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Smoking Cessation And Smoking As A Public Health Issue: Literature Review Assessment Answer

 Subject Code and Title
PUH6008: Capstone A: Applied Research Project in Public Health 
Assessment 2: Literature review 
4,000 words 
 Learning Outcomes  
This assessment addresses the following learning outcomes: 
  1. Integrate and apply their knowledge and skills in public health 
  2. Develop research skills and apply these to a public health issue 
  3. Conduct a small literature review which critically analyses key issues on a public health research topic 
  4. Define and justify a research question, based on the literature/public health issue, and outline its significance 
Total Marks  
100 marks 


By the end of module 3, student must provide to their learning facilitator a brief review of the literature on their chosen topic. The literature review must contain key references/theorists/researchers for the public health topic chosen. The literature review assignment must be designed to address the following questions: 


  • Who are the key theorists/researchers in your public health topic? 
  • What are the key issues? 
  • What are the gaps in the existing body of knowledge?

The literature review should provide a basis for justifying a clear research question or hypothesis to be explored further. 

You must also indicate the search strategy used for your literature review. For example, what were the key words you searched for, and which key databases or other sources did you use to conduct your literature review? (e.g. CINAHL, Proquest Public Health, Informit, Medline, Google Scholar). 

 Assessment Criteria:

  • Critical and comprehensive review of the literature (70%) 
  •  · Clarity of research question/hypothesis (10%) 
  • General assessment criteria (20%): 
  • Provides a lucid introduction 
  • Shows a sophisticated understanding of the key issues 
  • Shows ability to interpret relevant information and literature in relation chosen topic 
  • Demonstrates a capacity to explain and apply relevant concepts 
  • Shows evidence of reading beyond the required readings o  Justifies any conclusions reached with well-formed arguments and not merely assertions 
  • Provides a conclusion or summary 

 o  Correctly uses academic writing, presentation and grammar: 

Complies with academic standards of legibility, referencing and  bibliographical details (including reference list)

 Writes clearly, with accurate spelling and grammar as well as proper sentence and paragraph construction 

 Uses appropriate APA style for citing and referencing research




The report consists of a critical literature review on the smoking issue in Australia. It reviews peer-reviewed journal articles and data collected from credible web sources on the topic of "how smoking creates health issue among the Australian". Smoking is a significant cause of death and ill-health in Australia. Smoking tobacco contains more than 7000 chemicals that cause cancer. Smoking causes various diseases including different types of cancer, Type 2 Diabetes, cardiovascular diseases, Women's Reproductive problems, hip fractures, heart diseases, stroke, stomach ulcers, lung, and chest illness Aihw, (2019b) report discusses the Australian Government initiative to stop smoking among Australian people. Tobacco smoking increases the rate of death among the young and adult generation of Australia. The Australian Government has been taken many initiatives to stop smoking among the Youth and adult generation of Australia such as Tobacco Plain Packaging System, ban the tobacco advertising, etc. This report provides the concept of initiatives of the Australian Health Department to stop smoking. The report identifies the critical issues with respect to smoking cessation. Additionally, the report describes the health issues of Australian people related to smoking. The report reviews the literature of the different authors to justify the research report question and provides evidence of how smoking causes serious health issues among Australian. Finally, the research report draws some recommendations to improve the smoking cessation program in Australia. 

Key issues identified with respect to smoking cessation and public health issue

 There are multiple issues or challenges identified with respect to the significant public health issue caused as a result of smoking, as well as the practice of smoking cessation. One of the major issues identified in the case of smoking cessation is the presence of physical barriers while considering quitting. It is to be taken into account that the presence of nicotine in cigarettes or any other tobacco products used for smoking, leads to severe addiction, which becomes difficult for the human body to resist and quit smoking. In addition to that, passive smoking or inhaling of fumes for non-smokers also poses a problem, thereby actively contributing to the public health issue. In addition to that, it may be mentioned in this regard that smoking is often used as a strategy for many people as a source of stress management. Hence, increased oxidative stress is evident in this case (Kwan, Stratton & Bonnie, 2015).  

Following the identified and established 5A’s protocol for implementing smoking cessation is often not followed. It is to be mentioned in this regard that the 5As are a list of questions which are used to approach a potential smoker trying to quit smoking (Health, 2019). Furthermore, it is to be taken into account that the incidence of cancer has been found to be quite common, due to the presence of the carcinogenic compound nicotine in cigarettes. Moreover, it may be mentioned that the access to the resources and facilities have been reported to be inconsistent with the guidelines. Thus, it may be stated that there are a number of issues or barriers identified to be consistent with smoking cessation and the public health concerns developed due to the prevalence of smoking. Lastly, the indigenous population or community of Australia, have been known to smoke, irrespective of age and gender (Greenhalgh, 2016). Furthermore, it has been found to be on par with their cultural beliefs; hence, creating awareness does not always work out appropriately for these individuals. 

