Healthcare Research Assessment: Substance Abuse & Smoking Cessation

This healthcare research assessment delves into a study evaluating the effectiveness of a smoking cessation program, specifically targeting homeless individuals with substance abuse issues. The study design is a two-group randomized clinical trial comparing motivational interviewing combined with nicotine replacement therapy against standard smoking cessation procedures. The primary outcome measured was cotinine levels, indicating nicotine exposure, while secondary outcomes included used nicotine patch counts and self-reported adherence scales. The research also considered moderating factors such as substance abuse disorders and co-morbid psychiatric conditions. The assessment highlights the appropriateness of the study design, statistical power considerations, and sample grouping procedures in achieving the research objectives. Objective measures like patch checks, Morisky Scale scores, and various questionnaires were employed alongside subjective measures gathered through participant interviews regarding their history of alcohol and drug dependence. Desklib provides access to this and similar solved assignments for students.

Running head: HEALTHCARE RESEARCH ASSESSMENT: SUBSTANCE ABUSE
HEALTHCARE RESEARCH ASSESSMENT: SUBSTANCE ABUSE
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1HEALTHCARE RESEARCH ASSESSMENT: SUBSTANCE ABUSE
Response to Question 1
The study design used in the ‘Power to Quit’ Program, conducted by authors Goldade et
al. (2011), was a two-group, randomized clinical trial. As researched by Deaton and Cartwright
(2018), randomized controlled trials have been implicated as an accurate study design for
obtaining a comparative analysis between a novel clinical treatment, as against a standardized
procedure. The objectives of the given research aimed to evaluate the effectiveness of
motivational interviewing on cessation of smoking in comparison to standard procedures. Hence,
considering the primary research objectives of treatment efficacy comparison, a randomized
controlling trial is a good research design. Further, as examined by Thall, Fox and Wathen
(2015), randomized controlled trial necessitate participant selection through randomization, a
process known to reduce bias and inconclusiveness of research results. Hence, opting a
randomized controlled trial is appropriate research design for the given study, since it will aid in
the avoidance of research bias during subject selection.
Response to Question 2
The authors of the given research, based its evaluation of statistical power on the primary
outcomes of cotinine levels in participant’s saliva, which was measure at the 26th week.
According to Akobeng (2016), the statistical power of any research is aimed at reducing the
probability of occurrence of a null hypothesis which would be false. Hence, consideration of
cotinine levels to assess the efficacy of motivational interventional as against standard
procedures of enhancing adherence to nicotine replacement therapy is appropriate, considering
the release of cotinine - the substance produced in response to nicotine exposure, which remains

2HEALTHCARE RESEARCH ASSESSMENT: SUBSTANCE ABUSE
in the system for a prolonged period in comparison to rapid metabolism and disappearance of
nicotine. The secondary outcome of statistically powering the research is based upon checking of
used patches, evaluating the number of patches left and administration of self-reported Morisky
scale, which is appropriate, considering the necessary usage of nicotine patches in the
conductance of nicotine replacement therapy among participants.
Response to Question 3
The study arm consisting of 216 homeless participants receiving motivational
interviewing along with nicotine replacement therapy was the intervention arm of this study,
whereas the remaining 214 homeless individuals receiving standard smoking cessation was the
control arm of this study. According to Cor (2016), for ensuring validity and conclusiveness in
research findings, the sample selection must be in associated with the primary objectives of the
study. The authors of the chosen study, aimed to design a smoking cessation program with the
primary objective of evaluating the effectiveness of motivational interviewing as against
standard procedures of smoking cessation upon nicotine patch adherence. Hence, in order to
associate the primary objectives of the study the research design, the authors opted the above
sample grouping procedure.
Response to Question 4
The point-prevalence of cotinine was the primary outcome of the study. Direct
observation of used nicotine patches and patch counts were the secondary outcomes of the
study. The authors considered prevalence of substance abuse disorders and co-morbid psychiatric
disorders as moderating or mediating factors. The objective measures of the outlining

3HEALTHCARE RESEARCH ASSESSMENT: SUBSTANCE ABUSE
quantifiable results included patch checks, patch counts, scores of the Morisky Scale and results
from the Patient Health Questionnaire, MINI Generalized Anxiety Disorder Assessment,
Smoking Self-Efficacy Questionnaire, Perceived Stress Scale, Rost-Burnham Screening for
Depression and the Questionnaire of Smoking Urges. Subjective measures outlining qualitative
results included participant answers in response to authors’ questions concerning participants’
history of alcohol and drug dependence and drug treatments undertaken.

4HEALTHCARE RESEARCH ASSESSMENT: SUBSTANCE ABUSE
Reference
Akobeng, A.K., 2016. Understanding type I and type II errors, statistical power and sample
size. Acta Paediatrica, 105(6), pp.605-609.
Cor, M.K., 2016. Trust me, it is valid: Research validity in pharmacy education
research. Currents in Pharmacy Teaching and Learning, 8(3), pp.391-400.
Deaton, A. and Cartwright, N., 2018. Understanding and misunderstanding randomized
controlled trials. Social Science & Medicine, 210, pp.2-21.
Goldade, K., Whembolua, G.L., Thomas, J., Eischen, S., Guo, H., Connett, J., Des Jarlais, D.,
Resnicow, K., Gelberg, L., Owen, G. and Grant, J., 2011. Designing a smoking cessation
intervention for the unique needs of homeless persons: a community-based randomized clinical
trial. Clinical Trials, 8(6), pp.744-754.
Thall, P., Fox, P. and Wathen, J., 2015. Statistical controversies in clinical research: scientific
and ethical problems with adaptive randomization in comparative clinical trials. Annals of
Oncology, 26(8), pp.1621-1628.