How to Understand the Impact of Parental Smoking

The rate at which asthmatic diseases are growing amongst the youth, out of a population of 28000, was found to be a total of 11.2% of youth engaged in tobacco-using activities, 7.9% were smoking tobacco and 6.2% were using smokeless tobacco (FACTSHEET 2018 MALDIVES, 2019). Further, the percentage of adults that were exposed to tobacco smoke despite not using it was 25.35 in adults and 34.5% in Youth (FACTSHEET 2018 MALDIVES, 2019). The rate of tobacco consumers in Maldives is rising and despite knowing the side effects and consequences of it the quitting rate is as low as 39% only and out of the total population of 436000 in Maldives, the number of tobacco users is 76100 (FACTSHEET 2018 MALDIVES, 2019).

This drastic rise in smoking levels in Maldives and the negative effect it is creating on the health of non-smokers or children has made this area, a prominent field to be researched (Tettamanti and et.al., 2016). Clearly, the current prices and mechanisms are not enough and therefore new measures need to be developed especially for the expecting parents so that their child does not develop asthmatic diseases at an early age.

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SEARCH STRATEGY

RESEARCH CRITIQUE

Critiquing is the art of comparing different pieces of literature that present different aspects that are related to the topic and then an overall conclusion is derived. The authors, Birks et.al., (2017), have stated that critical analysis helps in finding are disadvantages of the same point or theory that is being praised by another. The critical appraisal of literature can be done using a variety of techniques such as the Critical Appraisal Skills Programme (CASP), JBI Critical Appraisal Checklist developed by Joanna Briggs Institute etc. (Gustavson et.al., 2017). These tools help in effectively comparing and critiquing he different articles that have been selected for the research being undertaken and then appropriate decision-making is done based on the comparison of the literature.

Currently, I have selected the CASP framework because the checklist under this is different for different types of articles that have been selected i.e. for qualitative articles a different checklist is present and for systematic review, a separate one is used (Bailey et.al., 2017). The current articles that have been selected is a qualitative research based on a retrospective basis and therefore the CASP checklist will help in critiquing in a relevant and credible manner. Also, the flexibility and ease that this checklist or appraisal tool provides is a big factor behind the selection of CASP as a critiquing tool.

Aim

The aim of the article presented by the authors is to identify the integration of maternal as well as paternal smoking while a mother is pregnant and the influence of such smoking on the chances of asthma in the offspring i.e. the child.

The Title of the research paper, as the authors, Pugmire, Sweeting and Moore, (2017), have stated must be comprehensive and fulfil the objective with which the research has been undertaken and results have been derived. Currently, the Title "Parental smoking and cessation during pregnancy and the risk of childhood asthma" justifies the objective and the research that has been conducted in the research.

Design

The research type that has been used by the researcher is quantitative research type where the figures are collected and analysed related to the research problem drawing quantitative conclusions (Vardavas And et.al., 2016).

The research design that has been selected is the cohort study i.e. a longitudinal study was conducted where the data pertaining to a common base is extracted over a period and then the comparison is being made. This design is completely suitable to the research because here the researchers are making a trend analysis of all the pregnant ladies that were smoking during pregnancy and how is their offspring impacted by parental smoking habits.

The advantages that Knopik et.al., (2016), have quoted of cohort study is that it helps in comparing the different effects, consequences or measures of the same cause and cumulative indices can be calculated. The disadvantage however is that it helps in understanding only one unit or aspect or base and might not develop rational and justified conclusions.

Data Collection Method and Tool

There are various methods through which primary data can be collected such as questionnaires, surveys, observation methods, case studies etc. and each method has different positive or negative aspects (Biederman et.al). In the current article, a retrospective observational approach was developed under which the past records can be studied to identify a common pattern and to ascertain what are the emerging trends over the years (Lodge et.al., 2018). This is the most appropriate technique as per Lodge et.al. (2018), as it helps in studying the figures and trends related to the pregnancy and the offspring that were affected by the asthmatic disease.