Justification of research question

 In order to proceed with research on smoking and its effects on public health as well as smoking cessation, it is essential to formulate research questions on the subject. The research questions developed are as follows: 

  1. What are the health effects of smoking?
  2. What are the guidelines for practising smoking cessation in Australia?
  3. What are the physiological markers for health deterioration due to smoking?
  4. How prevalent are nicotine addiction and its relevance to smoking?

 It may be stated in this context that smoking can be attributed to one of the major public health issues prevalent across the world. The Australian government has issued a set of guidelines or a framework in order to execute smoking cessation activities. Thus, the research questions are strongly indicative of the cessation practices and guidelines prevalent in Australia. Furthermore, the impact on health is one of the significant challenges identified in this regard. It has been evident that the prevalence of nicotine addiction, physiological issues, such as respiratory diseases, dental problems, as well as mental issues has been found among smokers in Australia (Kwan, Stratton & Bonnie, 2015). Hence, all of the aforementioned issues have been covered as the research questions for this subject. 

Significance of research on smoking cessation and public health issue

This research report researches on smoking cessation and public health issues in Australia.  This research report is significant to identify public health issues due to smoking. Smoking is one of the most preventable causes of disease like cancer and death in Australia (Health, 2019). Smoking causes comprehensive range diseases, including chest and lung diseases, different types of cancer, stroke, and heart diseases, stomach ulcers, etc. According to the research of the Australian Cancer Council, smoking causes mental health issues. According to the research of the cancer Council, 12.2% of Australian people aged more than 14 years smoked daily (Australia, 2019). Smoking causes 20% of the burden of cancer disease each year in Australia. Smoking is accounting for 13% of the deaths due to cancer each year. According to the research of the Cancer Council, in 2013, Tobacco smoking causes 16,610 cases of cancer and 9921 people deaths due to cancer (Australia, 2019). This research report is significant to identify the key issues related to public health issues due to smoking. Tobacco smoking causes 90% of lung cancer in males and also 65% of lung cancer in females. 

The significance of the research lies with understanding the smoking cessation services of Australian Health Department. The Health Department of Australian has taken many initiatives such as The Australian government increases the staged excise on tobacco products, organizes the education program to communicate about the negative effects of Tobacco smoking, organizes the national tobacco campaigns, banned tobacco advertising, sponsorship, and promotion, etc. This literature review explains each and every initiatives of the Australian government to stop tobacco smoking in Australia. The report is significant because of tobacco smoking kills 19,000 Australian each year according to the research of the Department of Health (Health, 2019). The economic and social cost of smoking in Australia is $31.5 billion each year (Aihw, 2019a). This research report provides evidence of these public health issues and smoking cessation service by reviewing different online literature. 

Literature review

Smoking: A public health issue

The review of literature on smoking cessation and smoking as a public health review has been undertaken with the aid of 4 peer-reviewed articles and one website source. Considering the first peer-reviewed article by Golechha (2016), focuses on the health promotion methods related to smoking prevention as well as smoking cessation. Published by NCBI, it comes with a distinct bibliography for supporting the statements of the article. According to Golechha (2016), smoking is a public health issue, which has been known to cause numerous diseases, including subclinical atherosclerosis, pneumonia, coronary heart disease, stroke, cancer and respiratory diseases namely, chronic obstructive pulmonary disease. Additionally, the mortality of smokers has been established at 60%-80% higher than non-smokers. Golechha (2016) had used MI or motivation interview method to obtain data for smoking cessation.

Published on the website, Tobacco In Australia by Greenhalgh (2016), discussed Tobacco cessation in Australia. Numerous topics have been investigated in this online publication, including the benefits of quitting smoking, prevention of relapse, the relationship between mental health and smoking, pharmacotherapy, as well as the prevalent National policies for the same (Prochaska, Das & Young-Wolff, 2017). According to Greenhalgh (2016), the implementation of theories such as Theory of planned behaviourOperant conditioning, Social cognitive theory, the Health belief model, and other Physiological models of addiction have been explored for further results.

