SNM660 Evidence Based Practice

Introduction:

Smoking is the most fatal use of tobacco and is responsible for more than 5 million deaths across the globe (Sela, 2013, p. 379; US Department of Health and Human Services, 2010). Estimates by the World Health Organization show that approximately 50% of smokers are bound to die prematurely due to their persistent smoking habits (WHO, 2011). Smoking is attributed to numerous health disorders both fatal and non-fatal and these include: peripheral vascular disease, muscular degeneration, asthma attacks, vascular dementia, cardiovascular disease, COPD, leukemia, stomach cancer, lung cancer, and cancer of the larynx (Dept of Health, 2010). Estimates also show that 20% of the world's population are smokers with 80% of tobacco related mortalities occurring in middle and low income nations (Binal, Rajesh, and Ahmed, 2013, p.2811; Jayakrishnan and Mathews, 2013, p. 2891).

Studies have shown that smoking initiation is as a result of various influencing factors. Some f these influence include those are based on favorite movie stars (Titus-Ernstoff, Dalton, and Adachi-Mejia et al., 2008, p. 15) parents that smoke (Scherrer, Xian, and Pan, 2012, p. 240), culture hookah-smoking (Reveles, Segri, and Botelh, 2013, p. 583) peer pressure (Harakeh and Volleberg, 2012, p. 220) environmental and genetic factors (Lawrence, Fagan, and Backinger et al., 2007, p. 687). Smoking among relatives, siblings, friends, and parent-teen conflicts, are smoking stages predictors that can be addressed through monitoring and discussion held by parents and the family with their children (Jeganathan, Hairi, and Al Sadat, et al., 2013, p.3483). An understanding of all factors that cause smoking initiation and the barriers to cessation is necessary for the development of an ‘impactful customized interventions to decrease burden of smoking' (Binal et al., 2013).

Smoking cessation can include influencing the smoker's behavior through regular counseling and via different channels of mass media; limiting family members' smoking influence as well as influence from smoking role models and tobacco industry; through empowerment, coercion, and education; and through promotion of rehabilitation in drug addiction centers (Dept of Health, 2010).  The goal if this study was  assessing the factors that influence the uptake and the current habits of smoking amongst 2016/2017 health studies students at the University of ... as well as exploring the different incentives that would promote smoking cessation.

Literature Review

According to the PHE report released in 2016, the number of persons that smoke in England has dropped to its lowest in the past 50 year history. Currently every 1 in6 adults (aged 16 and above) still smokes according to the report which also indicates a decline in cigarette sales. The health experts at PHE revealed that 16.9% of adults smoke which is a 2.4% drop from the 2012 statistics which stood at 19.3% (HSCIS, 2016). In addition, PHE also stated that in 2015, 500,00 people quit smoking due to an increase in use of nicotine gum and patches, as well as utilization of e-cigarettes. This was the highest number of persons to quit smoking in a given year. Over 50% of the male population in Britain were smokers in 1974 and the numbers have fallen to 19.1% in 2015. Similarly, in 1974, 40% of the female population were smokers while the numbers stand at 14.9% in 2015 (HSCIC, 2016).

7.2 million people (adults) smoke and while this numbers surpassed by the 14,6 million former smokers , it is the first time that smokers are less than 17% of England's population d which has declined from the 2012 statistics of 19.3% (HSCIC, 2016). Health campaigners stated that the steady decline of number of persons that quit smoking or are not initiated into smoking is due to specific measures that have been taken including rise in prices of cigarette packs, plain packaging of cigarettes, as well as continues and effective mass media campaigns that encourage smokes to quit (HSCIC, 2016).

However, doctors have stated that approximately 200 people succumb to premature deaths on a daily basis in England (Campbell, 2016). The premature deaths are as a result of breathing complications, strokes, and heart attacks caused by smoking.  The doctors have warned that  the current statistics on smokers is still alarmingly high and have stated that smoking along with unhealthy diet are the leading cause of premature and preventable deaths. Persons who quit stand to breathe easier, have better circulation, and reduce their blood pressure (Campbell, 2016).

