Research Critiques and PICOT Statement Final Draft

Grand Canyon University

NRS-433V-0500

03/22/2020

Title of Paper Comment by ESC: Missing title

PICOT Question: In cigarette smokers whose ages are more than 17 years (P), does nicotine substitution treatment (I), as opposed to utilizing other smoking discontinuation treatments (C) influence smoking end results (O) over a time of a quarter of a year (T)?

Background

There are numerous quantitative studies relating to the topic of nicotine substitution treatment as a therapy for smoking. Two examples of such studies are High-Risk Smoking Behavior and Barriers to Smoking Cessation Among Homeless Individuals by Chen, Nguyen, Malesker, and Morrow (2016), and Effect of Nicotine Replacement Therapy on Quitting by Young Adults in a trial Comparison Cessation services by Buller et al., (2014). Noting the high major challenge in ending nicotine smoking is an addiction, the researchers in these two studies aim to understand how this bottleneck can be addressed. In the first research, the authors note the high risk of smoking among homeless persons, hence a need to study the factors that elevate smoking behaviors and bar smoking cessation among these individuals. In the second study, the researcher notes how despite the high number of young adult smokers, they rarely use or seek medication for smoking, hence evaluate how effective nicotine replacement therapy is effective in ending smoking among this population. Comment by ESC: Incomplete, review grading rubric criteria

How the Articles Support the Nursing Issue

These two articles play contribute to the intervention in the PICOT statement. In the first article, the authors note that one of the most preferred intervention methods by the population of the study is nicotine replacement treatment (NRT), which is similar to the nicotine substitution therapy (NST). It also provides statistics of high stress and the use of smoking to elevate stress and anxiety, hence suggesting why NST may be effective in helping to curbing smoking. While the study population is different to the one stated in the PICOT statement, it is general, representing the homeless individuals who are at high risk of nicotine addiction, hence may include even the individuals above the age of 17 years who are smokers (Chen, Nguyen, Malesker & Morrow, 2016).

In the second article, it offers quantitative evidence of how effective NRT intervention is, in helping to smoke quitting among young adults. This helps in answering the PICOT question by providing statistical evidence on NST approach is effective in treating smoking among young adults. The population in this second study is individuals aged between 18 and 30 years. This closely relates to the population defined in the PICOT statement; hence the observed results are applicable to the population defined in PICOT (Buller et al., 2016).

Methods of Study Comment by ESC: Identify the type of quantitative design of each study: 1. Descriptive 2. Correlational 3. Causal-Comparative/Quasi-Experimental 4. Experimental Research

Chen, Nguyen, Malesker, and Morrow, (2016) an anonymous voluntary surveys. The survey questions were based on a previously implement instrument. The target was smokers residing at a homeless shelter. The participants were recruited from general homeless individuals willing to complete the anonymous questionnaire. The lowest age required was 19 years. One hundred participants were identified. These individuals were given the questionnaire, which contained 22 questions requiring to-fill in the blank or rank responses using the Likert scale. The data obtained were compiled using Excel 14.14.1 and then transferred to SPSS 21.0 for statistical analysis. For quantification and analysis of respondents' perceptions of the use of available cessation tools, the 5-value Likert scale questions were given point value between 1 and 5, with the higher number representing the option which was more favored. These responses were displayed as mean value and histogram of various options drawn.

On the other hand, Buller et al. (2016) applied a slightly different approach. The sample included individuals aged between 18-30 years who were smokers or had at least smoked one cigarette in the past one month. Four methods were used to recruit the participants. The first approach included sending of invitation to all the smokers during the recruitment period. They completed an online health risk assessment applied on college campuses. To increases the number of participants, another three methods were put in place. These methods were a direct advertisement of the trial to smokers using offline promotions, online advertisement, and screening by four state telephone quit lines. Those interested were issued with consent forms and a pretest survey. Using chi-square, the data was statistically analyzed.

Results of the Findings

According to Buller et al. (2016), there were 3094 participants were analyzed for the final reports. The mean age of smokers was 25years, and the average cigarettes per day were 18.1. The smokers who tended to do a follow up were the elderly, better educated, less addicted, spent the most time online, and employed. Over 69.0% and 74.8% in 12-week posttest and 26-week posttest consecutively reported applying NRT to help to cease. This indicated the high use of NRT for smokers completing posttests. Among those who received a course of nicotine patches, NRT use was higher and prolonger than those who did not. However, some smokers used NRT even without the course. This indicates the need for teaching to improve the effectiveness of NRT. This approach was also positively linked to quitting. Follow-ups and self-help resources predicted the high likeliness of using NRT among the participants.

In the second study, 90% of the participants participated in high-risk behaviors, despite 86.0% of them having been advised at least once to quit smoking. Only 25% of participants had ever asked for assistance cessation. Among the chosen interventions, NRT was the most preferred, with a likelihood of facilitating 35% cessation. 46% of the participants indicated stress as the main barrier for ceasing smoking, with 21% citing craving. This shows that for successful intervention, these main barriers need to be addressed.

The results from these two studies imply nicotine substitution therapy as not only the most preferred approach but also the most effective into leading to cessation. While addressing smoking cessation, it is essential to offer more information on the therapy. Since NRT treats craving effectively, it can also help in addressing the barriers associated with stopping smoking.

Outcomes Comparison

The expected outcome of the PICOT is that nicotine substitution therapy or nicotine replacement therapy will be more effective in curbing smoking among young adults aged above 17 years. The findings from these two quantitative studies support these expected outcomes. They indicate that, apart from the therapy being more preferred and effective, it can also help in addressing some of the barriers to successive quitting smoking. To make this approach more effective, it is essential to provide resources such as courses and reading material regarding the therapy.

Conclusion

References

Buller, D. B., Halperin, A., Severson, H. H., Borland, R., Slater, M. D., Bettinghaus, E. P., Tinkelman, D., Cutter, G. R., & Woodall, W. G. (2014). Effect of nicotine replacement therapy on quitting by young adults in a trial comparing cessation services. Journal of public health management and practice : JPHMP, 20(2), E7–E15. https://doi.org/10.1097/PHH.0b013e3182a0b8c7

Chen, J., Nguyen, A., Malesker, M., & Morrow, L. (2016). High-Risk Smoking Behaviors and Barriers to Smoking Cessation Among Homeless Individuals. Respiratory Care, 61(5), 640-645. doi: 10.4187/respcare.04439