In order to study the intensive health damage done through smoking, a recent survey conducted by Ford et al. (2016) on dental patients was based on their smoking habits. Furthermore, this peer-reviewed article discusses the preferences of the participants in cessation. Published in the Australian dental journal, the article claims that dentists harbour the belief of being concerned about their role in smoking cessation, regardless, they pay no heed to smoke, as a major factor affecting the health of the patients. According to the reports of Ford et al. (2016), 96% of the survey participants had mentioned that dentists should provide advice related to smoking cessation. References have been provided for the article. 

Another peer-reviewed article by Ford, Tran, Keen & Gartner (2015) had been published in the Australian dental journal, mentioned the relevance of the practice of health practitioners in Australia regarding the activities undertaken by them to integrate smoking cessation habits. It has been evident that 90.1% of the practitioners screened for smoking habits, while the major form of assistance was the referral to Quitline(45.7%). Additionally, 44.2% of participants stated that there is a distinct lack of access to the resources related to cessation. References have been provided for the paper. Moreover, it has been identified that the risk of periodontitis is consistent with cigarette smoking (Kwan, Stratton& Bonnie, 2015).

The final article by Vallance et al. (2018), discusses the impact of sitting and smoking, supported by a list of references and supporting information. According to Vallance et al. (2018), sitting for a prolonged period of time causes a lack of activity, which in turn may facilitate the harmful effects of smoking. Furthermore, the development of awareness through mass media related to public policies has been established as well.

Smoking cessation

According to Sharma et al. (2018), mental health practitioners have strongly recommended the practice of following the smoking cessation guidelines, in order to advise patients with mental issues for quitting smoking. A distinct relationship between mental health or stress and smoking has been evident through various research conducted on this subject (Prochaska, Das & Young-Wolff, 2017). Published in the International Journal of mental health nursing, this article mentions the practice of implementing the formerly mentioned 5As in addressing the challenges of smoking cessation. As per the survey carried out by Sharma et al. (2018), it has been evident that a majority of 77.5% of mental health practitioners ask about the smoking habits of their clients. However, only about 31.1% to 39.7% of the practitioners have been known to aid indirect assistance in smoking cessation (Sharma et al., 2018). Additionally, it is to be noted that a few references have been cited by the authors for this article, while the other relevant sources of information include the questionnaires and responses for the survey conducted. In order to proceed with providing assistance to smokers for quitting, the practitioners are expected to comply with the framework illustrated in Figure 1. As depicted in Figure 1, the overall framework has been highlighted as per the guidelines for practice as per the Department of Health of Australia. 

 5As outline for smoking cessation

Figure 1: 5As outline for smoking cessation

(Source: Health, 2019)

According to Health, (2019), the pattern to be followed for undertaking cessation activities begins with the case of known and unknown smokers. For practitioners (both mental and physiological) it is important to identify the individuals in need of help. In the case of unknown patients, the first step is to ask, which is gradually followed by the assessment or evaluation of nicotine dependence exhibited by the smoker. Once the assessment is complete, it is essential to advise and assist in the overall procedure of quitting smoking. Lastly, the assistance may be completed by arranging for a follow-up in order to prevent relapse of the patient. However, in the case of known patients, asking for smoking habits is not necessary, but the rest of the steps are to be followed and complied with thoroughly. It may be stated in this regard that coping strategies combined with a number of behavioural strategies are often implemented for addressing the cessation process of individuals, as a part of the 5A guidelines provided by the government. Furthermore, a patient resource such as Quitline 131 848, National Tobacco Campaign, and so on, has been found to be useful for the patients trying smoking cessation (Aihw, 2019b). 

A brief motivational interviewing or MI has been found to be applied by several medical practitioners to aid in cessation participation. Other major programs which are used are the Smokescreen program which evaluates the advantages and limitations of the impact of smoking for the patient. In addition to that, it is to be noted that a Decision Balance Exercise is implemented by practitioners, especially in Fresh Start Programs, as well as GASPs, commonly termed as GPs Assisting Smokers Program (Health, 2019). The outcomes can be assessed based on the motivation of quitting smoking, as well as the confidence levels of the personal ability of the patient to be able to execute the protocol and successfully quit smoking. It is to be mentioned in this context that low motivation for quitting may be addressed through the implementation of the Decision Balance Exercise (Health, 2019). On the contrary, in case a patient exhibits characteristics of low confidence combined with high motivation, it is imperative that the practitioner follows the guidelines and proceed with reference for further support or aim at providing intensive assistance (Health, 2019). 