The development of smoking habits among the youth is a process that is dynamic where the youth gradually progress from early experiences of cigarette trials, proceeds to intermittent use before becoming a regular user and tobacco dependant. Gaining an understanding of factors that can interfere with this trajectory progression or potentiate the smoking habit is critical in the intervention of smoking behavior. More importantly, the factors that play a role in influencing the early trial of smoking by youth may be different from those factors that influence their continued use and eventual dependence (Bernat, Erickson, and Widome, et al., 2008, p. 334).

Modern smoking development conceptualizations emphasize a perspective that is social- ecological which considers the environmental and social context in a broader sense in which youth use tobacco (Wen et al. 2009, p. 671; Ennett et al., 2010, p. 950). This socio-ecological perspective accedes that youth as well as young adults are not in isolated existence. Rather, this population group inhabits a complex and layered environmental and social contextual system where they socialize, learn, and carry out their day-to-day activities (Brook, Duan, and Brook et al., 2007, p. 450).

Theoretical models that encompass the different levels of environmental, socio-contextual, and neurobiological influence can be termed as biopychosocial-ecological integrated models (Sussman and Ames, 2008).  The interpersonal predictors in use of tobacco are nested, according to these models, within larger environmental and social structures. An example would be an individual's function of neurobiological variables  within a cognitive-related responses complex set and, conversely, operates within a small social group with regard to larger context  (for example peer groups,  families), which in turn operate within an even larger environmental and social context (for example neighborhoods, schools). The environmental large scale factors could either be physical or social (for example mass media communication, accessibility of tobacco products by youth), while small scale environmental factors could be social groups of which the youth are affiliated. Intrapersonal factors (for example brain structure and systems, genetics, and cognitive processes) could be based on cognitive psychological or biological variables (National Center for Chronic Disease Prevention and Health Promotion, 2012,).

These two types of predictors, intrapersonal and environmental, may have an effect on each other. For example, an individual that lacks self control with regard to neurotransmission imbalance (this is a neurobiological intrapersonal variable) and intends to become a cigarette smoker in the future (a cognitive intrapersonal variable) can be best discouraged to smoke in non-smoking peer groups in worksites where there is prohibition of smoking. In this example, two environmental variables would come into play and these are: physical (prohibition of smoking in non-smoking area) and social (small group). Multilevel techniques of modeling are utilized in examining how factors such as communities, schools, peer groups, and families interact together to influence the outcome of youth tobacco use. (NCCDPHP, 2012).

Materials and Methods

The study was conducted on DATES for a period of 1 month at the University of..... Faculty of Heath Studies. The 2nd year students were considered in the sampling frame. The inclusion criteria comprised of students in 2nd year, current smokers of tobacco products, and reported smoking occasionally or daily (CDC, 2012) and who were willing and ready to assent or give informed consent (along with consent from their parents for individuals below 18 years of age) for the study.

Participant recruitment was done on convenient sampling basis. The study investigators approached the students at the Faculty of Heath Studies on convenient basis and those who were found to be eligible for the study were offered an invitation to participate once the purpose of the study was explained to them.

The investigators repeated this procedure among all the 2nd year students in the faculty. The questionnaire was administered to the willing participants and this was done in a separate room so that confidentiality of the participants could be maintained. Participants' anonymity was also maintained by assigning different codes on the questionnaires. Individuals that were in the exclusion criteria were those that were involved in any other study, those unwilling to participate, those having physical or any other challenges. The study was approved by the University's research study ethics committee.  

Data collection

A sample questionnaire was first validated and modified before it was finally administered to the participants. The WHO ASSIST was modified contextually and utilized in this study. The WHO ASSIST is a validated, reliable, feasible, comprehensive, flexible, and cross-cultural tool that was linked to the study. The variables included in the questionnaire covered social demographics, smoking habits, smoking initiation and cessation, and expenditure (Humeniuk, Henry-Edwards, and Ali, 2010; Kumar, N Gupta, J Kishore., 2012).

