Smoking Cessation Among Indigenous Cohorts: Harm Minimization Strategies

Literature Review

Discuss About The Smoking Cessation Among Indigenous Cohorts?

In today’s world, smoking is a major public health issue that calls for greater attention and prudent intervention considering the adverse impacts it might exert upon the health status of the individuals who resort to such habits. There have been ongoing efforts to combat these bad habits across vulnerable population who might be most susceptible to face the wrath of the smoking behaviour. One such interventional approach meant for mitigation of these adverse impacts includes harm minimisation alongside other modality like that of smoking cessation. The work by Ober and Roche (1997) has laid focus on potentially utilizing the harm reduction principles in order to address the issue of smoking among Indigenous Australian population of Aboriginal and Torres Strait Islanders, more frequently prevalent than non-indigenous population. Thus, the opinion piece has clearly referred to the studied population thereby striving to address the clearly focused question in course of its proceedings.

The authors Ober and Roche (1997) in order to address their research questions have looked for a plethora of papers that attended to similar causes and issues. Most of the papers that the authors reviewed were opinion pieces whereby the respective authors have highlighted on issues regarding addictive behaviors like that of alcoholism, smoking and drug abuse. Very few papers have been chosen that were in line with the topic of harm minimization in case of smokers exclusively. Moreover, there were no specific study designs for most of the journal articles that were being referred to in the chosen article.

A small-scale literature review of articles on the chosen topic will be conducted in order to locate similar articles that are of particular significance in relation with the issue that is being considered for appraisal. An appropriate critical appraisal tool such as that of CASP (Critical Appraisal Skills Program) tool will adopted to consider effectiveness and rigor to aid in comparison of quality of evidence between studies. Efforts will be directed to identify whether the findings of these articles validate or refute the recommendations of the provided articles. Google Scholar database will be utilized in order to gain understanding of the topic with search terms like that of ‘smoking and Indigenous cohorts’ and ‘harm minimization principles of smoking in Indigenous cohorts’. Similar and or associated studies will be referred to for accumulating pertinent data in liaison with the topic so that greater insight may be gained for generating better understanding.

Critical Appraisal

Study by McRobbie et al. (2012) revealed that smoking an electronic cigarette (EC) containing nicotine increased the chances of smoking cessation in long-term in contrast to EC without nicotine. Thus, effectiveness of ECs in long-term smoking cessation has been observed. Jha and Peto (2014) presented statistical records describing the global impacts associated with smoking behavior, of quitting and in relation to taxing tobacco. Tobacco-attributed mortality as seen through national trends in UK, US and Poland has been depicted as well that further necessitated the utility of harnessing harm minimization strategies to combat the smoking adversities. Longer the smoking duration, shorter life expectancy was noted in the smoker individuals. Taylor, Ussher and Faulkner (2007) focused on recommending specific doses of exercise to manage the cigarette craving and withdrawal symptoms. Behavioral regulation in mitigation of smoking harm has thus been suggested. In another study by Gorber et al. (2009) emphasis has been laid on acquiring specific data related to accurate estimation of smoking status to drive suitable interventional strategies. Further, Fagerström and Bridgman (2014) stated that smoking related health hazards and mortality rates might be mitigated through adoption of harm minimization techniques like that of implementation of licensed medicinal nicotine products through promotion of public health awareness.

Reviewing the content of the work presented by Ober and Roche (1997) it may be said that in connection with the time in which it was published, efforts may be witnessed on their parts to incorporate studies that are most relevant. Many studies that are being referred to in the chosen article have articulated certain vital aspects related to addictive nature of smoking in addition to its adaptive and functional role. Discussions have also been made with respect to motivators and reinforcers that encourage the uptake as well as continuation of smoking among the Aboriginals. Perspectives of these people with respect to health and their relevance to smoking has been outlined as well in conjunction with reference to components of harm reduction strategies have also been described. Traditional practices of harm minimization have been emphasized throughout the discussion. However, the most recent advancements in relation to smoking cessation and reduction by utilizing electronic cigarettes have been largely overlooked as depicted through valid studies (McRobbie et al. 2012, Polosa et al. 2011). The global effects of smoking as well as quitting or levying of taxes on smoking have also not been taken into consideration, while other studies have highlighted this aspect for better understanding the harm minimization issue in smoking (Jha and Peto 2014). No studies that have been published in languages other than English has been included. Moreover, there is no clear indication as to which databases were explored for procuring the most suitable articles that further delineates the reliability of the findings expressed in course of the original article.