It is to be stated that the practitioners, as well as the patients, are encouraged to rate the motivation and confidence levels of the patients of smoking cessation on a scale of 1 to 10. Furthermore, developing an awareness for the smoker or the patient can be done by highlighting the health benefits of quitting smoking, as mentioned in the framework (a chart by hours, days and years demonstrating the key benefits of quitting smoking) by the Australian government in the official website (Health, 2019). 

Respiratory disease and smoking

 A distinct and defined relationship between respiratory disease and smoking exist due to the inflammation of the lung cells. The major symptoms of the onset of respiratory inflammation or diseases have been found to be coughing, wheezing, phlegm and dyspnea (Kwan, Stratton & Bonnie, 2015). Furthermore,in this context, Kwan, Stratton & Bonnie (2015), had stated that high concentrations of leukocytes had been found to be consistent with smoking. Thus, it is clearly an indication of the existing and predominant inflammatory response to the smoke and nicotine in the bloodstream (Kwan, Stratton & Bonnie, 2015). As evident from Figure 2, several types of respiratory diseases have been found to be quite common among the population of Australia, namely, COPD, chronic sinusitis, asthma and more (Pmc, 2014). Additionally, it is to be noted in this regard that the percentage of incidence of respiratory diseases is significantly higher among the indigenous population, that is, the Torres Strait Islander and the Aboriginal population (Pmc, 2014). This may be attributed to the religious as well as the cultural beliefs of these individuals, as previously discussed in this context. Furthermore, the ages for the inception of smoking among this population have been found to be as low as the age of 8 or 10 (Pmc, 2014). 

Types of respiratory diseases and prevalence among the Australian population

Figure 2: Types of respiratory diseases and prevalence among the Australian population

(Source: Pmc, 2014)

 In addition to that, the long-term statistics of the health effects, including morbidity, can be evaluated through the data presented in Figure 3. The rate of smoking and the subsequent rates of the incidence of respiratory diseases such as COPD as well as the morbidity rates have been found to be in accordance with smoking habits. This may be supported by the evidence that the decrease in the smoking rates has been consistent with the reduction in the death rates as well, thereby establishing a prominent link between the pathogenesis of COPD and smoking (Aihw, 2018a). 

Figure 3: Smoking and relevant COPD and morbidity rates in Australia from 1945 to 2010

(Source: Aihw, 2018b)

In addition to that, it has been established that both adaptive immunity as well as innate immunity rapidly and thoroughly depleted due to the exposure to the toxins derived from nicotine as a result of prolonged smoking. Furthermore, as per the article by Banks et al. (2015), published in the medical journal BMC Medicinementions that though Australia has a history of heavy and prolonged smoking, the current smoking rates include only 13% of the population doing so on a regular basis. Regardless, it has been evident from the findings of the survey conducted as a part of the research that approximately two-thirds of the population of smokers in Australia die due to the smoking habits (Banks et al., 2015). The incidence of major respiratory diseases, combined with other related diseases like cancer, have been found to be the major cause of the deaths.  

Physiological markers as symptoms of deteriorating health

Numerous effects or physiological markers have been found to indicate the poor health status of the individuals addicted to smoking the major issues in this regard as outlined as follows:

  • Nicotine addiction

Nicotine addiction, as per the reports of Kwan, Stratton & Bonnie (2015), is found to be consistent with smoking and begins with the beginning of smoking. Furthermore, it has been established that nicotine addiction plays a vital role in driving sustained and long-term dependence on smoking, despite high motivation for cessation. However, as per the cessation guidelines by the government, it has been stated that following Nicotine Replacement Therapy commonly known as NRT can be undertaken by practitioners to help the patients aiming to quit smoking (Health, 2019). 

  • Atherosclerosis

The thickness of the carotid intimal–medial is found to be an indicator of the relationship between the incidence of subclinical atherosclerosis and smoking (Kwan, Stratton & Bonnie, 2015). It has also been evident that the incidence of cardiovascular endpoints is consistent with cigarette smoking, and is a direct consequence of atherosclerosis (Kwan, Stratton & Bonnie, 2015).

  • Impaired immunity

As previously mentioned, the damage to both adaptive as well as innate immunity causes the smoker to be highly susceptible to any major or minor form of pathological diseases. Furthermore, as per the article by Thornton et al. (2017), published in the Australian and New Zealand journal of public health, it has been mentioned that use of mobile applications for addressing the aspect of smoking cessation has been conducted. Moreover, the references cited in the end support the theory that some of the major barriers discussed previously can be effectively managed with the help of these apps. Moreover, a depleting lipid profile of the individuals have also been noted, owing to the high LDL or low-density lipoprotein, triglyceride and serum cholesterol levels among smokers (Kwan, Stratton & Bonnie, 2015). Extensive research has established that these occurrences are consistent with the findings that can be correlated with smoking.  

