Addressing Tobacco Smoking among Young Adults in Barking and Dagenham

Introduction

In the UK, it is seen that many young adults are highly involved in smoking tobacco (Burke et al., 2017). This is evident as in 2019, 14.1% of young adults in the country are found to be addicted to smoking tobacco (ons.gov.uk, 2020). This has led the young adults to develop various health issues with cardiovascular health being one of the prominent health problems. It is evident as BHF mentions that people of any age who smoke are found to have 50% higher chances of facing early cardiovascular disorder (BHF, 2020). Thus, the current study is focussed to determine the evidence-based interventions to be implemented so that the risk of cardiovascular disease as a result of smoking among the young adults (18-35 years of age) in Barking and Dagenham is managed.

Background of the Study
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Overview of Smoking and its related health risk

Smoking is the act of inhaling and exhaling fumes of burning tobacco encased in cigars, cigarettes and pies. The act of smoking is performed to socialise with people or to relieve stress as the chemical known as nicotine present in the fumes helps to create pleasurable impact on the brain (Akcay and Yuksel, 2017). According to the World Data, 1 in 5 adults in the world are involved in smoking tobacco and most of them initiate to smoke tobacco at an early age of 15 years (Ritchie and Roser, 2020). In the 20th century, it is mentioned that nearly 100 million people died due to smoking and by the end of 21st century, it is estimated that 1 billion people are expected to die globally due to smoking (Ritchie and Roser, 2020).

Rationale of the Study

In the UK, one of the most affected area where smoking is been highly reported is the London Borough of Barking and Dagenham. It is evident as the average smoking rate in the Barking and Dagenham is 20.4% which is equal to 35,377 smokers present in the borough and most of these smokers are young adults (ONS.gov.uk, 2020). This average is higher than the average smoking rate in England, which is 14.1% (ONS.gov.uk, 2020). Thus, it indicates there is high smoking prevalence in the area compared to the national average and it highlights increased inequalities for health to be present in the borough which is contributing to development of the cause of smoking. As per reports, it is mentioned that 21.1% of the cardiovascular disease cases in the Barking and Dagenham is due to smoking habits among people (lbbd.gov.uk, 2019). This indicates that smoking is a major risk factor acting in the area to lead people develop heart issues and hindered cardiovascular health. There is lack of age-specific information of smoking and cardiovascular disease available in the Barking and Dagenham but the overall scenario presents that smoking is potential risk factor in the area for causing cardiovascular issues among all age groups (lbbd.gov.uk, 2019).

The habit of smoking is leading young adults to develop risk of cardiovascular disease which is affecting their progress in life as because the hindered cardiovascular health leads young individuals unable to lead their life with potential health condition and work effectively. It is evident as cardiovascular disease leads the young people have risk of additional heart attack due to which they are to take effective precautions and schedule health activities which act as barriers for people in providing effective physical and mental effort at work (Dikalov et al., 2019). The presence of cardiovascular disease as a result of smoking leads the young people to show behavioural disturbances or emotional distress such as depression and anxiety (Banks et al., 2019). The presence of hindered cardiovascular health among the young people due to smoking has current become an issue in the Barking and Dagenham because increased hospital admissions are reported to be faced due to the disease indicating it is highly affecting the quality of life of the people (King et al., 2017). It is evident as in 2015 nearly 640 hospital admission were reported due to cardiovascular health issues in Barking and Dagenham which is higher than national average (King et al., 2017). This issue of smoking leading to cardiovascular health issues in Barking and Dagenham has persisted instead of the Smoking policy been implemented in which people are banned to smoke in public places and cars. The policy is developed by complying with the requirements in Health and Safety at Work 1974 and Health Act 2006 (londoncouncils.gov.uk, 2014). Therefore, to ensure better behavioural, social and emotional health of the individuals and to upgrade their quality of life, effective understanding of the intervention required to manage risk of cardiovascular disease due to smoking among the young adults in Barking and Dagenham is to be discussed.

