Running head: CRITIQUE OF STUDY ON E-CIGARETTES Critique of Study on E-Cigarette Use Cheryl Meyer 1 CRITIQUE OF STUDY ON E-CIGARETTES 2 Critique of Study on E-Cigarette Use I think the title may give an incorrect impression regarding the products in use by the study participants because all NRT and e-cigarette users were in fact former combustible cigarettes smokers. The phrase ‘long-term use’ may give the impression of multiple years or decades of use whereas participants used NRT or e-cigarettes for as little as six months. The abstract is grossly representative of the article. The introduction clearly identifies that data is needed regarding the long-term effects of ecigarette use. The problem is introduced as a lack of real-life data to accurately assess risk associated with long-term e-cigarette use. The purpose for this study was to fill the gap in research by measuring biomarkers in long-term e-cigarette users and compare these levels against the control group (NRT users). A theoretical framework is not described in this study, however, it should be clearly identified and explained. Theoretical frameworks are often better developed in experimental studies and may be non-existent in descriptive studies (Grove, Gray, Bomer-Norton, & Daniel, 2019). The literature review included recent research that appeared to be relevant to this study, however, it appeared to be less than comprehensive in nature. The majority of the randomized control trials involved NRT rather than ecigarette use. The study design is identified as cross-sectional and the sample was self-selected through advertising. There were only 181 total participants in this study which was conducted over a six-month period in the city of London. Researchers should have collected data at multiple locations, throughout multiple countries, across a broader spectrum of ages and races, and with a better representation of the female sex. Threats to validity and reliability resulted from the use of participants that were all from London, 72% Caucasian, 61% male, with a mean age of 37.8 years. One of the things I found most striking is that researchers excluded any person with heart or lung disease from participating in the CRITIQUE OF STUDY ON E-CIGARETTES 3 study. Long-term smokers are likely to develop heart and lung disease and would be more representative of the general smoking public (Bold, et al., 2017). Participants spent a total of 30 minutes at the lab. After signing a consent, they collected sociodemographic data via a questionnaire, provided saliva and urine samples, and were then paid for their time and travel expenses. Researchers attempted to draw conclusions by comparing 35 biomarker results from five distinct groups with 36 participants in each group. To achieve a sufficient power (> or equal to 80%), only the largest of effects could be identified (Shahab, et al., 2017). I found the results to be confusing, overall. I think researchers could have reduced the number of biomarkers used for comparison between groups. These biomarker differences were intended to represent risk of future disease; however, it was difficult to appreciate the basis for that correlation. The tables and figures did not enhance my understanding of the conclusions drawn based on exposure outcomes. The results were explained in relation to the original research questions. For instance, researchers were able to conclude that e-cigarette use only resulted in less exposure to carcinogens and toxic chemicals than combustible cigarettes. Unfortunately, many e-cigarette users continued to smoke combustible cigarettes (Worku & Worku, 2019). Researchers relied on the honesty of participant responses to questionnaires to determine assigned groups. Study limitations were presented along with their implications and recommendations for future research. As an individual case control study/cross-sectional study, it is a Level 4 study. This study is not applicable to my practice primarily because of more recent research which has called into question the safety of e-cigarettes (more commonly called vaping, currently). The FDA has recently strengthened their warning related to vaping products based on more than 1000 reports of lung injuries including some deaths following the use of vaping products (2019). CRITIQUE OF STUDY ON E-CIGARETTES 4 References Bold, K. W., Kong, G., Camenga, D. R., Simon, P., Cavallo, D. A., Morean, M. E., & Krishnan-Sarin, S. (2017). Trajectories of e-cigarette and conventional cigarette use among youth. Pediatrics, 141(1). doi: 10.1542/peds.2017-1832 FDA. (2019). Vaping illness update: FDA warns public to stop using tetrahydrocannabinol (THC)containing vaping products and any vaping products obtained off the street. Retrieved from https://www.fda.gov/consumers/consumer-updates/vaping-illness-update-fda-warns-public-stopusing-tetrahydrocannabinol-thc-containing-vaping on October 5, 2019 Grove, S. K., Gray, J. R., Bomer-Norton, C. J., & Daniel, K. M. (2019). Understanding nursing research: Building an evidence-based practice. St. Louis, MO: Elsevier. Martínez, Ú, Martínez-Loredo, V., Simmons, V. N., Meltzer, L. R., Drobes, D. J., Brandon, K. O., . . . Brandon, T. H. (2019). How does smoking and nicotine dependence change after onset of vaping? A retrospective analysis of dual users. Nicotine & Tobacco Research, ntz043. doi:10.1093/ntr/ntz043 NIDA. (2019). Electronic Cigarettes (E-cigarettes). Retrieved from https://www.drugabuse.gov/publications/drugfacts/electronic-cigarettes-e-cigarettes on October 5, 2019 Shahab, L., Goniewicz, M. L., Blount, B. C., Brown, J., Mcneill, A., Alwis, K. U., … West, R. (2017). Nicotine, Carcinogen, and Toxin Exposure in Long-Term E-Cigarette and Nicotine Replacement Therapy Users. Annals of Internal Medicine, 166(6), 390. doi: 10.7326/m16-1107 Worku, D., & Worku, E. (2019). A narrative review evaluating the safety and efficacy of e-cigarettes as a newly marketed smoking cessation tool. SAGE open medicine, 7, 2050312119871405. doi:10.1177/2050312119871405