Information was collected based on the following variables: (a) socio-demographic variables  (gender, age,) (Kumar et al., 2012); (b) current smoking habits (tobacco substance used,  time of initiation, time of cessation, reducing smoking, effect of smoking habit on the financial status of the participant); (c) smoking initiation (what triggered initiation into smoking); (d) financial expenditure on tobacco products (e) tobacco smoking cessation (intention to quit smoking); and (f) incentives (different motivations and incentives that would influence smoking cessation). The questionnaire also included open ended question on what the participant viewed as other people's opinion about their smoking.  

Data Analysis

A quantitative descriptive analysis was done to report using univariate statistics standard deviations and means for the variables that were continuous and frequency distribution for the variables that were categorical. T-statistics was also performed for the comparison of the continuous variables differences and performance of chi-square analysis was done for the comparison of categorical variables analyses. Responses' analysis with regard to the open questions was done though extraction of common themes in the different categories after manual textual data coding. An analysis was done using SPSSv.16.

Results

The total number of participants was 11 and comprised of X males and Y females. All participants were aged between X-Y years residing in the city, from nuclear families. All participants were 2nd year students at the Faculty of Health Studies.

The average age of smoking initiation of the participants was 15 years (SD = 5). Approximately 45% (45 of the 11)of the participants smoke on a daily basis. 40% of the smokers experienced daily strong urges to smoke. All participants that smoke reported to have been initiated into smoking through peer pressure (60%) or family members that smoke (40%).

Most participants (80%) had attempted to quit smoking but had been unsuccessful.  60% of the participants that smoke would like to quit smoking due to the financial expenses of cigarettes.

Discussion and Recommendations

World Health Organization estimates for tobacco abuse increase stand at more than 1.5 million by the year 2020. (WHO, 2011). The primary objective of this study was to assess the  reasons behind smoking initiation among University students , barriers to smoking cessation, as well as explore the various incentives that would lead/promote/motivate smoking cessation in the said study group. The mean age of smoking initiation among the participants that smoke was 15 years (SD = 5). Age is significant determinant in the determination of future smoking habits of an individual. This points to the need to have early interventions for school going children so as to reduce incidences of future tobacco addiction among youth (Narain, Sardana, and Gupta 2011, p. 300; Al-Naggar, Jawad, and Bobryshev.  2012, p. 5539). The tobacco related risks increase exponentially among individuals who start smoking at an early age (Hendlin, Anderson, and Glantz, 2010, p 213)

Peer pressure and family were cited as the most common reasons behind smoking initiation. Literature shows that these factors are the main causants of smoking initiation among adolescents (Bhojani, Chander, and Devadasan, 2009, p. 294). These findings are an indication of the significant role that pressure and surrounding influence play and yet the two variables are an inevitable part of daily life. Targeted stress and peer education, as well as identification of strong influences, are strategies worth exploring with the aim of encouraging smoking cessation.

Family guidance and counselling should be channels that need to be explored. In addition, the University can work at promoting healthier living through campaigns and programs organized internally and which involve the larger neighbouring community. The close proximity of tobacco selling points to the University should be discouraged through petitioning by the University to local and Federal government representatives (Chan and Leatherdale, 2011).  

Approximately 18% of the participants had made attempts to quit smoking and were successful while 60% still had the intention to quit. Previous studies have shown that persons that intend to quit form 10%-88% of the smoking population (Farrelly, Davis, and Duke et al., 2009, p. 42). However, the failure rate of quitting is very high and can be attributed to various factors such as socioeconomic status, behaviour, health education, as well as work and environment culture. Unawareness on the available and effective ways of smoking cessation makes it difficult for persons wishing to quit to be successful in their endeavours. In addition, not knowing who to approach in order to imitate cessation is another reason for the higher failure rate (Eaton, Kann, and Kinchen, et al., 2010)

Urgent attention should be given to the establishment and public sensitization of the role of rehabilitation centers both at the local and national levels. Most of the participants were not aware of the existence of tobacco rehab centers that are located in the state. Public awareness of such centers should be a concerted effort between the healthcare fraternity, mass media, and other stakeholders.

