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1. Is there a clear statement of the research hypothesis/question?

2. Does the study address a question that has epidemiological relevance (have they made the case that this is an important public health issue)?

3. What study design has been used? Is it experimental or observational?

4. Is the study design appropriate for the hypothesis? Why/How? If not, which study design do you think would have been more suitable and why?

5. Have the authors attempted to refine prior approaches (does the study improve on previous work)?

6. How has the outcome been defined? Is there a precise case definition?

7. Have the authors accurately assigned people as having the outcome (or not)?

Growing Popularity of E-Cigarettes

The main purpose of this essay is to explore the public health issue such as the  use of E- cigarettes and the its impact on smoking rates and health conditions. In relation to this chosen topic, critical evaluation is carried out with following the template. In relation to this epidemiological study, literature has been evaluated with reference to the e-cigarettes and its impact on the health. This essay also elaborates the issue by critically analyzing the literature review.

The use of e-cigarettes has been growing popularly as more and more people are consuming e-cigarettes at an increasing rate as compare to the conventional cigarettes. The consumption of e-cigarettes has become a debating issue for the researcher and the public as well. It is a public issue because more and more adult and young people are engaging into the usage of e-cigarettes from the last one decade. Over the epidemiological study, it has been observed that the consumption of e-cigarettes is not harmful as compared to the consumption of traditional or conventional cigarettes. E-cigarette is an electronic cigarette-shaped tool full of a nicotine-based fluid that simulates the smoking experience of the user through inhalation. It also creates same feeling as the conventional cigarettes do. The smoking rates of e-cigarettes have been increased from 3% to 30% in the recent years (Breland, et al., 2017). Over the research, it is also argued that e-cigarettes are safer by 95% as compared to the conventional cigarettes.           

Apart from this, it is also assessed that the e-cigarettes are also impacting the human body and its parts that directly affected from inhaling of nicotine on regular basis. On the other hand, it is also researched that each country has different regulations over the permission of consuming cigarettes.

Impact of Use of E-cigarettes on Consumers and Population Health:

In the view of Chang, & Barry, (2015), E-cigarettes have been causing a significant impact on the health of smokers and public to a large extent. However, the law of e-cigarettes differ from country to country. Out of the 35 nations that participated in a 2011 WHO study, regarding availability and laws and of e-cigarettes within their country, 11 reported no availability, 19 reported they were available (10 unregulated, 7 with some type of regulation), and 5 were not sure. Although the use, sale and promotion of e-cigarettes are banned in the Australia, a few  states have not yet imposed restrictions. In this context,  Health and Medicine Week (2014) has noted that the outcomes of regulations, policies, healthcare costs and any health benefit for smokers or the general public would not be easy to analyze unless e-cigarettes are a regulated product. Presently, the data is insufficient for assessing a long-term benefit for smokers or for the population at large.

Impact of E-Cigarette Usage on Human Body

Hermann & Wolfgang, (2015) carried out 3 week open label examination on 40 smokers who wants to quit smoking. The results of the study showed that E-cigarettes have the potential  to minimize the use of tobacco and therefore, has been considered as a great alternate for the smokers. E-cigarettes have proven helpful in minimizing the breathing problem. E-cigarettes consumption does not harm the smokers' health. On the other hand, Dacre, & Britton,  (2016) argued that the consumption of e-cigarettes is similar to using the usual cigarette, and the excess consumption of the nicotine is harmful for the health for the users' as well as non users' health. Although e cigarette contains less amount of toxic ingredients but still it tends to produce harmful effects that are significant should not be ignored. Consumption of e-cigarettes have led to decrease in the smoking rate in Australia but the demand for e-cigarette among youngsters and even children  is rising which indicates that  the decline in rate of traditional smoking in past years is undo by growing use of Nicotine among the young generation. In support of this, Etter, (2018) has observed that e-cigarette products like nicotine may help the smokers to quit smoking through safer means but on the same time, it produces dangerous impact in reducing the brain immunity.