Findings

uthors Ober and Roche in course of their review did little to assess the quality of the included studies. It is not evident in the proceedings of the article that rigor of the identified studies were well evaluated making it difficult to rely on the facts and information stated in consequence to these findings. More actions could have been undertaken by the authors to understand the rigor of the studies referred to, thereby improving the quality of information that is being provided because of systematic reviewing of the articles. The nature of the study design that is whether they are retrospective or randomized control trial or cohort study might have provided a clearer insight onto the topic. A much-generalized approach has been sought in elucidating the harm reduction strategies for smoking in the Indigenous cohorts. Elements that are integral to define the harm reduction strategies has been mentioned without elaborating the implications for such propositions. Poor health outcomes due to smoking and perceptions surrounding this behavior have been taken into account alongside understanding about the adaptive nature of smoking. Recent studies concerning the disease burden because of exposure to second-hand smoke has also been explored through retrospective analysis whereby it has been emphasized that extension of public health strategies in coalition with clinical interventions might offer effective resolutions to combat ill effects of passive smoking (Öberg et al. 2011). Harm reduction is not a one-dimensional approach, instead calls for multidisciplinary interventions to tackle cigarette cravings, subsequent withdrawal symptoms that has been confirmed through recent investigations. Management of these crucial issues with respect to smoking has suggested on using exercise that normally works through stress reduction or neurobiological mechanisms (Taylor, Ussher and Faulkner 2007). Consideration of rigor of studies would have accentuated the feasibility of findings as represented in the article.

In the article by Ober and Roche (1997), mention has been made with respect to other articles that have offered insight into the topic succinctly. Combination of the results of the review has been done to represent distinctive themes in connection with the topic suitable for analysis in consecutive fashion. The findings as stated across diverse studies have been presented haphazardly instead of doing so in a systematic and well-organized manner that further devalued the chances of incorporating the findings as valid and reliable ones. Clumsy representation of the study findings have decreased the clarity of the research topic and decreased the reliability of the work. On the contrary, it has been represented in other systematic review study that a specific correlation between two interacting variables suggests the possible relation among the two. A study was conducted to evaluate the association between self-reported smoking status and smoking status represented through measures of cotinine in biological fluids. A definite search strategy was invested in order to retrieve the most relevant studies that met the inclusion criteria. Examination of the association between the variables was noted through such systematic review (Gorber et al. 2009). However, no such efforts was noted in case of the given article. The rationale behind combining the results of various articles hence cannot be justified properly as the results depicted in those articles were not properly interpreted or analyzed. Correct analysis of such findings would have generated better outcomes in terms of systematic representation of the study findings.

Discussion

The overall results of the review has brought to the forefront certain central themes that reiterates the need to focus more on the smoking issue among the Aboriginal Australians. The study represented that until date little attention has been given to the issue of harm reduction strategies in relation to smoking. Owing to the greater propensity of occurrence of smoking among the Indigenous Australians in addition to harboring negative health effects, harm reduction approaches may have positive utilities. This group of Aboriginal Australians may be benefited through following of the recommendations of harm reduction strategies. The study outcomes have been depicted very vaguely without any statistical tools employment to discuss the findings. The method utilized in outlining the pivotal ideas as emerged through thematic analysis of the topic has not been accurately demonstrated that further added to deter the reliability with respect to study findings. The bottom line representation of the results is rather haphazard and sketchy instead of being concrete and conclusive. No numerical representation of data was noted that reduced the feasibility and usage of the data retrieved. The expression of results did not go through any sort of rigorous statistical analysis that decreased the potential of the study to a large extent. Lack of statistical interpretation caused to lessen the gravity of the study findings significantly. Relevant findings in literature have argued in favor of proposition of rational public policy in an effort to cause tobacco harm reduction through appropriate risk analysis and subsequent recommendations (Sweanor, Alcabes and Drucker 2007).