Health promotion programs should also be availed at regular basis and should commence in early stage schools. By educating young children on the dangers of smoking, healthcare partners and other stakeholders including those in the government and education centers, will ensure a healthier future generation. ( Volpp, Troxel, and Pauly, et al., 2009, p. 699).

Limitations

The study had a number of limitations the first of which was the sample size. The number of participants was too small in comparison to the entire student population at the university. The second limitation is the sample collection area was limited to the University and hence interpretation of results with respect to the local community and State are open to interpretation. Since it was a University based study, results extrapolation to the wider current smokers' population may not be possible.

Conclusion:

Universities and other learning institutions may offer an effective platform for the delivery of targeted strategies that aim at discouraging smoking initiation and encourage cessation of smoking among the youth. Such targeted strategies should include regular health promotion programs, incentives, family and community interventions, and awareness of the existence of rehabilitation centers. In addition to these worthwhile causes, national guidelines should be reviewed in order to evaluate and regulate the availability of tobacco products sold in close proximity to children learning centers, neighbourhoods, and other areas where youth can access them easily.

References:

Al-Naggar, RA; Jawad, AA; Bobryshev, YV.2012. Prevalence of cigarette smoking and associated factors among secondary school teachers in Malaysia. Asian Pacific Journal of Cancer Prevention. 13:5539–43.

Bernat DH, Erickson DJ, Widome R, Perry CL, Forster JL. 2008. Adolescent smoking trajectories: results from a population-based cohort study. Journal of Adolescent Health. 43(4):334–40

Bhojani, UM; Chander, SJ;  Devadasan, N. 2009.  Tobacco use and related factors among pre-university students in a college in Bangalore, India. The National Medical Journal of India.22(9):294– 97 http://imsear.hellis.org/bitstream/123456789/139083/1/nmji2009v22n6p294.pdf (Accessed Mar 2017) 

Binnal, A; Rajesh, G; Ahmed, J et al. 2013.  Insights into smoking and its cessation among current smokers in India. Asian Pacific Journal of Cancer Prevention. 14(5):2811–18. 

Brook JS, Duan T, Brook DW, Ning Y. 2007. Pathways to nicotine dependence in African American and Puerto Rican young adults. American Journal on Addictions. 6(6):450–6.

Campbell, D, 2016. Number of smokers in England drops to all-time low. The Guardian Newspaper. Retrieved on 12 April 2017. https://www.theguardian.com/society/2016/sep/20/number-of-uk-smokers-falls-to-lowest-level

Centre for Disease Control and Prevention (CDC) 2012.  Smoking and Tobacco Use. Adult Cigarette Smoking in the United States: Current Estimate http://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/ (Accessed Mar. 2017)

Eaton DK, Kann L, Kinchen S, Shanklin S, Ross J, Hawkins J, Harris WA, Lowry R, McManus T, Chyen D, et al. 2010. Youth risk behavior surveillance—United States, 2009. Morbidity and Mortality Weekly Report. 59(SS-5):1–142

Ennett ST, Foshee VA, Bauman KE, Hussong A, Faris R, Hipp JR, Cai L. 2010. A social contextual analysis of youth cigarette smoking development. Nicotine & Tobacco Research. 2010;12(9):950–62.

Farrelly MC, Davis KC, Duke J, Messeri P. 2009. Sustaining ‘truth’: changes in youth tobacco attitudes and smoking intentions after 3 years of a national antismoking campaign. Health Education Research. 24(1):42–8

Harakeh, Z; Vollebergh, WA.2012.  The impact of active and passive peer influence on young adult smoking: An experimental study. Drug and alcohol dependence.121(3):220–223. 

