Critique of the Flanders-Stepans smoking hygiene intervention study

¶ … Flanders-Stepans, M., Wilhelm, S.L., & Dolence, K. (2006). Smoking Hygiene: Reducing Infant Exposure to Tobacco. Biological research for Nursing, 8(2), 104-114.

Considering the title of the work, one would believe that the problem statement would explain ways to reduce infant exposure; when in fact the article commences by explaining the large monetary burden that smoking related issues has brought about in the medical field. The article then begins to explain the correlation that exists between the smoking pattern of the mother and the level of exposure to Environmental Tobacco Smoke (ETS). Finally, it is explained that a strong correlation has been made between breastfeeding and reduced ETS; however it is also stated that in fact a child is more likely to have elevated levels & symptoms associated with ETS if the breastfeeding mother is a smoker. It is also stated that there is a distinct correlation between the smoking pattern of the mother and the ETS of the child. This ETS can lead to breathing issues i.e. respiratory viral bronchitis, acute otitis media, asthma, and loss of infant life.

Comments -- The problem statement was short and only partially related to the topic stated for the article. The problem is explained and there is a brief description of a possible solution and aid in this issue. Though it would have been more explicative to describe in more detail what ways are effective in reducing ETS, while explaining the background to this issue further into the reading. The problem does tie into the title of the work, while giving some aspects as to what caused the issues in the first place. Lastly, it would be useful to provide more information regarding why breastfeeding and not some other method. However, there is educational significance associated with the title and problem statement.

Purpose

The purpose of this study was to affirm that an intervention would cause a positive impact on the effects associated with children's ETS. It is believed that if mothers are given information regarding the negative effects that smoking has on infants that this will decrease the ETS and will affect children's health in a positive manner. The researchers utilized Neuman's system model to examine the problem of infant ETS.

Comments -- The purpose was clearly stated, there is an agreement with the problem and the title. The researcher insured that the study was limited to their capabilities and available resources. The purpose agrees with problem in that a correlation does exist between child exposure and maternal smoking patterns.

Objectives

The objective of this study was to evaluate the feasibility of determining the effects of a smoking hygiene intervention on infants of breastfeeding mothers who smoke cigarettes.

Comments -- The researcher's objective was answerable, and they chose to test using questionnaires and home visits. The hypothesis was testable and served to help explain the problem.

Review of Literature

The researchers provided an overview of the available literature in ETS related issues as it pertained to the objectives of the current study completed. The review of literature was rather detailed. However, there were a limited number of current works utilized in the study i.e. after the year 2000. Section titles were (1) Health Consequences of ETS Exposure -- explaining that each year the known effects from ETS continues to increase. This exposure leads to increased risk for health problems like bronchitis etc.; (2) Breastfeeding and Smoking -- in this literature it is explained that there is a belief that breastfed infants of smoking mothers can have urinary cotinine levels 10 times higher than those of bottle fed infants of smoking mothers.; (3) Physiological Effects and Measures of Exposure to ETS -- this section sought out to confirm that children with ETS in closer proximity can and will often display more symptoms and issues than children not in this same environment. Infants whose mothers smoke close by and/or in an enclosed space with them, especially in a motor vehicle, experience higher levels of exposure, which are reflected by higher levels of cotinine in their urine; and (4) Intervention Research -- this section showed that akin to previous research done very little difference was seen between testing and controlled groups. Reference citations appeared concise and used appropriate APA style. Theoretical reasoning was included and similar studies were cited.

Findings

The results indicate that although 35 mother-infant pairs were recruited into the study, only 27 completed the study. Discrepancies in degree of freedom were due to missing data. There were no differences between the maternal intervention and control group in family income, age, marital status, years of education, or number of cigarettes smoked during pregnancy at week 2 & 5. Although there were no differences between the two groups in number of cigarettes smoked at any data point, women in both groups smoked twice as much at 2 & 5 weeks after delivery than during pregnancy. Nearly half of the mothers had a family income of less that $19,000 per year. The average mother was in her mid-twenties and had a high school education.

There were limitations in the study primarily having a small sample size. In addition, the data collectors were not blind to the group assignment. Lastly, members of the intervention group did not do everything they were suppose to do and there was little uniformity over how data was collected as well as problems with lack of adherence to the smoking hygiene intervention.