Aim

The aim of the study is to determine evidence-based intervention in reducing risk of cardiovascular diseases that arises as a result of smoking among the young adults (18-35 years age) in the Barking and Dagenham.

Objectives

To develop concept regarding the relationship of smoking and cardiovascular disease among young people

To evaluate the intervention required for reducing risk of cardiovascular disease as a result of smoking among the young adults (18-35 years age) in the Barking and Dagenham

To analyse the challenges to be faced during implementation of the intervention required for reducing risk of cardiovascular disease as a result of smoking among the young adults (18-35 years age) in the Barking and Dagenham

To suggest strategies in overcoming the challenges faced during implementation of the intervention required for reducing risk of cardiovascular disease as a result of smoking among the young adults (18-35 years age) in the Barking and Dagenham

Research Questions

How smoking and cardiovascular disease presence in inter-related in young people?

What are the interventions required for reducing risk of cardiovascular disease as a result of smoking among the young adults (18-35 years age) in the Barking and Dagenham?

What are the challenges faced during implementation of the intervention required for reducing risk of cardiovascular disease as a result of smoking among the young adults (18-35 years age) in the Barking and Dagenham?

How to overcome the challenges to be faced during implementation of the intervention required for reducing risk of cardiovascular disease as a result of smoking among the young adults (18-35 years age) in the Barking and Dagenham?

Literature Review

The literature review informs about the existing information present the topic being explored. For this purpose, various scholarly articles are evaluated and analysed so that the information from them are represented to understand basic concept of the study.

Theory related to Health and Smoking

The Health Belief Model (HBM) is referred to as one of the vital theoretical models of health that helps to guide the way promotion of health regarding any health issue is to be achieved through successful healthcare intervention (Mohammadi et al., 2017). According to the model, perceived susceptibility, severity, benefits and barriers along with modifying variables and cues to action are the theoretical constructs of the model (Jeihooni et al., 2019). The HBM through perceived susceptibility mentions that people on perceiving they are susceptible to experience health problem develop interest to engage in behaviours to avoid the risk of experiencing the health issue (Mohammadi et al., 2017). Thus, by making people in Barking and Dagenham aware about the health risk of smoking to their heart, they can be made to change behaviour regarding smoking. The perceived severity indicates that people on perceiving the extent of risk towards their health intends to make change in behaviour (Panahi et al., 2018). This indicates that by making people in Barking and Dagenham aware of the extent to which smoking is posing as a serious health issue for them, they can be intended to make change to develop healthy behaviour.

The perceived benefits indicate making people aware of the advantage of changed behaviour and recommended intervention for certain health issue whereas perceived barriers indicate identifying the challenges to make the intervention successful so that it can be resolved (Jeihooni et al., 2019). Thus, to make people of Barking and Dagenham quit smoking to have enhanced cardiovascular healthy, they are to be made aware of the benefits of quitting smoking and challenges to be resolved that are posing as barrier for them to quit smoking. The modifying variables indicate identifying the characteristics that are to be modified which are leading to health issue and cues to action indicate the triggers to be focused in reaching health promotion regarding any health issue (Panahi et al., 2018).

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Impact of Smoking on cardiovascular health

According to DiGiacomo et al. (2019), the smoking of tobacco leads to release of harmful chemical such as nicotine which is the addictive substance in the tobacco smoke. The presence of nicotine in the body from the tobacco smoke stimulates individuals to produce adrenalin in the body that triggers flight-or-fight response in the body making the heartbeat faster. Moreover, nicotine acting as a sympathomimetic drug in the body causes the release of catecholamines that leads to contraction of the coronary arteries and increase the blood pressure of the body (Pan et al., 2019). The unnecessary increase in blood pressure and heart rate in the smokers leads their heart to often work under pressure compared to the heart of non-smokers which results them to be at increased risk of facing stroke or heart disease (ash.org.uk, 2016). In contrast, the study by Li et al. (2017) mentions that high blood pressure created due to smoking leads to create damage to the organs responsible in filtering blood like the kidneys. This leads poor quality blood to be transferred to the heart for dispersion in the body.

