This paper focuses on a systematic review of the article Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. The primary objective of the paper is to critique the levels of evidence of the studies used in the research review and the clarity with which the studies are presented and critiqued. In addition, the paper provides a description of the overall findings on the studies, as summarized in the review, as well as a critique on its conclusions and any possible implications on the nursing practices and future research.
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Levels of evidence of the studies
Despite the high number of studies used in this review, it is evident that the majority of them provide low quality evidence. This can be attributed to the fact that the evidence is based on uncontrolled before-and-after as well as observational study designs. A critical review of all the studies used indicates that three studies adopted a control location which was effective in providing comparative analysis of the phenomenon under study (Frazer, McHugh, Callinan, & Kelleher, 2016). Additionally, all the studies are heterogeneous and focus on the use of health outcomes data mortality data review, prisoner surveys, university students surveys, staff surveys, as well as patient surveys.
On the other hand, the majority of the studies were based on small sample sizes, while other provided limited inferential statistical analysis. Often, the size of a sample used in a study is important as far as the precision and accuracy of any given study is concerned. While a small sample size is easy to work with, it is relatively difficult to provide precise findings in such a case. The fact that the use of the inferential statistics was limited only to a few studies is an indication that only such studies provided comprehensive analysis of the subject under study. For this reason, it was significantly hard to rely on the provided evidence from the majority of the studies.
The identification of the smokers used in the majority of the studies was not thorough given that most of them used self-reported approach to smoking status, only two studies were based on biochemical verification of the smoking status of the participants used for analysis (Frazer et al., 2016). The implication is that out of seventeen studies, only two were reliable in terms of the smoking status of the people used in the study. This can be attributed to the unreliability of the self-reported approach because such a process of identifying the smoking status of the study participants could be accompanied by numerous errors. When compared to the biochemical approach, it is evident that such an approach provides reliable data about the smoking status of the study participants, hence, ensuring that the studies provided quality data for the purpose of making a comprehensive analysis of the impact of institutional smoking bans on reducing harms and secondhand smoke exposure.
Generally, the systematic review provided a low grade with regard to its summary on all the studies’ findings and hence, the evidence provided is considerably low following the study design used (Frazer et al., 2016). Evidently, the confidence obtained from the studies can be considered to be low implying that the findings from the studies might not reflect the true scenario as far as the impact of institutional smoking bans on reducing harms and secondhand smoke exposure is concerned.
Clarity of the studies
According to the provided systematic review, seventeen studies were used to investigate the relationship between the adoption of institutional bans and the reduction rate of secondhand smoke exposure and the associated harms. Even though the systematic review was based on such a large number of studies, the clarity and reliability of most of the studies is questionable (Frazer et al., 2016). For example, the approaches used in the identification of the study participants are not clear for the majority of the studies given that they relied on self-reporting of the individuals. This is attributable to the fact that the self-reported approach could involve smokers’ bias and error categorization, which could be transferred to the final results. The implication of such transfer is that results could not be entirely relied on as a clear investigation of the phenomenon of study.
Description of findings
The primary objective of this review was to examine the impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Seventeen studies were reviewed with the tobacco control bans as well as any other related policies that were considered in this case, included partial smoke-free, comprehensive smoke-free, and complete tobacco-free bans (Frazer et al., 2016). Jurisdictions in terms of national legislative bans did not limit any form of extensions involving smoke-free policies. Out of the seventeen studies, eight of them were based on carries that do not have any national legislature on the ban of smoking.
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It was observed that the introducing a new smoking policy in universities or prisons, as well as in hospital setting led to a decrease in the rates of active smoking. Additionally, quit attempts and the rate of prescription of NRT products was evident in the majority of the studies. In spite of this, the review discovered that bias and the confounding possibility was common, which adversely affected the quality of the evidence provided. On the other hand, it was evident that there was a reduction in the exposure to passive smoke (Frazer et al., 2016). Nevertheless, such findings were not validated biochemically and hence, led to high number of inconsistences as far as the implementation of smoke control and bans was concerned in various setting such as in the prisons.
Conclusions and Future Research
According to the analysis about the impact of institutional smoking bans on reducing harms and secondhand smoke exposure, the review identified that settings-based smoking policies as far as the reduction of the rate of active smoking in universities and hospitals have had significant impact. For example, carrying out a comparison analysis of hospital and universities setting indicates that the smoking active rates in hospitals had the greatest reductions. In addition, the review reported reduction in the mortality rate associate with smoking and secondhand exposure to smoking in prisons. According to the review, the implementation of various policies on tobacco ban led to numerous cares of quit attempts as well as noticeable support for the control of tobacco use. In spite of this, there is a weak methodology used in the assessment of the impact of institutional smoking bans on reducing harms and secondhand smoke exposure. In addition, the studies used adopted inconsistent methodological approach as far as all the participant groups are concerned.
Based on the provided evidence and the methods used, it is evident that studies that are more thorough are needed to carry out in-depth analysis of this subject. Such studies should ought to adopt control groups to enable comparison of outcomes effective. In addition, there is a need for more studies that document data on pre-and post-ban of smoking in various settings.
Frazer, K., McHugh, J., Callinan, J., & Kelleher, C. (2016). Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Cochrane Database Of Systematic Reviews. Web.