Assignment: Nursing Article Critique – Smoking Cessation and Pregnancy

Nursing Article Critique – Smoking Cessation and Pregnancy: Timing of Cessation Reduces or Eliminates the Effect on Low Birth Weight. Pamela K. Xaverius · Zach O’Reilly · April Li · Louise H. Flick · Lauren D. Arnold…

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Assignment: Nursing Article Critique – Smoking Cessation and Pregnancy

Solution

Nursing Article Critique

Smoking Cessation and Pregnancy: Timing of Cessation Reduces or Eliminates the Effect on Low Birth Weight. Pamela K. Xaverius · Zach O’Reilly · April Li · Louise H. Flick · Lauren D. Arnold

Research Problem

Women who continue smoking while pregnant are at an increased risk of conceiving low birth weight infants (LBW), elevating the likelihood of infant mortality and morbidity such as chronic conditions in their later life. Smoking cessation can lower the risk of LBW, but the effect of cessation timing on reduction of smoking impacts on birth outcomes regarding pregnancies is unknown.

Research Purpose

The study aims to assess the rates and timing of smoking cessation during pregnancy on infants’ birth weight.

Literature Review

The article identifies and describes findings from previous studies. Most research studies described in the literature review are current (not older than ten years) from when the study was conducted (2019). The article also includes older studies up to 2006. It examines research findings from these studies that relate to the research framework and those with conflicting results. The author provides conflicting results from various studies regarding the relationship between smoking cessation and LBW. The article also includes current knowledge of the research problem. The authors point out that the current knowledge on the subject suggests that women who continue to smoke into their pregnancies have an elevated risk for adverse birth outcomes.

Research Hypothesis and Variables

The article hypothesizes that LBW risk increases when smoking continues throughout pregnancy. Limiting the sample to full-term births reduces bias in that all full-term infants would have equal exposure to smoking effects throughout pregnancy. The independent variable is the mother’s smoking status before and during pregnancy, classified into a non-smoker, preconception cessation, 1st-trimester cessation, 2nd-trimester cessation, and smoker throughout pregnancy. The dependent variable is LBW outcome (birth weight<2500g). There are covariates, including maternal race/ethnicity, maternal education level, payment method during delivery, maternal marital status, maternal sexually transmitted infection, maternal chronic disease, and maternal body mass index.

Sample Description

The article includes birth certificate data from Missouri singleton, full-term births between 2010 and 2012 for 183,353 women. The sampling technique was convenient and purposeful, collecting samples from Missouri, where approximately 23% of women are cigarette smokers compared to 17.4% of women in the entire US. Full-term births constant is defined as 37-46 weeks. The authors made an exception based on missing data regarding the covariates, reducing the original sample from N=194,387 to N=183,353.

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Measurement Methods

The authors used SPSS for analysis. They used chi-square tests to evaluate the distribution of the five categories of smoking status among covariates. Bivariate logistic regressions helped assess the crude relationship between the covariates and infants’ LBW status. They used multivariable logistic regression that involved all covariates in the model except marital status for its collinearity with paternity acknowledged.

Researcher’s Interpretation of the Findings

The expected findings include: continued smoking into pregnancy increases the risk of LBW, and women with higher education attainment, private insurance, and those of Asian and Hispanic races are more likely to quit smoking during pregnancy. The study findings demonstrate that smoking cessation timing reduces the smoking effect on LBW in full-term pregnancies.

The results also indicate that the risk of LBW increases as smoking continues during pregnancy. The odds are also higher for Black non-Hispanic mothers, mothers with lower educational attainment, teenage mothers, inadequate parental care, and mothers with a chronic condition. Lack of prenatal care utilization also increases the risk for LBW. These findings relate to the study framework, and they are keeping with the expected results.

Generalization of Findings

Generally, the timing of smoking cessation lowers the smoking effect on LBW in full-term pregnancies, and the risk for LBW increases as smoking continues throughout the pregnancy.

Implication of the Findings

Healthcare providers should target higher-risk groups during the planning of prenatal interventions to have the most significant effect on lowering LBW. The study results emphasize the risk of smoking and the importance of all pregnant women quitting cigarette smoking.

Suggestion for Further Study

The study encourages further exploration of paternity acknowledgement-Medicaid-smoking interaction. Future research should also investigate the differences among the categories used in the study in a stratified analysis. Further study is required to understand the role of alcohol and drug use on women smoking during pregnancy.

Missing Elements

The study omits the effect of alcohol and drug use on LBW. The study does not also include the differential impact of smoking frequency and depth of inhaling. The analysis may have underreported data on the smoking women’s history because women know they should not smoke during pregnancy.

Replication Ability

The study is comprehensive, and the description is sufficiently clear to allow replication. The relationships between variables are well-described, making it easier to apply them in other situations and subjects.

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Ethical Considerations

Asking women about their smoking history can exert psychological harm, especially for those who struggled with cessation. The study does not include a description of how they addressed this issue. Consent could also be an ethical issue considering that study involved birth certificate data. The study does not describe how it managed participant’s consent. A preterm bias was highly likely during the investigation. To address this issue, the researchers limited their sample collection to full-term pregnancies to ensure all infants have equal exposure to smoking effects.

Overall Evaluation

The study has vital clinical and public health implications. It encourages nurses to promote modification of health behavior before pregnancy. Nurses should also encourage smoking cessation before or in the first trimester, which is better than continuous smoking during pregnancy. The study also demonstrates the relevance of interpersonal support systems, especially on individuals living in poverty. Healthcare providers should target smoking cessation among high-risk groups like women on Medicaid, teenagers, women with lower education, and a chronic condition. Implication on the policy includes the need to have higher cigarette taxes, minimum purchase ages, enhanced cessation interventions, and smoke-free environments.

Reference

• Xaverius, P. K., O’Reilly, Z., Li, A., Flick, L. H., & Arnold, L. D. (2019). Smoking cessation and pregnancy: timing of cessation reduces or eliminates the effect on low birth weight. Maternal and child health journal, 23(10), 1434-1441.

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