Mechanism of cardiovascular disease development due to smoking

The tobacco smoke also contains carbon monoxide as the harmful substance which is a form of colourless and odourless gas. It is the fourth common harmful chemical present in the tobacco smoke apart from 4000 other different constitutes in the smoke and its make-up 3-5% of the volume in the tobacco smoke (ash.org.uk, 2016). The presence of carbon monoxide in the blood from the tobacco smoke leads the blood to lose ability to effectively bind oxygen. This is because the particles of carbon monoxide attach themselves to the haemoglobin which is the key oxygen-carrying agent in the blood more easily compared to the oxygen. It results the tissues in the body as well as in the heart to be starved of oxygen and die in the process (Qiu et al., 2020). Thus, as a result of high carboxyhaemoglobin levels, the smokers experience shortness of breath along with increased heart rate. In contrast, the study by Hallit et al. (2019) mentioned that smoking tobacco has effective contribution in hindering the blood cholesterol level in the body. This is because the presence of acrolein in the smoke is seen to affect the ability of the body in processing cholesterol leading them to be in increased amount in the blood. The condition leads to lower the ratio of good cholesterol (high-density lipoprotein) to bad cholesterol (low-density lipoprotein) in the body. The increased number of low-density lipoproteins along with presence of additional fatty substances overtime is seen to narrow the blood vessels in the smokers causing development of atherosclerosis (Kamimura et al., 2018).

The progression of atherosclerosis leads blood flow to be lowered to the heart leading to hindered performance of the heart (ash.org.uk, 2016). Moreover, if the atheroma breaks with time, it leads to development of thrombosis or clot in the blood vessels leading to entirely block the blood flow to the heart through the specific blood vessels. This sudden clot in the heart may lead stroke to be faced by the individual (Markidan et al., 2018). The atherosclerosis may be developed in the arteries due to other reason but the presence of harmful substance from the tobacco smoke in the body leads towrads faster formation of plaques which leads top early development of cardiovascular disease (ash.org.uk, 2016). The risk of thrombosis among smokers is also raised due to the effect of the tobacco smoke on the fibrinogen which results to increase the aggregation of blood platelets making the blood to be stickier. This results to creates hindered blood flow to the heart and formation of blood clots leading the individuals to develop risk of cardiovascular disease such as stroke (Lowery et al., 2017). Thus, it can be seen that wide studies effectively mention that smoking is highly inter-related with development of risk of cardiovascular disease and effective intervention regarding the process is required to avoid risk towards health of individuals.

Gaps in Literature

The existing studies explain the ways smoking and cardiovascular health are inter-related. However, the studies do not explain the way cardiovascular health issues raised due to smoking are to be resolved. Moreover, it does not explain the specific therapeutic interventions to be focussed to avoid cardiovascular risk due to smoking among the young individuals. Therefore, to resolve these gaps in the study, the current research is been developed.

Research Methodology

The research methodology refers to specific techniques and procedures that are used to determine, select, process, and analyse data collected for a topic (Snyder, 2019).

Research Design

The epistemology explains way knowledge is to be gathered in the study and from which resources, but the ontology informs the certainty of the existence and nature of object being researched regarding the study (Goldman et al., 2018). The ontology is of two types positivism and interpretivism. In this study, the positivism will be used because it helps in logical analysis if gathered information for presentation regarding the topic. The interpretivism will not be used as it leads to raise bias in the study due to subjective analysis by the researcher (Ryan, 2018).