Hendlin Y, Anderson SJ, Glantz SA. ‘2010. Acceptable rebellion’: marketing hipster aesthetics to sell Camel cigarettes in the US. Tobacco Control. 19(3):213–22.

Humeniuk, R; Henry-Edwards, S; Ali, R 2010. The Alcohol, Smoking and Substance involvement Screening Test (ASSIST): manual for use in primary Care.  http://whqlibdoc.who.int/publications/2010/9789241599382_eng.pdf. (Accessed Mar. 2017)

Jayakrishnan, R; Mathew, A; Uutela, A et al. 2013. Multiple approaches and participation rate for a community based smoking cessation intervention trial in rural Kerala, India. Asian Pacific Journal of Cancer Prevention. 14(5):2891–96.

Jeganathan, PD; Hairi, H N; Al Sadat, et al. 2013.  Smoking Stage Relations to Peer, School and Parental Factors among Secondary School Students in Kinta, Perak. Asian Pacific Journal of Cancer Prevention. 14(6):3483–89. 

Kumar, Gupta, and Kishore.2012.  Kuppuswamy’s socioeconomic scale: updating income ranges for the year 2012. Indian Journal of Public Health; 56

Lawrence D, Fagan P, Backinger CL, Gibson JT, Hartman A. 2007.  Cigarette smoking patterns among young adults aged 18–24 years in the United States. Nicotine Tob Res. 9(6):687–697.[PubMed]

Leatherdale ST. 2011.Tobacco retailer density surrounding schools and youth smoking behaviour: a multi-level analysis. Tobacco Induced Diseases. 9(1):9

Narain, R; Sardana, S, Gupta, S. 2011. Age at initiation & prevalence of tobacco use among school children in Noida, India: A cross-sectional questionnaire based survey. Indian Journal of Medical Research. 33(3):300–07

National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. 2012. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); Social, Environmental, Cognitive, and Genetic Influences on the Use of Tobacco Among Youth. 

HSCIC:PHE Report, 2016. Statistics on smoking, England 2016. http://www.hscic.gov.uk/pubs/smoking16

Reveles, CC; Segri, NJ; Botelho, C.2013.  Factors associated with hookah use initiation among adolescents. Jornal de pediatria. 89(6):583–587

Scherrer, JF; Xian, H;  Pan, H. 2012.  Parent, sibling and peer influences on smoking initiation, regular smoking and nicotine dependence. Results from a genetically informative design. Addictive Behaviours. 240–47. 

Sela, BA 2013. Time for setting a good example: physicians, quit smoking now. Editorial. Israeli Medical Association Journal. 15:379–81.http://www.ima.org.il/FilesUpload/IMAJ/0/60/30260.pdf (Accessed 15 Sep. 2014) [PubMed]

Sichletidis, LT; Chloros, DA; Tsiotsios, AI. 2009.  Prevalence and risk factors for initiation of smoking in Greek high-school students. International Journal of Environmental Research and Public Health. 6(3):971–79. 

Sussman S, Ames SL.2008.  Drug Abuse: Concepts, Prevention, and Cessation. New York: Cambridge University Press.

Titus-Ernstoff L, Dalton MA, Adachi-Mejia AM, Longacre MR, Beach ML. 2008. Longitudinal study of viewing smoking in movies and initiation of smoking by children. Pediatrics. 121(1):15–21.

U.S. Department of Health and Human Services. 2010. Ending the Tobacco Epidemic: A Tobacco Control Strategic Action Plan for the US Department of Health and Human Services. Washington: Office of the Assistant Secretary for Health.

Volpp, KG; Troxel, AB; Pauly, MV et al. 2009. A randomized, controlled trial of financial incentives for smoking cessation. New England Journal of Medicine. 360(7):699–709.