According to Callahan-Lyon, (2014), the use of e-cigarettes for health is a safe choice to replace traditional cigarettes by the users. It has also been found that many of the users have stopped this bad habit of excessive smoking with the help of e cigarettes, thus reducing the overall smoking rate. Another study was conducted by Gerald et al. (2018) who has done the research on e- cigarettes and their impact on the health of the consumers. The data was gathered from the producers of tobacco, and it was found that people using e cigarettes or nicotine replacement therapy brings an adverse impact on the lungs as well as heart. The regular smokers of e- cigarettes are exposed to lung or heart damage in the long run in one or the other way.  The study carried out by Byrne et al. (2018) on assessing the impact of smoking substitute products found that  a large number of the general public has the wrong awareness on the usage of the e- cigarettes. They think  that it is less injurious and more soothing than traditional cigarettes. However, this is not the truth as e cigarettes contain the poisonous substance known as carcinogens that can cause major health problems to the human body through cancer, lung issues, and damaged respiratory system of human body. In contrast to this, in his study, Schneider, & Diehl, (2015). has stated that smoking usually harms because it burns toxin product called tobacco inside the body of the users and general public exposed to it . Therefore, in the opinion of him,  e- cigarettes are the better substitutes for the smokers in order to quit traditional smoking. In addition to this, he has analyzed that the harmful impacts associated with using e cigarettes is comparatively low which suggests that this great alternative must be encouraged among the smoking adductors as a safe option. Also, this product must be advertised publically. However, in oppose of this, Christine Bond (2016) argued that an in-depth discussion is still required on the prevention policies of the e-cigarette because there are not enough evidences confirming the usage of  e-cigarette as a safe one due to the observance of many diseases in the consumers in spite of using this alternative.   

Variations in Regulations for E-Cigarette Usage

On the basis of the above review, it has been determined that the e-cigarette cannot be claimed as a100% safe alternative for the human health. The experimental researches have shown that the people are getting more addicted towards the e-cigarette because of their wrong perception regarding its impact on health. Thus, a further research study is needed to prove that e-cigarette products are 95% safer in compare to the traditional cigarette.  

It has been found that there exists a clear statement of the research question in the paper, that is "Impact of Use of E-cigarettes on Consumers and Population Health". This research question has a epidemiological relevance because it is one of the most important health issues that can be seen not only in adults but also in  youths and children. In this paper, an optimal eventual observational study design has been adopted in order to analyze exposure to e-cigarette of a large group of smokers who want to quit or are making efforts, in detail prior to evaluate the smoking cessation outcome (Schneider, & Diehl, 2015). However, the drawback of this study design is that smokers themselves decide whether or not to consume e cigarettes. Those who do and do not prefer to consume e-cigarettes may vary in ways that has the probability to influence a smoker’s chances of success, thus baffling the observed outcomes of e-cigarettes to quitting.

Since in observational study design, the researcher is more reliable on the results of past experiments, it sometimes leads to inaccurate analysis. Thus, for the purpose of this hypothetical study, experimental study design has been more suitable than observational one. In addition to this, it can be observed that the present study has improved on its previous works as the authors have attempted to refine the earlier applied approaches (Koval, Willett, & Briggs, 2018). This is a retrospective cohort research, which means that the exposure and outcomes have already occurred. Thus, the outcomes have been defined on data that already exists from prospective researches. In this context, the exposures are defined before assessing the on hand outcome data to check whether exposure to a risk factor is dependent on a statistically significant difference within the outcome development rate.

From the results, it can be said that the authors have accurately assigned people as having the outcome. The different exposures studies in the paper are adolescent exposure, consumer exposure, and general public exposure (Levy et al., 2016). The self-report measures of quitting cigarette has been used in the study in order to measure the disease frequency. Although the role of chance has been assessed by the researcher but the confidence intervals or p-values have not been presented and discussed in the paper. Since the method of selection of subjects applied in this research is random sampling method, there is less chances of any bias in the results. This is because this method provides equal chance to the population to participate in the study. Also, the measurement of the exposure of e-cigarette is also less likely to be biased. Confounding variables have the ability to spoil an experiment and yield ineffective outcomes. Therefore, the investigators have not considered the cofounders.

Studies on Minimizing Tobacco Use

Apart from this, the authors have acknowledged that each potential bias has the potential to influence the outcomes in terms of either information or selection. Also, the author has not made any statement about the clinical significance, and interpretation of the results effectively reflect the outcomes of the research done. However, it has also been found that the finding of various scholars are not consistent with each other. Many of the findings are producing conflicting information. For example, some researchers are saying that e-cigarette is safer than traditional cigarette (Mental Health Weekly Digest, 2016). On the other hand, some researchers have proved that e-cigarette like nicotine can cause lungs and heart diseases if the over doses are consumed by the users, in the long run. The authors have drawn conclusion that e cigarette cannot be considered completely safe alternate to traditional smoking practice. Research on the impact of e-cigarette like nicotine has shown that there is a need for labeling potential e-cigarette warnings on the packaging in the future. A further study is also required to be conducted in the light of scientific developments regarding the nicotine warning’s efficacy.