In the study, the correlational research design will be used because the design allows effective measurement of relationship between two variables without either of them being controlled by the researchers (Albagawi, 2019). Since the study is focussed on understand the impact of intervention in controlling smoking as a variables and risk of cardiovascular disease as another variable, thus the use of correlational design will help in measuring the extent of effect of the intervention on the two variables to be controlled. The correlational research design will be used because it helps in determining the strength of direction of any relationship so that the findings can be narrowed down for better enriched execution of the study (Albagawi, 2019). The experimental research design will not be used because it produces findings that are not real and is applicable in explain single situation in the study (Flannelly et al., 2018). The descriptive research design will not be used because they led to create certain level of bias in the findings (Atmowardoyo, 2018). The exploratory research design will not be used because it leads to development of judgemental and biased data (Pantano and Vannucci, 2019).

Research Approach

The qualitative research approach is the process of collecting and analysing non-numerical information to explain and understand opinions, experience and concepts of the study (Tuffour, 2017). In contrast, the quantitative research approach includes collecting and presenting statistical data in testing any hypothesis or exploring any idea (Apuke, 2017). However, the mixed research approach in the combination of the qualitative and quantitative data used to derive theories regarding the research topic and present findings in support of the raised problem in the study (Creamer, 2017). In this study, the mixed research approach will be used indicating qualitative and quantitative data will be included in resolving the raised research questions. The mixed approach will be used because it helps to avoid the limitations to be faced while using either qualitative or quantitative approach (Creamer, 2017).

Data Collection methods

The primary data collection method will be used because it allows collection of both qualitative and quantitative data directly from the participants without manipulation in the middle by the influence of the researcher’s belief and attitude (Franzitta et al., 2020). In gathering qualitative data, the interview method will be used. This is because interview helps to understand the feelings and attitude of the participants that led them to present the detailed information regarding the study along with assist in collecting detailed verbal explanation of their thoughts regarding the topic of interest (Chu and Ke, 2017). In gathering quantitative data, the survey method will be used. This is because it is cost-effective and ensure less use of time to gather objective information from large number of participants (Chu and Ke, 2017). The interview will be performed by using semi-structured interview questionnaire through skype so that person-to-person contact is avoided which is required to be maintained during the Covid-19 pandemic situation. In executing the survey, the closed-ended survey questionnaire will be used for collecting data and they are be provided to participants via email.

Sampling Technique

The probability sampling will be used in selecting participants for the qualitative data collection process because it allows to recruit subject who are representative of whole population ensuring generalisation of the results to be achieved (Etikan and Bala, 2017). According to it, 75 participants out of 100 young individuals of 18-35 years of age who are smokers and living in Barking and Dagenham will be selected. The non-probability sampling will be used in recruiting sample for the interview process because it helps to include subjects who specifically relevant to the study and known to the researcher (Etikan and Bala, 2017). In this aspect, 5 healthcare professionals living in Barking and Dagenham will be included in the study as it is within my scope to evaluate the results from that much sample size. The data from the interview will be presented by analysing the verbatims of the subject and the data from the survey will be analysed by using statistical methods.

Ethical Consideration

The study will be valid and reliable as it will be reviewed by additional researchers to identify ant error due to the influence of the current researchers. The ethical aspect in the study will be ensured by avoiding disclosing any personal data or identity of the participants by following guidance presented in the Data Protection Act 1998. The informed consent from the participants will be received by allowing them to previously understand the way their responses are to be used. Moreover, the participation in the study will be voluntary and participants will be allowed to leave the research in the middle if they feel their privacy or confidentiality is been compromised.

Limitation

One of the limitations to be faced is that the sample size is small due to which generalisation of the study could not be reached. The limited time in executing the study would also act as limitation in leading researchers unable to widen the search in gathering more information. The lack of research experience regarding the study topic may led to raise error in data presentation in the study.

Significance of the Study

The significance of the study is that it will help the researcher as Public health student to understand the steps to be taken to reduce smoking prevalence in the area of Barking and Dagenham as well as would help to reduce the risk of smoking-induced cardiovascular disease in the area. Moreover, the topic is significant as it will help to promote the health and well-being of young adults in the Barking and Dagenham . The study is also significant as it will help to resolve gaps in the literature by explaining the strategies to be followed in tackling cardiovascular health issues raised due to smoking in young adults.

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