Analysis of the results in the chosen article authored by Ober and Roche (1997), suggests that there is a lack of precision in representing the study findings. The article did not utilize any statistical tool because of which no confidence intervals have been used in the study outcomes. Therefore, the results depict that type of data being qualitative in nature there lie less scope of putting it into the radar of statistical evaluation. Hence, lack of precision in the result interpretation is suggestive of the dearth of performing statistical computations with the available data as the nature of data is entirely qualitative. On the other hand, it has been depicted through appropriate studies that cohort study may essentially incorporate confidence intervals in their study design while doing the statistical operations so that the causative factors may be adequately identified. Follow up studies with suitable cohort respondents attempted to investigate the parameters related to quit attempts, motivation to quit, smoking status, weight and weight concern, nicotine cue, withdrawal symptoms, health-related factors in addition to smoking cessation aids. Findings suggested that in a model of cessation, motivation plays a crucial role to foster quit attempt while plays lesser role in cases of relapse (Zhou et al. 2009). Hence, lesser precision in terms of the study findings may be largely attributed to the study design and lack of rigorous statistical application.

Conclusion

Deeper retrospection into study findings reveals that the study outcomes is applicable to only the Aboriginal Australian community only. The entire study has been undertaken with respect to contextual analysis of the Indigenous cohorts of Australia. The measures and strategies that have been suggested for mitigation of problems are only concerned with this vulnerable population. The findings are not generalizable to other populations thereby restricting its application to other Indigenous cohort population. Across the globe, initiatives have been streamlined to remedy the smoking menace through improvisation and implementation of harm reduction strategies. Studies have highlighted on incorporation of suitable strategies that may be unanimously accepted and followed in the form of policy to drive optimal benefits in mitigating smoking related adverse health impacts for the concerned population. In this connection, smokeless tobacco has been suggested as a harm reduction measure to be incorporated within a policy framework (Gartner et al. 2007). Further, in another study efforts are evident to regulate nicotine product by means of prudent application of harm reduction measures to curb the threatening problems of tobacco smoking (Britton and Edwards 2008). Therefore, considering the plethora of opportunities that rest with respect to expanding the results into the local population, cautions must be undertaken to gauge the applicability of similar measures in the context of other similar population in diverse situational context. The differences in characterizing the harm reduction measures across the population need to be taken into consideration while applying the results to other population in different context.

he article by Ober and Roche (1997) has paid considerable attention to address certain outcome measures. Both the addictive as well as adaptive nature of smoking apart from its functional role has been mentioned. Both the motivators and reinforcers responsible for the uptake and continuation of smoking by Aboriginal people have been considered for discussion. As opposed to the cessation strategies that are part of the traditional approaches, the utility of the harm reduction measures as tools of ameliorating smoking have also been part of the discussion of the chosen article. The outcomes have been discussed under various themes where focus was essentially laid upon smoking among Aboriginal health workers with reference to prevalence rates and perceptions about the effects of smoking. The feasibility of the adoption of the harm reduction strategies are also analyzed through suitable references to various relevant articles that corroborated with the study outcomes. The appropriateness of the strategies may be understood in the light of other relevant article that threw light in similar issue. Recent investigations have also attended to the potential of reducing harm because of tobacco smoking. In order to improve public health, regulated and safer nicotine alternatives have gained prominence in today’s world that has the capacity of exerting discernible impacts through use of potential alternatives like that of electronic cigarettes and others (Fagerström and Bridgman 2014). In the chosen article, mainly the behavioral aspect related to smoking and harm reduction strategy has been highlighted in contrast to the traditional abstinence program. Information related to other aspects such as that concerning the alternatives available to mitigate smoking menace has been overlooked grossly.

