The Uk Smoking Problem Health And Social Care Essay

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The aim of this writing is to critically evaluate and compare and contrast the research strategies, designs and methods, as well as their importance used in MILCH, E. Catherine et al (2004). Smoking cessation in primary care: a clinical effectiveness trial of two simple interventions published in Preventive Medicine Vol. 38, pp. 284 - 294 and COLEMAN Tim, CHEATER Francine and MURPHY Elizabeth (2004). Qualitative study investigating the process of giving anti-smoking advice in general practice published in Patient Education and Counseling, Vol. 52, pp. 159 - 163. At the very beginning of this piece, it should be made clear, that main focal point is to assess research methodologies and methods applied in this two journal articles, along with their appropriateness for addressing the chosen research questions. Additionally, attention will be paid to motivation literature and issues of sampling, reliability and validity.

First, a summary of the findings of this paper will be provided. Then, the research design of each journal article will be discussed in turn. Finally, conclusions will be drawn in order to satisfy the aims of this paper.


Through the world smoking presents a public health problem. In UK, as well as in USA smoking is one of the leading causes of death [1] and is responsible for extremely high health care costs. Although, in both countries there are numerous anti-smoking champagnes, in USA nearly one-quarter of adult Americans smoke [2] and in UK about the same percentage of adults declares themselves as smokers [3]. Coleman et al., as well as Milch et al. suggest that around 70 % of smokers see their general practitioner (GP) at least once a year. Numerous studies (Ockene 1987, Glynn 1988, Manley, Epps and Glynn 1992 and Silagy and Ketteridge 1999) show that smokers perceive practitioners' advice to quit as strong motivation for cessation. Both studies stress that, unfortunately GP often fail to provide their patients with cessation advice either to avoid confrontation with patients or they do not possess a range of skills for smoker cessation counselling. For this reasons Coleman, Cheater and Murphy wrote this paper exploring process of giving anti-smoking advices in general practice, one of a few which they based on same data. Realizing the importance of systematic protocols for identification of patients who smoke, Milch et al. set up clinical effectiveness trial to evaluate effectiveness of two simple interventions (vital sign stamp and smoking assessment questionnaire) on smoking cessation in primary care.

Your overall impression??????



The paper „Qualitative study investigating the process of giving anti-smoking advice in general practice" posits an interesting connection between (1) GP; (2) their repertoire of techniques for dealing with smokers who were not motivated to stop and (3) factors that influence the process of giving anti-smoking advices. Previous study conducted by same authors „ Factors influencing discussion about anti smoking between general practitioners and patients who smoke: a qualitative study" British Journal of General Practitioners 2000; Vol. 50, pp. 207 - 210 suggests that GPs usually expect negative reaction from patients to whom they give anti smoking advice. Moreover, GPs perceive relationship between doctor and patient as poor. For all this reasons, they were less likely to talk about smoking with patients and they cautiously choose with which patients to discuss it. The paper aims to gain insight into GP behaviour in relation to anti-smoking counselling and construct hypothesis and recommendations how this process could be improved in future. This was at the time of great importance as new smoking cessation services were adopted in UK that proposed training of health professionals in anti smoking methods. Therefore, efficient training course for GPs should include findings from current clinical practice. Though, significant for contributing to GPs practice, it must be mentioned that previous papers of this authors based on the same data and dealing with very similar questions compromise the originality of this piece of writing. Additionally, number of assumptions that sparked off this paper is based on data produced by the same group of authors which might suggest that researcher bias exists to some extent.

It is always useful to include other research papers reducing researcher bias


This paper is important because it makes a contribution to knowledge how GP start anti smoking discussion, what is content of their messages and what approach GP adopt. Coleman, Cheater and Murphy suggest that GPs take great care how to raise question of smoking. Two ways are prevailing; approximately half of the GPs interviewed say that they use several different methods to start conversation and observe patients reaction and other half use `humour or "low key" approaches to induce the topic in a non-threatening manner` Coleman, Cheater and Murphy (2004, p. 161). Additionally, general practitioners admitted that they lack adequate methods and skills for assessing smokers` motivation to quit. Body language, posture and eye contact were one of very important motivation indicators. If patients stated that they are in the middle of quitting or are "cutting down" on cigarettes they were considered as motivated. The one failing to stop, despite several talks with GPs, was considered as unmotivated. Once successfully initiating the conversation, general practitioners focused on transmitting the message about health and economic benefits of stopping smoking, as well as raising awareness about smoking and contradictory health condition i.e. hypertension or contradictory treatment i.e. contraceptive pill. More or less three quarters of general practitioners said that they prefer using non-confrontational approaches, which they described as "non-didactic", "low-key", "encouraging", over confrontational, "getting across" and "shouting" approaches. Despite their preference, around half of GPs admit that they use confrontational approach. Small number even admitted frightening patients; especially those who suffer smoking caused illnesses.