Conclusion 

On the basis of the above analysis, it can be concluded that the e-cigarettes have become the substitutes of conventional cigarettes but it can also be summarized that it might impact the body due to the inhaling of nicotine. Over the critical analysis of epidemiological study, it can also be said that the c-cigarettes are becoming more popular with relation to the traditional cigarettes but it very critical in context of adverse impact over the human body. It can also be concluded that there is also a need of particular study over the smoking rate and its impact on cigarettes inhalers.     

Over the critical analysis, it can be stated that the epidemiological study has been analyzed the pros and cons of the study but the real impact over the public has not been evaluated in effective manner so it can be suggested that the particular study should be designed with the appropriate number of participants in order to reach with a particular conclusion (Etter, 2018). With respect to this, the country based evaluation can be carried out with reference to the promotion of e-cigarettes with its real impact on the human body.  

References

Brazier, Y., (2018). Are e-cigarettes a safe alternative to smoking?. Retrieved from https://www.medicalnewstoday.com/articles/216550.php

Breland, A., Soule, E., Lopez, A., Ramôa, C., El?Hellani, A. & Eissenberg, T., (2017). Electronic cigarettes: what are they and what do they do?. Annals of the New York Academy of Sciences, 1394(1), 5-30.   

Byrne S, Brindal E, Williams G, Anastasiou KM, Tonkin A, Battams S & Riley MD (2018). E-cigarettes, smoking and health. A Literature Review Update. Australia: CSIRO.

Callahan-Lyon, P., (2014). Electronic cigarettes: human health effects. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995250/

Chang, Y., & Barry, M., (2015). The Global Health Implications of e-Cigarettes. JAMA. Retrieved from https://jamanetwork-com.ezproxy.ecu.edu.au/journals/jama/fullarticle/2428965

Christine Bond (2016). The pros and cons of E-cigarettes: a challenge for public Health. International Journal of Pharmacy Practice. 24,147–148.

Dacre, J. & Britton, J., (2016). Lung, e-cigarettes, and health: response from the Royal College of Physicians. Retrieved from https://dx.doi.org/10.1016/ S0140-6736(16)30444-5.     

Etter, J.F., (2018). Gateway effects and electronic cigarettes. Addiction, 113(10), pp.1776-1783.       

Gerald W. Valentine, Hefner, K., Jatlow, P., Rosenheck, R., Gueorguieva, R., & Sofuoglu, M. (2018). Impact of E-cigarettes on Smoking and Related Outcomes in Veteran Smokers with Psychiatric Comorbidity. Journal of Dual Diagnosis, 14(1), 2-13.

Health and Medicine Week (2014). Health and Medicine; Studies from Roswell Park Cancer Institute Update Current Data on Public Health (The impact of the 2010 Polish smoke-free legislation on the popularity and sales of electronic cigarettes). Retrieved from https://search-proquest-com.ezproxy.ecu.edu.au/docview/1551482283?accountid=10675

Hermann F., & Wolfgang, S., (2015). Waterpipes and e-cigarettes: Impact of alternative smoking techniques on indoor air quality and health. Atmospheric Environment, 106, 429-441.

Koval R, Willett J, Briggs J., (2018). Potential Benefits and Risks of High-Nicotine e-Cigarettes. JAMA. 320(14), 1429–1430.

Levy, D., Cummings , K., & Villanti, A., Niaura1, R., David B.,  Fong, G. & Borland, R., (2016). A framework for evaluating the public health impact of e-cigarettes and other vaporized nicotine products. Society for study of Addition, 22(3), 90-93.

Mental Health Weekly Digest (2016). The impact of flavouring on the rewarding and reinforcing value of e-cigarettes with nicotine among young adult smokers. Retrieved from https://search-proquest-com.ezproxy.ecu.edu.au/docview/1824287958

Schneider, S. & Diehl, K., (2015). A public health strategy for e-cigarettes. Wien Klin Wochenschr 2(1), 26-32.  

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