Outcomes to be Assessed:
The primary objective is to see that subjects of the program cease smoking and remain abstinent from tobacco use. This will be the primary outcome to be assessed therefore. Individuals in both the experiment and control groups would be consulted at the six-month juncture and the one year point in order to determine how many among them have remained abstinent from tobacco use in that duration and up to that point.
Other outcomes to be assessed would be long-term health factors relating to the use of tobacco. According to statistics compiled and sponsored by the T.J. Samson Community Hospital in Glasgow, Kentucky and most recently updated in the spring of 2006, habitual smokers of cigarettes are "fourteen times as likely to die of lung cancer" and twice as susceptible to fatality by heart disease. (T.J.S.C.H, 1) This means, according to the Community Hospital, that an individual addicted to cigarettes has a 50% chance of premature fatality due to said addiction. This constitutes a significant enough correlation to denote that at the five, ten and fifteen year markers following intervention programs, there would be an experimental value in monitoring the peripheral health experiences of subjects. Intended outcomes in those who had been exposed to the cessation intervention would be a lesser prevalence of chronic obstructive pulmonary
Disease or myocardial infarction at long-term points following the intervention
The measure applied to indications of the abstention from smoking at the six-month and one year points would be based on the number of daily cigarettes smoked on average since the cessation. This would help to demonstrate such findings as the effectiveness of the intervention in the longterm at promoting abstinence from smoking or, conversely, indications that the intervention had only been temporarily successful and that subjects experienced a relapse. Such determinations should be compared to measures of average daily cigarette intake prior to intervention in order to denote relative improvements or otherwise.
With respect to the presence of peripheral health problems, measures would actually be qualitative investigation of individual health outlooks. These will contribute to quantitative presentations of the statistical prevalence of either pulmonary disease or heart disease in both control and experimental groups.
The plan for meeting the identified need should include the array of strategies that have proven individually and in combination to help promote cessation. The AHA endorses "combining interventions such as physician advice and follow-up with nicotine gum and behavior modification may increase success rates. Smoking cessation programs seem especially helpful for people who smoke more than 25 cigarettes a day." (AHA, 1) In addition to providing access to the nicotine patch and nicotine inhalers, public health practitioners would offer weekly patient seminars on the premises as well as a context for support group interaction.
The use of educational methods, the provision of strategies for coping with temptations and modes of altering negative lifestyle indicators related to smoking all will be employed with consideration to the currently accepted best practices in smoking cessation. The study provide cessation therapists with a common curricular reference to avoid any unwanted distinctions between difference public health facilities.
Procedures for Data Gathering:
The use of multiple public health facilities means that the study will be provided with multiple samples by which to make comparative analysis. This should help to provide evidence of consistent patterns or a lack thereof. Data would be gathered in three forms. The first would be a survey instrument designed to collect information from subjects of both the control and experimental group...
All respondents would fill out the exact same survey each time, which would self-reported data on the amount of cigarettes smoked since the intervention, the reasons for lapsing and the identification of both peaks and valleys in tobacco usage.
This would be followed up by one on one open ended interview in which subjects would provide qualitative data regarding their experiences through the process of intervention, cessation and, where such has occurred, uptake. All subjects would be asked to discuss their reasons for succeeded with cessation, failing with cessation or experiencing no change in tobacco use habits during the measured period of time.
A final phase of the data gathering process would be a health physical in which primary health indicators would be measures in both control and experimental groups. These could be used to make health projections about subjects and to associated larger patterns in such indicators to the success, neutrality or failure of the cessation intervention in question.
Strengths, Limitations, and Vulnerabilities:
Essentially, the strength of this research endeavor and the proposed intervention would be denoted by an actual statistical distinction between control and experimental groups. Indeed, a failure to denote a statistical difference would demonstrate that those who experienced the intervention remained on the same health path as those who had not. Accordingly Lipsey & Hurley (2009) denote that "statistical criteria are used to reject the null hypothesis of no difference between the mean on the outcome measure for the persons in the treatment condition and the mean for those in the control condition. In particular, we conclude that there is an effect if an appropriate statistical test indicates a statistically significant difference between the treatment and control means." (Lipsey & Hurley, 45)
This goal though is supported by the use of multiple public health facilities for the execution of this program. By establishing consistent rates of statistical difference, modest or significant, between control and experimental groups through a wide set of sample clinics should help to assure validity.
A vulnerability of the study is its reliance upon self-report for two of the three primary data-gathering methods. As is always the case with self-report, the degree of accuracy and honesty provided by those filling out surveys and consenting to interviews may reflect any number of motives that diverge from truly accurate data.
That said, the use of physical health indicators to measure peripheral health effects relating to intervention should serve as another layer of data-gathering by which to properly scrutinize self-report data.
With respect to limitations, the study's focus on only adult subjects denotes that there is still the very significant issue of adolescent nicotine addiction that should be addressed in its own separate study.
American Heart Association (AHA). (2009). Smoking Cessation. Americanheart.org.
Bickman, L. & Rog, D.J. (2009). Randomized Controlled Trials for Evaluation and Planning. The Sage Handbook of Applied Social Research Methods.
Euromonitor International (EI). (2009). Tobacco in Costa Rica. Euromonitor.com
Fiore, M.C.; Novotny, T.E.; Pierce, J.P.; Giovino, G.A.; Hatziandreu, E.J.; Newcomb, P.A.; Surawicz, T.S. & Davis, R.M. (1990). Methods Used to Quit Smoking in the United States. The Journal of the American Medical Association, 263(20), 2760-2765.
John, K. (2008). Smoking Ban Proposed For Public Spaces in Costa Rica. Costa Rica Pages. Online at http://www.costaricapages.com/blog/costa-rica-news/smoking-ban-proposed/752
Lipsey, M.W. & Hurley, S.M. (2009). Design Sensitivity. The Sage Handbook of Applied Social Research Methods.
" (AAFP, nd) The Health Maintenance Organization further should "…negotiate with both public and private payers for adequate reimbursement or direct payment to cover the expenses of interpreter services so that they can establish services without burdening physicians…" and the private industry should be "…engaged by medical organizations, including the AAFP, and patient advocacy groups to consider innovative ways to provide interpreter services to both employees and the medically underserved." (AAFP,