiologic disadvantage, absenteeism
from work, poor self-reported health, and susceptibility to respiratory disorder (Lydon‐Staley
and Geier 2018). In addition, the immediate impacts of smoking on health includes increased
inflammation, impairment in immune status, nicotine addiction, coughing, phlegm, dyspnoea,
altered lipid profile, and depletion of antioxidant micronutrients. This calls for the need of
quitting tobacco consumption.
Research evidences suggest the smoking cessation significantly decreases the risks of
developing different chronic diseases and also helps in effective treatment of tobacco or
nicotine dependence (Bonnie, Stratton and Kwan 2015). The term spirometry translates to
measurement of the breath of a person and is used to denote a lung function test that is
commonly recommended for patients who have been diagnosed with pulmonary problems.
This procedure helps in lung assessment, in relation to the flow and volume of air that is
inhaled and exhaled by an individual (Koltowski et al. 2019). The results obtained are
represented in form of a pneumotachograph that helps in assessment and diagnosis of
particular respiratory conditions such as, bronchitis, COPD, asthma, and pulmonary fibrosis.
The research question for this assignment is given below:
Does dissemination of spirometry results help in smoking cessation?
Search strategy- With the aim of searching articles that are relevant to the research
question stated above, two electronic databases namely, CINAHL and PubMed were
extensively searched. The search terms that were fed in the databases for article extraction
were namely, smoking, cessation, spirometry, dynamic spirometry, facilitate, promote,

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increase, quitting, and termination. These search terms were combined using the boolean
operators ‘AND’ and ‘OR’ that helped in either broadening and narrowing down the results.
Articles that had been published in English language, on or after 2014 were considered
relevant. In addition, only peer-reviewed articles that focused on primary research were
included. Any forms of grey literature, secondary research, and case studies were excluded
(McGowan et al. 2016). This can be accredited to the fact that selecting primary research
based article helped in addressing the target issue, had better data interpretation and allowed
assessment of original data that was highly specific to the research question. After analysis of
the titles and abstracts of the 17 articles obtained, one was considered to be most relevant to
the research question.
Critical appraisal- The authors addressed a clearly focused issue owing to the fact
that they recognised the importance of smoking cessation, in relation to the health burden that
occurs due to tobacco consumption (Takagi et al. 2017). The research was based on the fact
that cigarette smoking has been identified as a major public health issue on an international
basis and no significant decline has been observed in the smoking rates (Bilano et al. 2015).
Furthermore, the researchers also stated that Japan, an estimated 19.3% adults smoked in
2014, with no change in the rates from the past four years (Takagi et al. 2017). Furthermore,
different smoking cessation efforts that have been undertaken by the government were also
elucidated such as, imposition of taxes, restricting smoking zones, plain packaging, and
cessation programs (van der Deen, Wilson and Blakely 2016).
Taking into consideration the fact that the process of spirometry helps in detection of
smokers who have been identified at an increased risk of different respiratory disorders, the
researchers wanted to investigate the impacts of information about “spirometric-lung-age”
(SLA) on cessation rates. Cohort studies typically refer to longitudinal research where a
group of individuals sharing particular characteristic, or experiencing common event are

4SUMMATIVE 2
selected (Creswell and Creswell 2017). The researchers recruited the cohort in an appropriate
manner since they enrolled prospective smokers for the study from outpatient clinics. This
recruitment was conducted from December 2010 to September 2011, followed by subjecting
the smokers to the standardized smoking cessation program (Takagi et al. 2017). Although
the study subjects were representative of the larger population, the sample size was small,
indicating that all prospective participants had not been selected. The exposure was also
accurately measured since during the first visits, the smokers were subjected to the
Prochaska’s questionnaire. In addition, they were also asked to complete the Tobacco
Dependence Screener (TDS). Use of the aforementioned self-administered questionnaire
ensured that the participants provided their responses about smoking, without being
influenced by the researchers (Mushtaq and Beebe 2015).
Outcomes of a research seek to comprehend the end results of specific interventions
and healthcare practices that provide an illustration of the impacts that the study participants
care about and experience. The primary outcome of this research was smoking quit rate,
based on the visit 5. In other words, smoking termination outcome was assessed using the e-
CO, in relation to the standardised program. Measurement of the outcomes between the
control and intervention group was similar. The researchers measured continuity of
abstinence from smoking after a year, as the secondary outcome (Takagi et al. 2017). Hence,
the measurements accurately reflected and validated the results. Blinding refers to the
procedure where one of more individuals in a research are kept ignorant of the treatment arms
in which the research subjects have been allocated (Hróbjartsson et al. 2014). This was a
single-blinded study where the participants did not know about the group where they had
been assigned. This helped in maximising validity of the results by minimising bias.
Confounding factors generally refer to outside influences that create an impact on
independent and dependent variables, thus affecting the outcomes of the research (Kyriacou

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and Lewis 2016). Thus, the researchers conducted a multivariate logistic regression analysis
for identification of the confounding factors that created a significant impact on the rate of
smoking cessation during visit 5 and a year later (Takagi et al. 2017). Follow-up is typically
conducted with the aim of increasing the general efficacy of the study effort. The researchers
evaluated the impacts of disseminating SLA after a year, hence the duration was long enough.
Nonetheless, individual circumstances of people who failed to stop smoking after a year were
not explored.
It was found that percentage of smokers who did not smoke a year later was
comparable in both groups namely, SLA and control (78.6% vs. 69.0%; P=0.5497). Findings
from the multivariate logistic regression analysis suggested that informing about SLA, in
addition to age and varenicline use brought about significant reduction in smoking cessation.
The statistical results displayed 95% CI, thus indicating that there was 95% chance of
obtaining similar results on repeating the research later on, thereby proving its accuracy
(Takagi et al. 2017). The results are applicable to the local population since the methodology
employed in the cohort study was accurate for addressing the research question. The subjects
enrolled for the study were appropriate and it is less likely that the local setting will differ
from the population of interest of the research. In addition, spirometry can be administered
upon smokers from the local population, without any problems. Though the findings of this
study are congruent with other available evidences, there is discrepancy in the baseline
smoking cessation rates. The implications of the study can be accredited to the fact that it will
encourage the healthcare professionals to conduct spirometry amid smokers and inform them
about their SLA, in order to motivate them to abstain from tobacco smoking.
Conclusion- To conclude, the scale of the public health danger due to tobacco consumption
arises from two factors namely, (i) high prevalence of tobacco smoking, and (ii) deleterious
health effects. Cigarette smoking results in the onset and development of several chronic

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diseases that typically appear with an increase in age, such as lung cancer and COPD. In
addition, stopping smoking is also associated with reduced risk for lung cancer, infertility
amid women, and peripheral vascular diseases. Therefore, tobacco smoking is a matter of
public health priority and must be addressed on an urgent basis, in order to reduce the
deleterious impacts on the population. The findings from the research suggested that
disclosing SLA to smokers motivates them to stop smoking.

7SUMMATIVE 2
References
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