Outcomes of this research suggest that general practitioners need broader spectrum of strategies and methods for giving anti smoking advices. In addition to this, two new field of study need to be further explored: use of confrontation and frightening as driver for behaviour change and ways of assessing patients' motivation by GPs. Lack of GPs` competences and methods for giving anti smoking advices suggests that paper has implications for NHS smoking cessation services, Department of Health in UK in 2004, the year it was published.


The motivation of authors is clear. Realizing how crucial are general practitioners in smoking cessation process they set out to discover to what extent are GPs are skilled and how developed are their methods for giving anti smoking advices. At the time being this issue vas very contemporary, as UK government proposed training in smoking cessation methods and to know from where improvements should start determining current clinical practice was crucial.


Paper `Smoking cessation in primary care: a clinical effectiveness trial of two simple interventions` presents relationship between (1) vital sign stamp, (2) smoking assessment questionnaire (SAQ) and (3) their effect on smoking cessation. As previously mentioned, clinicians often are unsuccessful in accessing tobacco use or in delivering anti-smoking advices. This leads us to conclude that there is need for practical, time and cost effective smoking cessation intervention. Milch et al. successfully confirm their initial hypothesis that these two uncomplicated interventions improve indentifying smokers and prompt anti smoking advices. Greatest strength of this study lies in the fact that it `was designed to resemble real-world practice` Milch et al. (2004, pp. 293), it requires minimal training, no extra clinicians and recommends improvements for GPs` practice. However, it should not be overlooked that a few initial assumptions are based on rather old literature, such as Ockene, JK. (1987), Glynn, TJ. (1988), etc. Collis and Hussey (2009) suggest that a danger exists when a piece is relying on old data, because it has little relevance to modern practice and that further use of this data can be `incidental and opportunistic`.


Key findings imply that interventions used positively affected screening for smoking and did not have any `dramatic effect on clinicians providing cessation advice` Milch et al. (2004, pp. 290). Both interventions increased rated of anti smoking advices by primary care practitioners (PCP) 47% on the stamp group and 52% on the SAQ group in comparison to 33% on control group. It is interesting that smoking cessation rate was the highest on the SAQ group - 30%, than on the stamp group - 4% and control group - 11%. Why smoking cessation rate was higher than the stamp group rate demands further exploration. Last but not the least, high segment of patients in the intervention teams stated that they reduced the number of cigarettes, greater than before motivation, confidence about stopping to smoke, thinking of quitting and awareness of health risks. Although, a few initial assumptions are based on old articles and the research showed that smoking cessation rate was higher in the control group than in the stamp group, it must be admitted that this research has implication to GPs practice.


The most significant outcome of Milch et al. article (2004) is the confirmation of hypothesis that two simple interventions used will improve identification of smokers and induce smoking cessation advices. In addition to this, this research has implication for general practitioners` practice as methods analysed here are uncomplicated, easy to learn, time and cost effective.


Motivation of authors of this research is very clear. Additionally, it is similar to motivation of Coleman, Cheater and Murphy`s. Both research paper address contemporary issue at that time - lack of methods for screening patients for smoking and underdeveloped methods for starting and delivering anti smoking advices.


[4] Ockene JK. Physician-delivered interventions for smoking cessation; strategies for increasing effectiveness. Preventive Medicine 1987; 16 723 - 737

[5] Manley, MW Epps RP, Glynn TJ The clinicians role in promoting smoking cessation among clinic patients. Med Clin Nort America 1992 76 477-494

[6] Glynn, TJ Relative effectiveness of physician initiated smoking cessation program Cancer Bulletin 1988 40 359 - 364

[7] Silagy C. Ketteridge S. physician advice for smoking cessation (Cochrane Review). The Cochrane Library, Issue I Oxford: Update Software 1999

Bryman, Alan (2008). Social Research Methods. 3rd ed., Oxford University Press

Collis, Jill and Hussey, Roger (2009). Business Research, A Practical Guide for undergraduate and postgraduate students. 3rd ed., Palgrave Macmillan