World Health Organization. 2011. WHO Report on the Global Tobacco Epidemic, 2011: Warning About the Dangers of Tobacco. Geneva (Switzerland): World Health Organization.

Part B

Critical Analysis of the Research Study

The Title of the paper is Factors that influence smoking among 2nd Year Health Studies Students. The aim of the study was to assess the factors that influence the uptake and the current habits of smoking amongst 2016/2017 health studies students at the University of....  A sample of current smokers in the 2nd year students from the Faculty of Health Studies were enrolled. The title is relevant as it explains to the reader what the research study is all about and what to expect

Introduction and Literature Review.

The paper begins with a brief introduction on the prevalence of cigarette smoking within a global context. A list of some of the diseases attributed to behavioral smoking is also stated. The purpose of this first part of the introduction is to create a clear description on why smoking is a habit that needs to be discarded. The list of diseases strengthens the argument on why smoking cessation among the youth is an issue that needs to be pursued relentlessly.

The remainder of the introduction part highlights on what causes persons to adopt a tobacco smoking habit. This information is important as it points out the areas that policy makers need to focus on when it comes to creating anti-smoking campaigns. Suggested support channels for smokers who want to discontinue the habit have also been described in this section.

In the Literature Review, a description of how development of smoking habits among the youth progresses is given. This description offers an understanding on how and why that appears to be seemingly harmless (such as watching movies that have actors that smoke) but can have a lasting impact on a young child.

The current theoretical models that seek to explain the uptake of smoking habits and the continued pursuance of the same mainly focus on neurobiological, socio-contextual, and environmental factors. This explains the different reasons why a young person may be pre-disposed to smoking (genetic) even when the environment he/she is put in is basically a non-smoking one. Other than the pre-existing biological conditions, a person can adopt a habit of smoking because of external environment that glorifies smoking. This is the case with smoking initiation among youth that results from peer pressure or from observing close family members that are smokers. In such incidences, despite the youth being aware of the downside of tobacco smoking, he/she chooses to smoke either from compulsion or from  a skewed admiration of smokers.

The aim of the study is very clear and the preceding literature gives weight to the need for the study to be conducted.  By highlighting the reasons why youth may take up smoking (as defined by the as biopychosocial-ecological integrated models) the investigators were able to formulate a questionnaire that would gather the appropriate information for the study analysis.

Materials and Methods

The research aimed at finding out the factors that influence uptake of cigarette smoking and as such , the best suited method of collecting data would be through direct approach to potential participants. The investigators opted to use questionnaires to collect information from 2nd Year Health Studies students.

Design

Quantitative design was used in this research study. Quantitative methods put an emphasis on the objective measurements as well as numerical, mathematical, or statistical data analysis collected through surveys, questionnaires, polls, or through the manipulation of pre-existing data by utilizing computational techniques. The focus of quantitative research is on numerical data gathering and generalizing the same data over a given population or for the explanation of a specific phenomenon (Babbie, 2010).

The aim of conducting a quantitative research study is determining the relationship that exists between one subject which is the independent variable, with another that is the outcome or dependent variable within the study. The design of a quantitative research can either be descriptive where the subject is measured only once, or experimental where measurement of the subjects is done prior to and after treatment. A descriptive study aims at establishing association between given variables while establishment of causality is achieved through experimental quantitative (Mujis, 2010)

Descriptive Quantitative design was appropriate for the study as the researchers sought to collect numerical data to establish a relationship between independent variables and the 2nd Year Health Studies characteristics with regard to their smoking habits.

Sample

Sampling of participants was done through convenient sampling. The participants were approached and requested if they would like to take part in the study. Those that were willing were given questionnaires to fill.  This method of sampling was not the best to use as most persons that were approached tended to decline the offer.  The reason could have been because smoking is a social habit that is often looked down on. This happens because of the numerous negative health outcomes related to smoking both to the smoker and to other non-smokers who can be affected by secondary smoke. That being the case, most students prefer to smoke in a private place where they do not have to be under a scrutinizing and judgmental eye.