The major strength of the cohort study tool is that it helps in identifying the trends that have been developing over time and the comparison of figures that have been collected also becomes simplified and cohesive but the major disadvantage is that it is not a conclusive tool to make future predictions or suggest anything based on the collection of observational data (He and et.al., 2017). A cohort study is however an extremely reliable and valid tool as the data collected is not assumed and valid conclusions are drawn based on this realistic data (Obel et.al., 2016).

Sampling

Sampling can be done in a probabilistic and non-probabilistic manner i.e. under the probabilistic method, the respondents are selected randomly without any pre-formulated criteria or basis and under the non-probabilistic method, the selection is done only after the set criteria is met by the respondents (Jones and et.al., 2011).

Currently, researchers used the non-probabilistic method at Kuopio University Hospital, a University-based Obstetrics and Gynaecology Department in Finland by selecting cases of women who delivered between the years 1989 to the year 2006 and were found to be linked to the register of asthma reimbursement (Jones et.al., 2011). There were various factors such as age, asthmatic disease in parents, smoking habits, delivery mode etc. were included in the research and a questionnaire was also filled by midwives and nurses. Here 75 questions related to the health and eating habits of the expecting parents and data related to the complacencies if any were added. Since there were no selection criteria between the data of the pregnant women induced with asthmatic tendencies the chances of biases were reduced substantially (Obel et.al., 2016). This is because all the females were selected automatically without giving preference to a particular race age or any other factor.

Ethics

The researchers complied with all the ethical research while conducting their study where they included informed written consent from the midwives that were selected for the interview. Also, no personal data pertaining to the cases that were selected for research was either used or disclosed by the researchers (Ruisch et.al., 2018). The researchers, Harju et.al., (2016), got the study approved by the Ethics Research Committee of Kuopio University Hospital and published the article only after getting their publishing approval.

Data Analysis

The data analysis method that was used in the research was the quantitative tool and the different tests and techniques were used to measure the data. The researchers tabulated the parameters related to asthmatics by implementing the Chi-Square Test and the Mann- Whitney test so that statistical interpretation can be made and the trends related to the variableness can be ascertained (Rice et.al., 2018). Additionally, the researchers also employed the logistic regression analysis under which the multivariate-adjusted data analysis was done along with the inference on parental smoking and its impact on the chances of the offspring developing asthmatic diseases. The Statistical Package for the Social Sciences 21.0 Software was used for analysing the quantitative data thus collected and interpreting appropriate results that have been detailed in the findings section. This tool helps in drawing relevant conclusions that are based on numerical figures rather than facts thus avoiding any chance of bias.

The technique above was appropriate for the type of research study that was being undertaken because it helped in increasing the quality of the data that was collected and then the analysis and interpretation that was done was specific because the data was collected from the records of one University i.e. hospital only. The statistical analysis tools that were used helped in making appropriate interpretations pertaining to the data. Although, there were some aspects on which precise information was not available such as the age of the patients, forced or planned pregnancy choice etc., different interviews and questionnaire methods helped in fulfilling the data gaps. If these data would also have been given, it would have helped in generating a deeper insight.

The researcher tried to minimize the bias that might have occurred in the research in the form of higher emphasis or impact on the research of the children who had asthmatic problems and therefore had regular follow-up tests as compared to those children who didn't. Therefore, in order to reduce the impact of such factors on the research, the researcher compared the different variables of children with no follow-up separately as compared to the similar variables associated with children with regular follow-ups (Dolan et.al., 2016).

Main Findings

The major finding from this report was that:

When the paternal and maternal smoking effect was compared to the offspring, it was concluded that the effect of paternal smoking is more because, mothers, due to societal constraints and self-denial, tended to avoid smoking during pregnancy (Dong et.al., 2018). Further, prenatal exposure has proved to have a greater impact rather than postnatal exposure.

When only mothers smoke effect is 1.7 as compared to non-smokers, when only fathers smoke it was, 2.9 fold but when both smoke it is found 3.7 fold.