  • Depletion of the concentrations of circulating antioxidant micronutrients

In accordance with the reduced immune response and the higher risks of the incidence of infectious lung disease inhibit lung growth and development. It may be noted in this account that owing to the oxidative stress in the bodybuilding up as a direct result of smoking depletes the body’s immunity or defence mechanism. It has been proven and supported by substantial evidence that b-carotene, a-carotene along with cryptoxanthin have been found to be at least 25% less in smokers as compared to non-smokers. 

  • The onset of COPD and asthma

The toxins present in the tobacco from the cigarette have been found to be inhaled by smokers, as well as the people around them (leading to passive smoking), giving rise to COPD, as well as other chronic respiratory diseases such as asthma, as previously discussed. 

  • Cancer 

The carcinogenic toxins present in cigarettes or nicotine lead to the development of cancer due to prolonged periods of smoking. Furthermore, smoking has been found to be consistent with at least 12 different sorts of malignancy in cancer (Kwan, Stratton & Bonnie, 2015). 

  • Several forms of arthritis

The decrease in bone density has been evident in smokers, especially postmenstrual women, which eventually lead to hip fractures as well as arthritis among several other bone-density related diseases. Furthermore, the association of smoking and rheumatoid arthritis has been established owing to the dysregulation of the immune system in smokers. Furthermore, nuclear cataracts, macular degeneration in the eyes have also been reported to be associated with smoking. 

  • Diabetes

 It is to be mentioned in this context that diabetes mellitus of Type 2 is a leading global health issue. However, smoking is also noted to contribute to the onset of Type 2 diabetes mellitus, which may eventually lead to blindness and kidney failure after a prolonged period of time and exposure to smoking and cigarettes (Kwan, Stratton & Bonnie, 2015).  

  • Maternity and pregnancy-related issues

A reduced chance of conception has been evident from multiple types of research, in women who smoke. Moreover, the impact of smoking on the fetus during the several growth and development stages have been found to be profoundly affected by the mothers addicted to smoking. Furthermore, maternal smoking has been noted to be thoroughly associated with reduced chances of optimal fetal growth as well as a full-term gestation period. Placenta abruption, placenta previa, as well as membrane rupture, are common incidents associated with maternal smoking (Kwan, Stratton & Bonnie, 2015).  

Gaps in literature

The rate of success achieved through the implementation of the 5As framework as designed by the Department of Health Australia. In addition to that, it is to be taken into account that a major number of the indigenous population is often excluded from the statistical numbers despite being citizens of the country. The staunch cultural and religious beliefs of the people can be attributed to this issue. Hence, due to this issue, the statistical data, though collected from government websites and peer-reviewed articles remain at risk of invalidation of the data. Additionally, a detailed study on the prevalence of smoking based on age, gender and social classes have not been undertaken in this paper. Lastly, the detailed structure for the pathogenesis of the health issues identified to be associated with smoking has not been provided due to the lack of resources for conducting extensive research on the same. 

Conclusion and recommendations

An article by Lim (2018), published in the Medical acupuncture, mentions that the use of laser acupuncture may be implemented in order to facilitate smoking cessation among individuals who are motivated enough to quit smoking but cannot due to the presence of the barriers in cessation. According to Lim (2018), synergy in the homeostatic process of the human body can be brought about through this method of laser acupuncture, which promotes healing and aids in smoking cessation. Furthermore, the implementation of a combination of TCM principles, along with the PLA technique, may be used to gain better results for smoking cessation. Lastly, it may be mentioned that the use of the framework provided by the Department of Health of Australia, covering the 5As protocol may prove beneficial in assisting patients with addiction to smoking. 

 A number of diseases have been found to be inherently associated with smoking, and hence, the significance of conducting campaigns and undertaking programs for promoting smoking cessation has been found to be important. The prevalence of major cardiovascular diseases, such as COPD, respiratory diseases, namely asthma, chronic sinusitis and more have been found to be related to smoking habits of individuals. The use of the 5As framework to assist individuals interested in quitting smoking is to be implemented as per the instructions of the Australian government. Moreover, this study focuses on the rates of morbidity associated with smoking and the long-term effects of smoking, which include the risk of cancer, asthma, dental problems and more. The gaps in literature have been identified as the rate of success obtained from the implementation of the cessation frameworks and so on.  

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