ay in hA Critique of the Research Report titled
“Examining the association between substance use disorder treatment and smoking cessation”
using the Polit & Beck approach.
The research report attempts to establish a connection between the chance of quitting of smoking in
Substance Use Disorder (SUD) individuals based on whether or not they received treatment for SUD. It
begins by making several assertions based on previous studies that acknowledge smoking as the most
important avertible cause of distress and fatality and that a SUD individual is more likely to be a smoker
than an individual in the regular population. The report then goes on to establish a method for collecting
and analyzing data related to smoking cessation in SUD individuals and finally, gives out an inference that
SUD individuals who receive treatment have less chance to stop smoking than those who do not go for
treatment.
The study which is completely analytic in nature is fairly rigorous in its design methodology. It follows observational style of research and no element of experimentalism is seen because the study is dependant on the data from another survey already completed. It starts by analyzing 4 years (2009 to 2012) of the National Survey on Drug Use and Health (NSDUH) and selecting a sample of life-time smokers as big as 12796 in number who have undergone substance use in the previous year. Within this sample, it distinguishes individuals as in-patient only, outpatient only, in and out patient and no treatment. It further distinguishes the population based on age, race, marital status, health insurance and other socio-economic factors thus allowing for appropriate comparisons that develop illustratability of the findings. To minimize biases, the study performs a sensitivity analysis in which it accounts for cases where the cessation of smoking occurs before treatment. There was however no attempt to validate the NSDUH survey methodology for the context of this study. First major limitation this study faces is that the NSDUH only records last year SUD treatment, thereby leaving behind a big area of data untouched. Secondly as there are a number of variables involved, there may be unnoticed variances in the degree of substance use that can confuse the results. The authors themselves acknowledge that It is not possible to draw any casual relationships from the analysis because of the cross-sectional nature of the data.
The sample population was clearly identified and described as adults aged 18 or older “life-time
smokers” who were SUD individuals based on 4 years of NSDUH survey findings. A “life-time smoker”
was identified as a person who smoked 100 or more cigarettes in his entire life. The sampling criteria
was thorough enough to include those who received SUD treatment and those who did not. Among
those who received treatment, all possible treatment types were included to enhance the sample’s
representativeness. To minimize sample bias, care was taken to account for quitting timing in
relation to treatment timing. Though a sample size of 12,796 appears large enough to avoid statistical
invalidity, there was no scientific method applied to determine the appropriate sample size for this
study.
The dependent and independent variables were clearly identified but they were operationalized based
on the NSDUH survey findings rather than an independent method. In so doing, the authors defer to
NSDUH for the validity of the survey methodology. Without studying the NSDUH survey methodology,
it is difficult to validate if specific instruments used by the NSDUH to collect the data in the survey were
apt for the study population. Nor can we conclude upon the validity and reliability of the data. Apart from
this the researcher’s decision to rely on this huge available data was good.
SUD intervention types are very clearly detailed, but there is not a lot of detail on what each intervention
type entails. There is reference to a “life-time treatment” but it is not clear what this signifies. Again it
defers to the NSDUH survey for such details. There was an extensive plan to minimize bias by
categorizing SUD individuals into various categories of treatment and consideration was given to
the timing of smoking cessation relative to treatment. Authors state that nothing is known about the way
the effectiveness of these interventions vary by various factors like the timing.
Though information given on the statistical analysis methods used is very concise and it includes core statistical terms and ideas, it is evident from the text that it sufficiently takes care of the key variables and the characteristics of the sample population. Appropriate measures are used to minimise errors and the report contains inferential statistics. Overall the statistical report shares with the readers adequate information about the evidence the study brings out. Through explanation on the appropriateness of the selected statistical methods are absent in the text, because of the volume of analytical work they undertook and information on the measures they have taken to minimise possible errors, it is clear that an extensive and well organised approach was adopted. There is a considerable amount of statistical information available and chance of type 2 errors are minimum as the results of statistical test are significant. Findings are clearly and logically organised. The authors have stated that they have studied summary statistics for both dependant and independent variables. The tables are clearly presented in a communicable way and the information in the text and tables correlate with each other.
In conclusion, the study finds that the likelihood of quitting smoking is evidently lower among those smokers with life-time SUD treatment compared with others who did not take any SUD treatment. Whether it was in-patient or out-patient didn’t make any influence on the possibility of smoking cessation. 29% of non-treated population had a chance to quit smoking while only 16% of those from who took SUD treatment. Stoppage of smoking was lowest among heroin users. Followed by cocaine users and Marijuana users. Alcohol SUD individuals had the best opportunities to quit smoking. The study did employ statistical significance validation techniques along with confidence interval information. There are no unjustifiable casual inferences and there is no need of alternative explanation for the findings. There are recommendations from authors that toolkits developed with a special focus on stopping smoking should be distributed and implementing no smoking policy at SUD treatment sites.
Overall the study appears to be valid in how it analyses the NSDUH survey and its consequent findings.
More importantly the study highlights one glaring deficiency in the current SUD treatment – the lack of
emphasis on smoking cessation. This evidence can be used to better the current nursing practice on SUD
treatment. A simple educational program providing information related to the negative impacts of
smoking as part of SUD treatment is likely to better the results of this study.
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