Maternal Cessation only reduces risk from 3.7 to 2.8 fold but the effect of paternal smoking cessation was higher due to passive exposure of mother and fetus. The risk was reduced by 0.4 fold (Harju et.al., 2016). Fathers who quit smoking during pregnancy presented lesser risk when compared to non-smoker fathers.

RESEARCH CONTEXT

The systematic review article that has been selected for comparison was the impact of passive smoking in a household on the increased chances of bronchiolitis, bronchitis and other respiratory infections. (Harjuand et.al., 2016)

The findings of both articles were similar in the aspect that smoke exposure should be prevented by the associated maternal and paternal smokers during pregnancy. However, the articles differed on the point of measuring consequences that is, the first article identified the impact related to childhood asthma and the second article identified that what were the chances of a child developing bronchitis and other respiratory diseases.

It can be suggested that there are various qualitative articles that have included rigorous research in their papers or studies (Sciberras et.al., 2017). They have evaluated the facts and human emotions that are related to the smoking parents and this research would have also addressed aspects like why single and expecting mothers are more prone to smoking as compared to the ones who were expecting but are habitual to smoking (Biederman et.al., 2017). Such qualitative insight would have added to the strength of evidence that was currently produced, i.e. currently only it was found that the risk of asthma is greater for kids whose fathers have quit smoking during pregnancy as compared to the dads who were non-smokers. Qualitative factors Huang et.al., (2018), suggest that the use of RCT that is, Randomized Control trials helps remove all the biases by selecting those research papers or evidence that are approved by the researcher i.e. the information hence collected is filtered and unbiased but same is not the case of cohort studies that have been selected in the first article. It is more vague and is like a natural phenomenon.

Additionally, as authors, Thacher et.al., (2016), have suggested, the hierarchy of evidence symbolizes that what are the ranks of the evidence that has been collected for the research based on the rigorousness of the research and the biases of the data that has been collected. Since, the article that has been selected is based on a systematic review and further, they have conducted meta-analysis, the article is present at the top of the hierarchy. However, the primary article that was selected for the current research involves quantitative data that is analysed on the basis of Cohort Study and therefore, the ranking on the hierarchy of evidence is lower level.

Therefore, there are many points at which differences between the first and the second articles can be identified.

SUMMARY OF KEY POINTS AND RECOMMENDATIONS

The major findings of the primary article, as discussed above was that the parents who were prone to smoking during pregnancy involved babies with higher chances of developing asthmatic diseases. Despite the lack of any certainty regarding certain aspects that were included in the research, the cohort study method based on the data collected from one institute only helped the researchers in conducting research effectively (Sciberras et.al., 2017). The findings of the second article which was a systematic review were also in accordance with the findings of the primary article where it was concluded that parents should be discouraged from adopting or continuing smoking habits while the mother is pregnant so that the child does not develop any respiratory diseases.

On the basis of the research, certain recommendations can be made for doctors or nurses (Dolan et.al., 2016). The papers above show that it is necessary to increase the degree of awareness programmes that are being implemented in the company and therefore the medical professionals that are working, i.e. the nurses, the doctors, the RN's etc. can be trained to enhance their knowledge which they can further transfer. Currently, a smoking cessation clinic is already present in the hospital and another one can be established that majorly counsels and monitors mothers and fathers who are expecting (Biederman and et.al., 2017). The critique further helped in determining that despite so many factors, there are many other factors and aspects related to human nature that have not been addressed or the environmental factors that could have been used in the research.

CONCLUSION

The research conducted in both the papers above can be used to evidently conclude that paternal and maternal both should discourage smoking as soon as they begin expecting. The first article concluded that paternal impact, if they smoke, is higher in children where they can develop asthmatic diseases and the second article concluded that passive smoking along with maternal smoking increased the chances of infants developing respiratory problems. Further, the critical analysis also identified that the RCT is a higher evidenced strategy than cohort studies and the hierarchy of evidence was taken into consideration.

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