Comments -- The findings were objectively reported; in addition there do not appear to be any errors associated with this report. The researchers explain that there was very little difference between the two groups. In addition repeated-measures ANOVA indicated no significant difference for nicotine present in infant urine of the control and intervention groups. The research also shows in its findings that there was no significant difference associated with nicotine levels in the breast milk of the mothers in the control and intervention group.

Summary

There was a summary of everything from the introduction right through the hypothesis and procedures. Tables were included to support the documentation.

Conclusion

There was a conclusion included for the objective and the basis for that conclusion was stated. The conclusion was logically stated and related to the logic included.

Recommendations

As stated in the research article though the smoking hygiene intervention did not result in a reduction in levels of infant exposure to ETS, researchers should continue to explore ways to reduce this risk to infant health. Although it is difficult to change the behavior of an individual there may be other methods that prove useful in bringing about a change and effecting ETS in a positive manner. Another recommendation would be to increase the sample size, though it is obvious that results may have provided the same results; there could have been enough of a change in data to offer some insight to any aspects of the intervention method that may, by itself or enhanced prove beneficial in decreasing ETS.

It would have proven more beneficial to have more current data and research available to correlate with the hypothesis. It could have also been beneficial to introduce a group of children into the research whom do not have a smoking mother but perhaps other relatives, family members or care providers that smoke and if in fact this alone provided any shift in data. This will show that it is just as much ETS in environment as it is having a mother that smokes. The ultimate goal is to find a way to stop or at least at first decrease the amount of ETS that infants are having, in order to try to decrease the amount that is spent medically due to health issues and death.

A shift in hypothesis could also prove beneficial, considering the amount of literature used to support this research and all of the literature confirmed the same results already indicated leave room for pause and further thought. It would be useful to find or search for data that displays that there is an opportunity to gain a different outcome than those of previous and current data.

List of References

The format of the list of references was consistent with APA style and was from a variety of journals and books. The researchers utilized a majority of older sources i.e. before 2000.

Overall Critique of the Study

Strengths - One of the main strengths to this article is the structure behind it. All aspects are covered in one way or another. Supporting information is provided as well as a clear a concise testing method. Details were provided regarding the monetary effects that ETS has on the medical field, the theoretical framework was discussed and explained. The lit review discussed in short all aspect associated with the subject in question i.e. The consequences associates with ETS, The correlation between breastfeeding and smoking, what physiological effects ETS has and how they are measured, as well as research conducted regarding intervention. The research also clearly states the sample, what instrumentation was utilized i.e. demographic questionnaire, maternal smoking habits questionnaire, etc. The procedures were clearly explained as well as detailed regarding the smoking hygiene intervention and the intervention schedule. Tables were provided to give further support to the hypothesis, testing, and results of the research, which were pertinent and resourceful. Lastly, results were clearly indicated with accompanying tables to support findings in addition to documentation for the need for additional research to find ways of decreasing ETS. It is also important to mention that a strength to this research and article is the amount of available research to support the hypothesis and research.

Weaknesses - Though there is, a lengthy list of references utilized in this article there could have been more useful information provided from these sources. In addition, considering the fact of the redundancy of this research compared to the previous research it would have been an improvement to look at another alternative to decreasing ETS. Though the title of the research would lead one to believe that this will in fact be about ways to decrease ETS, this is not what is truly portrayed in the research in the beginning. The reader is given information as to how much money ETS is costing medically due to health issues and infant related deaths, but very little discusses the impact that breast feeding has. It appears in the beginning that the researchers want to prove that children should be breastfeed and that mothers should not smoke because the infants that are breastfed are protected from the health problems associated with ETS. However little information is given neither in the intro nor in the review of literature to show what impact there really is for a child that is breastfed by a mother that does not smoke, in relationship to ETS from second hand sources i.e. cars, malls etc. Another weakness, which I have already discussed several times through this critique, is the sample size. This was a rather small sample and the ways in which the control and test group were handled may not have been the best methods possible. Ultimately, this research left me wondering why one would want to conduct research to confirm the already obvious, while offering no additional information to the resolution or problem at hand.

Reference

Flanders-Stepans, M., Wilhelm, S.L., & Dolence, K. (2006). Smoking Hygiene: Reducing Infant Exposure to Tobacco. Biological research for Nursing, 8(2), 104-114.