The results of the study findings of the article have focused on resorting to harm reduction strategies rather than traditional approaches which mostly comprised of conforming to abstinence programs. It has been further mentioned in the article that abatement of adverse health outcomes due to smoking may be facilitated through recruitment of suitable strategies that aimed to mitigate the smoking issue to a considerable extent. For the Aboriginal community in Australia, adoption of harm reduction approaches might be an effective way of combating the adverse outcomes that may be effectively used in the community group context. Application of a wider flexible array of approaches may further contribute to account for harm reduction in the concerned community. With the passage of time, novel approaches and initiatives have come up that direct to lessen the impact of smoking through adoption of suitable harm reduction strategies. Among the initiatives that are in vogue, electronic cigarettes have garnered more attention as choicest tobacco harm reduction product (Bergen, Nissen and Phillips 2009). The analysis of profile users of e-cigarettes alongside its utilization, satisfaction and perceived efficacy has been undertaken to perceive the issue of smoking on a broader spectrum (Etter and Bullen 2011). Therefore, judging the relative importance of benefits associated with harm reduction strategies in contrast to the cost incurred and harm it may be said that it may be useful if the harm reduction strategies are put in force appropriately.

Based on the knowledge and information gained by critically appraising the article and undertaking short literature review, it may be said that incorporation of the most relevant strategies might be beneficial in tackling the smoking menace among the Indigenous cohorts. In order to account for harm minimization in case of tobacco smoking, prudent and pragmatic approaches must be directed to drive positive outcomes. Traditional approaches for harm minimization must be replaced by novel and effective methods that will result in generation of more optimal results. As per evidences provided through recent investigations, electronic cigarettes have garnered much attention in curbing harm due to smoking of tobacco that may be considered for further exploration as a suitable alternative. Hence, funding should be given to interventions that aim to streamline initiatives for reducing harms linked with smoking cigarettes that contain tobacco.

References

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Britton, J. and Edwards, R., 2008. Tobacco smoking, harm reduction, and nicotine product regulation. The Lancet, 371(9610), p.441.

Etter, J.F. and Bullen, C., 2011. Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy. Addiction, 106(11), pp.2017-2028.

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Gartner, C.E., Hall, W.D., Chapman, S. and Freeman, B., 2007. Should the health community promote smokeless tobacco (snus) as a harm reduction measure?. PLoS Medicine, 4(7), p.e185.

Gorber, S.C., Schofield-Hurwitz, S., Hardt, J., Levasseur, G. and Tremblay, M., 2009. The accuracy of self-reported smoking: a systematic review of the relationship between self-reported and cotinine-assessed smoking status. Nicotine & tobacco research, 11(1), pp.12-24.

Jha, P. and Peto, R., 2014. Global effects of smoking, of quitting, and of taxing tobacco. New England Journal of Medicine, 370(1), pp.60-68.

McRobbie, H., Bullen, C., Hartmann-Boyce, J. and Hajek, P., 2012. Electronic cigarettes for smoking cessation and reduction. Cochrane Database Syst. Rev, 12.

Ober, C. and Roche, A.M., 1997. Rethinking smoking among Aboriginal Australians: the harm minimisation-abstinence conundrum. Health Promotion Journal of Australia: Official Journal of Australian Association of Health Promotion Professionals, 7(2), p.128.

Öberg, M., Jaakkola, M.S., Woodward, A., Peruga, A. and Prüss-Ustün, A., 2011. Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. The Lancet, 377(9760), pp.139-146.

Polosa, R., Caponnetto, P., Morjaria, J.B., Papale, G., Campagna, D. and Russo, C., 2011. Effect of an electronic nicotine delivery device (e-Cigarette) on smoking reduction and cessation: a prospective 6-month pilot study. BMC public health, 11(1), p.786.

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Taylor, A.H., Ussher, M.H. and Faulkner, G., 2007. The acute effects of exercise on cigarette cravings, withdrawal symptoms, affect and smoking behaviour: a systematic review. Addiction, 102(4), pp.534-543.

Zhou, X., Nonnemaker, J., Sherrill, B., Gilsenan, A.W., Coste, F. and West, R., 2009. Attempts to quit smoking and relapse: factors associated with success or failure from the ATTEMPT cohort study. Addictive behaviors, 34(4), pp.365-373