The researcher assumed this to be the case because smoking remains to be the  No. 1 causation of preventable death in the  US (CDC, 2014) and has continued to top the list for decades. Smoking kills more people than  traffic accidents,  firearms, infectious disease, substance abuse, and  obesity (CDC, 2014).  Every year, more than 443,000 Americans succumb to smoking-related illnesses (Christensen, 2015).

A better approach at collecting data would have been offering a minimal compensation to all persons that willingly participated. For example , the investigators could have offered a free service/product/ or monetary compensation for participants.

Data Collection

Data collection was done by administering questionnaires to 2nd year Health Studies students. The questionnaire was structured to cover the key areas that the study sought to analyse. A sample questionnaire was first validated and modified before it was finally administered to the participants. The WHO ASSIST was modified contextually and utilized in this study. The WHO ASSIST is a validated, reliable, feasible, comprehensive, flexible, and cross-cultural tool that was linked to the study (Humeniuk, Henry-Edwards, and Ali, 2010; Kumar, N Gupta, J Kishore., 2012).

With regard to confidentiality, participants that opted to fill the questionnaires did so in a different location from where the questionnaires were being administered. In addition, the privacy of the participants was guaranteed by using codes on the questionnaire in place of the participants' names.

Data Analysis

Reporting was done using univariate statistics standard deviations and means for the variables that were continuous and frequency distribution for the variables that were categorical. T-statistics was also performed for the comparison of the continuous variables differences and performance of chi-square analysis was done for the comparison of categorical variables analyses. Responses' analysis with regard to the open questions was done though extraction of common themes in the different categories after manual textual data coding. An analysis was done using SPSSv.16.

The results that were stated include: the average age of smoking initiation of the participants; the main reasons for initiation into smoking; average number of cigarette sticks smoked/day by the heavy smokers; the participants' preferred smoking environment; reasons for smoking initiation; incentives for cessation; and accessibility of tobacco products. These results were appropriate and answered the research questions.

Ethics

Ethical considerations when conducting research are very critical. Ethics can be defined as the standards or norms for conduct that allow for the distinguishing of what is good and right from what is not. Ethics help in determining what comprises behavior that is acceptable and one that is not (Grady, 2010, p. 1122).  Ethical considerations are important for a number of reasons. For starters, ethical standards prevent data falsification or fabrication and hence, they promote truth and knowledge pursuit which is the research's primary goal. Secondly, ethical behavior plays an important role in work collaboration as it encourages accountability, mutual respect, and trust environment amongst researchers. This is most apparent with regard to issues related to co-authorship, data sharing, confidentiality, copyright guidelines, among several other issues. (Dich, McKee, and Porter, 2013) 

Researchers are expected to abide by ethical regulations and standards so as to gain the support, trust, and respect of the public with regard to their research studies. The public needs assurance that the appropriate guidelines have been followed and these include animal welfare, human rights, law and regulations compliance, safety, conflict of interest, health standards, and several other aspects. The manner in which ethical issues are handled goes a long way in impacting the research project's integrity and can affect the decision on whether the project will get funding or not (Mazur, 2007) 

The research study was ethical and the investigators received permission from the University's ethics committee to proceed with it. The ethics checklist was filled duly.

Discussion

The literature reviews and the results of the study are in harmony. The literature pointed out that most youth start smoking due to neurobiological and social impacts. The participants in the study reported that smoking initiation was due to peer pressure and also because there were family member(s) who were also smokers and who influenced them to do the same.  In addition, the literature points out that the development of smoking habits among the youth is a process that is dynamic where the youth gradually progress from early experiences of cigarette trials, proceeds to intermittent use before becoming a regular user and tobacco dependant. Gaining an understanding of factors that can interfere with this trajectory progression or potentiate the smoking habit is critical in the intervention of smoking behavior.

The participants had cited their attempts to quit smoking with no success. The average smoking initiation age among the participants was 15 years. If intervention had taken place at the earliest stage of initiation, then smoking cessation would have been more possible. By understanding the trajectory projection, mediators would have been introduced early enough and the participants would most likely have quit smoking before becoming addicted to tobacco.

In the field of healthcare, Evidence-based practice (EBP) describes the process through which a researcher combines interventions that are well researched with ethics and clinical experiences; culture; and client preferences, to inform and guide the delivery of services and treatments (Mullen, Bledsoe, and Bellamy, 2008) The researcher, practitioner, and client, need to work in collaboration so as to identify what works best and in what conditions. By so doing, the services and treatments when utilized as intended, will result in outcomes that are highly effective as the research demonstrates. It also ensures that successfully proven programs will be disseminated more broadly and that they will benefit larger populations (Mullen et al., 2008)

Evidence Based Practice (EBP) can thus be described as the utilization of decision-making systematic service provision or processes which have been validated, through scientific evidence, to improve measurable outcomes for clients, in a consistent manner.  Rather than using single observations, gut instincts, or tradition as a decision-making basis, EBP is reliant on viable data gathered from experimental accounts and research for clinician expertise as well as individual client characteristics EBP is tri-pronged that takes into consideration: the individual expertise of the practitioner, expectations and values of the client, and also best evidence (Nichols, 2016).

The current study that was conducted was based on evidence that the investigators collected from willing participants. Participants were informed of their rights as well as the purpose of the study. They were also informed on the necessity to answer all questions truthfully and in an unbiased manner. The information collected through the questionnaires offered viable data that was used in extrapolating the recommendation given by the investigators.

In addition, the literature used by the investigators was reliable as it was extracted from peer-reviewed articles and journals. The works cited in the paper is all from recognized institutions and documented research work. Thus, the results, discussion, and recommendations made in the current study were based on the findings of the study as well as other relevant research studies that underpinned it. Therefore, findings in the current study can be used in informing policy makers and other stakeholder's decision making processes.

References:

Babbie, Earl R. 2010.The Practice of Social Research. 12th ed. Belmont, CA: Wadsworth Cengage.

CDC 2014. Mortality Data. Nat. Center for Health Stats. https://www.cdc.gov/nchs/nvss/deaths.htm

Christensen, J. 2015. We know it can kill us: Why people still smoke. CNN Health Edition. http://edition.cnn.com/2014/01/11/health/still-smoking/

Dich, L., McKee, H. A., & Porter, J. E. 2013. Ethical Issues in Online Course Design: Negotiating Identity, Privacy, and Ownership. Selected Papers of Internet Research, 3.

Grady, C. 2010. Do IRBs protect human research participants?. JAMA: The Journal of the American Medical Association, 304(10), 1122-1123.

Humeniuk, R; Henry-Edwards, S; Ali, R 2010. The Alcohol, Smoking and Substance involvement Screening Test (ASSIST): manual for use in primary Care.  http://whqlibdoc.who.int/publications/2010/9789241599382_eng.pdf. (Accessed Mar. 2017)

Kumar, Gupta, and Kishore.2012.  Kuppuswamy’s socioeconomic scale: updating income ranges for the year 2012. Indian Journal of Public Health; 56

Mazur, D. J. 2007. Evaluating the science and ethics of research on humans: a guide for IRB members.

Muijs, Daniel. 2010. Doing Quantitative Research in Education with SPSS. 2nd edition. London: SAGE Publications

Mullen, E.J., Bledsoe, S.E., & Bellamy, J.L. 2008. Implementing Evidence-Based Social Work Practice. Research on Social Work Practice, 18, 325-338.

Nichols, D.  2016. Evidence Based Research for Social Work. University of Michigan Research Guides Library. http://guides.lib.umich.edu/EBP-Research